2. Sero Negative Flashcards
General Characteristics of SA
Asymmetric peripheral arthritis - oligoarticular
Fibrosis, ossification, and new bone growth – end in bony ankylosis or contracture
Loves the spine – sacroilitis and spondylitis
Hereditary – associated w/ Class I HLA-B27 (cause of psoriasis)
o Presents as arthritogenic peptide
Considered to be most destructive arthropathy of the 1st IPJ!
Inflammatory Enthesopathy – inflammation isn’t at joint spaces (like in RA/OA), it’s at insertions
Unifying Pedal Characteristics of all Seronegative Arthopathies
Locations
o (both medial and lateral problems, not just asymmetric like RA)
o Sesamoids
o Ankle joint – very common o Calcaneus sites 2-5
o PT and flexor attachments o Achilles insertion
o Base of 5th met
1st IPJ – shows circumferential
o PIPs and DIPS – major distinguisher from RA
o MPJs
Unifying Pedal Characteristics of all Seronegative Arthopathies
Clinical Signs of Seronegative Arthritis
o Acute heel pain – in young males
o Asymmetric Dactylitis – (in psoriatic arthritis) swollen toes; 50% are associated w/ periostitis o Initial monoarticular arthritis, then oligo (rarly polyarthritis)
Radiographic Signs of Seronegative Arthritis
o Acro-osteolysis or Acro-sclerosis – erosive changes or profound sclerosis on distal phalanx
- Sclerosis - As we go distal from the mets, the bones should get darker (not as dense), if they don’t
- Usually acro-sclerosis (increased medullary density) w/ thinning cortical osteolysis as well….pencilling
o Narrowed Joint space – due to pannus destruction o Marginal & Central Erosions – most at DIPJ
“Fluffy” periostitis that wanders into the diaphysis
Pencil in Cup Deformity – like the met head is a pencil tip and
prox. phalange is cup (in psoriatic)
Marginal Whiskering – fluffy changes at margins
o Subchondral Cysts
o Boney Ankylosis – 30% of joints in psoriatic arthritis fuse via boney ankylosis (highest frequency of any arthropathy)
Seronegative Heel
– calcaneal Arthopathies
In general
o Involved in 50% of Reiter’s
o Spurs are frequent at Achilles attachment
Seronegative Heel
– calcaneal Arthopathies
Radiology
o Achillo-bursitis
o Large Spurs of calcaneus
o Erosive changes posterior and/or inferior calcaneus
o Ill-defined w/ fluffy contours
o Inactive “burnt-out” spurs become well-defined
o Reiter’s – E & P sites 1, 2, 4
o Psoriatic and Ankylosing Spondylitis – E & P sites 2-5
Seronegative Arthopathies – all affect systemic but some have predilection for spine or feet
Ankylosing Sponylitis –
syndesmophytes form across joints of vertebral column and fuse the spine
o Only 10% presents in hands and feet
Seronegative Arthopathies
Reactive Arthritis/Reiter’s Disease –
infection-induced systemic illness manifested by inflammatory
synovitis (basically, arthritis that occurs in response to a bacterial/viral agent)
Seronegative Arthopathies
Basic traits:
*even though it’s caused by bacteria, it is NOT purulent
Synovial fluid is negative for organisms
o Attacks/symptoms occur 1-4wks post-infection
Most common cause of peripheral arthritis in young males
Starts in GI and GU and progresses peripherally
Incomplete Reiter’s – lack evidence of urethritis or conjunctivitis (~40% of pts)
Seronegative Arthopathies
o Cause of Reactive SA – infectious agent
Chlamydia (GU)
Salmonella (GI) Shigella (GI)
Yersinia (GI)
Campylobacter Ureplasma
Clostridium
Neisseria
Seronegative Arthopathies
o Peripheral locations of Reactive SA Ankle and feet most common Knees
SI joints
Rare locations for SA – hips and upper extremity UE only involved if LE is too!
Seronegative Arthopathies
o Peripheral Manifestations of Reactive SA
Articular Manifestations – the last symptoms to occur
less than or equal to 4 joints – single joints aren’t common (starts as 1 joint) Asymmetric
Attacks can last 3-12 months!
Heel pain
Peripheral Manifestations of Reactive SA
Extra-articular Manifestations
Mucocutaneous features
o Kerotoderma blennorrhagicum
o Toenail and fingernail problems
o Circinate balanitis
o Painless oral ulcers
o Acute anterior uveitis
Visceral features – aortitis (a very late change)
Peripheral Manifestations of Reactive SA
o Prognosis of Reactive SA
One episode every 4-12 months then recovery
1/3 – relapse after nonsymptomatic years
20% - develop chronic peripheral arthritis and progressive spondylitis – disabling 15% - develop total disability (death is rare)
o Radiographic Nuances of Reiter’s
Seen more in the feet than hands
Early extra-juxta-articular osteoporosis (w/ return of normal mineralization)
Infrequent ankylosis
1st IPJ and MPJ preferred over DIP’s and PIP’s
Greater frequency in the heel – less dactylitis, more heel pain
Doesn’t affect spine as much as psoriatic
