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-MSK Diseases > 6.5. Rheumatology - Seronegative Arthritis (Spondyloarthritis) > Flashcards

6.5. Rheumatology - Seronegative Arthritis (Spondyloarthritis) Flashcards

1
Q

What is Seronegative Arthritis (Spondyloarthritis)?

A

Arthritis which is Negative for Rhumatoid Factor

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2
Q

What gene can Seronegative Arthritis (Spondyloarthritis) be associated with?

A

HLA-B27

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3
Q

How does Seronegative Arthritis (Spondyloarthritis) normally present?

A
  1. Asymmetric Arthritis
  2. Involvement of the Axial Skeleton (Spine)
  3. Enthesitis (Soft Tissue Irritability)
  4. Extra-Articular Features:
  5. a) Uveitis
  6. b) Inflammatory Bowel Disease
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4
Q

What are some different Clinical Presentations of Seronegative Arthritis (Spondyloarthritis)?

A
  1. Ankylosing Spondylitis
  2. Psoriatic Arthritis
  3. Bowel Related Arthritis (Crohn’s / U.C.)
  4. Reactive Arthritis
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5
Q

What is Ankylosing Spondylitis?

A

Chronic Inflammatory Rheumatic Disorder with a Predilection for the Axial Skeleton and Entheses (connective tissue between tendon / ligament and bone)

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6
Q

Who commonly gets Ankylosing Spondylitis?

A
  1. Males
  2. During the 2nd to 3rd Decade
    Note - Prevalence Varies in Different Parts of the World
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7
Q

What gene is associated with Ankylosing Spondylitis?

A

HLA-B27

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8
Q

How does Ankylosing Spondylitis present?

A
  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
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9
Q

How is Poor Spinal Mobility tested?

A
  1. Modified Schober (Bending Forward)
  2. Lateral Spinal Flexion (Hand down the Thigh)
  3. Occiput / Tragus to a Wall
  4. Cervical Rotation
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10
Q

How Radiogrpahic Sacroillitis graded?

A 
Grade 0 - Normal
Grade 1 - Suspicious Changes
Grade 2 - Minimal Abnormality
Grade 3 - Unequivocal Abnormality
Grade 4 - Severe Abnormality - Total Ankylosis
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11
Q

What other features of Ankylosing Spondylitis can occur?

A
  1. Peripheral Joint Arthritis (Hips / Shoulders / Knees)
  2. Achilles Tendonitis / Dactylitis
  3. Uveitis
  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
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12
Q

How is Ankylosing Spondylitis managed?

A
  1. Physiotherapy
  2. NSAID’s
  3. DMARD’s - Sulfasalazine
  4. Biologics - Anti-TNF, Anti-IL-17
  5. Treatment of Osteoporosis
  6. Surgery - Joint Replacement
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13
Q

What Joints are commonly affected by Psoriatic Arthritis?

A
  1. Joints in the Hands / Feet
  2. Ankles / Wrists
  3. Knees / Elbows
  4. Base of the Spine / Neck
  5. Shoulder
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14
Q

What are the Clinical Sub-types of Psoriatic Arthritis?

A
  1. Arthritis with Distal Inter-Phalangeal Joint Involvement
  2. Symmetric Polyarthritis
  3. Asymmetric Oligoartigular Arthritis
  4. Arthritis Mutilans
  5. Predominant Spondylitis
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15
Q

Does the Severity of the Joint Disease in Psoriatic Arthritis correlate to the extend of the Skin Disease?

A

No

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16
Q

What is the treatment of Psoriatic Arthritis?

A
  1. DMARD’s - Sulfasalazine / Methotrexate / Leflunomide / Cyclosporin
  2. Biologics - Anti-TNF, Anti-IL-17, Anti-IL-23
  3. Steroids
  4. Physiotherapy and Occupational Therapy
    Note - Axial Disease is treated similar to Ankylosing Spondylitis
17
Q

What is Reactive Arthritis?

A

Sterile Synovitis after a Distant Infection

18
Q

What bacteria can cause Reactive Arthritis?

A
  1. Salmonella
  2. Shigella
  3. Campylobacter
  4. Chlamydia Trachomatis / Pneumoniae
  5. Yersinia
  6. Borrelia
  7. Neisseria
  8. Streptococci
19
Q

What infections commonly cause Reactive Arthritis?

A
  1. Throat
  2. Urogenital
  3. G.I.
20
Q

How does Reactive Arthritis usually present?

A
  1. Usually Mono / Oligoarthritis but the Disease may be Systemic
  2. Dactylitis / Enthesitis
21
Q

Due to Reactive Arthritis being caused by an infection, what is also commonly seen?

A

Skin and Mucous Membrane Involvement:

  1. Keratoderma Blenorrhagica
  2. Circinate Balanitis
  3. Urethritis
  4. Conjunctivitis
  5. Iritis
22
Q

What are recurrent attacks of Reactive Arthritis common in?

A

Chlamydia induced Arthritis

23
Q

What is Reiter’s Syndrome?

A
  1. Arthritis
  2. Urethritis
  3. Conjunctivitis
24
Q

What are the prognostic signs for Chronicity of Reactive Arthritis?

A
  1. Hip / Heel pain
  2. High ESR
  3. Family History
  4. HLA-B27 positive
25
Q

How is Acute Reactive Arthritis treated?

A
  1. NSAID’s
  2. Joint Injection (if infection is excluded)
  3. Antibiotics
26
Q

How is Chronic Reactive Arthritis treated?

A
  1. NSAID’s

2. DMARD’s (Sulphaslazine, Methrotrexate)

27
Q

What is Enteropathic Arthritis associated with?

A
  1. Inflammatory Bowel Disease:
  2. a) Crohn’s Disease
  3. b) Ulcerative Collitis
  4. Infectious Enteritis (Rare)
  5. Whipple’s Disease (Rare)
  6. Coeliac Disease (Rare)
28
Q

How does Enteropathic Arthritis often present?

A
  1. Peripheral Disease
  2. Axial Disease
  3. Enthesopathy
    Note - Both 1 and 2 are seen
29
Q

How is Enteropathic Arthritis treated?

A
  1. NSAID’s (difficult to use)
  2. DMARD’s (Sulfasalazine, Methrotrexate)
  3. Steroids
  4. Biologics (Anti-TNF)
  5. Dowel Resection (may alleviate peripheral disease)

-MSK Diseases (43 decks)

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