MSK 6 Inflammatory Arthropathies Flashcards Preview

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Flashcards in MSK 6 Inflammatory Arthropathies Deck (50):
1

Inflammatory arthropathies:
Common Types →

➢ Rheumatoid Arthritis (RA)
➢ Spondyloarthropathies
➢ Systemic lupus erthematosus (SLE)
➢ Crystal-related arthropathies
➢ Polymyalgia rheumatic

2

Rheumatoid Arthritis:Cause

T cell driven (autoimmune) disease

3

Rheumatoid Arthritis: Early signs

Joint stiffness (15 mins lasting)
Joint tenderness
Cant close fist
Loss of grip strength

4

Rheumatoid Arthritis:Longer signs

Multiple joints involved
Evidence of deformities in joints
Poor skin/ulceration
Severe limitation of movement

5

Rheumatoid Arthritis:Pathogenesis

Mass of tissue forms → Pannaus containing macrophage setc. (pro-inflammatory cells)
Mass of tissue (Pannaus) secrete enzymes that erodes cartilage and bone

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Rheumatoid Arthritis:Serum

Seropositive

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Spondyloarthropathies: General definition

Group of rheumatic diseases regarded as a variant of RA but distinct from it

8

Spondyloarthropathies:Main features

1. A family of inflammatory joint diseases characterised by involvement of synovium and enthuse (tendon insertion sites)
2. Leads to spinal and oligarticular peripheral arthritis in genetically predisposed (HLA B27) individuals
3. Spine effected (high frequency)
4. Multiple joints effects
5. Bowel inflammation
6. Eye inflammation
7. Cytotoxic T cell inflammation (initiation) recognising antigen bound to HLA B27)

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Spondyloarthropathies: Common types of spondylarthropathies

8. Ankolysing spondylitis
9. Reactive arthritis
10. Psoriatic arthrisis

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Spondyloarthropathies: Key features

Enteses →tendon insertion sites.

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Ankolysing spondylitis: Definition

Ankolysing (fusion) spondylitls (arthritis of vertebrae) is a chronic inflammatory rheumatic disease that primarily affects the sacroiliac joints and spine.

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Ankolysing spondylitis: Characteristic features

Severe back pain
Early morning stiffness of effected joints
Dorsal pysphosis
Flatten lumbar lorodis
Flattened knee
Prominent abdominal folds
Severe limitation in movement in all planes

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Ankolysing spondylitis: Common joints effect

Spine
Shoulder
Hip joint
Sacroliliac joints

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Ankolysing spondylitis: Tendon insertion sites eroded

Pelvis ASIS etc.

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Ankolysing spondylitis: Serology

Most markers of systemic markers elevated (CRP) (ESR).

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Ankolysing spondylitis: Gross anatomy of spine

Formation of bony bridges uniting vertebraes

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Ankolysing spondylitis: Epi

The male to female ratio: 5:1

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Ankolysing spondylitis: Defining feature

Involves high frequency of inflammation at the enthese

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Ankolysing spondylitis: 90% of the patients

Are HLA B27 positive compared to 6% of the unaffected individuals. Unique structure of HLA B27 suggest that CD8+ T-cells or natural killer cells are involved in pathogenesis

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Ankolysing spondylitis: Serum

Seronegative – no rheumatoid factors in the blood

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Ankolysing spondylitis: Prevalence

0.5-1.0% in Caucasians

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Ankolysing spondylitis: Mechanism of AS

HLA-B27 carry specific amino acids can bing to appropriate antigen that triggers AS

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Reactive arthritis: (Rieter’s syndrome) Definition

Initial arthritis can be described as antibodies and T-lymphocytes reacting with the bacterial antigens

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Reactive arthritis: (Rieter’s syndrome)Confirmation

Test synovial fluid and stain for bacteria associated with reactive arthritis

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Reactive arthritis: (Rieter’s syndrome)Treatment

Antibiotics?

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Reactive arthritis: (Rieter’s syndrome)Joint inflammation

Occurs in 1-4% of the patients following enteric infection with:
1. Salmonella
2. Shigella
3. Camplyolbacter
Yersinia

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Reactive arthritis: (Rieter’s syndrome) Pathogenesis

Bacterial component and T-cell eactive to these antigens can be found within the synovial membrane and synovial fluid

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Reactive arthritis: (Rieter’s syndrome) Epi

Male: female equal

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Reactive arthritis: (Rieter’s syndrome) Features

Skin lesions (keratoderma blenorrhagicum/pustulosis palmoplantaris)

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Reactive arthritis: (Rieter’s syndrome) 60-70% of patients

Are positive for HLA B27

31

Psoriatic arthritis: Definition

Is an inflammatory skin disorder characterised by epidermal hyper-proliferation and abnormal keratinisation (skin)

32

Psoriatic arthritis: Features

Typically effects small joints of hand
But Can also effect elbow and knee
Mirrored image

33

Psoriatic arthritis:Joint involvement

Wrist
Phalanges
Shoulder
Metatarsals

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Psoriatic arthritis: Koebner phenononmen

Factors trigger (heat, tropical medicine, clothes) psoriasis to flare

35

Psoriatic arthritis:Immune involvement

Eviden of involvement and production od pro-inflammatory cytokines (Il-1, TNF)

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Psoriatic arthritis:Epi

5-8% develop arthritis and the prevalence in Caucasians is between 0.2 and 0.1%

37

Psoriatic arthritis:Treatment and explanation

Though to be a TH1 mediated disease because of the beneficial effects of cyclosporine (immunesuppressant) A and other anti-CD4 treatmetns

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Psoriatic arthritis:Antigen involved

Unknown but antigens derived from the keratinocytes or group A streptococci are possible candidates.

39

Systemic Lupus erythematousus: Definition

An inflammatory multi-system disease associated with complement C4 deficiency

40

Systemic Lupus erythematousus:Clinical features

Inflamamtion in various organ systems including skin and mucus membrane, joints, kidneys, brain,serous membranes, lung, heart, GI tract.

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Systemic Lupus erythematousus: Affect

Primarily women

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Systemic Lupus erythematousus: Common manifestation

1. Arthritis but not erosive or destructive of bone
2. Butterfly redness – from sunlight
3. Any part of body exposed to sunlight
4. Vasculitis
→ Small vessels effected = Necrosis around nails and skin of fingertips

5. Acute arthritis may affect any joint but the small joints of the hands, wrist and knees are involved
6. Soft tissue swelling and joint effusions present

43

Systemic Lupus erythematousus: Pathological processes in SLE

1. Inherited complement deficiencies
2. Histocompatibility antigens – freqeuncy of HLA-A1, B* and DR3 is 3x greater in SLE than controls
3. Sex hormones – SLE is 6-10x higher in females
4. Polyclonal B-cell activation and multiple autoantibody production

44

Systemic Lupus erythematousus: Recognisable feature

5. Most cases are symmetric but asymmetric polyarthritis is also seen

45

Crystal-related arthropathies: Epi

More common in men
40-60yrs

46

Crystal-related arthropathies: Characterised

Acute attacks of arthritis

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Crystal-related arthropathies:Pathology

Urate crystals in synovial fluid from patients with gout

48

Crystal-related arthropathies:Two types

Gout → Urate crystals
Pseudo Gout → different crystals calcium pyrophosphate dehydrate (CPD)

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Crystal-related arthropathies: Two genes associated with Gout

ABCG2
SLC2A9

50

Crystal-related arthropathies: Long-term mechanisms and presentation

Tophi – accumulations of crystals
Crystals become coated with proteins in synovial fluid e.g. MSU crystal can become coated with IgU
Apolipoprotein coats the crystals and inhibits the recognition by pro-inflammatory cells

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