Spondyloarthritis Flashcards
What is Spondyloarthritis?
Spondyloarthritis is a form of inflammatory joint disease characterized by inflammation of the axial skeleton (spine and sacroiliac joints) and/ or the peripheral joints, often associated with inflammation of the eye, gastrointestinal tract, genitourinary system, and skin.
What is Axial spondyloarthritis ?
Axial spondyloarthritis is the term used when the spine is the site of inflammation, and peripheral spondyloarthritis indicates inflammation of the joints and periarticular tissues in the extremities.
علایم شایع ؟
علامت بالینی کاردینال اسپوندیلوارتریت چیه؟
در مورد extraspinal ها چطور ؟
The cardinal clinical feature of spondyloarthritis is inflammation of the sacroiliac joints (i.e., sacroiliitis) and the spine (i.e., spondylitis).
Inflammation of tendon insertion sites (i.e., enthesitis), inflammation of entire digits (i.e., dactylitis), and inflammation of one to four lower extremity joints (i.e., oligoarthritis) are extraspinal skeletal findings.
A positive family history,
eye inflammation (i.e., anterior uveitis or con- junctivitis),
and the absence of rheumatoid factor and subcutaneous nodules are common.
در اسپوندیلوارتریت چه یافته های رادیولوژیک شایعی پیدا میکنیم؟
Patients with axial spondyloarthritis with typical radiographic features including sacroiliac joint erosions, spinal syn- desmophytes, and ankylosis of the joints have ankylosing spondylitis.
اگه شک بالینی قوی داشتیم ب اسپوندیلوارتریت ولی در رادیولوژی چیزی پیدا نشد چه میکنسم؟
In the absence of these radiographic changes, nonradiographic axial spondyloarthritis may be present if there are typical symptoms accompanied by magnetic resonance imaging inflammatory signs at the sacroiliac joint or spine.
What is Reactive arthritis?
Reactive arthritis refers to spondyloarthritis with onset within a few weeks of certain types of infection.
What is psoriatic arthritis & IBD-related spondyloarthritis?
Axial or peripheral inflammatory joint disease in the setting of psoriasis or inflammatory bowel disease (IBD) is termed psoriatic arthritis or IBD-related spondyloarthritis, respectively.
شايع ترین ژنی که در بیماران اسپوندیلوارتریت وجود داره چیه؟
Spondyloarthritis is strongly associated with human leukocyte anti- gen B27 (HLA-27), a specific allele of the B locus of the HLA-encoding class I major histocompatibility complex genes. The frequency of HLA-B27 among white individuals is approximately 8%. However, up to 90% of white patients with ankylosing spondylitis and 80% of white patients with reactive arthritis or juvenile spondyloarthritis are HLA- B27 positive, and these percentages are even higher among patients with uveitis. The rate of HLA-B27 positivity among patients with inflammatory bowel disease or psoriasis with peripheral arthritis is not markedly increased unless they have spondylitis, in which case the fre- quency of HLA-B27 is 50%. The frequency of HLA-B27 varies widely among other ethnic groups and accounts for the broad variation of the prevalence of ankylosing spondylitis in different populations.
اپیدمیولوژی Ankylosing spondylitis ؟
Ankylosing spondylitis is much more common among adolescent boys and young men, but this finding may reflect underdiagnosis in women, in whom disease manifestations may be milder than they are in men.
اپیدمیولوژی Reactive arthritis?
Reactive arthritis is more common among men when it follows genitourinary Chlamydia trachomatis infection, but the sex distribution is even among patients after dysentery.
شیوع ارتریت التهابی در بیماران سوریازیس یا اونایی که کرون دارن چقدره؟
خانوما شایع تر یا مردا؟
کدوم کوموربیدتی شیوعشو زیاد میکنه؟
Inflammatory arthritis including spondylitis affects approximately 5% to 8% of patients with psoriasis
and 10% to 25% of patients with ulcerative colitis or Crohn’s disease.
Men and women are affected equally.
The prevalence of spondyloarthritis, particularly psoriatic and reactive arthritis, is increased in populations with high human immunodeficiency virus (HIV) infection rates.
patients infected with HIV appear more likely to have severe dis- ease, especially psoriatic arthritis. When HIV infection is treated with antiviral agents, the incidence of spondyloarthritis declines.
چه باکتری هایی عامل reactive arthritis اند؟ 5
1-Genitourinary infection with C. trachomatis
or diarrheal illness with 2-Shigella, 3-Salmonella, 4-Campylobacter, 5-and Yersinia species
can induce reactive arthritis.
Several additional infectious agents are less commonly implicated. They appear to trigger an inflammatory response, possibly as a result of persistence of bacterial antigens, or cause an aberrant immunologic response to infection that results in misfolding of HLA-B27 molecules in antigen-presenting cells, generating a persistent inflammatory reaction.
در اسپوندیلوارتیت التهاب از کجا شروع میشه؟
Pathophysiologic studies show that the inflammation originates at the interface of bone and cartilage in the sacroiliac joint and bone and fibrocartilage in the enthesis.
سلول ها و سایتوکین های دخیل در پانوفیزیولوژی اسپوندیلوارتریت؟
Macrophages and CD4+ and CD8+ T cells are present, and Th17 appears to play a critical role in the inflammatory process.
Proinflammatory cytokines interleukin-17 (IL-17), interleukin-23 (IL-23), and tumor necrosis factor-α (TNF-α) and are abundant.
Synovial tissue becomes inflamed, and osteoclasts are activated, leading to bone resorption, reminiscent of rheumatoid arthritis joint inflammation.
تفاوت RA و اسپوندیلیت در پاتوفیزیولوژی؟
Unlike in rheumatoid arthritis, early bone resorption is followed by a secondary phase during which osteoblast activity predominates, leading to new bone formation in periarticular bone (i.e., hyperostosis) and around joints (i.e., osteophytosis) or vertebral bodies (i.e., syndesmophytes).
Ultimately, bony fusion of joints (ankylosis) occurs. The relationship between these paradoxical phases of bone resorption and proliferation is an area of active investigation.
کدم Clinical manifestation هست که در همه ی انواع اسپوندیلوارتریت ب طور شایع وجود داره؟
The cardinal clinical features common to all of them are inflammatory spine pain and an asymmetrical, predominantly lower extremity inflammatory joint or tendon disease.
Inflammatory spine pain should be suspected in young patients (<40 years) who have an insidious onset of chronic low back pain or buttock pain associated with prolonged morning stiffness and relieved by exercise.
اون Peripheral joint diseaseی که به دنبال اسپوندیلوارتریت رخ میده چه ویژگی هایی داره؟
The characteristic peripheral joint disease involves one to four joints, usually in the lower extremities, and may be associated with tendon insertion inflammation (i.e., enthesitis) or sausage digits (i.e., dactylitis).
چه علایمی به نفع اسپوندیلوارتریت هلی سوریازیس و iBD است؟
🔸Symmetrical polyarthropathy involving the upper extremities and clinically similar to rheumatoid arthritis is seen in some forms of psoriatic or inflammatory bowel disease–related spondyloarthritis 🔸Anterior uveitis, 🔸enthesitis, 🔸dactylitis, 🔸psoriatic skin or nail changes, 🔸inflammatory bowel disease, 🔸a family history of spondyloarthritis, 🔸or a history of preceding gastrointestinal or genitourinary infection suggests spondyloarthritis.
وضعیت هر کدوم اژ موارد زیر در اسپوندیلیت:
RF
ANA
Subcutaneous noodles
معمولا منفی اند و دیذه نمیشن
منظور از Undifferentiated spondylarthritis چیه؟
In a given patient, the clinical features of these disorders may accumulate over a prolonged period.
Some patients do not initially demonstrate the typical findings of a specific disorder. They are considered to have undifferentiated spondyloarthritis.
در مراحل اولیه اسپوندیلوارتریت بر چه اساسی طبقه بندیش میکنیم؟
Early disease can be subcategorized as predominately axial spondyloarthritis or predominately peripheral spondyloarthritis, depending on the site of the dominant symptoms.
Many patients later have clinical findings consistent with a specific subtype of spondyloarthritis.
مشخصه و کارردینال ساین axial disease چیه؟
Inflammatory spine pain is the cardinal feature of axial disease and results from inflammation in the sacroiliac joints and spinal elements.
اگر اسپوندیلوارتریت درمان نشه چه عواقبی داره برای بیمار و چه مشکلاتی ایجاد میکنه ؟
Uncontrolled disease may lead to ankylosis (i.e., bony fusion) at sacroiliac joints and throughout the vertebral column, culminating in loss of spinal and costovertebral motion, deformity, and restrictive extrapulmonary physiology.
Enthesitis
چیه و درکجا ها رخ میده؟
🔸Enthesitis is defined as inflammation of the entheses, the insertion sites of tendons and ligaments to the bone surface.
Enthesitis can occur in many different anatomic locations. They include spinous processes, costosternal junctions, ischial tuberosities, plantar aponeuroses, and Achilles tendons.
ویژگی های peripheral arthritis of spondyloarthritis ؟
When peripheral arthritis of spondyloarthritis occurs, it frequently begins as an episodic, asymmetrical, oligoarticular process that often involves the lower extremities. The arthritis can progress and may become chronic and disabling. A unique feature of spondyloarthritis is the appearance of fusiform swelling of an entire finger or toe, referred to as dactylitis or sausage digits.
درگیری چشم در اسپوندیلوارتریت به چه صورت هایی است؟
1-Anterior uveitis, or inflammation of the anterior chamber of the eye, is a common extra-articular manifestation of spondyloarthritis, especially among HLA-B27–positive patients.
Acute bouts of uveitis are usually monocular, painful, and accompanied by eye redness and blurred vision.
Recurrent attacks are common and can lead to blindness.
Scleritis, episcleritis, and conjunctivitis are less commonly associated phenomena.
دستکاه قلبی عروقی و عصبی در اسپوندیلوارتریت چجوری درگیر میشن و چ مشکلاتی دارن برای فرد؟
1-Aortitis, especially occurring in the ascending segment, can result in aortic insufficiency from aortic root dilation, aortic dissection, and cardiac conduction system abnormalities.
2-Pulmonary fibrosis of the apical regions can occur, often in an insidious fashion. :یعنی بیماری کشنده ای که در ظاهر ب نظر میاد بی خطره
3-Spinal cord compression can result from atlantoaxial joint subluxation, cauda equina syndrome, or vertebral fractures.
4-In rare cases, long-standing spondyloarthritis is associated with secondary amyloidosis.
