Seronegative Arthritis(Spondyloarthritis)

Question 1

What is spondyloarthritis?

Answer 1

Group of diseases characterised by inflammation of the spine and joints

->spondylitis=inflammation of spine
arthritis=inflammation of joints

Also just to note they are negative for the antibodies which are linked with rheumatoid arthritis (anti-CCP and rheumatoid factor)

Question 2

Which gene may spondyloarthritis be associated with?

Answer 2

HLA-B27

->important to note that the presence of this gene is NOT diagnostic

Question 3

Is spondyloarthritis/seronegative arthritis usually symmetrical or asymmetrical?

Answer 3

Asymmetrical most of time

Question 4

Which part of the skeleton is involved in spondyloarthritis?

Answer 4

Axial skeleton

Question 5

What are some of the extra-articular features of spondyloarthritis?

Answer 5

Uveitis- eye condition
IBD
Psoriasis- approx 10% of people w psoriasis develop an inflammatory arthritis

Question 6

You have probs heard of ankylosing spondylitis but what is this now known as?

Answer 6

Axial spondyloarthritis

Question 7

When does reactive arthritis occur?

Answer 7

Triggered by infection

Question 8

What type of inflammation can many different types of spondyloarthritis all have?

Answer 8

Sacroiliitis

Question 9

When is the onset of axial sponyloarthritis most common?

Answer 9

2nd to 3rd decade of life

Question 10

Does axial sponyloarthritis affect more men or women?

Answer 10

Males > females

Question 11

Axial sponyloarthritis is a chronic inflammatory disorder which affects which parts of the body?

Answer 11

Axial skeleton…get it from the name
Entheses- site of attachment of tendon, ligament, fascia, or capsule to bone.

Question 12

Show is spinal mobility assessed?

Answer 12

Checking for spinal flexion/extension and measuring from spinal processes (clinical skills-to see if fingers move apart) or by using the Schober test involving a tape measurer
Lateral flexion too

Question 13

What are the clinical features of axial sponyloarthritis?

Answer 13

Inflammatory back pain
Limited movements in anterior, posterior and lateral directions of lumbar spine
Limitation of chest expansion

(Relating to back pain)- Significant morning stiffness which get betters with movement
Night pain
Buttock pain

Question 14

Increasingly more people are being diagnosed with non-radiographic axial sponyloarthritis.
What does this mean?

Answer 14

Their x-rays will look normal, inflammation is picked up on MRI scans

Question 15

What are some other features that patients with axial sponyloarthritis may have?

Answer 15

Peripheral joint arthritis
Achilles tendonitis
Uveitis
Heart block
IBD
Osteoporosis
Cauda equina syndrome
Secondary amyloidosis

Question 16

Management of axial sponyloarthritis?

Answer 16

Physiotherapy
NSAIDs
Short term steroids
DMARDs- both biologic and conventional synthetic

Sometimes surgery for joint replacements and spinal surgery

Question 17

RECAP- which joint tends to be involved in rheumatoid arthritis?

Answer 17

MCP joints

Question 18

Which joints tend to be affected by psoriatic arthritis?

Answer 18

Larger joints e.g. shoulder, elbow, knees, ankles

Smaller joints can be affected

Question 19

People with psoriatic arthritis may not have any skin signs…what should be checked?

Answer 19

Nails for disease- pitting, etc.

Question 20

There are many different subtypes of psoriatic arthritis, what tends to be the common?

Answer 20

Asymmetric oligoarticular arthritis

Question 21

First line treatment for psoriatic arthritis>?

Answer 21

Methotrexate
Physio and OT input too

->good as treats the psoriasis and arthritisand IBD and uveitis which may be present too

Question 22

Which infections can cause reactive arthritis?

Answer 22

Pretty much any infection

-but salmonella, campylobacter, chlamydia, streptococcal, Neisseria

Question 23

What triad is indicative of Reiter’s syndrome?

Answer 23

Triad of arthritis, urethritis and conjunctivitis

Question 24

Treatment for acute reactive arthritis?

Answer 24

NSAID
Joint injection
Antibiotics in some cases like chlamydia, in which contacts need antibiotics too

Question 25

Treatment for chronic reactive arthritis?

Answer 25

NSAID
DMARD- e.g. methotrexate

Question 26

Which conditions is enteropathic arthritis associated with?

Answer 26

IBD

Question 27

Treatment of enteropathic arthritis?

Answer 27

Sulfasalazine
Steroids
Methotrexate
Anti-TNF