Spondyloarthritis

Question 1

What are examples of seronegative spondyloarthritides?

Answer 1

Psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis, reactive arthritis, spondylitis with IBD, and undifferentiated spondyloarthritis

Question 2

What are the clinical features of articular disease in reactive arthritis?

Answer 2

• additive (not migratory) joint involvement
• asymmetric oligoarthritis
• diffuse digit swelling (“sausage toes”)
• enthesitis
• inflammatory arthritis (similar presentation to RA)
• lower back pain

Question 3

What are the extraarticular manifestations of reactive arthritis?

Answer 3

• scaly rash, psoriasis-like
• thickened opaque nails
• conjunctivitis or uveitis

Question 4

What HLA marker is commonly found in reactive arthritis?

Answer 4

HLA-B27

Question 5

What are the RF and ANA findings associated with reactive arthritis?

Answer 5

Both usually negative, hence seronegative classification

Question 6

What are the synovial fluid findings in reactive arthritis?

Answer 6

Fluid is inflammatory but sterile

Question 7

What is the pathogenesis of reactive arthritis?

Answer 7

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

Question 8

What is the treatment for reactive arthritis?

Answer 8

• Anti-inflammatory agents (NSAIDs or corticosteroids)
• disease modifiers (sulfasalazine, methotrexate)
• biologics (TNF inhibitors)
• antibiotics for acute infections

Question 9

What is the classic pattern of joint involvement for psoriatic arthritis?

Answer 9

Asymmetric oligoarthritis with possible sacroiliac and DIP joint involvement

Question 10

How can psoriatic arthritis be differentiated from rheumatoid arthritis?

Answer 10

It is associated with psoriasis, it is seronegative, and it has synovium with a more prominent vascularity than RA

Question 11

What is +HLA-B27 associated with in the context of psoriatic arthritis?

Answer 11

Spinal involvement

Question 12

What is the clinical articular presentation of psoriatic arthritis?

Answer 12

• additive, asymmetric joint involvement
• sausage digits
• enthesitis
• sacroiliitis if spinal involvement

Question 13

What do syndesmophytes indicate in psoriatic arthritis?

Answer 13

Spinal involvement

Question 14

What are risk alleles for psoriatic arthritis?

Answer 14

HLA-Cw6/B13/B17/B27

Question 15

What is a protective allele for psoriatic arthritis?

Answer 15

HLA-B22

Question 16

What is the Koebner phenomenon?

Answer 16

Psoriatic lesions arising at sites of trauma

deep koebner phenomenon is when there are psoriatic arthritic changes in previously injured joints

Question 17

What are the treatments for psoriatic arthritis?

Answer 17

• anti-inflammatory agents (NSAIDs, corticosteroids)
• disease modifiers (methotrexate, sulfasalazine, etc)
• biologics (TNF-inhibitors, IL-12/23, 23, or 17 inhibitors)

Question 18

What is axial spondyloarthritis?

Answer 18

An inflammatory disease of the sacroiliac joint and spine that can also have extra-articular manifestations

Question 19

What is the major demographic group for axial spondyloarthritis?

Answer 19

Young adults, both men and women

Question 20

What is the pathogenesis of axial spondyloarthritis?

Answer 20

Unknown, maybe associated with previous klebsiella infection

Question 21

What is the treatment for axial spondyloarthritis?

Answer 21

• Anti-inflammatory agents (NSAIDs, corticosteroids)
• disease modifying drugs (sulfazaline)
• Biologics (TNF-inhibitors, IL-17 inhibitors)

Question 22

What is the clinical presentation of arthritis associated with inflammatory bowel disease?

Answer 22

• sacroiliitis
• peripheral joint disease with asymmetric oligoarthritis
• conjunctivitis
• oral ulcers, erythema nodosum

Question 23

Which biologics are useful in treating arthritis associated with inflammatory bowel disease?

Answer 23

TNF-inhibitors, IL-12/23 inhibitors