Spondyloarthritis

Question 1

How is spondyloarthropathy categorized / what are the types of spondyloarthritis?

Answer 1

Axial and peripheral

Axial:
- Radiologically axial spondyloarthritis (ank spond)
- Non radiologically active spondyloarthritis

Peripheral:
- Psoritic arthritis
- IBD associated arthritis
- reactive arthritis

Question 2

What is the new term for ank spond?

Answer 2

Axial spondyloarthritis

Question 3

What is the male to female ration in ank spond?

Answer 3

2:1

Question 4

Pt has clinical features of anylosing spoindylitis. NIl XR changes but there is inflammation on MRI. What condition?

Answer 4

Non radiological axial spondyloarthritis
- Other manifestations include uvewitis, urethritis etc

Question 5

What is the most common extra intyestinal manifestation of a IBD?

Answer 5

spondyloarthritis

Question 6

What is classified as inflammatory back pain / typical presentation?

Answer 6

Young age
Insidious onset
Improvement with exercise
NIl improvement with rest
Pain at night

Question 7

What percentage of HLA B27 get spondyloarthritis?

Answer 7

20%, most dont

Question 8

Where does inflamation begin in the pathogenesis of spondyloarthropathies?

Answer 8

Enthesis

Question 9

Which are the main cytokines in spondyloarthritis? WHich of these induce bone destruction?

Answer 9

TNF alphas, IL 23, IL 17
- TNF and IL 17 induce bone destruction

IL17 made by TH17 cells in response to IL 23

Question 10

What is a thought to be a key feature in spondyloarthritis pathogenesis?

Answer 10

Skin or gut barrier breakdown

Question 11

What is a key unifying XR finding (if present) that is reasonably specific for spondyloarthritis?

Answer 11

New bone formation

Question 12

What spondyloarthritis agents are contraindicated in pts with IBD?

Answer 12

IL17 agents (IL17 is improtant in protection from gut infection in pts with gut breakdown)

Examples:
- Brodalumab

Question 13

Aside from back pain, what other clinical features of ank spond?

Answer 13

Large joint oligoarthritis
Enthesitis (achilles tendon most common)
Achiles or plantar fascitis
Dactylitis (sausage fingers)
Uveitis

Question 14

What is the most common extraarticular manifestation of ank spond?

Answer 14

Uveitis (acute monocular anterior uveitis)

Question 15

What is Rx for ank spond?

Answer 15

Exersise and NSAIDs first line
If fails these then biologicz

Question 16

What are typical findings of axial spondyloarthritis on XR?

Answer 16

Hip XR:
- Narrowing or loss of the sacroiliac joint lines (fusion=ankylosis)
- Irregular joint line, sclerosis (more white stuff)

Lumbar spine:
- Squaring the the vertebral bodies
- Syndesmophytes (cross linking between vertebral bodies
- Bamboo spine if all ankylosed

Question 17

Does dactylitis (sausage finger) occur in other forms of spondyloarthris aside from psoriatic?

Answer 17

Yes

Question 18

Which spondyloarth does HLA B27 confer teh highest risk of?

Answer 18

Ank spond

Question 19

What is the HLA associated with Psoriatic arthritis?

Answer 19

HLA C06*02
- can also have HLA B27 but less

Question 20

What is the main complication / associated condition with psoiriatic arthritis?

Answer 20

Cardiovascdular disease
- obesity is often present

Question 21

What pattern of psoriasis skin involvment confers highest risk fo developing psoriatic arthritis?

Answer 21

Scalp, genital or nail involvment

Question 22

What is the main difference between the small joint arthritis in PS vs RA?

Answer 22

DIP involvement and nail change DO NOT occur in RA
this would be PA

Question 23

What are the classic XR findings in PA?

Answer 23

pencil in cup deformity (responsible for the clinical telescoping of severe PA)

Question 24

What are some features of reative arthritis?

Answer 24

keratoderma blennorrhagicum
- THicken patches or spots of keratosis over the soles of the feet

Migratory glossitis
- SHifting qhite tongue plaques

Circinate balanitis
-m White plaque like inflamation of the head of penis

Can also get uveitis, urethritis and ofc arthritis (can see, cant pee, cant climb a tree)

Question 25

Can reactive arthritis occur post STIs?

Answer 25

Yes it can

Question 26

What is Rx of reactive arthritis?

Answer 26

Treat infection
SYmptom managment with NSAID +/- joint injections
Sulfasalizine

Question 27

Is post strep arthritis different from reactive arthritis?

Answer 27

It is different

Question 28

What is management for IBD assocaited arthritis?

Answer 28

Treat IBD