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Rheumatology > Sero-Negative arthritis > Flashcards

Sero-Negative arthritis Flashcards

1
Q

What are the Seronegative spondyloarthropathies

A

Seronegative spondyloarthropathies are a family of joint disorders that classically include ankylosing spondylitis (AS), psoriatic arthritis (PsA), inflammatory bowel disease (IBD) associated arthritis, reactive arthritis (formerly Reiter syndrome; ReA), and undifferentiated SpA.

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2
Q

What are classic features of the Seronegative spondyloarthropathies

A

Negative rheumatoid factor

May be associated with HLA- B27

Usually an asymmetric arthritis

Involvement of axial skeleton (spine) – sacroiliitus

Enthesitis

Extra-articular features- uveitis, inflammatory bowel disease, Psoriasis

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3
Q

What is Enthesitis

A

Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone.

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4
Q

What is common in all the Seronegative spondyloarthropathies

A

Sacroiliitus

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5
Q

What at the common seronegative arthritis’

A

Ankylosing spondylitis (AS),

Psoriatic arthritis (PsA),

Inflammatory bowel disease (IBD) associated arthritis,

Reactive arthritis (formerly Reiter syndrome; ReA),

Undifferentiated SpA.

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6
Q

What is Ankylosing Spondylitis

A

Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses

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7
Q

What is Epidemiology

of Ankylosing Spondylitis

A

Onset in second to third decade of life

Males 3X more likely that Females

Prevalence varies in different parts of the world

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8
Q

What are the genetics of Ankylosing Spondylitis

A

HLA B27 is positive in 80-95% of patients with AS

BUT
It is not diagnostic of AS/Spa

Risk of AS increases in relatives

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9
Q

What are the common presenting symptoms of Ankylosing Spondylitis

A

Inflammatory back pain
- Stiffness in morning that gets better during day

Sacroiliac pain (buttock region)

Limitation of movements in antero-posterior as well as lateral planes at lumbar spine

Limitation of chest expansion

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10
Q

What examinations can be done to test for Ankylosing Spondylitis

A

Schober’s Test

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11
Q

What is the Schober’s Test

A

Have the patient stand straight. Find the L5 vertebrae. Mark a point 10cm above and 5cm below this point (15cm apart from each other). Then ask the patient to bend forward as far as they can and measure the distance between the points.

If the distance with them bending forwards is less than 20cm, this indicates a restriction in lumbar movement and will help support a diagnosis of ankylosing spondylitis.

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12
Q

What investigations can be used for Ankylosing Spondylitis

A

MRI

Xray

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13
Q

What radiographic investigation would you do first for Ankylosing Spondylitis

A

MRI is used to pick up sacroiliitis initially. (picks up bone marrow oedema)

Changes take a while to be seen on an X-ray

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14
Q

What are the changes seen on an MRI of Ankylosing Spondylitis called

A

Non-radiographic stage changes

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15
Q

What are the changes seen on an X-ray of Ankylosing Spondylitis called

A

Radiographic stage changes

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16
Q

What Radiographic stage changes could be seen in Ankylosing Spondylitis

A

Squaring of the vertebral bodies

Subchondral sclerosis and erosions

Ossification of the ligaments, discs and joints.

Fusion of the facet, sacroiliac and costovertebral joints

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17
Q

What is the typical description of the xray appearance of the spine in later stage ankylosing spondylitis.

A

Bamboo spine

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18
Q

What is the diagnostic criteria for ankylosing spondylitis

A

Sacroiliitis on imaging and one SpA feature

OR

HLA-B27 and >2 SpA feature

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19
Q

What are diagnostic SpA features

A 
Inflammatory back pain 
arthritis 
enthesitis 
Uveitis 
dactylritis 
Psoriaisas 
Crohns 
Good response to NSAIDS 
Family Hx
Elevated CRP
20
Q

What is first line treatment of ankylosing spondylitis

A

Physiotherapy

21
Q

What are the treatment options for ankylosing spondylitis

A 
Physiotherapy 
NSAIDS 
DMARDs- Sulfasalazine
Anti-TNF
Anti-IL-17 
Treatment of osteoporosis
Surgery
22
Q

What is Psoriatic Arthritis

A

Psoriatic arthritis is a type of arthritis that affects some people with the skin condition psoriasis. It typically causes affected joints to become swollen, stiff and painful.

23
Q

What is the prognosis of Psoriatic Arthritis

A

Can be bad but if its treated early, it’s progression can be slowed down and permanent joint damage can be prevented or minimised

24
Q

What are the important sub-groups of Psoriatic Arthritis

A

Symmetric polyarthritis

Asymmetric oligoarticular arthritis

Spondylitic pattern

Arthritis mutilans

25
Q

What is the epidemiology of Psoriatic Arthritis

A

It occurs in 10-20% of patients with psoriasis and usually occurs within 10 years of developing the skin changes. It typically affects people in middle age but can occur at any age.

26
Q

Describe Symmetric polyarthritis

A

presents similarly to rheumatoid arthritis and is more common in women. The hands, wrists, ankles and DIP joints are affected. The MCP joints are less commonly affected (unlike rheumatoid).

27
Q

Describe ASymmetric oligoarticular polyarthritis

A

Asymmetrical pauciarthritis affecting mainly the digits (fingers and toes) and feet. Pauciarthritis describes when the arthritis only affects a few joints.

28
Q

Describe Spondylitic pattern

A

Spondylitic pattern is more common in men. It presents with:

Back stiffness
Sacroiliitis
Atlanto-axial joint involvement

29
Q

What are signs of Psoriatic arthritis

A 
Plaques of psoriasis on the skin
Pitting of the nails
Onycholysis 
Dactylitis 
Enthesitis
30
Q

What is Onycholysis

A

Separation of the nail from the nail bed

31
Q

What is Dactylitis

A

Inflammation of the full finger

32
Q

What is Enthesitis

A

Inflammation of the entheses, which are the points of insertion of tendons into bone

33
Q

What is management for Psoriatic arthritis

A 
DMADS 
Anti-TNF therapy
Anti- IL-17 and IL-23
Steroids
Physiotherapy and occupational therapy
34
Q

Name some DMADS that can be used for Psoriatic arthritis

A

methotrexate
leflunomide
sulfasalazine

35
Q

Name some Anti-TNFs that can be used for Psoriatic arthritis

A

Etanercept
Infliximab
Adalimumab

36
Q

What is Reactive arthritis

A

Reactive arthritis is where synovitis occurs in the joints as a reaction to a recent infective trigger

37
Q

What did Reactive arthritis used to be known as

A

Reiter Syndrome

38
Q

What is a typical presentation of Reactive arthritis

A

Acute monoarthritis, affecting a single joint in the lower limb (most often the knee) presenting with a warm, swollen and painful joint.

39
Q

What infections typically causes Reactive arthritis

A

Gastroenteritis

STI

40
Q

What STI most commonly causes Reactive arthritis

A

Chylamydia

41
Q

Whats the prognosis of Reactive arthritis

A

Usually resolve within 6 months but sometimes need medications

42
Q

What are common associated symptoms of Reactive arthritis

A

Bilateral conjunctivitis (non-infective)

Anterior uveitis

Circinate balanitis dermatitis of the head of the penis

43
Q

What is Circinate balanitis

A

Circinate balanitis is dermatitis of the head of the penis

44
Q

What is treatment for acute Reactive arthritis

A

NSAID

Joint injection (if infection excluded)

Antibiotics in chlamydia infection (contacts as well)

45
Q

What is treatment for chronic Reactive arthritis

A

NSAID

DMARD (e.g. sulphasalazine, methotrexate)

Rheumatology (11 decks)

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