Ankylosing spondylitis affects?
males>females, 16-40yo, Caucasians
What are the s/s of ankylosing spondylitis?
inflammatory back pain (insidious, prolonged morning stiffness, improvement with exercise, no neuro sequelae), SI joint tenderness, loss of ROM, deformities and reduced chest expansion
Ankylosing spondylitis frequently affects _____, which are areas of cartilaginous union with bone.
What labs and radiologic findings will be seen in ankylosing spondylitis?
elevated ESR, negative RF, negative ANA; sacroiliitis with bone erosion and sclerosis; radiographic spondylitis; inflammatory hip disease
Reactive arthritis affects?
males>females, childhood to age 40-50, Caucasians
What are the s/s of reactive arthritis?
infectious diarrhea or urethritis preceding peripheral arthritis (asymmetric, lower extremities); dactylitis; enthesopathy (Achilles tendonitis or plantar fasciitis); eye disease, mucocutaneous lesions, heart problems
What labs and radiologic findings will be seen in reactive arthritis?
elevated ESR, negative RF, negative ANA; erosive changes of feet, ankles, and sometimes knees; SI joint and spine abnormalities; erosion and calcification of enthesis insertion
What organisms cause the diarrhea in reactive arthritis?
shigella, salmonella, Yersinia, or campylobacter
What organisms cause the urethritis?
Name the extra-articular manifestations of ankylosing spondylitis.
1. acute anterior uvetis (25%) 2. osteoporosis (19-62%) 3. micro. colitis (22-69%), Crohn's-like lesions (7%) 4. pulm. atypical fibrosis (2%) 5. CV disease (10%) 6. cauda equine syndrome 7. amyloidosis
What is another name for complete spinal fusion that 10% of ankylosing spondylitis pts get?
What is the associated allele in ankylosing spondylitis?
What is the clinical hx for reactive arthritis pts?
infectious diarrhea or urethritis 2-4 weeks prior to arthritis beginning
What extraarticular finding are assoc. with reactive arthritis?
inflammatory eye disease (conjunctivitis/acute anterior uveitis) mucocutaneous lesions (painless oral ulcers, balanitis, keratoderma blennorrhagicum) aortic/heart defects
What are the colitic arthropathies?
inflam. peripheral arthritis in pts with IBS following activity of bowel disease OR axial arthritis in SI/spine resembling AS not following activity of bowel disease
What is psoriatic arthritis?
psoriasis pts that get peripheral and/or axial arthritis, but skin disease does not correlate to arthritis severity. Mostly upper extremities esp DIPs, PIPs, and MCPs, asymmetric; dactylitis. Resembles reactive arthritis in spine.
What is the primary and unique pathologic site in spondyloarthropathies?
Name 5 theories as to why HLA-B27 can predispose a pt to develop AS.
1. arthritogenic peptide hypothesis (peptides bind to HLA-B27 and are presented to CD8+) 2. molecular mimicry 3. free heavy chain hypothesis (can form homodimers that can activate NK cells directly) 4. unfolded protein hypothesis (propensity to misfold, causing stress response and increased cytokines) 5. inflammation and calcification (aggregan in cartilage is released, causing inf)
What is the treatment for the spondyloarthropathies?
back exercises and good posture smoking cessation NSAIDs (indomethacin, tolmetin) steroids sulfasalazine/methotrexate anti-TNF agents
What is the treatment for reactive arthritis?
tetracycline, erythromycin, quinolone (bc of initial infections)