Seronegative Arthritis

Question 1

What are the features of the spondyloarthropathies?

Answer 1

An asymmetric arthritis involving the spine and associated with negative rheumatoid factor and HLA-B27

Question 2

How is sero-negative rheumatoid arthritis classified?

Answer 2

Question 3

What is the clinical and genetic basis for the grouping of sero-negative inflammatory arthritis?

Answer 3

Genetics:

• HLA B27 gene is associated with Psoriatic Arthritis, intestinal arthropathies, ankylosing spondylitis
• Negative rheumatoid factor
• ANA

Clinical:

• All spondyloarthropathies have a degree of sacroiliitis (inflammation of the sacroiliac joints)

Question 4

What is the characteristic pattern of joint involvement in spondylo-arthropathies compared with other arthropathies?

Answer 4

Spondyloarthropathies have an asymmetric pattern of joint involvement compared to other arthropathies such as osteoarthritis

Question 5

What are the characteristic features of Ankylosing spondylitis?

Answer 5

• Question mark posture
• Inflammatory back pain
• Stiffness which improves with exercise
• Bilateral sacroiliitis on X-rays

Question 6

What are the characteristic features of enteropathic spondyloarthropathies?

Answer 6

• IBD (Crohn’s or UC)
• Peripheral or axial disease often present
• Sacroiliitis

Question 7

What are the characteristic features of Psoriatic arthritis?

Answer 7

• Psoriasis (well-demarcated salmon-pink plaques with scaling)
• Joint pain and stifness
• Swelling of affected joints
• Nail changes (yellowing, onycholysis, pitting and subungual hyperkeratosis)

Question 8

What are the characteristic features of reactive arthritis?

Answer 8

• Urethritis
• Conjunctivitis
• Uveitis/Iritis

Question 9

What is Reiters syndrome?

Answer 9

• Arthritis
• Urethritis
• Conjunctivitis

Question 10

What is meant by the term spondyloarthropathy?

Answer 10

Any joint disease of the vertebral column

Question 11

What are the extra-articular features of spondylarthritides?

Answer 11

• Uveitis
• Psoriasis
• GI tract involvement
• Aortic Regurgitation

Question 12

What are the spondyloarthropathies?

Answer 12

Ankylosing spondylitis

Reactive arthritis

Psoriatic arthritis

Enteropathic spondyloarthropathies

Question 13

With which disease are enteropathic spondyloarthropathies associated?

Answer 13

Crohn’s

UC

Question 14

What is the epidemiology of ankylosing spondylitis?

Answer 14

Males

Onset in 2nd-3rd decade

Question 15

What are the tests to assess spinal mobility?

Answer 15

Modified Schober

Lateral spinal flexion

Occiput to Wall

Question 16

What are the extra-articular features of Ankylosing spondylitis?

Answer 16

1 - Uveitis

2 - Arthritis

3 - Psoriasis

4 - Crohns/UC

5 - HLA-B27

Question 17

How is ankylosing spondylitis treated?

Answer 17

1 - Physiotherapy

2 - NSAID’s

3 - DMARDS (Sulphasalazine)

4 - Anti-TNF

5 - Surgery

Question 18

What infections are associated with reactive arthritis?

Answer 18

1 - Salmonella

2 - Campylobacter

3 - Shigella

4 - Chlamydia