6.5. Rheumatology - Seronegative Arthritis (Spondyloarthritis)

Question 1

What is Seronegative Arthritis (Spondyloarthritis)?

Answer 1

Arthritis which is Negative for Rhumatoid Factor

Question 2

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

Answer 2

HLA-B27

Question 3

How does Seronegative Arthritis (Spondyloarthritis) normally present?

Answer 3

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

Question 4

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

Answer 4

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

Question 5

What is Ankylosing Spondylitis?

Answer 5

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

Question 6

Who commonly gets Ankylosing Spondylitis?

Answer 6

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

Question 7

What gene is associated with Ankylosing Spondylitis?

Answer 7

HLA-B27

Question 8

How does Ankylosing Spondylitis present?

Answer 8

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

Question 9

How is Poor Spinal Mobility tested?

Answer 9

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

Question 10

How Radiogrpahic Sacroillitis graded?

Answer 10

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

Question 11

What other features of Ankylosing Spondylitis can occur?

Answer 11

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

Question 12

How is Ankylosing Spondylitis managed?

Answer 12

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

Question 13

What Joints are commonly affected by Psoriatic Arthritis?

Answer 13

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

Question 14

What are the Clinical Sub-types of Psoriatic Arthritis?

Answer 14

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

Question 15

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

Answer 15

No

Question 16

What is the treatment of Psoriatic Arthritis?

Answer 16

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

Question 17

What is Reactive Arthritis?

Answer 17

Sterile Synovitis after a Distant Infection

Question 18

What bacteria can cause Reactive Arthritis?

Answer 18

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

Question 19

What infections commonly cause Reactive Arthritis?

Answer 19

1. Throat
2. Urogenital
3. G.I.

Question 20

How does Reactive Arthritis usually present?

Answer 20

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

Question 21

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

Answer 21

Skin and Mucous Membrane Involvement:

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

Question 22

What are recurrent attacks of Reactive Arthritis common in?

Answer 22

Chlamydia induced Arthritis

Question 23

What is Reiter’s Syndrome?

Answer 23

1. Arthritis
2. Urethritis
3. Conjunctivitis

Question 24

What are the prognostic signs for Chronicity of Reactive Arthritis?

Answer 24

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

Question 25

How is Acute Reactive Arthritis treated?

Answer 25

1. NSAID's 2. Joint Injection (if infection is excluded) 3. Antibiotics

Question 26

How is Chronic Reactive Arthritis treated?

Answer 26

1. NSAID's | 2. DMARD's (Sulphaslazine, Methrotrexate)

Question 27

What is Enteropathic Arthritis associated with?

Answer 27

1. Inflammatory Bowel Disease: 1. a) Crohn's Disease 1. b) Ulcerative Collitis 2. Infectious Enteritis (Rare) 3. Whipple's Disease (Rare) 4. Coeliac Disease (Rare)

Question 28

How does Enteropathic Arthritis often present?

Answer 28

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

Question 29

How is Enteropathic Arthritis treated?

Answer 29

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