Spondyloarthropathies

Question 1

What is the definition of Spondyloarthropathies?

Answer 1

• they are a distinct group of diseases that cause inflammation of the spine (spondylitis)
• separate from sero-positive Rheumatoid Arhtritis and other inflammatory arthropathies

Question 2

What is the characteristic pathology of Spondyloarthropathies?

Answer 2

ENTHESOPATHY: inflammation at the insertion of ligaments and tendons into bone.

bony fusion is a consequence of this inflammation (body’s way of healing is to produce spurs –> fusion –> spine can no longer move)

Question 3

What is the classic disease of spondylitis?

Answer 3

Ankylosing Spondylitis (AS)

-very limited and disabled, can’t bend over, turn necks.

Question 4

What is one of the first places we look in spondyloarthropathies?

Answer 4

sacroiliac joint: sacroilitis is one of first places you see this.

Question 5

In patients with spondyloarthropathies, what do they NOT have? (2)

Answer 5

• Rheumatoid factors (an immunoglobulin reactive against the Fc portion of IgG, usually IgM isotype but may be IgG or IgA)
• Rheumatoid nodules

Question 6

What is the genetic predisposing host factor to spondyloarthropathies/spinal inflammation?

Answer 6

MHC Class I HLA -B27

one of the most strongly known associations of a genetic marker with a disease (AS = 90%)

note: less thatn 5% of B27 individuals develop AS, but B27+ individuals have a 20fold greater risk of developing spondyloarthropathies.

Question 7

Which bacteria are known to be associaed with development of post-infectious reactive arthritis? (5)

What is the presumed mechanism of disease?

Answer 7

Shigella flexneri (NOT sonnei), Chlamydia, Salmonella, Yersinia, Campylobacter

Molecular mimicry: then the body fails to recognize self and continues to react against self proteins.

Question 8

How does B26 antigen contribute to the disease?

Answer 8

B27 does not appear to influence bacterial invasion into cells but probably prolongs intracellular survival of bacteria.

Question 9

Post infectious reactive arthritis manifestations

Answer 9

painless mucosal ulcers, urethritis, swelling around achilles tendon, ee inflammmation.

Question 10

What is the current concepts of the Gut and Arthritis?

Answer 10

• the GI tract is not a complete barrier
• there is permeability to both bacterial and dietary antigen
• in certain pathological disease states, this permeability is increased

Question 11

what is the most common extraarticular manifestation of Inflammatory bowel disease?

Answer 11

Arthritis. Patients with ACTIVE IBD become intolerant of their own bacterial flora, can be revered when GI disease is under control. Peripheral arthritis flares with flares of the gut disease.

Previous studies have demonstrates that subclinical inflammatory bowel disease may exist in patients with post-infective reactive arthritis.

Question 12

What is bypass arthritis?

Answer 12

25% of patients who underwent bypass surgery developed arthritis: considered to be due to bacterial overgrowth in the normally sterile small bowel, with excessive absoprtion of bacterial antigen.

pts improved if reversed the surgery or treated with abx

Question 13

What is the likelyhood of getting inflammatory musculoskeeltal disease (arthritis, spondylitis, ethesitis, dactylitis) if you have psoriasis?

Answer 13

25%

Question 14

hows does psoriatic arthritis compare to ankylosing spondylitis?

Answer 14

• has more peripheral involvement
• less iritis
• spondylitis may be more severe in psoriatics

Question 15

what is increased in the epidermis in Psoriatic Arthritis?

Answer 15

CD8 cells

Question 16

what is 8x more common in psoriatics?

Answer 16

Crohns disease