Spondyloarthritis lecture notes

Question 1

What gene is associated with ankylosing spondylitis?

Answer 1

HLA B27
(not all who have this gene have ankylosing sponylitis)

Question 2

What is molecular mimicry?

Answer 2

When immune system recognises a foreign antigen but is similar to host cells and immune system ends up attacking both the foreign antigen and its own cells.

Question 3

What are clinical features of spondyloarthritis?

Answer 3

Axial spondyloarthritis (also called ankylsing spondyloarthritis) - painful, stiff, rigid spine

Swollen Achilles tendon
Tennis elbow and golfers elbow

Uveitis (inflammatory eye problems)
Peripheral arthritis, often asymmetrical oligoarthritis (a few joints)

Skin psoriasis often associated
IBD/Crohn’s diseas

Question 4

Mnemonic for Spondyloarthritis presentations

Answer 4

SPINEACHE
Sausage digit
Psoriasis
Inflammatory back pain
NSAID good response
Enthesitis (heel)
Arthritis
Crohn’s/ Colitis / elevated CRP
HLA B27
Eye (uveitis)

Question 5

What is the gold standard imaging for spondyloarthritis?

Answer 5

MRI

Question 6

How does axial spondyloarthritis often present?

Answer 6

Young patients
More than 3 months of back pain
Gets better with activity
Early morning stiffness for at least 30 mins
Waking with back pain
Alternating buttocks pain, aching

Question 7

What does non-radiographic mean in relation to axial spondyloarthritis?

Answer 7

No changes on x-ray. May be changes on MRI, but not x-ray yet.

Question 8

What treatment is there available?

Answer 8

Biologic drugs like anti-TNF, IL-17 blockers

Question 9

How may psoriatic arthritis present?

Answer 9

Peripheral arthritis
Polyarticular
Dystrophic nails
Pitting
Red and swollen DIPJs
Skin psoriasis

Question 10

Dactylitis

Answer 10

Sausage shaped digit
Hot
Red
Swollen

Question 11

Hidden sites for psoriasis

Answer 11

Behind ear, inside scalp, inside ear, across eyebrows, pitting nails, nail bed lifted away from nail bed and thickened.

Question 12

For just axial inflammation, do DMARDs work?

Answer 12

No, useful for peripheral arthritis not axial (spine)

Question 13

Reactive arthritis is sterile inflammation of the s_____ m_____, tendons and fascia triggered by an infection at a distant site, usually GI or genital.

Answer 13

synovial membrane

Question 14

What kind of infections can cause reactive arthritis?

Answer 14

STIs

Question 15

What is the classical triad for reactive arthritis?

Answer 15

Arthritis
Conjunctivitis
Urethritis

Question 16

Enteropathic arthritis

Answer 16

Episodic peripheral synovitis, patients with IBD.
Asymmetric lower limb arthritis, usually reflects the disease activity

Question 17

For patients with SPA, think…

Answer 17

inflammatory back pain
psoriasis
IBD
Infection