Uiuc M2 2010 Fcp Seronegative Spondyloarthropathies

Front 1

undiferentiated spondyloarthropathy

criteria: (6)

Back 1

1) Inflammatory axial arthritis (sacroiliitis and spondylitis)
2) Peripheral arthritis (often asymmetric and oligoarticular)
3) Enthesitis (inflammation at tendinous/ligamentous insertions)
4) HLA-B27 positivity
5) XRay evidence of erosions +/- hyperostosis (reactive bone)
6) Extra-axial, Extra-articular Features

Front 2

spondyloarthropathy:

Associated Extraarticular Features: (7)

Back 2

1) Periarticular: Enthesitis, tendinitis, 2) dactylitis (sausage-digit)
3) Ocular: Uveitis, Conjunctivitis
4) GI: Painless oral ulcerations, asymptomatic gut inflammation, symptomatic colitis
5) GI: urethritis, vaginitis, balanitis
6) Cardiac: Aortitis, valvular insufficiency, heart block
7) Cutaneous: keratoderma blennorrhagicum, psoriasis or nail lesions (onycholysis, dystrophy, pitting).

Front 3

Spondyloarthopathies
ESSG Criteria:

Back 3

Inflammatory Spinal Pain
or
Synovitis (Asymmetrical or Predominantly lower limbs)
AND (one of following)

1) Alternate buttock pain
3) Sacroiliitis
3) Positive family history
4) Psoriasis
5) Inflammatory bowel disease
6) Urethritis or cervicitis or acute diarrhea occurring within 1 month before the onset of arthritis

Front 4

HLA-B27

Back 4

Class I MHC, important in antigen presenation → CD8 T cells

Associated with the spondyloarthropathies.

normal gene found in 8% of Caucasians, 3-4% of AA

risk of developing AS in ANY HLA-B27: 1-2%
> 95% of patients with AS are B27+

HLA-B27+ → ↑risk uveitis, more severe clinical course
HLA-B27neg → peripheral arthropathritis, skin and nail disease, or IBD.

Front 5

ANKYLOSING SPONDYLITIS

Modified New York Criteria-
Clinical criteria:
Radiographic criteria::

Back 5

1) Low back pain and stiffness for >3 mo, improves w/ exercise, not relieved by rest.
2) Limited lumbar spine motion
3) Limitations of chest expansion

EITHER Bilateral sacroiliitis ≥ Grade 2 or Unilateral sacroiliitis ≥ Gr 3

Definite AS = ≥1 clinical plus 1 radiographic criteria

Probable AS = 3 clinical criteria and no radiologic criteria or
1 radiologic criterion and no clinical criteria

Front 6

ANKYLOSING SPONDYLITIS

demographic

Back 6

More common in Caucasians than African-Americans
Male Predominant 5:1 to 10:1
onset 16-30 yrs. Rare after 45 yrs

Front 7

Triad: Inflammatory back pain, immobility, AM Stiffness

Back 7

ANKYLOSING SPONDYLITIS

Front 8

ANKYLOSING SPONDYLITIS

Severe Complications: (6)

Back 8

1) Spinal stiffness/ankylosis in kyphotic position
2) Osteoporosis/spinal fractures
3) Severe uveitis (25-40%)
4) Neurologic complications
5) Other organ involvement: heart, lung, kidney
6) Mortality

Front 9

REACTIVE ARTHRITIS

timing:
symptoms:
demographic:
complications:

Back 9

1-3 weeks after infectious event (GU, GI, idiopathic)
self limiting (< 6 mos), chronic, or intermittent

1) Arthritis recurrent in 15-30%, more in chlamydial arthritis pts
2) urethritis (vaginitis)
3) conjunctivitis

HLA-B27+ in 75-80% Caucasians
Post-venereal onset: Sex 5:1 M:F
Post-dysenteric (less common) M=F

complications: Acute anterior uveitis 5%, carditis, fasciitis

Front 10

TRIAD: arthritis + urethritis (vaginitis) + conjunctivitis

Back 10

(classic triad found in < one-third of pts)

REACTIVE ARTHRITIS

Front 11

Infectious Triggers for Reactive Arthritis

COMMON PATHOGENS:

Back 11

Enteric:
1) Shigella flexneri
2) Salmonella typhimurium, S. enteritidis
3) Yersinia enterocololitica
4) Campylobacter jejuni

Urogenital Infections:
Chlamydia trachomatis, C.Pneumoniae
Ureaplasma Urealyticum

Front 12

B27+ HIV+ patients

Back 12

may manifest a severe form of:
Reactive arthritis; Psoriatic arthritis; Spondyloarthropathy

asymmetric poly- or oligoarthritis, lower extremitiy arthritis, dactylitis, enthesitis, fasciitis, conjunctivitis, urethritis

Front 13

Psoriatic arthritis

what is it:
demographic:

Back 13

Inflammatory polyarthritis associated with psoriasis
• May occur prior to the onset of skin disease
• Usually RF seronegative
M=F, Prevalence: 0.1%

Front 14

Psoriatic arthritis

presentations: (6)
associated symptoms:

Back 14

1) Inflammatory DIP disease
2) Asymmetic oligoarthritis with large and small joints
3) Symmetric polyarthritis
4) Arthritis mutilans
5) Spondyloarthropathy
6) Spondylitis and sacroiliitis

1) Nail pitting
2) Skin disease
3) Pitting edema
4) Inflammatory eye disease

Front 15

SAPHO Syndrome

Back 15

Synovitis, Acne, Pustolosis, Hyperostosis, Osteitis
(Pustular Skin Disease + Osteitis or Arthritis)

Front 16

BD patients (Crohns disease or Ulcerative colitis)

relationship to arthritis:
risk increase w: (2)

Back 16

5-20% of IBD patients will develop inflammatory arthritis

1) ↑extent of colonic dz
2) extraintestinal manifestations: abscesses, E. Nodosum, uveitis, pyoderma gangrenosum