Spondyloarthritis lecture notes Flashcards

1
Q

What gene is associated with ankylosing spondylitis?

A

HLA B27
(not all who have this gene have ankylosing sponylitis)

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2
Q

What is molecular mimicry?

A

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.

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3
Q

What are clinical features of spondyloarthritis?

A

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

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4
Q

Mnemonic for Spondyloarthritis presentations

A

SPINEACHE
Sausage digit
Psoriasis
Inflammatory back pain
NSAID good response
Enthesitis (heel)
Arthritis
Crohn’s/ Colitis / elevated CRP
HLA B27
Eye (uveitis)

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5
Q

What is the gold standard imaging for spondyloarthritis?

A

MRI

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6
Q

How does axial spondyloarthritis often present?

A

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

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7
Q

What does non-radiographic mean in relation to axial spondyloarthritis?

A

No changes on x-ray. May be changes on MRI, but not x-ray yet.

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8
Q

What treatment is there available?

A

Biologic drugs like anti-TNF, IL-17 blockers

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9
Q

How may psoriatic arthritis present?

A

Peripheral arthritis
Polyarticular
Dystrophic nails
Pitting
Red and swollen DIPJs
Skin psoriasis

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10
Q

Dactylitis

A

Sausage shaped digit
Hot
Red
Swollen

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11
Q

Hidden sites for psoriasis

A

Behind ear, inside scalp, inside ear, across eyebrows, pitting nails, nail bed lifted away from nail bed and thickened.

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12
Q

For just axial inflammation, do DMARDs work?

A

No, useful for peripheral arthritis not axial (spine)

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13
Q

Reactive arthritis is sterile inflammation of the s_____ m_____, tendons and fascia triggered by an infection at a distant site, usually GI or genital.

A

synovial membrane

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14
Q

What kind of infections can cause reactive arthritis?

A

STIs

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15
Q

What is the classical triad for reactive arthritis?

A

Arthritis
Conjunctivitis
Urethritis

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16
Q

Enteropathic arthritis

A

Episodic peripheral synovitis, patients with IBD.
Asymmetric lower limb arthritis, usually reflects the disease activity

17
Q

For patients with SPA, think…

A

inflammatory back pain
psoriasis
IBD
Infection