SM_228a: Spondyloarthropathies Flashcards Preview

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Flashcards in SM_228a: Spondyloarthropathies Deck (28)
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1

Describe spondyloarthritis

Spondyloarthritis: group of related disorders with common clinical, biological, and genetic characteristics

  • Genetic markers (e.g. HLA B27)
  • Spine involvement, namely sacroiliitis
  • Asymmetric joint involvement
  • Enthesitis
  • Iritis
  • Absence of female predominance
  • Negative rheumatoid factor

2

Two main classes of spondyloarthritis are ____ and ____

Two main classes of spondyloarthritis are axial and peripheral

 

  • Axial spondyloarthritis / ankylosing spondylitis: mainly axial
  • IBD arthritis: mainly axial
  • Psoriatic arthritis: mainly peripheral
  • Reactive arthritis: mainly peripheral

3

Describe reactive arthritis

Reactive arthritis

  • Acute inflammatory arthritis following GI or GU infection
  • Affects men > women
  • Usually self-limited, may be recurrent or chronic
  • Can't see, can't pee, can't climb a tree

4

Reactive arthritis is acute inflammatory arthritis following a ____ or ____ infection and is characterized by symptoms "____"

Reactive arthritis is acute inflammatory arthritis following a GI or GU infection and is characterized by the symptoms "can't see, can't pee, can't climb a tree"

 

(affects men more than women)

5

Describe the articular features of reactive arthritis

Articular features of reactive arthritis

  • Additive, asymmetric mono- or oligo- arthritis involving more commonly large lower extremity joints
  • Dactylitis: diffusely swollen digits, "sausage toe" or finger
  • Enthesitis: heel pain at tendon insertion
  • Inflammatory low back pain: sacroiliitis

6

Inflammatory enthesopathy in reactive arthritis involves _____ and _____

Inflammatory enthesopathy in reactive arthritis involves subchondral bone inflammation and resorption and periosteal new bone formation

7

Describe the extra-articular features of reactive arthritis

Extra-articular features of reactive arthritis

  • Skin: keratoderma blennorhagicum (histology like psoriasis): keratotic conical lesions on lateral and palmoplantar aspects of hands and feet
  • Mucosal lesions: oral ulcers (painless), circinate balanitis (annular erythematous lesions on glans pens)
  • Nails: thickened, opacified (like psoriasis)
  • Eyes: conjunctivitis, acute anterior uveitis

8

This is _____ from _____  

This is keratoderma blennorrhagicum from reactive arthritis

9

Describe pathogenesis of spondyloarthritis, especially reactive arthritis

Pathogenesis of spondyloarthritis, specifically reactive arthritis

  • Genetic predisposition (HLA-B27+ and others)
  • Environmental triggers: enteric infections, urogenitcal infection (urethritis)
  • Causatove agent may be asymptomatic

10

HLA-B27 is an ______ 

HLA-B27 is an antigen-presenting protein

11

Pathogenesis of spondyloarthritis involves ____, which involves immune system confusion due to ____ between ____ and ____

Pathogenesis of spondyloarthritis involves molecular mimicry, which involves immune system confusion due to sequence homology between HLA-B27 "self" and bacteria "non-self"

12

13

Presence of HLA-B27 ____ disease but is predictive of disease in the ____

Presence of HLA-B27 does not mean presence of disease but is predictive of disease in the spine

14

Describe treatment of reactive arthritis

Treatment of reactive arthritis

  • NSAIDs
  • Physical therapy
  • If NSAIDs fail: corticosteroids, disease modifying agents (DMARDS), biologics (peripheral and axial)
  • Do NOT use antibiotics

15

Describe psoriatic arthritis

Psoriatic arthritis

  • 5-39% of people with psoriasis
  • Equal in males and females
  • Peak onset in late 20s to 30s

16

Describe clinical features of psoriatic arthritis

Clinical features of psoriatic arthritis

  • Cutaneous disease: psoriatic plaques, oncholysis/fingernail pitting, guttate/pustular/erythrodermic variants
  • Inflammatory arthritis: asymmetric, symmetric, axial
  • Dactylitis
  • Enthesitis
  • Rheumatoid factor negative
  • Productive erosions (pencil in cup)

17

_____ is pathognomonic for psoriatic arthritis

Pencil in cup (productive erosions) is pathognomonic for psoriatic arthritis

18

Describe the presentation of psoriatic arthritis

Psoriatic arthritis presentation

  • Skin disease usually precedes joint disease
  • No correlation between severity of skin and joint disease but presence of joint disease is more likely with severe skin disease
  • Nail findings associated with joint disease
  • Enthesitis or tendonitis is a common finding

19

Describe treatment for psoriatic arthritis

Psoriatic arthritis therapy

  • Traditional: NSAIDs, corticosteroids, DMARDs (sulfasalazine, methotrexate)
  • Next generation: phosphodiesterase-4 inhibitor, JAK inhibitor, biologics

20

Etancercept is less effective for treating _____ but equally effective for treating _____ in psoriatic arthritis compared to the other TNF-alpha inhibitors

Etancercept is less effective for treating psoriasis but equally effective for treating arthritis in psoriatic arthritis compared to the other TNF-alpha inhibitors

21

Ustekinumab binds to ____ subunit of ____ and ____, blocking them from binding to receptors

Ustekinumab binds to p40 subunit of IL-12 and IL-23, blocking them from binding to receptors

 

(want to block IL-23, blocking IL-2 makes it less effective

22

Describe mechanisms of action of IL-17 inhibitors in treating psoriatic arthritis

IL-17 inhibitors to treat psoriatic arthritis

  • Secukinumab, Ixekizumab bind to IL-17A
  • Brodalumab blocks IL-17 receptor

23

Describe presentation of axial spondyloarthritis

Axial spondyloarthritis presentation

  • Late diagnosis but symptoms begin in 20s
  • Inflammatory back pain and stiffness - bone bridging across vertebrae
  • Sacroilitis
  • Oligoarthritis
  • Enthesitis
  • Systemic symptoms (fatigue, impaired sleep)
  • Extra-articular disease (uveitis, IBD, aortitis)

24

Axial spondyloarthritis is ____ that picks up more ____

Axial spondyloarthritis is a systemic disease that has all features of ankylosing spondylitis without some of the bone changes and picks up more women

25

Describe treatment for axial spondyloarthritis

Axial spondyloarthritis treatment

  • Exercise / physical therapy
  • NSAIDs
  • Corticosteroids
  • Sulfasalazine
  • Methotrexate
  • TNF inhibitors 
  • IL-17 inhibitors

26

Describe the effect of biologics on progress of axial spondyloarthritis

Effect of biologics on progress of axial spondyloarthritis

  • No controolled trials of disease progression with TNF or IL-17 inhibitor therapies
  • All available therapies reduce MRI evidence of inflammation
  • Structural progression of radiographic changes may be reduced

27

Describe presentation of IBD related arthritis

IBD related arthritis

  • Inflammatory back pain and stiffness
  • Sacroiliitis
  • Oligoarthritis
  • Enthesitis
  • Dactylitis
  • Systemic symptoms (fatigue, impaired sleep)
  • Change in bowel habits

28

Spondyloarthritis treatment involves a shared approach to therapy driven by _____ more than _____

Spondyloarthritis treatment involves a shared approach to therapy driven by disease manifestations more than specific diagnosis

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