Spondyloarthropathies

Question 1

What’s the genetic predisposition for spondyloarthropathies?

Answer 1

HLA-B27

Question 2

Define: axial skeleton, dactylitis, enthesis, enthesitis, monoarticular, oligoarticular, osteitis, periarticular, spondylitis, spondylolisthesis, spondylolysis

Answer 2

Bones of cranium, ribcage, and vertebral column

Swelling of a finger or toe, reactive arthritis, “sausage digit”

Site of lig attachment to bone, the insertion

Inflammatory changes of the lig insertion

One joint

Few joints

Inflammation of a bone

Around a joint

Inflammation of vertebrae

Anterior displacement of a vertebral body relative to adjacent vertebral body below

Stress fracture in pars interarticularis of vertebrae

Question 3

What are the periarticular manifestations of spondyloarthropathies?

Answer 3

GI/GU inflammation
Ocular inflammation
Psoriatic-like skin/nail lesions
Aortic root and cardiac conduction lesions
Absence of RF and ACCP (hence seronegative)
Assymetric oligo arthritis
Plantar fasciitis and achilles tendonitis

Question 4

Why are these path manifestations called “seronegative”?

Answer 4

No RF or ACCP abnormalities (these values are normal, no serum evidence of dx)

Question 5

What are the 4 seronegative spondyloarthropathies?

Answer 5

A
R
E
P

Ankylosing spondylitis
Reactive arthritis
Enteropathic arthritis
Psoriatic arthritis

Question 6

What symptom is not found in RA, but is found in ankylosing spondylitis?

Answer 6

Iritis (anterior uveitis)

Question 7

What is the Schober Test associated w/?

Answer 7

Ankylosing spondylitis

Forward flexion test that’s pos in AS, lost spinal mobility

Question 8

Serology results for ankylosing spondylitis?

Answer 8

Inc: ESR and CRP, TNFa
- anemia of chronic dx

Norm: RF, ACCP, ANA

Question 9

What sign is seen on imaging of the spine in AS?

Answer 9

Bamboo spine, syndesmophytes (bridging of vertebrae)

Question 10

What are late complications of ankylosing spondylitis?

Answer 10

Restrictive lung dx d/t excessive thoracic kyphosis

Compression fractures

Cauda equina syndrome > irritation of lumbar plexus and LE pain and/or BB dysfunction

Question 11

In AS, does stiffness improve or worsen w/ use during the day?

Answer 11

Improve

Question 12

What’s the tx for AS? What doesn’t work?

Answer 12

TNFa inh, exercise/PT

MTX, can’t reach spine

Question 13

What clinical manifestations are seen in reactive arthritis?

Answer 13

Enthesitis & Dactylitis

Circunate balanitis (vesicles/ulcers on the glans penis)

Keratoderma blennorrhagicum (painless eruption on palms and soles)

Eyes (conjunctivitis/uveitis)

Question 14

What is enthesitis and what’s it associated w?

Answer 14

Inflammation/swelling of the achilles tendon insertion and plantar fasciitis

reactive arthritis

Question 15

What is Dactylitis and what’s it associated w/?

Answer 15

Sausage fingers/toes

Reactive arthritis

Question 16

What is circunate balanitis and what’s it associated w/?

Answer 16

Vesicles/ulcers on the glans penis

Reactive arthritis

Question 17

What’s Keratoderma blennorrhagicum and what’s it associated w/?

Answer 17

Painless eruption on the palms and soles

Reactive arthritis

Question 18

Is reactive arthritis self-limiting?

Answer 18

Usually yes, can progress to chronic though

Question 19

What’s the tx for Chlamydia?

Answer 19

Macrolides

• azithromycin
• doxacycline

Question 20

What joints are affected in Psoriatic arthritis?

Answer 20

DIP, PIP, MCP, MTP + large joints

Question 21

What joints and dx are/is associated w/ a “pencil in a cup” appearance?

Answer 21

DIPs in psoriatic arthritis

Question 22

Does psoriatic arthritis have a specific diagnostic test?

Answer 22

No

Question 23

What are the likely infections causing reactive arthritis?

Answer 23

Chlamydia trachomatis
Campylobacter jejuni
Salmonella
Shigella
Yersinia

Question 24

What is MTX (all non-bios) used to tx for regarding seronegative spondyloarthropathies?

Answer 24

Peripheral arthritis, NOT axial

Question 25

What can biologicals tx? What are they and what do they act on?

Answer 25

Axial arthritis

Etanercept
Infliximab
Adalimumab
Rituximab

TNFa