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16 Cards in this Set
- Front
- Back
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Common features of spondyloarthropathies.
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Young onset, male predominance
Sacroiliitis, spinal inflammn Asymmetric peripheral arthritis Fibrosis and bony fusion (ankylosis) |
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Lab features of spondyloartrhopathies
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No rheum factor
No ANA Mod elevation ESR, CRP |
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How does ankylosis arise?
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Chronic low grade inflammn in joints and entheses-->prolifern of fibroblasts and collagen-->scarring
Scars become calcified, ossified and result in bony bridges leading to ankylosis Ankylosis = fibrosis and bony fusion Enthesis = group of tissues including adjacent bone, tendon insertion |
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HLA-B27
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Very common in ankylosing spondylitis; but also present in other things
Theory is some sort of immune trigger (exposure to pathogen) results in activation of HLA-27 and later results in diarrhea/gut inflammn, arthritis For every 10 people with HLA-27, only 2 will develop dz. |
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Ankylosing spondylitis:
Presentation Effects Extraarticular manifestations |
Axial arthritis (sacroiliac inflammn is required for dx)
Results in symmetric sacroiliac and spinal fusion Extraarticular manifestations: acute uveitis (may precede spinal arthritis)*** Aortic insuff.; aortitis Reduced chest expansion |
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Reactive arthritis:
Presentaiton Extraarticular manifestations |
Arthritis following infection
Asymmetric oligoarthritis of lower extremeties Heel pain Extraarticular: Diarrhea or GU in preceding 4 weeks |
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Can't see, can't pee, can't climb a tree.
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Reactive arthritis
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What agents may initiate reactive arthritis?
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Enteric infections: shigella, salmonella, etc.
GU infections HIV |
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Enteropathic Arthritis:
Presentation |
Peripheral arthritis as presenting feature of colitis (Crohn's, UC)--no HLA assocn
SPondylitis: Sacroiliitis, ascending spondylitis; not related to colitis; HLA-B27 present in 50-90% |
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Psoriatic spondylitis:
Presentation |
Peripheral arthritis in pts w/psoriasis
Spondylitis related to HLA-B27--but peripheral arthritis is not |
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Spondyloarthropathy:
General Presentation |
Onset before age 40
Bilateral low back and buttock pain MORNING STIFFNESS (over 2 hours) Improves w/exercise |
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This exercise is recommended for the treatment of ankylosing spondylitis.
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Spinal extension exercises
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TNF-alpha plays a role in _______.
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Ongoing inflammation in AS
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TGF-beta plays a role in ______.
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Ossification and ankylosis in AS
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Role of anti-TNF therapy in spondylotherapy.
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Effective in tx, but unknown whether prevents progressive fusion.
There's potential for infection w/use. |
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Psoriatic Arthritis:
Presentation |
Arthritis before psoriasis
No extraarthritic effects Usually changes in nails |
