seronegative spondylo-arthropathies

Question 1

what falls under the family of SpA ?

Answer 1

PsA ( psoriatic arthritis )
AS ( Ankylosing spondylitis)
Enteropathic ( IBD associated)
Reactive Arthiritis

Question 2

what does sero negative mean ?

Answer 2

serology is negative for both RF and anti-CCP

Question 3

what is the genetic association with SpA?

Answer 3

HLA-B27

Question 4

what are the different types of psoriatic arthritis ?

Answer 4

1- DIP affection and small joints of the hand (dactylitits)
2- asymmetrical oligoarthiritis 
3- symmetrical polyarthritis ( resembles RA )
4- arthritis of sacroiliac joint and spine 
5- arthiritis mutilans

Question 5

how can i differentiate between psoriatic arthritis (symmetrical polyarthiritis) and RA?

Answer 5

skin changes found in psoriasis not in RA
affection of the tendons in PsA not in RA
DIP is not affected in RA

Question 6

what are the poor prognosis factors for PsA?

Answer 6

a strong family history of psoriasis 
disease onset younger than 20 
polyarticular disease 
erosive disease 
extensive skin involvement

Question 7

what is the classic presentation of psoriatic arthiritis ?

Answer 7

1.nail involvement:
pitting and seperation from the nail bed ( Onchylosis)
yellow-pink discoloration ( oil-drop sign)
2. dactylitits : sausage digits
3. enthesopathy : inflammation of the tendon
4. DIPJ involvement

Question 8

what characteristic sign do we see in X ray in psoriatic arth ?

Answer 8

pencil in cup appearance

Question 9

what does the term axial spondylo-arthiritis include ?

Answer 9

ankylosing spondylitis

non-radiographic axial spondyloarthiritis

Question 10

what is the differernce between AS and nr-axSpA ?

Answer 10

AS- inflammatory back pain but with radiological manifestations
nr-axSpA - inflammatory back pain with no radiological manifestations

Question 11

how can we diagnose a patient with nr-axSpA ?

Answer 11

using MRI to show signs of inflammation : sacroillietis

shiny corner sign

Question 12

what is the criteria to diagnose a patient with inflammatory back pain ?

Answer 12

back months of at least 3 months duration :
1- Age of onset at least 40 years
2- insidious onset
3- improvement with exercise
4- no improvement with rest
5- Pain at night ( with improvement on getting up)

Question 13

what are the 4 As associated with ankylosing spondylitis ?

Answer 13

aortic valve/root disease
anterior uveitis
apical fibrosis
amyloidosis

Question 14

what are the clinical signs of AS and what are the tests used for diagnosis ?

Answer 14

1- question mark position - thoracic kyphosis and loss of cervical lordosis
2- modified schober test - limited lumbar flexion less than 5 cm
3- SIJ stress test = FABERs test
4- cervical test - occiput to wall or tragus to wall
5- thoracic chest expansion

Question 15

what radiological finding is associated with late stages of AS ?

Answer 15

bamboo sign

Question 16

what is reactive arthritis preceded by ?

Answer 16

infection such as gonorrhea, salmonella, shigella, campylobacter

Question 17

what is the triad of reactive arthritis ?

Answer 17

Reiters triad :
arthritis
urethritis
conjunctivitis

Question 18

what investigations would be required ?

Answer 18

inflammatory markers :
ESR , CRP
CBC , renal, liver , bone , vitamin D
serology : RF, CCP, ANA, Ig PEP, Anti-TTG

Question 19

what is the first line treatment for Axial spond ?

Answer 19

NSAIDS ( this also applies to mild form of psoriatic SpA)
law 2 NSAIDS ma7awa2sh
biological treatments

Question 20

what are the biological treatments available for SpA?

Answer 20

Anti TNF blockers
IL-12,23 - ustekinumab
IL-17

Question 21

what is the first line treatment for peripheral affection ?

Answer 21

DMARDS
law 2 DMARDS ma7awa2oosh then
Biological treatments

Question 22

what is the CASPAR criteria for the diagnosis of psoriatic arthiritis ?

Answer 22

1- evidence off current psoriasis or family history of it
psoriatic nail dystrophy
2- negative RF
3- dactilyitis
4- radiological evidence of juxta-articular new bone formation

Question 23

what does the schober test assess ?

Answer 23

lumbar flexion

Question 24

what are thee MRI findings of thee SIJ associated with ankylosing spondylitis ?

Answer 24

romanus lesions
shiny corner sign

Question 25

what are the pathognomonic features associated with reactive arthritis ?

Answer 25

keratoderma blenorrhagica ( sole of the foot)
pustular rash
tenosynovitis of small joints
conjunctivitis

Question 26

what must be excluded when suspecting reactive arthritis ?

Answer 26

septic arthritis must be excluded

Question 27

what diseases are associated with enteropathic arthritis ?

Answer 27

IBD
whipple disease
intestinal bypass
vitamin D deficiency and low bone mineral density

Question 28

what is the treatment for peripheral SpA ?

Answer 28

NSAIDS
DMARDS
steroids

Question 29

when should biologics be started in peripheral SpA?

Answer 29

if failed or intolerant of 2 DMARDs

Question 30

what is the role of DMARDs and steroids in axial disease ?

Answer 30

no role for steroids or DMARDs