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Questions and Answers
Which type of arthritis is more common in patients with Enteropathic Arthritis?
Which type of arthritis is more common in patients with Enteropathic Arthritis?
There is a correlation between bowel activity and axial arthritis.
There is a correlation between bowel activity and axial arthritis.
False
What is the most common cardiac complication associated with Enteropathic Arthritis?
What is the most common cardiac complication associated with Enteropathic Arthritis?
Aortic regurgitation
The percentage of patients with axial arthritis who are HLA B-27 positive is __________.
The percentage of patients with axial arthritis who are HLA B-27 positive is __________.
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Match the types of peripheral arthritis with their characteristics:
Match the types of peripheral arthritis with their characteristics:
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What is the primary characteristic of LMAP arthritis?
What is the primary characteristic of LMAP arthritis?
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Psoriatic arthritis affects males and females equally.
Psoriatic arthritis affects males and females equally.
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What is the preferred treatment for SMAP-u arthritis?
What is the preferred treatment for SMAP-u arthritis?
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The percentage of patients with psoriatic arthritis who also have nail changes is ________%.
The percentage of patients with psoriatic arthritis who also have nail changes is ________%.
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Match the following clinical manifestations with their descriptions:
Match the following clinical manifestations with their descriptions:
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Which of the following is a characteristic of keratoderma blennorrhagicum?
Which of the following is a characteristic of keratoderma blennorrhagicum?
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Asymmetrical peripheral arthritis is characterized by monarthritis more often than oligoarthritis.
Asymmetrical peripheral arthritis is characterized by monarthritis more often than oligoarthritis.
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What is the significance of HLA B-27 in acute sterile arthritis?
What is the significance of HLA B-27 in acute sterile arthritis?
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_____ is often described as a sausage digit associated with dactylitis.
_____ is often described as a sausage digit associated with dactylitis.
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Match the terms with their descriptions:
Match the terms with their descriptions:
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What condition is associated with uric acid levels greater than 7 mg/kg/d?
What condition is associated with uric acid levels greater than 7 mg/kg/d?
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Hypercalcuria is the most common condition related to calcium levels above 4 mg/kg/d.
Hypercalcuria is the most common condition related to calcium levels above 4 mg/kg/d.
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What is the medical term for excessive uric acid excretion in urine?
What is the medical term for excessive uric acid excretion in urine?
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Levels of calcium greater than ______ mg/kg/d indicate hypercalcuria.
Levels of calcium greater than ______ mg/kg/d indicate hypercalcuria.
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Match the following components with their associated condition:
Match the following components with their associated condition:
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Which of the following types of crystal arthropathies is associated with gouty arthritis?
Which of the following types of crystal arthropathies is associated with gouty arthritis?
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Basic calcium phosphate (BCP) is represented by the formula $Ca_3(PO_4)_2OH$.
Basic calcium phosphate (BCP) is represented by the formula $Ca_3(PO_4)_2OH$.
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What is the end product of purine metabolism in humans?
What is the end product of purine metabolism in humans?
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The activation of the _____ pathway is involved in the pathogenesis of crystal arthropathies.
The activation of the _____ pathway is involved in the pathogenesis of crystal arthropathies.
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Match the following crystal types to their respective sources:
Match the following crystal types to their respective sources:
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Which condition is associated with pencil-in-cup deformity?
Which condition is associated with pencil-in-cup deformity?
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Paravertebral ossification is symmetrical and fine in appearance.
Paravertebral ossification is symmetrical and fine in appearance.
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Name one treatment option for conditions associated with psoriatic arthropathy.
Name one treatment option for conditions associated with psoriatic arthropathy.
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The condition characterized by erosion of MCP, PIP, and DIP in the same finger is known as _____.
The condition characterized by erosion of MCP, PIP, and DIP in the same finger is known as _____.
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What is considered hyperuricemia in males?
What is considered hyperuricemia in males?
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Match the following treatments with their drug classes:
Match the following treatments with their drug classes:
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Asymptomatic hyperuricemia is not related to metabolic syndrome.
Asymptomatic hyperuricemia is not related to metabolic syndrome.
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What is a common mnemonic for drug-induced hyperuricemia?
What is a common mnemonic for drug-induced hyperuricemia?
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In females, hyperuricemia is defined as levels above _____ mg/dl.
In females, hyperuricemia is defined as levels above _____ mg/dl.
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Match the defective enzyme with its related disease:
Match the defective enzyme with its related disease:
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Which characteristic is exclusive to psoriatic arthritis?
Which characteristic is exclusive to psoriatic arthritis?
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Rheumatoid arthritis is associated with psoriasis.
Rheumatoid arthritis is associated with psoriasis.
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What type of progression is commonly observed in psoriatic arthritis?
What type of progression is commonly observed in psoriatic arthritis?
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Psoriatic arthritis is characterized by the presence of __________, which is not typical for rheumatoid arthritis.
Psoriatic arthritis is characterized by the presence of __________, which is not typical for rheumatoid arthritis.
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Match the features with the types of arthritis they are associated with:
Match the features with the types of arthritis they are associated with:
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Which type of psoriasis is characterized by a widespread, bright red rash covering a large area of skin?
Which type of psoriasis is characterized by a widespread, bright red rash covering a large area of skin?
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All types of psoriasis are associated with psoriatic arthritis.
All types of psoriasis are associated with psoriatic arthritis.
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What is the classical sign associated with psoriatic nails that appears as slightly depressed spots?
What is the classical sign associated with psoriatic nails that appears as slightly depressed spots?
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The most common type of psoriatic arthritis is ___________ polyarthritis.
The most common type of psoriatic arthritis is ___________ polyarthritis.
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Match the type of arthritis with its characteristic:
Match the type of arthritis with its characteristic:
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Which type of psoriasis is the most destructive and requires ruling out HIV?
Which type of psoriasis is the most destructive and requires ruling out HIV?
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Longitudinal ridging is a characteristic associated with gout.
Longitudinal ridging is a characteristic associated with gout.
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What term describes the separation of nails from the nail bed in psoriatic conditions?
What term describes the separation of nails from the nail bed in psoriatic conditions?
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What is the primary cause of acute kidney injury (AKI) in uric acid nephropathy?
What is the primary cause of acute kidney injury (AKI) in uric acid nephropathy?
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Gout predominantly affects females, especially during the post-menopausal period.
Gout predominantly affects females, especially during the post-menopausal period.
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What are the typical presenting symptoms of acute gouty arthritis?
What are the typical presenting symptoms of acute gouty arthritis?
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In chronic gout, frequent pain and the formation of ______ occurs in joints.
In chronic gout, frequent pain and the formation of ______ occurs in joints.
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Match each stage of gout with its corresponding feature:
Match each stage of gout with its corresponding feature:
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Study Notes
Spondyloarthritis
- Spondyloarthritis is a type of arthritis that affects the spine and the joints.
- It is characterized by inflammation of the joints, tendons, and ligaments.
- Spondyloarthritis is associated with the HLA-B27 gene, which is a gene that codes for a protein involved in the immune system.
Types of Spondyloarthritis
- Reactive Arthritis: This type of spondyloarthritis is often triggered by an infection, such as a urinary tract infection or a sexually transmitted infection.
- Psoriatic Arthritis: This type arthritis is associated with psoriasis, a skin condition that causes red, scaly patches.
- Enteropathic Arthritis: This type of spondyloarthritis is associated with inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis.
- Ankylosing Spondylitis: This type of spondyloarthritis causes inflammation of the spine, which can lead to stiffness and pain.
Axial Involvement of Reactive Arthritis
- Axial involvement of reactive arthritis affects the spine.
- It is characterized by asymmetrical sacroiliitis (inflammation of the sacroiliac joints).
- Syndesmophytes (bone growths) are often present and described as being thick, large, coarse, fluffy, and non-marginal.
Clinical Manifestations
- Inflammatory Arthritis of the Knee Joint: This is a common symptom of spondyloarthritis and can cause pain, swelling, stiffness, and limited movement.
- Enthesitis: This is inflammation of the tendons and ligaments where they attach to bone. It can cause pain and tenderness in the affected area.
- Dactylitis: This is inflammation of the fingers or toes. It can cause swelling and pain in the affected digits, giving the appearance of a "sausage digit".
- Mucocutaneous Manifestations: These are skin and mucous membrane manifestations that can occur with spondyloarthritis. They include keratoderma blennorrhagicum, which is a condition that causes hyperkeratotic vesicles on the palms and soles, and circinate balanitis, a shallow erythema ulcer of the glans penis.
Treatment
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first-line treatment for spondyloarthritis.
- Disease-modifying antirheumatic drugs (DMARDs) can be used to slow the progression of the disease.
- Biologic therapies, which target specific proteins in the immune system, can be used to treat severe cases of spondyloarthritis.
Psoriatic Arthritis
- Psoriatic Arthritis is a type of arthritis that affects people with psoriasis.
- It can affect any joint in the body but often affects the hands, feet, and spine.
- The disease occurs in about 7-40% of psoriatic cases.
- About 60% of psoriatic patients develop arthritis before psoriasis.
- It is more common in people over the age of 40 years and affects men and women equally.
- Nail changes are common in psoriatic arthritis and occur in almost 90% of cases.
Clinical Manifestations of Psoriatic Arthritis
- Psoriatic arthritis involves the joints and tendons and causes inflammation of these tissues, resulting in pain, stiffness, swelling, and reduced mobility.
- It is often described as a thick, non-marginal and asymmetric arthritis.
- The disease generally does not involve mucocutaneous manifestations, but can affect the heart, lungs, and kidneys.
- It can cause cardiovascular problems, including aortic regurgitation and conduction blocks.
- It can also cause renal complications, including secondary IgA nephropathy.
Enteropathic Arthritis (IBD-associated arthritis)
- It is much more common in people who have Crohn's disease than ulcerative colitis.
- It typically affects the peripheral joints (hands, feet, and wrists) more than the axial joints (spine).
Axial Arthritis
- It is characterized by inflammation of the spine and sacroiliac joints.
- Axial arthritis is often associated with HLA-B27, but it is not always present.
- It has a presentation similar to Ankylosing Spondylitis.
Peripheral Arthritis
- It is associated with inflammation of the joints in the limbs (hands, feet, wrists, elbows, knees, etc.).
- There are two types of peripheral arthritis associated with inflammatory bowel disease, LMAP and SMAP-u.
Crystal Arthropathies
- Crystal arthropathies are a group of disorders that occur when crystals form in the joints, causing inflammation and pain.
- The most common type of crystal arthropathy is gout, which is caused by the formation of uric acid crystals in the joints.
Gout
- Acute Gouty Arthritis: This involves a sudden, intense attack of pain in a joint, often the big toe. The pain can be severe and last for several days or even weeks.
- Chronic Gout: This involves repeated attacks of gout, which can lead to joint damage, tophi formation, and renal disease.
Renal Manifestations of Hyperuricemia
- Renal manifestations are a significant concern related to hyperuricemia and gout.
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- Uric acid nephropathy: Uric acid crystals can precipitate in the renal tubules.
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- Urate nephropathy: Long-term hyperuricemia can lead to chronic tubulo-interstitial disease.
Causes of Hyperuricemia
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Age at Pregnancy:
- Increasing age at pregnancy can increase the risk of hyperuricemia in both the mother and the child.
- This is due to a decreased number of nephrons, which are the filtering units of the kidneys.
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Genetic Causes:
- The vast majority (90%) of hyperuricemia cases are caused by an unknown genetic defect leading to either underexcretion or overproduction of urate.
- Some rare genetic defects can also contribute to hyperuricemia (e.g., Lesch-Nyhan syndrome).
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Secondary Causes:
- Certain medications can cause hyperuricemia, such as diuretics and some antibiotics.
Psoriatic Arthritis vs. Rheumatoid Arthritis
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Psoriatic Arthritis:
- It is associated with psoriasis.
- It is characterized by asymmetric involvement, enthesopathy, dactylitis, nail dystrophy, and HIV association.
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Rheumatoid Arthritis:
- It is not associated with psoriasis.
- It is characterized by symmetrical involvement and lacks the characteristic features of psoriatic arthritis (i.e., dactylitis and nail dystrophy).
X-rays and Imaging in Psoriatic Arthritis
- Radiological images play a crucial role in diagnosing and monitoring psoriatic arthritis.
- These images reveal characteristic patterns of joint damage and bone erosions, helping differentiate psoriatic arthritis from other forms of arthritis.
- X-ray findings include:
- Pencil-in-Cup Deformity: Characterized by bone erosion and bone proliferation around affected joints.
- Whiskering: This refers to marginal erosion with proliferation of bone adjacent to eroded areas, giving a "whiskering" appearance.
- Telescoping of digits: The bones in fingers or toes appear shortened and overlapping.
- Ray pattern: Erosion of joints in the same finger, specifically the MCP, PIP, and DIP joints.
Treatment of Spondyloarthritis
- Disease-modifying antirheumatic drugs (DMARDs): These medications can slow the progression of psoriatic arthritis.
- Biologic therapies: These are a class of medications that target the immune system to help reduce inflammation and joint damage.
- Anti-TNF alpha drugs: This is a type of biologic therapy that targets the TNF-alpha protein, which is involved in inflammation.
- Apremilast (PDE 4 inhibitor): This medication is used to treat moderate to severe plaque psoriasis and psoriatic arthritis.
- Ustekinumab and Secukinumab: These are IL-12/23 inhibitors that are used to treat psoriatic arthritis.
- Tofacitinib: This is a small molecule JAK inhibitor that is used to treat psoriatic arthritis.
- Methotrexate and Leflunomide: These are traditional DMARDs that are used to treat psoriatic arthritis.
Nail Changes in Psoriatic Arthritis
- Yellow nail margins (longitudinal): These are a common finding in psoriatic arthritis.
- Deep and coarse nail pitting: This is a hallmark of psoriatic arthritis.
- Onycholysis with subungual hyperkeratosis: This is a separation of the nail from the nail bed with thickening underneath the nail.
- Oil drop sign: This is a classical finding in psoriatic arthritis characterized by irregular, slightly depressed spots on the nail.
- Longitudinal ridging: These are vertical grooves in the nail.
Wright and Moll Classification for Psoriatic Arthritis
- This is a classification system to categorize the different types of psoriatic arthritis. It is based on the clinical symptoms and radiographic evidence.
- Symmetric Polyarthritis: This is the most common type of psoriatic arthritis and is characterized by symmetrical involvement of the joints.
- Asymmetrical Oligoarthritis: This variant is less common and involves a smaller number of joints.
- Predominant DIP Arthritis: This pattern of arthritis involves the small distal joints.
- Predominant Spondyloarthritis: This pattern of arthritis involves the spine.
- Axial Pattern: This is characterized by spinal involvement.
- Cervical Predominance: This pattern of arthritis affects the neck and shoulder joints.
- Arthritis mutilans: This is a severe form of psoriatic arthritis that leads to complete destruction of the affected joints and is characterized by significant joint deformity.
Types of Psoriasis
- Guttate Psoriasis: This type is not associated with arthritis and characterized by a reddish-brown, spotted rash.
- Erythrodermic Psoriasis: This type is not associated with arthritis and characterized by a widespread bright red rash covering a large area of skin.
- Pustular Psoriasis: This type is associated with the most destructive type of arthritis.
- Psoriasis nail changes: These include yellowing of the nail margins, often accompanied by ridges along the nails.
Treatment of Gout
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Used to reduce pain and inflammation during acute gout attacks.
- Colchicine: It is used to prevent and treat acute gout attacks.
- Corticosteroids: Used to reduce inflammation during acute gout attacks, especially if NSAIDs or colchicine are ineffective.
- Uricosuric drugs: These drugs promote the elimination of uric acid from the body and include Probenecid and sulfinpyrazone.
- Xanthine oxidase inhibitors: These medications block the production of uric acid and include allopurinol and febuxostat.
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Description
This quiz covers the different types of spondyloarthritis, including reactive arthritis, psoriatic arthritis, enteropathic arthritis, and ankylosing spondylitis. Learn about their characteristics, causes, and connections to other conditions. Test your knowledge on this important topic in rheumatology.
