Ankylosing Spondylitis and Related Conditions Quiz

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Questions and Answers

What symptom is commonly associated with ankylosing spondylitis (AS) that improves with exercise?

Numbness in limbs

Increased joint swelling

Reduction in muscle tone

Inflammatory back pain (correct)

What percentage of patients with ankylosing spondylitis may experience hip and shoulder arthritis?

35-40%

25-30% (correct)

10-15%

50-55%

Which laboratory study is commonly elevated in patients suspected of having ankylosing spondylitis?

Urinalysis

Liver function tests

Complete blood count

Erythrocyte sedimentation rate (ESR) (correct)

Which of the following is a common extraarticular involvement associated with ankylosing spondylitis?

Anterior uveitis Signup and view all the answers

A positive Schober test indicates what condition in patients with suspected ankylosing spondylitis?

Reduced spinal flexibility Signup and view all the answers

Which joints are commonly involved in ReA?

Knee and ankle Signup and view all the answers

What is a common constitutional feature associated with ReA?

Fatigue and malaise Signup and view all the answers

How does sacroiliitis in ReA typically present compared to AS?

Unilateral and asymmetric Signup and view all the answers

What laboratory findings are often elevated in ReA?

ESR and CRP Signup and view all the answers

What type of nail change is characteristic of onycholysis?

Distal yellowish discoloration Signup and view all the answers

Which statement best describes the prognosis of ReA?

Most cases resolve within 3-12 months. Signup and view all the answers

What is a significant risk for patients with psoriasis regarding arthritis?

They may develop rheumatoid arthritis alongside PsA. Signup and view all the answers

What type of arthritis is associated with DIP involvement in PsA?

Psoriatic arthritis Signup and view all the answers

What is the percentage chance of developing Ankylosing Spondylitis (AS) if a first-degree relative has AS and the individual is HLA-B27 positive?

30% Signup and view all the answers

Which of the following is NOT a radiographic finding associated with Ankylosing Spondylitis?

Swelling of the joint Signup and view all the answers

What type of arthritis is classically associated with uveitis, urethritis, and arthritis?

Reactive Arthritis Signup and view all the answers

What is the ratio of male to female prevalence in Reactive Arthritis?

1:1 Signup and view all the answers

Which of the following conditions is NOT classified under Reactive Arthritis?

Psoriatic Arthritis Signup and view all the answers

What is a key characteristic of peripheral arthritis in spondyloarthropathy associated with Reactive Arthritis?

Predominantly involves lower extremities Signup and view all the answers

How soon after infection do symptoms of Reactive Arthritis typically appear?

1-4 weeks Signup and view all the answers

Which of the following is a common infectious trigger for Reactive Arthritis?

Chlamydia Trachomatis Signup and view all the answers

What is a characteristic finding in ankylosing spondylitis pathology?

Erosions and panus formation in the sacroiliac joint Signup and view all the answers

Which cytokine is associated with the inflammation caused by HLA-B27 in ankylosing spondylitis?

IL-17 Signup and view all the answers

At what peak age is ankylosing spondylitis most commonly diagnosed?

20 to 30 years Signup and view all the answers

What demographic is most likely to present with ankylosing spondylitis?

Whites aged 20 to 30 Signup and view all the answers

What is the significance of HLA-B27 in ankylosing spondylitis?

It is involved in the immune response leading to inflammation. Signup and view all the answers

Which statement regarding the occurrence of symptoms in ankylosing spondylitis is TRUE?

Symptoms first noticed in late adolescence or early adulthood. Signup and view all the answers

What role does IL-23 play in the mechanism of ankylosing spondylitis?

It induces IL-17 production by Th-17 cells. Signup and view all the answers

Which of the following conditions is classified as a spondyloarthritis?

Ankylosing spondylitis Signup and view all the answers

Study Notes

Spondyloarthropathies

Spondyloarthropathies are a group of disorders characterized by inflammation of the spine.
They are considered seronegative because they are rheumatoid factor negative.
Types of spondyloarthropathies
- Non-radiographic axial spondyloarthropathy
- Ankylosing spondylitis
- Reactive arthritis
- Psoriatic arthritis
- Inflammatory bowel disease (IBD) associated with arthritis or spondylitis
- Juvenile onset spondylitis

Objectives

Formulate differential diagnoses based on different demographic characteristics of the seronegative spondyloarthropathies (SSpAs).
Distinguish the different SSpAs' clinical features and compare them to other types of arthritis.
Distinguish the unique laboratory and x-ray features.
Develop a basic treatment plan for each of the SSpAs.

Ankylosing Spondylitis (AS)

AS is a chronic inflammatory disease of the axial skeleton.
Key symptoms include back pain and progressive stiffness of the spine.
AS can also affect joints and extraarticular structures.
AS pathology involves
- Sacroiliac joint: subchondral granulation tissue, marrow edema, synovitis, pannus formation, erosions, enthesitis, scattered areas of new cartilage formation, and osteitis.
- Eventually, eroded joint margins are replaced by fibrocartilage regeneration and ossification, obliterating (ankylosing/fusing) the joint.
HLA-B27 is an MHC Class I molecule, found in 8% of Whites and 4% of Blacks.
- Antigens presented by HLA-B27 are recognized by reactive CD8+ T cells causing inflammation.
- The B-27 heavy chain of HLA-B27 has an unusual tendency to misfold, which may be proinflammatory.
IL-23 stimulates IL-17 production from Th-17 cells.
IL-17 stimulates macrophages and neutrophils to produce TNF-α.
Increased IL-12 has also been found in some cases.

AS Demographics

U.S. Prevalence is from 0.2 to 0.5 percent.
More common in Whites than Blacks.
Males are more affected than females (2-3:1).
Peak age of onset is between 20 and 30 years old.
Symptoms are first noticed in late adolescence and early adulthood, with a median age of 23.
The first manifestations occur after the age of 40 in only 5% of patients.

AS Clinical Manifestations

Onset less than 40-45 years.
Symptoms usually start insidiously with dull low back pain or in the gluteal and posterior knee areas.
Back complaints are the first symptoms in approximately 75% of patients, greatly improved by NSAIDs.
Symptoms include morning stiffness improving with exercise and pain at night.
Bony tenderness may accompany pain or stiffness.
Sites of pain include costosternal junctions, spinous processes, iliac crest, greater trochanters, ischial tubercles, and tibial tubercles and heels.
25-30% of patients have hip and shoulder arthritis.
30% of patients have asymmetric peripheral arthritis excluding the hips or shoulders

AS Exam Findings

In the examination, SI tenderness may be present, but not always.
Usual chest expansion is 5 cm or more; less than 2.5 cm is abnormal.
An abnormal chest expansion impairs pulmonary function.
The Schober test is positive.

AS Laboratory Studies

Laboratory studies are nonspecific.
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often elevated.
Mild normocytic normochromic anemia may be present.
HLA-B27 is positive in 90% of AS cases, but 6% of the general population is also positive.
A first-degree relative with AS and being HLA-B27 positive will increase the chance of contracting AS by 30%.

AS Radiographic Findings

Blurring of cortical margins.
Erosions.
Sclerosis.
Pseudowidening of joint space.
Fibrous and bony ankylosis.
Symmetric changes.
Straightening and loss of lordosis and scoliosis observed.
Reactive sclerosis, osteitis at the corners of the vertebral bodies, and subsequent erosions may be observed.
Squaring and syndesmophyte (ossificiation) formations.

Reactive Arthritis (ReA)

ReA is an arthritis associated with an infection or previous infection elsewhere in the body.
Symptoms classically include uveitis, urethritis, and arthritis.
The peripheral arthritis in spondyloarthropathy is of acute onset, predominantly involving the lower extremities (especially knees, ankles, and feet).
It's typically asymmetrical and often affects only one to three joints.

ReA Etiology

Specific infections linked with ReA include
- Urethritis (Chlamydia Trachomatis, Ureaplasma)
- Infectious diarrhea (Shigella, Salmonella, Campylobacter, C. Difficile)
- Pneumonia (Chlamydia Pneumoniae)

ReA Pathogenesis

Bacterial antigens, DNA, and RNA have been found in synovial fluid, suggesting the presence of the organism.
Specificity of these findings isn't clear as similar findings are observed in other rheumatic diseases.

ReA Epidemiology

The prevalence of HLA-B27 in ReA is over 50%.
Common age range for ReA is 18-40, but it also occurs in children over 5 and older adults.
Male:Female is a 1:1 ratio.

ReA Clinical Features

Symptoms range from isolated and transient monoarthritis or enthesitis to a severe multisystem disease.
Symptoms are frequent 1–4 weeks after an infection, but some patients show no clinical or laboratory evidence of infection.
Most cases are self-limited, and resolve within 3-12 months. However, some patients experience minor residual symptoms beyond 12 months.
ReA relapses occur in up to 15% of cases, and chronic cases in another 15-20%.

ReA Arthritis Features

Joints often involved include the knee, ankle, subtalar joint, metatarsalphalangeal joints; wrists and fingers can also be involved.
Tendinitis and fasciitis may also be observed.
Clinically, constitutional features, such as fatigue and malaise, fever, and weight loss, are common in ReA.
Spondylitis can occur in 10% of cases and is characterized by low back pain, muscle spasms, and unilateral sacroiliitis.
Urogenital issues (prostatitis, cervicitis, salpingitis, circinate balinitis) are common.
Onycholysis (nail changes) with yellowish discoloration also occur in ReA patients.

ReA Labs and Radiographic Findings

ESR and CRP are elevated.
HLA B-27 positivity is seen in half of the patients.
Extensive cases might present marginal erosions, loss of joint space, and periostitis, with new bone formation and plantar fascia spurs.
Sacroiliitis is asymmetric in nature.
Syndesmophytes are coarse and nonmarginal, and also asymmetric.

Psoriatic Arthritis (PsA)

Inflammatory arthritis associated with psoriasis.
It affects women and men equally.
Incidence is approximately 6 per 100,000 people.
Prevalence rates are roughly 100 per 100,000 people.
Among those with psoriasis, the prevalence is 5-30 per 100 patients.

PsA Clinical Presentation

Morning stiffness lasting over 30 minutes, which worsens with immobility and improves with activity.
DIPs (distal interphalangeal joints) and spine are vulnerable to PsA.
PsA is seronegative (rheumatoid factor negative).

PsA Patterns

Asymmetric oligoarthritis (30%).
Symmetric polyarthritis (40%).
Arthritis mutilans (<5%).
Spondyloarthropathy alone (including both sacroiliitis and spondylitis)(5%).

PsA Radiographic and Laboratory Findings

Erosive changes and new bone formation are common.
Lysis of the terminal phalanges, with fluffy periostitis and new bone formation at enthesitis sites, may occur.
Pencil-in-cup deformities can form.
Lack of osteoporosis; SI involvement is unilateral (asymmetric).
ESR and CRP are elevated.
Uric acid may be elevated in severe psoriasis, but these are not diagnostic tests.

IBD Associated Arthritis

Peripheral joint disease occurs in 10-20% of IBD patients.
The arthritis can precede other symptoms of IBD.
The arthritis is usually migratory, asymmetric, and oligoarticular.
Rarely is the peripheral joint disease destructive.
Sacroiliitis and spondylitis occur in 10-20% of IBD patients. Its activity is independent of active IBD.

Treatment for Spondyloarthropathies

Refer to specific treatment slides for the indicated ailment.

Fibromyalgia

Chronic pain disorder (connective tissue).
Characterized by widespread muscle pain (myalgia).
Prevalence is 2–7% affecting nearly 6 million people in the U.S.
Peak age is 45-60 years old.
Significantly more prevalent in women (3.4%) than men (0.5%).
Occurs during early and middle age.

Fibromyalgia Diagnosis

Based on a complete physical or clinical examination, along with a thorough patient history.
There are no specific laboratory or imaging tests that confirm the diagnosis.
Symptoms include widespread pain, fatigue, sleep disturbances, anxiety, irritable bowel syndrome, headache, and paresthesia.

Fibromyalgia Treatment

Sleep hygiene.
Exercise.
Pool exercise.
Low-dose antidepressants (duloxetine, gabapentin, pregabalin).

Disclaimer

These notes are for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for diagnosis and treatment options.

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Description

Test your knowledge on ankylosing spondylitis (AS) and related conditions like reactive arthritis (ReA) and psoriatic arthritis (PsA). This quiz includes questions about symptoms, diagnostics, and prevalence associated with these conditions. Challenge yourself to see how well you understand the complexities of these arthritic diseases.