6.5. Rheumatology - Seronegative Arthritis (Spondyloarthritis) Flashcards Preview

3rd Year - MSK Diseases > 6.5. Rheumatology - Seronegative Arthritis (Spondyloarthritis) > Flashcards

Flashcards in 6.5. Rheumatology - Seronegative Arthritis (Spondyloarthritis) Deck (29):
1

What is Seronegative Arthritis (Spondyloarthritis)?

Arthritis which is Negative for Rhumatoid Factor

2

What gene can Seronegative Arthritis (Spondyloarthritis) be associated with?

HLA-B27

3

How does Seronegative Arthritis (Spondyloarthritis) normally present?

1. Asymmetric Arthritis
2. Involvement of the Axial Skeleton (Spine)
3. Enthesitis (Soft Tissue Irritability)
4. Extra-Articular Features:
4. a) Uveitis
4. b) Inflammatory Bowel Disease

4

What are some different Clinical Presentations of Seronegative Arthritis (Spondyloarthritis)?

1. Ankylosing Spondylitis
2. Psoriatic Arthritis
3. Bowel Related Arthritis (Crohn's / U.C.)
4. Reactive Arthritis

5

What is Ankylosing Spondylitis?

Chronic Inflammatory Rheumatic Disorder with a Predilection for the Axial Skeleton and Entheses (connective tissue between tendon / ligament and bone)

6

Who commonly gets Ankylosing Spondylitis?

1. Males
2. During the 2nd to 3rd Decade
Note - Prevalence Varies in Different Parts of the World

7

What gene is associated with Ankylosing Spondylitis?

HLA-B27

8

How does Ankylosing Spondylitis present?

1. Inflammatory Back Pain
2. Limitation of Ant-Post as well as Lateral Movements
3. Limitation of Chest Expansion
4. Bilateral Sacroiliitis on X-Rays

9

How is Poor Spinal Mobility tested?

1. Modified Schober (Bending Forward)
2. Lateral Spinal Flexion (Hand down the Thigh)
3. Occiput / Tragus to a Wall
4. Cervical Rotation

10

How Radiogrpahic Sacroillitis graded?

Grade 0 - Normal
Grade 1 - Suspicious Changes
Grade 2 - Minimal Abnormality
Grade 3 - Unequivocal Abnormality
Grade 4 - Severe Abnormality - Total Ankylosis

11

What other features of Ankylosing Spondylitis can occur?

1. Peripheral Joint Arthritis (Hips / Shoulders / Knees)
2. Achilles Tendonitis / Dactylitis
3. Uveitis
4. Aortic Incompetence / Heart Block
5. Restrictive Disease Pulmonary (Apical Fibrosis)
6. Inflammatory Bowel Disease (U.C. / Crohn's)
7. Osteoporosis / Spinal Fracture
8. AAD / Cauda Equina Syndrome
9. Secondary Amyloidosis

12

How is Ankylosing Spondylitis managed?

1. Physiotherapy
2. NSAID's
3. DMARD's - Sulfasalazine
4. Biologics - Anti-TNF, Anti-IL-17
5. Treatment of Osteoporosis
6. Surgery - Joint Replacement

13

What Joints are commonly affected by Psoriatic Arthritis?

1. Joints in the Hands / Feet
2. Ankles / Wrists
3. Knees / Elbows
4. Base of the Spine / Neck
5. Shoulder

14

What are the Clinical Sub-types of Psoriatic Arthritis?

1. Arthritis with Distal Inter-Phalangeal Joint Involvement
2. Symmetric Polyarthritis
3. Asymmetric Oligoartigular Arthritis
4. Arthritis Mutilans
5. Predominant Spondylitis

15

Does the Severity of the Joint Disease in Psoriatic Arthritis correlate to the extend of the Skin Disease?

No

16

What is the treatment of Psoriatic Arthritis?

1. DMARD's - Sulfasalazine / Methotrexate / Leflunomide / Cyclosporin
2. Biologics - Anti-TNF, Anti-IL-17, Anti-IL-23
3. Steroids
4. Physiotherapy and Occupational Therapy
Note - Axial Disease is treated similar to Ankylosing Spondylitis

17

What is Reactive Arthritis?

Sterile Synovitis after a Distant Infection

18

What bacteria can cause Reactive Arthritis?

1. Salmonella
2. Shigella
3. Campylobacter
4. Chlamydia Trachomatis / Pneumoniae
5. Yersinia
6. Borrelia
7. Neisseria
8. Streptococci

19

What infections commonly cause Reactive Arthritis?

1. Throat
2. Urogenital
3. G.I.

20

How does Reactive Arthritis usually present?

1. Usually Mono / Oligoarthritis but the Disease may be Systemic
2. Dactylitis / Enthesitis

21

Due to Reactive Arthritis being caused by an infection, what is also commonly seen?

Skin and Mucous Membrane Involvement:
1. Keratoderma Blenorrhagica
2. Circinate Balanitis
3. Urethritis
4. Conjunctivitis
5. Iritis

22

What are recurrent attacks of Reactive Arthritis common in?

Chlamydia induced Arthritis

23

What is Reiter's Syndrome?

1. Arthritis
2. Urethritis
3. Conjunctivitis

24

What are the prognostic signs for Chronicity of Reactive Arthritis?

1. Hip / Heel pain
2. High ESR
3. Family History
4. HLA-B27 positive

25

How is Acute Reactive Arthritis treated?

1. NSAID's
2. Joint Injection (if infection is excluded)
3. Antibiotics

26

How is Chronic Reactive Arthritis treated?

1. NSAID's
2. DMARD's (Sulphaslazine, Methrotrexate)

27

What is Enteropathic Arthritis associated with?

1. Inflammatory Bowel Disease:
1. a) Crohn's Disease
1. b) Ulcerative Collitis
2. Infectious Enteritis (Rare)
3. Whipple's Disease (Rare)
4. Coeliac Disease (Rare)

28

How does Enteropathic Arthritis often present?

1. Peripheral Disease
2. Axial Disease
3. Enthesopathy
Note - Both 1 and 2 are seen

29

How is Enteropathic Arthritis treated?

1. NSAID's (difficult to use)
2. DMARD's (Sulfasalazine, Methrotrexate)
3. Steroids
4. Biologics (Anti-TNF)
5. Dowel Resection (may alleviate peripheral disease)

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