Rheumatology: Axial Arthropathies Flashcards Preview

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Flashcards in Rheumatology: Axial Arthropathies Deck (33)
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1

What are the group of diseases known as axial arthropathies characterized by?

1. Axial arthritis
2. Peripheral arthritis
3. Enthesitis
4. Mucocutaneous lesions

2

The pathogenesis of axial arthropathies is unknown, but it is strongly associated with what?

HLA-B27 and unknown infecious agent

3

What three demographics are found most often in ankylosing spondylitis?

1. Men > Women
2. Between 16-40 years
3. Caucasians

4

All patients with ankylosing spondylitis have inflammatory back pain characterized by...

1. Insidious onset of pain lasting > 3 months
2. Prolonged morning stiffness ( > 30-60 minutes)
3. Improvement of pain with exercise
4. No neurological sequelae

5

What would you find on physical examination of a patient with ankylosing spondylitis?

-SI joint tenderness
-Global loss of spine range of motion
-Late in disease course may find back deformities and reduced chest expansion

6

What percent of patients with AS also have peripheral arthritis?

25%- Hip and shoulder

7

What are synchondroses?

Areas of cartilaginous union with bone. This includes manubriosternal joint, costovertebral joints, and pubic ramis

8

Name some extraarticular manifestations of AS.

1. Acute anterior uveitis- 25%
2. Osteoporosis
3. Microscopic colitis
4. Pulmonary apical fibrosis
5. Cardiovascular disease
6. Cauda equina syndrome
7. Amyloidosis

9

Which of the following tests would be positive or negative for a patient with AS:
-ESR
-ANA
-RF

ESR- positive
ANA- negative
RF- negative

10

What percentage of sarcoiliitis is found in patients by age 45?

100%

11

What three deomgraphics are found most often in patients with reactive arthritis?

1. Males> Females
2. Onset occurs from childhood to age 40-50
3. Caucasians

12

What precedes the onset of reactive arthritis?

History of infectious diarrhea or urethritis which precedes by 2-4 weeks

13

What microorganisms cause the diarrhea preceding reactive arthritis?

Shigella
Salmonella
Yersinia
Camphylobacter

14

What microorganism causes urethritis preceding reactive arthritis?

Chlamydia

15

What is the site of reactive arthritis?

Inflammatory peripheral arthritis, typically lower extremities

Inflammatory back pain symptoms

16

How does the peripheral arthritis associated with reactive arthritis present?

Asymmetric, oligoarticular, and predominately lower extremity arthritis (knee and ankles)

Dactylitis- Diffusely swollen toes due to tendon inflammation

17

What percentage of reactive arthritis patients experience inflammatory back disease?

25%

18

What is enthesopathy and what percentage of patients with reactive arthritis have it?

Pathology of tendons
-Achilles tendinitis and/or plantar fasciitis in 20% of patients

19

Name three extraarticular manifestations of reactive arthritis.

1. Inflammatory eye disease- conjunctivitis (50%) and acute uveitis (20%)

2. Mucocutaneous lesions (20%)

3. Aortitis and cardiac conduction defects (rare)

20

What are the results of the following tests of a patient with reactive arthritis?
-ESR
-ANA
-RF

ESR- Positive
ANA- Negative
RF- Negative

21

Describe colitic arthropathies.

- Inflammatory peripheral arthritis occurs in 10-20%

-Axial arthritis involving sacroiliac joints and spine occurs in 5% of patients and resembles AS

22

Describe psoriatic arthritis.

-10% of patients with psoriasis will develop peripheral and/or axial

-Inflammatory peripheral arthritis predominantly involves upper extremities especially DIP, PIP, and MCP (asymmetric )

-Axial arthritis in 5-10% of psoriatic arthritis pts.

23

What is the strongest of all associations with anklyosing spondylosis?

Over 90% of Caucasians with AS are HLA-B27 positive

24

What percentage of the general population have AS?

0.1-0.2%

25

What is the chance of developing AS for individuals that are HLA-B27 positive?

What if the patient is HLA-B27 positive and has a first-degree relative with AS?

1-2%

10-20%

26

What is enthesis?

Inflammation of ligamentous, tendinous, and fibrous structures as they insert into bone.

27

What are the inflammatory infiltrates involved in enthesis?

Macrophages
T cells
Cytokines

28

What are the four possible theories of how HLA-B27 can predispose a person to developing AS?

1. Arthitogenic peptide hypothesis
2. Molecular Mimicry
3. Free heavy chain hypothesis
4. Unfolded protein hypothesis

29

How is arthritis triggered in reactive arthritis?

Monocytes transport bacteria either alive or dead to the joints

30

Which bacterium reaches the joint alive in reactive arthritis?

Chlamydia which causes urethral infections