spondyloarthritis

Question 1

Common features of spondyloarthropathies (5)

Answer 1

association with class I MHC molecs
axial involvement (spine, shoulders, hips) common
inflammation in bone and entheses common (CT tissue btw ligament/tendon and bone)
peripheral arthritis usually asymmetric
share extra-articular manifestations like psoriasis, uveitis, and inflammatory bowel disease

Question 2

types of spondyloarthritis

Answer 2

psoriatic arthritis, ankylosing spondylitis, reactive arthritis

Question 3

Sites of joint involvement: RA, psoriatic arthrits, ankylosing spondylitis

Answer 3

RA: synovial inflammation
psoriatic arthritis: bone, enthesis, and synovium
ankylosing spondylitis: bone, enthesis

Question 4

features of psoriasis

Answer 4

inflammatory condition with well-demarcated plaques, usually on flexor surfaces, that is red and scaly. if the pt is going to get psoriatic arthritis, it usually begins about 10 yrs after the onset of psoriasis

Question 5

psoriatic arthrits epidemiology

Answer 5

prevalence of psoriasis 2-3%; 25% of these pts have psoriatic arthritis.

Question 6

clinical and lab features of psoriatic arthritis

Answer 6

asymmetric arthritis, DIP involvement, dactylitis (diffuse swelling of the digits), nail pitting or onycholysis, no rheumatoid nodules, RF negative, erosive arthritis without ostepenia, sacrolitis, enthesopathy (inflammation of tendons or ligaments)
progressive and destructive but jts are less painful and less swollen than in RA

Question 7

complications of psoriatic arthritis

Answer 7

joint erosions and fusions

Question 8

what are the risk factors for psoriatic arthritis

Answer 8

much more heritable than other autoimmune diseases
associated with Class I MHCs (esp. HLAC?)
even numbers of males and females
may be triggered by trauma, infection, stress

Question 9

What cytokines are important for psoriasis and psoriatic arthritis?

Answer 9

IL-17 and IL23 (promotes devo of Th17 T cells)

Question 10

What are features of inflammatory enthesitis?

Answer 10

periosteal new bone formation and subchondral bone inflammation and resorption: new bone is being made AND old bone is being destroyed. there are problems with the mesenchymal-derived cells (osteoblasts) and with the myeloid lineage cells (osteoclasts)

Question 11

subtypes of psoriatic arthrits

Answer 11

asymmetric, symmetric, axial disease, DIP involvement, arthritis mutilans

Question 12

common comorbidities with psoriasis and psoriatic arthritis

Answer 12

obesity, HTN, DM, hyperlipidemia, steatosis, metabolic syndrome, MI, uveitis, Crohn’s disease