Spondyloarthrritis

Question 1

seronegative spondyloarthropathies

Answer 1

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

Question 2

characteristic features of apondyloarthropathies

Answer 2

seronegative
association with HLA B27
sacroliths
spondylitis
peripheral arthritis
enthesitis
psoriasiform skin and nail lesions
anterior uveitis
chronic GI inflammation
chronic Genitourinary inflammation

Question 3

criteria for diagnosis of Ank Spond

Answer 3

1. limited lumber motion
2. low back pain for 3 months improved by exercise, not improved by rest
3. reduced chest expansion
4. radiographic sacrolitis

ank spond if criteria 4 plus 1, 2 or 3

Question 4

role of HLA-B27 in the pathogenesis of any spond

Answer 4

HLA-B27 misfiling
arthogenic peptide theory
formation of B 27 homodimers

Question 5

sequence of structural damage in and spond

Answer 5

1. inflammation
2. erosive damage
3. repair
4. new bone formation (too much new bone)

Question 6

characteristics of back pain in ank spond

Answer 6

insidious onset of back pain before 40 years
duration longer than 3 months
associated with morning stiffness
decreases with exercise
response to NSAIDs

Question 7

ank spons mostly affects

Answer 7

M>F
2.5:1

Question 8

reactive arthritis

Answer 8

occurs predominantly men in young-mod age
acute onset
may occur with infectious triggers

Question 9

psoriatic arthritis

Answer 9

occurs equally between males and females of young-middle aged with variable onset

Question 10

enteropathic arthritis

Answer 10

occurs equally in males and females of young-middle age with variable inset

Question 11

skeletal features of ank spend

Answer 11

axial arthritis eg. sacroiliitis and spondylitis
arthritis of girdle joints (hips and shoulders)
peripheral arthritis uncommon
may also cause enthesitis, osteoporosis, vertebral fractures, spondylodiscitis, pseudoarthrosis

Question 12

extrraskeletal features of ask spond

Answer 12

acute anterior uveitis
cardiovascular involvement
pulmonary involvement
cauda equina syndrome
enteric mucosal lesions
amyloidosis

Question 13

testing spinal mobility

Answer 13

patient standing erect
mark an imaginary line connecting both posterior superior iliac spines
another mark placed 10cm above
the patient bends forward maximally, measure the distance between the two marks
report increase in distance

Question 14

5 subtypes of psoriatic arthritis

Answer 14

DIP predominant
Oligoarticular
Polyarticular
Spondyloarrthropathy
arthritis mutilans

Question 15

describe reactive arthritis

Answer 15

a sterile joint infection that develops after a distant infection

Question 16

which types of infections in reactive arthritis associate with

Answer 16

enteric: salmonella, shigella, campylobacter jejuni, C defficile, yersinia
urogenital: esp. chlamydia

Question 17

clinical manifestations of reactive arthritis

Answer 17

Question 18

difference between spondyloarthritis, reactive arthritis, and septic arthritis

Answer 18

Question 19

treatment of reactive arthritis

Answer 19

antibiotics if infection is still present, especially for chlamydia
NSAIDs
glucocorticoids (intraartiicular or oral)
DMARDs

Question 20

general points for treatment of spondyloarthritis

Answer 20

exercise
NSAIDs
anti-TNF alpha therapy

Question 21

rituximab targets

Answer 21

beta cells (monoclonal antibody to CD20)

Question 22

abatacept targets

Answer 22

T cells (inhibitor of T cell co-stimulation)