Spondyloarthritis Flashcards
What are examples of seronegative spondyloarthritides?
Psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis, reactive arthritis, spondylitis with IBD, and undifferentiated spondyloarthritis
What are the clinical features of articular disease in reactive arthritis?
- additive (not migratory) joint involvement
- asymmetric oligoarthritis
- diffuse digit swelling (“sausage toes”)
- enthesitis
- inflammatory arthritis (similar presentation to RA)
- lower back pain
What are the extraarticular manifestations of reactive arthritis?
- scaly rash, psoriasis-like
- thickened opaque nails
- conjunctivitis or uveitis
What HLA marker is commonly found in reactive arthritis?
HLA-B27
What are the RF and ANA findings associated with reactive arthritis?
Both usually negative, hence seronegative classification
What are the synovial fluid findings in reactive arthritis?
Fluid is inflammatory but sterile
What is the pathogenesis of reactive arthritis?
Suspected to be due to cross-reactivity in an immune response to microbial peptides and host HLA-B27 that leads to an auto-immune attack
What is the treatment for reactive arthritis?
- Anti-inflammatory agents (NSAIDs or corticosteroids)
- disease modifiers (sulfasalazine, methotrexate)
- biologics (TNF inhibitors)
- antibiotics for acute infections
What is the classic pattern of joint involvement for psoriatic arthritis?
Asymmetric oligoarthritis with possible sacroiliac and DIP joint involvement
How can psoriatic arthritis be differentiated from rheumatoid arthritis?
It is associated with psoriasis, it is seronegative, and it has synovium with a more prominent vascularity than RA
What is +HLA-B27 associated with in the context of psoriatic arthritis?
Spinal involvement
What is the clinical articular presentation of psoriatic arthritis?
- additive, asymmetric joint involvement
- sausage digits
- enthesitis
- sacroiliitis if spinal involvement
What do syndesmophytes indicate in psoriatic arthritis?
Spinal involvement
What are risk alleles for psoriatic arthritis?
HLA-Cw6/B13/B17/B27
What is a protective allele for psoriatic arthritis?
HLA-B22
What is the Koebner phenomenon?
Psoriatic lesions arising at sites of trauma
deep koebner phenomenon is when there are psoriatic arthritic changes in previously injured joints
What are the treatments for psoriatic arthritis?
- anti-inflammatory agents (NSAIDs, corticosteroids)
- disease modifiers (methotrexate, sulfasalazine, etc)
- biologics (TNF-inhibitors, IL-12/23, 23, or 17 inhibitors)
What is axial spondyloarthritis?
An inflammatory disease of the sacroiliac joint and spine that can also have extra-articular manifestations
What is the major demographic group for axial spondyloarthritis?
Young adults, both men and women
What is the pathogenesis of axial spondyloarthritis?
Unknown, maybe associated with previous klebsiella infection
What is the treatment for axial spondyloarthritis?
- Anti-inflammatory agents (NSAIDs, corticosteroids)
- disease modifying drugs (sulfazaline)
- Biologics (TNF-inhibitors, IL-17 inhibitors)
What is the clinical presentation of arthritis associated with inflammatory bowel disease?
- sacroiliitis
- peripheral joint disease with asymmetric oligoarthritis
- conjunctivitis
- oral ulcers, erythema nodosum
Which biologics are useful in treating arthritis associated with inflammatory bowel disease?
TNF-inhibitors, IL-12/23 inhibitors
