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Flashcards in Spondyloarthritis Deck (25)
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1
Q

What is spondyloarthropathy

A

Any joint disease of the vertebral column

2
Q

What is spondyloarthritis with inflammation called

A

Axial spondyloarthiritis

3
Q

Where is HLA B27 expressed

A

on all cells except RBCs (it is a tissue type - you are either HLA B27 + or -ve)

4
Q

What encodes HLA B27

A

MHCs on chromosome 6

5
Q

What tissue type usually gets Axial spondyloarthiritis

A

B27 -ve

B27 +ve do not get these

6
Q

Why is B27 linked to spondyloarthritis (3)

A
  1. Infection -> immune response -> infectious agents have peptides similar to B27 -> auto-immune response triggered against HLA B27
  2. Mis-folding theory
  3. HLA B27 heavy chain homodimer hypothesis
7
Q

What is the HLA B27 misfiling theory

A
  1. Unfolded HLA-B27 proteins accumulate in ER
  2. A pro inflammatory response called the ER unfolded protein response occurs
  3. IL-23 is released by macrophages which activate T-helper cells
  4. T-helper cells release IL-17 which causes an inflammation cascade
8
Q

What pro-inflammatory mediators are released in response to IL-17

A

IL-6
IL-1
TNF-alpha

9
Q

What is the HLA B27 heavy chain homodimer hypothesis

A

B27 heavy chains can form stable dimers which dimerise and accumulate in the ER

This initiates ERUPR

Heavy chains and dimers bind to NK cells causing survival of more pro inflammatory leukocytes

10
Q

Clinical features of SpA

A
  1. Inflammatory arthritis of axial skeleton causing fusion of vertebrae (people look hunched over)
  2. Enthesitis (inflammation of junction between ligament/tendon and bone in heel)
  3. Iritis (inflammation of anterior chamber of the eye)
  4. Peripheral arthritis (large joints)
  5. Skin psoriasis)
SPINEACHE 
S-sausage digit
P - Psoriasis
I - Inflammatory back pain 
N - NSAID good response
E - Enthesitis
A - Arthritis
C - Crohn's/elevated CRP (can be normal at times)
H - HLA B27
E - Eye (iritis)
11
Q

What is ankylosing spondylitis

A

Inflammatory arthritis of spine and rib cage leading to new bone formation and fusion of joints

12
Q

When is ankylosing spondylitis seen

A

Late teen years/20s

13
Q

What people have the worst prognosis for ankylosing spondylitis

A
  1. Male
  2. Smokers
  3. B27 +ve
  4. Syndesmophytes
  5. High CRP
14
Q

What are syndesmophwytes

A

Boney growth originating in a ligament (of a spine in patients with AS)

15
Q

What are romans lesions

A

Syndemophytes in the anterior vertebral corners

16
Q

Consequence of sarcolitis in ankylosing spondylitis

A

Erosions

Loss of joint space

17
Q

What would be seen in an MRI positive for AS

A
  1. Subchondral periarticular bone marrow oedema

2. Acute sacrolitis

18
Q

What happens in the advanced disease of AS

A
  1. Kyphosis of thoracic and cervical spine

Patient can’t look ahead while walking

19
Q

What is the proposed structural damage in ankylosing spondylitis

A

Inflammation
Erosive damage repair
New bone formation

20
Q

Outline the criteria that defines the Inflammatory back pain felt in AS (most people have back pain, why is this so different)

A
  1. Onset younger than 40
  2. Improves with excersise
  3. Insidious onset
  4. Pain at night
  5. Morning stiffness
21
Q

What is the non-radiographic stage of AS

A
  1. Back pain and sacrolitis seen on MRI

MRI diagnosis= non-radiographic

22
Q

What is the radiographic stage of SpA

A
  1. Back pain
  2. Radiographic sacrolitis
  3. Syndesmophytes seen
23
Q

What is the classification criteria for diagnosing axial spondyloarthritis

A

(in patients with more than 3 months back pain and less than 45 years old):
1. Sacroilitis on imagine + 1Spa Feature (IBP, arthritis, psoriasis, good response to NSAIDs etc)

  1. HLA-B27 +ve
    plus 2 or more SpA features
24
Q

What is seen on imaging when sacroilitis is present

A
  1. Inflammation seen on MRI
25
Q

How is ankylosing spondylitis treated

A

TNFi (blockers):
Infliximab and adalimumab
DMARDs (disease-modifying antiarrythmic drugs)
NSAIDs

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