Rheumatoid Arthritis

Question 1

What are forms of seronegative spondyloarthopathy?

Answer 1

Conditions with no positive autoantibodies. Chronic sacroillitis – inflammation of sacroiliac joints. Leads to ankylosing spondylitis. Results in spinal fusion (ankylosis). Common demographic: 20-30yrs, M. Associated with HLA B27. Psoriatic arthritis and enteropathic synovitis also fall under seronegative spondyloarthropathy.

Question 2

Describe clinical presentation of ankylosing spondylitis

Answer 2

Lower back pain + stiffness
Early morning
Improves with exercise
Reduced spinal movements
Peripheral arthritis
Plantar Fasciitis, Achilles Tendonitis
Fatigue

Question 3

What are physical signs of ankylosing spondylitis?

Answer 3

Hyperextended neck, loss of lumbar lordosis, flexed hips and knees. Exaggerated thoracic kyphosis. Back pain >3 months, <45 years is suggestive of possible Ank Spond.

Question 4

What investigations are carried out for ankylosing spondylitis?

Answer 4

Bloods to check for normocytic anaemia, raised CRP/ESR, HLA-B27
Imaging - X-ray and MRI
MRI checks for:
Squaring Vertebral bodies, Romanus lesion (shiny corners of vertebrae)
Erosion, sclerosis, narrowing SIJ
Bamboo Spine - bone fusion
Bone Marrow Oedema

Question 5

What is psoriatic arthritis?

Answer 5

Psoriasis is an autoimmune disease affecting the skin (scaly red plaques on extensor surfaces eg elbows and knees). ~10% of psoriasis patients also have joint inflammation. Unlike RA, rheumatoid factors are not present (“seronegative”).

Question 6

What is the clinical presentation of psoriatic arthritis?

Answer 6

Classically asymmetrical arthritis affecting IPJs. Can also manifest as:
Symmetrical involvement of small joints (rheumatoid pattern)
Spinal and sacroiliac joint inflammation
Oligoarthritis of large joints
Arthritis mutilans

Question 7

What investigations are used for psoriatic arthritis?

Answer 7

X-rays of affected joints – pencil in cup abnormality
MRI – sacroiliitis and enthesitis
Bloods – no antibodies as seronegative

Question 8

What management can be used for psoriatic arthritis?

Answer 8

DMARDs – methotrexate

Avoid oral steroids – risk of pustular psoriasis due to skin lesions

Question 9

What are other cumulative trauma disorders?

Answer 9

Systemic Sclerosis
Myositis
Sjogrens syndrome
Mixed connective tissue disease