Seronegative AI Inflam arthropathies

Question 1

Where does ankylosing spondylitis affect?

Answer 1

Spine and sacro-iliac joints

Question 2

What eventually happens in ank spondylitis?

Answer 2

Fusion of intervertebrla joints (“bamboo spine”) and SI joints

Question 3

Are females more affected in ank spon?

Answer 3

No males are 3:1

Question 4

What do pateints with ank spon present with?

Answer 4

Pain and stiffness in back and SI joint

extra-articular features - enthesitis, dactylitis, ANTERIOR uveitis, plantar fasciitis, achilles tendinitis

Question 5

Syndesmophytes are what?

Answer 5

Bony spurs from vertebral bodies seen in ank spon

Question 6

What HLA is ank spon associated with?

Answer 6

HLA-B27 (90%)

Question 7

Why is ank spon known as the “A disease”?

Answer 7

Axial arthritis 
Anterior uveitits 
Aortic regurgitation 
Apical fibrosis 
Achilles tendintitis 
Amyloidosis 
plAntar fasciitis

Question 8

The Modified New York Criteria for Diagnosis of AS is what?

Answer 8

1. Lower back pain for 3 months - improved with exercise and not relieved by rest
2. Limited lumbar motion - reduced Schobers test (<19cm)
3. Reduced chest expansion
4. Bilateral grade 2-4 sacroilitis on x-ay
5. Bilateral grade 3-4 sacroilitis on x-ray

Definite diagnosis if 4 or 5 plus 1, 2 or 3

Question 9

What treatment options are given for AS?

Answer 9

Physiotherapy 
exercise 
OT 
Simple analgesia (paracetamol or NSAIDs)
DMARDs for more aggressive disease

Question 10

Describe the basics of psoriatic arthritis.

Answer 10

Inflammatory asymetric oligoarthritis 
Sacroilitis 
Spondylitis 
Dactylitis 
Enthesitis (achilles tendinitis, plantar fasciitis) 
Eye disease 
Nail changes

Question 11

What nail changes occur in psoriatic arthritis?

Answer 11

Pitting 
Onycholysis (lifting of the nail from it's bed)
Subungual hyperkeratosis 
Colour change to yellow-brow 
Fungal nail infections can occur

Question 12

Psoriatic arhritis occurs in what % of people affected by skin psoriasis?

Answer 12

30%

Question 13

What bloods are seen in psoriatic arthritis?

Answer 13

Raised inflam markers

Negative RF

Question 14

On x-ray what changes are seen in psoriatic arthritis?

Answer 14

Marginal erosions 
"whiskering" 
"pencil in cup" deformity 
Osteolysis 
Enthesitis

Question 15

What is enthesitis?

Answer 15

Inflammation of the site where tendon or ligament inserts onto the bone.

Question 16

What treatment can be given for psoriatic arthritis?

Answer 16

Physiotherapy, Ot, Orthotics, Chiropodist
NSAIDs
Corticosteroids/ joint injection
DMARDs (MTX, SZP)
Anti-TNF (Etanercept) - most effective agents

Question 17

What is enterpathic arthritis?

Answer 17

An inflammatory arthritis involving the spine and peripheral joints occuring in pateints with IBD, coeliac disease and pts with extensive bowel resections

Question 18

What is reactive arthritis?

Answer 18

Arthritis occurs in response to an infection in another part of the body - infection triggers and AI arthropathy

Question 19

What are the most common infections that initiate reactive arthritis?

Answer 19

Shigella 
Salmonella 
Campylobacter
Cryptosporidium
Giardia 
Chlamydia 
Neisseria

Question 20

Why is history important in rective arthritis?

Answer 20

If food poisioning 2/3 weeks prior then think about reactive arthritis

Question 21

What investigations are done for reactive arthritis?

Answer 21

Raised inflam markers
Cultures - blood, stool, urine
Joint fluid analysis - rule out infection of joint
X-ray affected joints