Flashcards in Rheumatology: Axial Arthropathies Deck (33)
What are the group of diseases known as axial arthropathies characterized by?
1. Axial arthritis
2. Peripheral arthritis
4. Mucocutaneous lesions
The pathogenesis of axial arthropathies is unknown, but it is strongly associated with what?
HLA-B27 and unknown infecious agent
What three demographics are found most often in ankylosing spondylitis?
1. Men > Women
2. Between 16-40 years
All patients with ankylosing spondylitis have inflammatory back pain characterized by...
1. Insidious onset of pain lasting > 3 months
2. Prolonged morning stiffness ( > 30-60 minutes)
3. Improvement of pain with exercise
4. No neurological sequelae
What would you find on physical examination of a patient with ankylosing spondylitis?
-SI joint tenderness
-Global loss of spine range of motion
-Late in disease course may find back deformities and reduced chest expansion
What percent of patients with AS also have peripheral arthritis?
25%- Hip and shoulder
What are synchondroses?
Areas of cartilaginous union with bone. This includes manubriosternal joint, costovertebral joints, and pubic ramis
Name some extraarticular manifestations of AS.
1. Acute anterior uveitis- 25%
3. Microscopic colitis
4. Pulmonary apical fibrosis
5. Cardiovascular disease
6. Cauda equina syndrome
Which of the following tests would be positive or negative for a patient with AS:
What percentage of sarcoiliitis is found in patients by age 45?
What three deomgraphics are found most often in patients with reactive arthritis?
1. Males> Females
2. Onset occurs from childhood to age 40-50
What precedes the onset of reactive arthritis?
History of infectious diarrhea or urethritis which precedes by 2-4 weeks
What microorganisms cause the diarrhea preceding reactive arthritis?
What microorganism causes urethritis preceding reactive arthritis?
What is the site of reactive arthritis?
Inflammatory peripheral arthritis, typically lower extremities
Inflammatory back pain symptoms
How does the peripheral arthritis associated with reactive arthritis present?
Asymmetric, oligoarticular, and predominately lower extremity arthritis (knee and ankles)
Dactylitis- Diffusely swollen toes due to tendon inflammation
What percentage of reactive arthritis patients experience inflammatory back disease?
What is enthesopathy and what percentage of patients with reactive arthritis have it?
Pathology of tendons
-Achilles tendinitis and/or plantar fasciitis in 20% of patients
Name three extraarticular manifestations of reactive arthritis.
1. Inflammatory eye disease- conjunctivitis (50%) and acute uveitis (20%)
2. Mucocutaneous lesions (20%)
3. Aortitis and cardiac conduction defects (rare)
What are the results of the following tests of a patient with reactive arthritis?
Describe colitic arthropathies.
- Inflammatory peripheral arthritis occurs in 10-20%
-Axial arthritis involving sacroiliac joints and spine occurs in 5% of patients and resembles AS
Describe psoriatic arthritis.
-10% of patients with psoriasis will develop peripheral and/or axial
-Inflammatory peripheral arthritis predominantly involves upper extremities especially DIP, PIP, and MCP (asymmetric )
-Axial arthritis in 5-10% of psoriatic arthritis pts.
What is the strongest of all associations with anklyosing spondylosis?
Over 90% of Caucasians with AS are HLA-B27 positive
What percentage of the general population have AS?
What is the chance of developing AS for individuals that are HLA-B27 positive?
What if the patient is HLA-B27 positive and has a first-degree relative with AS?
What is enthesis?
Inflammation of ligamentous, tendinous, and fibrous structures as they insert into bone.
What are the inflammatory infiltrates involved in enthesis?
What are the four possible theories of how HLA-B27 can predispose a person to developing AS?
1. Arthitogenic peptide hypothesis
2. Molecular Mimicry
3. Free heavy chain hypothesis
4. Unfolded protein hypothesis
How is arthritis triggered in reactive arthritis?
Monocytes transport bacteria either alive or dead to the joints