Rhemuatology: Seronegative arthropathies Flashcards
Whata re the seronegative arthropathies?
Ankylosing spondylitis
Psoraitic arthritis
Enteropathic arthritis
Reactive arthritis
What is ankolysing spondylitis?
A chronic inflammatory disease of the spine and sacroiliac joints that can lead to eventual fusion of the intervertebral and SI joints
What test is used to measure lumbar spine flexion?
Schobers test. This involves measuring 5cm below the iliac crests and 10cm above whilst the patient is upright and then asking them to bend forwards and remeasuring this distance. In normal patients it should be more than 20cm
What other conditions are associated with ankolysing spondylitis?
Anterior uveitis
Aortitis
Pulomnary fibrosis
Amyloidosis
Which HLA type is associated with ankolysing spondylitis?
HLA B27
What do X Rays of ankolysing spondylitis show?
Sclerois/fusion of SA joints
Bony spurs from the vertebral bodies (syndesmophytes) which can bridge the intervertebral disc and lead to bamboo spine.
What does MRI of ankolysing spondylitis show?
Bone marrow oedema
Enthesitis of spinal ligaments
What is the treatment for anklyosisng spondylitis?
Phsyio Exercise NSAIDS Anti TNF inhibitos (DMARDS do not help spinal disease but may be used if there is peripheral joint inflammation)
What % of people with psoriasis get psoriatic arthritis?
30%
What is the general pattern on spondyloarthritis?
An asymmetrical oligoarthritis
Spondylitis, dactylitis and enthesitis also occur
What nail changes do you get in psoriatic arthritis?
Pitting
Oncholysis (lifting of the nail from the nailbed)
What is the treatment for psoriatic arthritis?
DMARS (methotrexate)
Anti TNF
What is the general pattern of enteropathic arthritis?
Large joint asymmetrical oligoarthritis
What kind of infections can lead to reactive arthritis?
Genitourinary (Chlamydia, Neisseria)
GI (Salmonella, Campylobacter)
What is reactive arthritis?
Large joints such as the knee become inflamed 1 - 3 weeks following an infection (usually GI or GU)
What is the treatment of reactive arthritis?
Treating the underlying infection
May need steroid injections
DMARD occasionally needed
What is reiters syndrome?
Urethritis
Uveitis/Conjuntivitis
Arthritis
What is the most useful initial investigation for ankolysing spondylitis?
Plain X Ray of the sacroiloiac joints
What are the X Ray features of ankolysing spondylitis?
Sacroilitis (subchondral erosison, sclerosis)
Squaring of the lumbar spine
Bamboo spine
Syndesmophytes
What are the chest X Ray features that occur in late ankloysing spondylitis?
Apical fibrosis
