Spondyloarthritis lecture notes Flashcards
What gene is associated with ankylosing spondylitis?
HLA B27
(not all who have this gene have ankylosing sponylitis)
What is molecular mimicry?
When immune system recognises a foreign antigen but is similar to host cells and immune system ends up attacking both the foreign antigen and its own cells.
What are clinical features of spondyloarthritis?
Axial spondyloarthritis (also called ankylsing spondyloarthritis) - painful, stiff, rigid spine
Swollen Achilles tendon
Tennis elbow and golfers elbow
Uveitis (inflammatory eye problems)
Peripheral arthritis, often asymmetrical oligoarthritis (a few joints)
Skin psoriasis often associated
IBD/Crohn’s diseas
Mnemonic for Spondyloarthritis presentations
SPINEACHE
Sausage digit
Psoriasis
Inflammatory back pain
NSAID good response
Enthesitis (heel)
Arthritis
Crohn’s/ Colitis / elevated CRP
HLA B27
Eye (uveitis)
What is the gold standard imaging for spondyloarthritis?
MRI
How does axial spondyloarthritis often present?
Young patients
More than 3 months of back pain
Gets better with activity
Early morning stiffness for at least 30 mins
Waking with back pain
Alternating buttocks pain, aching
What does non-radiographic mean in relation to axial spondyloarthritis?
No changes on x-ray. May be changes on MRI, but not x-ray yet.
What treatment is there available?
Biologic drugs like anti-TNF, IL-17 blockers
How may psoriatic arthritis present?
Peripheral arthritis
Polyarticular
Dystrophic nails
Pitting
Red and swollen DIPJs
Skin psoriasis
Dactylitis
Sausage shaped digit
Hot
Red
Swollen
Hidden sites for psoriasis
Behind ear, inside scalp, inside ear, across eyebrows, pitting nails, nail bed lifted away from nail bed and thickened.
For just axial inflammation, do DMARDs work?
No, useful for peripheral arthritis not axial (spine)
Reactive arthritis is sterile inflammation of the s_____ m_____, tendons and fascia triggered by an infection at a distant site, usually GI or genital.
synovial membrane
What kind of infections can cause reactive arthritis?
STIs
What is the classical triad for reactive arthritis?
Arthritis
Conjunctivitis
Urethritis