Spondyloarthropathy

Question 1

Enteropathic Arthritis

Answer 1

-gut is leaky barrier exposed to commensal/pathogenic microorganisms
-microbiota essential for maturation/reg of immune system
-GI tissue-micro interaction balances b/w inflammatory defense and tolerance
Crohn’s (immune deficiency from genetic polymor)
Inflammatory Bowel-joint disease
HLA-B27 interacts
-Celiac disease - 25% joint manifestations
-Whipple’s disease - joint symptoms
-Microscopic colitis-extraenteric autoimmune

Question 2

Psoriatic Arthritis in patients?

Answer 2

• asymmetric joint distribution pattern
• dactylitis, enthesitis, inflammatory-type back pain
• negative for rheumatiod factor
• Classification of Psoriatic Arthritis**

Question 3

Psoriatic Arthritis Disease

Answer 3

• progressive, 47% develop erosins w/in 2 years
• role of CD8 T-cells & innate immune response
• TNF inhibitors effective for skin & joint disease

Question 4

Psoriatic Arthritis: Poor outcome

Answer 4

• polyarticular disease

- elevated erythrocyte sedimentation rate

Question 5

How to distinguish spondyloarthropathy from RA?

Answer 5

• -increase in vascularity
• presence of neutrophils
• synovial CD3+ T cell infiltrate correlate with clinical response to treatment**

Question 6

Where could psoriatic arthritis originate?

Answer 6

-enthesis (from prominate entheseal involvement with bone marrow on MRI)

Question 7

Enthesitis

Answer 7

inflammation where ligaments touch bones

-in spondyloarthropathies

Question 8

Dactylitis

Answer 8

inflammation of digits

-in spondyloarthropathies

Question 9

HLA-B27

Answer 9

MHC class I, presents to surface of all cells
90% of patients with ankylosing spondylitis (8% normal population)

Question 10

Causes of Reactive Arthritis

Answer 10

M>W

• more common in HIV*
• Shigella -10-30days after diarrhea
• Salmonella-most common
• Chlamydia-urethritis (1-4% develop)

Question 11

Clinical Features of Reactive Arthritis

Answer 11

• arthritis, urethritis, conjunctivitis*
• Arthritis-asymmetric, dactylitis, axial disease (sacroiliitis and spondylitis)
• Enthesitis (achilles, plantar fascia, symphsis p., ribs)
• Urethritis-mucopurulent discharge
• Oral ulverations
• Circinate balanitis
• Conjunctivitis
• Skin-Keratoderma blennorrhagica
• Nails-onycholysis
• Eyes-
• Cardiac (rare)

Question 12

Enteropathic Arthritis Clinical Features

Answer 12

• Peripheral: -oligoarticular (asymmetric)
  - lower extremity joints
  - dactylitis and enthesitis
  - GI inflammation (parallels arthritis)
• Axial disease: -clinically & raido identical to AS
  - does not parallel GI disease

Question 13

Psoriatic Arthritis Clinical Features

Answer 13

polyarticular pattern (>4)
oligoarticular(<=4)
DIP involvement pattern
-arthritis mutilans
-axial involvemetn
Nails: pitting, hyperkeratosis, onycholysis
Skin: psoriasis, sclap, perineum, natal cleft, umbilicus 
Eye: conjunctivitis, iritis

Question 14

Enteropathic Arthritis Pathology

Answer 14

-inflammatory response to gut 
Crohn's -TNF-alpha
IBD-IL-2  (2-20%)
Whipples, Ulverative colitis
M=F
-axial disease associated with HLA B27
-Usually after onset of GI disease