Spondyloarthritis

Question 1

What are the four common forms of spondyloarthropathy

Answer 1

ankylosing spondylitis
inflammatory bowel disease with associated arthritis
psoriatic arthritis
reactive arthritis.

Question 2

List features that increase the likelihood of spondyloarthropathies

Answer 2

inflammatory back pain
enthesitis- heel pain
peripheral arthritis
dactylitis
acute anterior uveitis
good response to NSAIDs
elevated ESR/CRP
HLA-B27
sacroiliitis

Question 3

Describe the proposed pathogenesis of reactive arthritis

Answer 3

susceptible host with HLA-B27 allele + arthritogenic infection occurs with I enteroinvasive organisms such as Klebsiella, Shigella, Salmonella, Yersinia, Campylobacter, Chlamydia, Mycoplasma, C. difficile, or Giardia.

Question 4

Describe the proposed pathogenesis of ankylosing spondylitis

Answer 4

HLA-B27 + environmental facors

Question 5

Describe the histopathology of ankylosing spondylitis

Answer 5

synovitis, pannus formation, cartilage destruction, enthesitis, new bone formation, and eventual bony ankylosis

Question 6

Radiographic findings of erosions with irregular margins at the SI joints suggest ______

Answer 6

ankylosing spondylitis

Question 7

____ and ____ fusion eventually can ankylose the SI joints and then ascending vertebral levels creating bamboo spine

Answer 7

cartilage and chondral

Question 8

The hallmark of spondyloarthropathy is __________

Answer 8

inflammatory low back pain, worse in morning, improves with activity

Question 9

What is enthesopathy?

Answer 9

inflammation at the tendinous insertion on to bone. esp Achilles

Question 10

What are common extra-articular manifestations of spondyloarthropathies

Answer 10

conjunctivitis, uveitis
painful mouth sores
psoriasis, nail pitting, oncholysis, keratoderma
GU infections

Question 11

List classic exam findings of spondyloarthropathy

Answer 11

SI tenderness, limited low spine mobility with forward flexion, limited chest expansoion, enthesopathy

Question 12

In ______, there will be symmetric sacroiliitis

In _____ or ____, there will be unilateral sacroiliitis

Answer 12

ankylosing spondylitis

psoriatic or reactive

Question 13

________ is critical in the treatment of spondyloarthropathy

Answer 13

physical therapy- maintain spine mobility

Question 14

Describe the progression of the manifestations of ankylosing spondylitis

Answer 14

shiny corner on vertebrae–> bridging syndesmophytes–> bamboo spine–> late c spine

Question 15

Describe medications used for spondyloarthritis

Answer 15

NSAIDs are disease modifying
TNF agents
methotrexate and sulfasalazine for peripheral manifestations