IAs-Seronegative Inflammatory Arthropathies Flashcards
What is seronegative inflam
ankylosing spondylitis, psroiatic arthritis, enteropathic arthritis and reactive arthritis.
characterised by inflammation and/or arthritic disease of the spine, known as spondyloarthropathy, and an asymmetric oligoarthritis.
Sacroiliitis, uveitis, dactylitis and enthesopathies are common
Indications AS
HLA‐B27 positive (although only a minority of HLA‐B27 positive patients develop a spondyloarthritis).
CRP and ESR are usually elevated.
Ankylosing spondylitis
chronic inflammatory disease of the spine and sacro‐iliac joints which can lead to eventual fusion of the intervertebral joints and SI joints.
Risk factors ankylosing spondylitis
Males are more commonly affected (3:1) and age of onset is typically between 20‐40 years.
Symptoms ankosing spondylitis
spinal pain and stiffness
knee pain or hip arthritis.
Spinal morning stiffness is marked and improves with exercise.
signs ankylosing spondylisi (3)
a “question mark” spine/ bamboo spine
loss of lumbar lordosis
increased thoracic kyphosis
examination AS (4)
Lumbar spine flexion can be measured using Schobers test.
measuring 5cm below the posterior superior iliac crests + 10cm above, whilst the patient is upright, then asking them to bend forwards and remeasuring the distance.
In normal situations it should extend beyond 20cm.
Investigations AS (5)
Xrays - sclerosis and fusion of the sacroiliac joints and bony spurs from the vertebral bodies
HLA‐B27 positive.
MRI can detect earlier features - bone marrow oedema and enthesitis of the spinal ligaments.
Treatment AS (6)
physiotherapy, exercise, NSAIDs and anti-TNF inhibitors for more aggressive disease.
DMARDs do not have any impact on spinal disease but may be used if there is peripheral joint inflammation.
Surgery is mainly reserved for hip and knee arthritis and kyphoplasty to straighten out the spine is controversial and carries considerable risk.
Psoriatic arthritis (5)
30% of people affected by skin psoriasis.
asymmetrical oligoarthritis but may also affect the hands in a pattern similar to RA.
Spondylitis, dactylitis and enthesitis commonly occur.
Symptoms psoriatic arthritis (2)
nail changes =
-pitting
-onycholysis (lifting of the nail from its nailbed).
treatment psoriatic arthritis (3)
methotrexate.
Anti-TNF therapy is available for those who do not respond to standard treatment.
Joint replacement can be considered in larger joints which are severely affected and DIP joint fusion can occasionally help.
Enteropathic arthritis (3)
inflammatory arthritis involving the peripheral joints and sometimes spine
patients with inflammatory bowel disease (Crohn’s disease and Ulcerative Colitis).
large joint asymmetrical oligoarthritis.
Symptoms & signs enteropathic arthritis
10‐20% of IBD sufferers will experience spine or joint problems.
Treatment of enteropathic arthritis
usually involves finding medication to manage both the underlying condition and the arthritis..
