All about ERA
Is a rash only skin deep?
Psoar ... iatic arthritis
How I treat ...
Choose your own adventure
100
Name 1 exclusion criteria for Enthesitis-Related Arthritis by ILAR criteria.
Bonus points if you can name all 4!
What is:
-psoriasis in patient or first degree relative?
-presence of IgM RF on at least 2 occasions at least 3 months apart?
-systemic JIA
-arthritis fulfilling two JIA categories
100
This rash is associated with what form of JIA.
What is psoriatic arthritis?
100
TRUE/FALSE: Most children with psoriatic arthritis typically present with more than 4 joints at diagnosis
FALSE - 60-80% of children present with oligoarticular arthritis
100
If a patient presents with axial involvement, name a medication that is appropriate to start or an appropriate immune molecule to target.
What is TNF inhibitor? Enbrel, Humira, Remicade/Infliximab, Simponi/Golimumab
OR What is IL-17 inhibitor? secukinumab (Cosentyx)
OR What is JAK inhibitor? Tofacitinib (Xeljanz), Upadacitinib (Rinvoq)
100
This side of the sacroiliac (SI) joint has a higher frequency of abnormalities in enthesitis-related arthritis (ERA).
Bonus points for why this might be :)
What is the iliac side?
The iliac side of the joint is protected by a thin layer of fibrocartilage whereas the sacral side of the joint is covered by hyaline cartilage.
200
TRUE/FALSE: Axial disease is uncommon at disease onset.
TRUE - majority of children with ERA have peripheral disease at presentation. When axial disease is present at presentation, it has often been preceded by peripheral disease.
200
Name at least one place to specifically look for psoriasis rashes
What is :
- hairline, umbilicus, behind the ears, intergluteal crease?
200
Chronic uveitis occurs this frequently in children with psoriatic JIA.
What is 10-15%?
200
This medication is the initial pharmacologic treatment for patients with enthesitis-related arthritis (ERA) or spondyloarthropathy and in adults may result in disease remission.
What is an NSAID?
Per chapter 20, it is probable that children respond best to naproxen or indomethacin.200
Axial involvement occurs in about 10-30% of patients with psoriatic JIA.
TRUE/FALSE: There is a tendency for asymmetrical sacroiliac joint involvement in psoriatic JIA.
TRUE
300
By ILAR criteria, enthesitis-related arthritis can be diagnosed if a patient has arthritis + enthesitis OR arthritis or enthesitis with at least 2 additional criteria. Name 2 additional criteria.
Bonus points to name all 5!
What is:
- SI joint tenderness and/or inflammatory lumbosacral pain
-presence of HLA-B27
-onset of arthritis in a boy after 6 years of age
- family history of HLA-B27-associated disease (AS, ERA< SI with IBD, reactive arthritis, acute anterior uveitis) in a first degree relative
- acute symptomatic anterior uveitis
300
Psoriasis occurs this frequently in patients with psoriatic arthritis.
What is 40-66%?
300
According to ILAR criteria, if a patient does NOT have psoriasis, they must have arthritis plus at least two other features - name 2 of these features.
What is:
- Dactylitis?
- Nail pits or onycholysis?
- Family history of psoriasis in a 1st degree relative?
300
Targeting this cytokine should be avoided if there are concerns for inflammatory bowel disease.
Extra points: name one example
What is IL-17?
medications such as: secukinumab or ixekizumab (both target and bind IL-17A)
300
Name a bug that can trigger reactive arthritis.
What is:
Salmonella, Shigella, Yersinia, or Chlamydia?
400
Unlike other types of JIA, involvement of this joint at disease onset and during the course of disease is common and arthritis isolated to this joint may be the presenting feature.
What is the hip?
400
This is the most common form of psoriasis to occur in the majority of psoriatic arthritis patients.
Extra points if you can name the second most common pattern.
What is vulgaris form?
Extra points: what is guttate psoriasis.
Pustular and erythrodermic variants are rare.
400
Name the two most common extremities to be affected by dactylitis.
What is the second toe and index finger?
400
Name a potential adverse side effect of indomethacin which may limit its use.
What is:
- headache, epigastric pain, or inability to pay attention in school?
400
Name another disease (other than psoriatic arthritis) in which digit swelling may occur.
What is:
-sickle cell disease?
-tuberculous osteomyelitis?
-sarcoid arthropathy?
500
Name the most HLA-B27 subtype that is most strongly associated with ERA.
What is HLA-B*2705?
HLA-B*2702, HLA-B*2704, and HLA-B*2707 confer disease risk as well
500
This rash is associated with what form of JIA.
Photo from Akaluck Thatayatikom, MD in Juvenile Idiopathic Arthritis
https://www.ncbi.nlm.nih.gov/books/NBK554605/figure/article-23835.image.f1/
What is systemic juvenile idiopathic arthritis?
500
SNPs in this cytokine have been found to be associated with adult and psoriatic forms of arthritis. Hint: ustekinumab targets this pathway
What is IL-23R?
Will also accept IL-23 as an answer.500
The mechanism of action of apremilast, which can be used to treat psoriasis, peripheral arthritis and enthesitis in psoriatic arthritis
What is phosphodiesterase 4 inhibitor?
500
This infection is known precipitant for guttate psoriasis.
What is streptococci?