Flashcards in 6.5. Rheumatology - Seronegative Arthritis (Spondyloarthritis) Deck (29):
What is Seronegative Arthritis (Spondyloarthritis)?
Arthritis which is Negative for Rhumatoid Factor
What gene can Seronegative Arthritis (Spondyloarthritis) be associated with?
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
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
What is Ankylosing Spondylitis?
Chronic Inflammatory Rheumatic Disorder with a Predilection for the Axial Skeleton and Entheses (connective tissue between tendon / ligament and bone)
Who commonly gets Ankylosing Spondylitis?
2. During the 2nd to 3rd Decade
Note - Prevalence Varies in Different Parts of the World
What gene is associated with Ankylosing Spondylitis?
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
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
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
What other features of Ankylosing Spondylitis can occur?
1. Peripheral Joint Arthritis (Hips / Shoulders / Knees)
2. Achilles Tendonitis / Dactylitis
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
How is Ankylosing Spondylitis managed?
3. DMARD's - Sulfasalazine
4. Biologics - Anti-TNF, Anti-IL-17
5. Treatment of Osteoporosis
6. Surgery - Joint Replacement
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
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
Does the Severity of the Joint Disease in Psoriatic Arthritis correlate to the extend of the Skin Disease?
What is the treatment of Psoriatic Arthritis?
1. DMARD's - Sulfasalazine / Methotrexate / Leflunomide / Cyclosporin
2. Biologics - Anti-TNF, Anti-IL-17, Anti-IL-23
4. Physiotherapy and Occupational Therapy
Note - Axial Disease is treated similar to Ankylosing Spondylitis
What is Reactive Arthritis?
Sterile Synovitis after a Distant Infection
What bacteria can cause Reactive Arthritis?
4. Chlamydia Trachomatis / Pneumoniae
What infections commonly cause Reactive Arthritis?
How does Reactive Arthritis usually present?
1. Usually Mono / Oligoarthritis but the Disease may be Systemic
2. Dactylitis / Enthesitis
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
What are recurrent attacks of Reactive Arthritis common in?
Chlamydia induced Arthritis
What is Reiter's Syndrome?
What are the prognostic signs for Chronicity of Reactive Arthritis?
1. Hip / Heel pain
2. High ESR
3. Family History
4. HLA-B27 positive
How is Acute Reactive Arthritis treated?
2. Joint Injection (if infection is excluded)
How is Chronic Reactive Arthritis treated?
2. DMARD's (Sulphaslazine, Methrotrexate)
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)
How does Enteropathic Arthritis often present?
1. Peripheral Disease
2. Axial Disease
Note - Both 1 and 2 are seen