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Muscluloskeletal Systems > Seronegative Arthritis (Spondyloarthritis) > Flashcards

Seronegative Arthritis (Spondyloarthritis) Flashcards

1
Q

What is seronegative arthritis?

What will be raised? Whats the pattern? What are its other features?

A

Negative rheumatoid factor

May be associated with HLA-B27

Usually an asymmetric arthritis

Involvement of axial skeleton (spine)

Enthesitis

Extra-articular features- uveitis, inflammatory bowel disease

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2
Q

What is enthesitis?

A

Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone.

One of the primary entheses involved in inflammatory autoimmune disease is at the heel, particularly the Achilles tendon.

It is associated with HLA B27 arthropathies like ankylosing spondylitis, psoriatic arthritis, and reactive arthritis.

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3
Q

Name 4 different clinical presentations of seronegative arthritis?

A

PAIR
-Psoriatic arthritis

-Ankylosing Spondylitis

  • Intestinal Arthropathy
  • —Bowel related arthritis
  • –(Crohn’s, UC)

-Reactive arthritis

others

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4
Q

What is reactive arthritis also known as?

A

Reiter Syndrome

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5
Q

What is the epidaemiology of ankylosing spondylitis?

A

Onset in second to third decade of life

Males > females

Prevalence varies in different parts of the world

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6
Q

What are the 4 different tests for spinal mobility?

A

Modified Schober

Lateral Spinal Flexion

Occiput to Wall and Tragus to Wall

Cervical Rotation
-Uses Goniometer

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7
Q

What are the clinical features of ankylosing spondylitis?

A

Inflammatory back pain

Limitation of movements in antero-posterior as well as lateral planes at lumber spine

Limitation of chest expansion

Bilateral sacroiliitis on X-rays

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8
Q

How do you grade radiographic sacroiliitis?

5 grades

A

Grade 0 = Normal

Grade 1 = Suspicious changes

Grade 2 = Minimal abnormality
-Small localised areas with erosion or sclerosis, without in the joint width

Grade 3 = unequivocal abnormality
-Moderate or advanced + 1 or more of: erosions, evidence of sclerosis, widening, narrowing or partial ankylosis

Grade 4 = Severe abnormality
-Total ankylosis

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9
Q

What is Diffuse Idiopathic Skeletal Hyperostosis?

A

Non-inflammatory spondyloarthropathy of the spine.

Characterised by ulilateral bridging spondylophytes mimicking mixed syndesmophytes and extensive calcification of anterior spinal ligament

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10
Q

What is the ASAS classification criteria for axial spondyloarthritis?

(dont need to go into SpA features, just what qualifys as axial spondyloarthritis)

A

3 or more months back pain at age

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11
Q

What are the SpA features used to classify axial spondyloarthritis?

A 
Inflammatory back pain
Arthritis
Enthesitis (heel)
Uveitis
Dactylitis
Psoriasis
Crohn's/colitis
Good response to NSAIDs
FH for SpA
HLA-B27
Elevated CRP
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12
Q

What is the management of ankylosing spondylitis?

A

Physiotherapy

NSAIDs

DMARDs -> sulphasalazine

Anti-TNF

Treatment of osteoporosis

Surgery- joint replacements and spinal surgery

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13
Q

What joints are commonly affected by psoriatic arthritis?

A
  • Neck
  • Shoulders
  • Elbows
  • Base of spine
  • Wrist
  • All joints of knuckles, fingers and thumbs
  • Knees
  • All joints of toes
  • Ankles
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14
Q

Name some clinical subtypes of psoriatic arthritis?

A

Arthritis with DIP joint involvement

Symmetric polyarthritis- similar to RA

Asymmetric oligoarticular arthritis

Arthritis mutilans

Predominant spondylitis

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15
Q

What is the treatment of psoriatic arthritis?

A 
Sulphasalazine
Methotrexate
Leflunomide
Cyclosporin
Anti-TNF therapy
Steroids
Physiotherapy + Occupational therapy
Axial disease treated similar to Ankylosing Spondylitis
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16
Q

What is Reactive arthritis?

A

Autoimmune condition that develops in response to an infection in another part of the body (cross-reactivity).

Sterile synovitis after distant infection

By the time the patient presents with symptoms, often the “trigger” infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

17
Q

What is Reiter’s syndrome?

A

Reactive arthritis + other characteristic symptoms like urethritis and conjunctivitis

18
Q

What infections cause reactive arthritis?

A
  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter
  • Chlamydia trachomatis or pneumoniae
  • Borrelia
  • Neisseria
  • Streptococci
19
Q

How can skin and mucous membrane be involved in reactive arthritis?

(Name symptoms/ signs)

A 
Keratoderma blenorrhagica
Circinate balanitis
Urethritis
Conjunctivitis
Iritis
20
Q

What is Keratoderma blennorrhagicum?

A

Skin lesions commonly found on the palms and soles but which may spread to the scrotum, scalp and trunk. The lesions may resemble psoriasis

Commonly seen as an additional feature of reactive arthritis in almost 15% of male patients.

The appearance is usually of a vesico-pustular waxy lesion with a yellow brown colour. These lesions may join together to form larger crusty plaques with desquamating edges.

21
Q

What is circinate balanitis?

A

Dermatologic manifestation of reactive arthritis comprising a serpiginous annular dermatitis of the glans penis.

Circinate balanitis is the most common cutaneous manifestation of reactive arthritis. However, circinate balanitis can also occur independently.

22
Q

What treatments are used for circinate balanitis?

A

Topical corticosteroid therapy is the most commonly used treatment, and topical calcineurin inhibitors have also been used successfully

23
Q

Recurrent attacks are common in reactive arthritis caused by what organism?

A

Chlamydia

24
Q

What prognostic signs indicate chronic reactive arthritis?

A

Hip/heel pain
High ESR
FH and HLA-B27 +ve

25
Q

What is the acute treatment of reactive arthritis?

A

NSAID

Joint injection (if infection excluded)

Antibiotics in chlamydia infection (contacts as well)

26
Q

What is the treatment of chronic reactive arthritis?

A

NSAID

DMARD (e.g. sulphasalazine, methotrexate)

27
Q

Enteropathic arthritis is commonly associated with which diseases?

It is rarely seen with which diseases?

A

Commonly associated with IBD (Crohn’s and UC)

Rarely seen with infectious enteritis, whipple’s disease and coeliac disease

28
Q

What is the distribution of joints in enteropathic arthritis?

What can also be affected?

A

Can present with both peripheral and/or axial disease

Enthesopathy commonly seen

29
Q

What is the treatment of enteropathic arthritis?

A
  • NSAIDs difficult to use
  • Sulfasalazine
  • Steroids
  • Methotrexate
  • Anti-TNF
  • Bowel resection may alleviate peripheral disease

Muscluloskeletal Systems (29 decks)

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