arthritis

Question 1

what are the two types of arthritis

Answer 1

seronegative

seropositive

Question 2

give examples of seronegative arthritis

Answer 2

reactive arthritis
enteropathic arthritis
psoriatic arthritis
anklyosing spondylitis

Question 3

give examples of seropositive arthritis

Answer 3

Rheumatoid arthritis (RA)

Question 4

what is reactive arthritis

Answer 4

this occurs in response to an infection in another part of the body

Question 5

what is the cause of reactive arthritis

Answer 5

GU infections (chlamydia, gonorrhoea)
GI infections (salmonella, campylobacter)
direct inoculation following new joint or trauma

Question 6

what are the symptoms of reactive arthritis

Answer 6

large joint inflammation 1-3weeks after infection 
Reiter's syndrome:
- urethritis
- uveitis or conjunctivitis 
- arthritis

Question 7

what is the treatment of reactive arthritis

Answer 7

most cases are self-limiting

15-30% are chronic have frequent relapses = treat underlying infection, IA or IM steroid injections, DMARDs

Question 8

what is enteropathic arthritis

Answer 8

an inflammatory arthritis involving the peripheral joints and occasionally the spine in patients with IBD

Question 9

what are the symptoms of enteropathic arthritis

Answer 9

large joint, asymmetrical oligoarthritis

Question 10

what is psoriatic arthritis

Answer 10

occurs in 30% of people with skin psoriasis

Question 11

what is arthritis mutilans

Answer 11

an aggressive and destructive form of psoriatic arthritis

Question 12

what is the symptoms of psoriatic arthritis

Answer 12

asymmetrical, oligoarthritis 
spondylitis
dactylitis
nail changes = pitting onycholysis
arthritis of the DIP in fingers and toes

Question 13

what is the treatment of psoriatic arthritis

Answer 13

DMARDs

anti-TNF = if not responding to DMARDs

Question 14

what are the common features of seronegative arthritis

Answer 14

sacroiliitis
dactylitis = inflammation of a digit
uveitis
enthesopthies:
- achilles insertional tendonitis
- plantar fasciitis

Question 15

what is associated with seronegative arthritis

Answer 15

HLA-B27

Question 16

what is ankylosing spondylitis

Answer 16

chronic inflammatory disease of the spine and sacro-illiac (SI) joints which can eventually lead to the fusion of the intervertebral joints and SI joints

Question 17

who is commonly affected by ankylosing spondylitis

Answer 17

men 20-40

Question 18

what are the symptoms of ankylosing spondylitis

Answer 18

spinal pain
hip or knee arthritis
spinal morning stiffness
loss of spinal movement 
development of "question mark" spine = loss of lumbar lordosis + increased thoracic kyphosis

Question 19

what conditions are associated with ankylosing spondylitis

Answer 19

uveitis
aortitis
pulmonary fibrosis
amyloidosis

Question 20

what are the investigations for ankylosing spondylitis, what would you expect to see

Answer 20

schober’s test = lumbar spine flexion
x-ray = sclerosis, bamboo spine
MRI = bone marrow oedema, enthesitis of spinal ligaments

Question 21

what is the criteria for diagnosis in ankylosing spondylitis

Answer 21

need number 4 or 5 plus one of 1-3 for diagnosis:

1 = limited lumbar movement
2 = lower back pain > 3 months
	improved with exercise
	not relieved by rest
3= reduced chest expansion
4 = bilateral, grade 2-4 sacroiliitis on X-ray
5 = unilateral, grade 3-4 on X-ray

Question 22

what is the treatment for ankylosing spondylitis

Answer 22

physio
exercise
NSAIDs
Anti-TNF = if aggressive
DMARDs = if peripheral joint inflammation is present