Seronegative arthritides (spondyloarthropathies)

Question 1

What are the four main seronegative arthritides?

Answer 1

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis

Question 2

What HLA type is associated with the SAs?

Answer 2

HLA-B27

Question 3

What is the typical pattern of joint involvement?

Answer 3

Axial arthritis (spine and sacro-iliac joints)
Asymmetrical large-joint oligo/mono-arthritis

Question 4

What are a) enthesis and b) dactylitis?

Answer 4

Enthesis- inflammation at the point of tendon attachment onto bone
Dactylitis- whole-digit inflammation

Question 5

What extra-articular manifestations are often seen in the SAs?

Answer 5

Anterior uveitis
Oral ulcers
Aortic valve incompetence
IBD
Psoriatic rash

Question 6

What group of patients typically get ankylosing spondylitis?

Answer 6

Young men

Question 7

How does ankylosing spondylitis present?

Answer 7

Gradual onset of lower back/buttock pain, worse at night and may waken them, gets better with exercise

Question 8

What enthesitises may be seen?

Answer 8

Plantar fasciitis

Achilles tendonitis

Question 9

What are the “A”’s of ankylosing spondylitis?

Answer 9

Axial arthritis
Aortic incompetence
Apical fibrosis
Anterior uveitis
Achilles tendonitis
Amyloidosis
plAntar fasciitis
IgA increase

Question 10

What may be seen in the following investigations of ankylosing spondylitis?

a) FBC
b) ESR and CRP
c) HLA testing
d) X-ray

Answer 10

a) normochromic normocytic anaemia
b) both elevated
c) 95% are HLA-B27
d) radiographic changes are late- may see sacroilitis (“blurry” SI joints), vertebral syndesmophytes

Question 11

How is ankylosing spondylitis treated?

Answer 11

Exercise/PT
NSAIDs for symptom relief
DMARDs
Anti-TNF e.g. infliximab

Question 12

What is psoriatic arthritis?

Answer 12

Inflammatory arthritis occurring in 10-40% of patients with psoriasis

Question 13

What are the classical patterns of arthritis in psoriatic arthritis?

Answer 13

1. Confined to DIP joints
2. Symmetrical polyarthritis
3. Spondylitis +/- peripheral arthropathy
4. Asymmetrical oligoarthritis with dactylitis
5. Arthritis mutilans

Question 14

When is reactive arthritis seen?

Answer 14

Usually 1-4 weeks after urethritis (chlamydia) or dysentery (salmonella, shigella, campylobacter)

Question 15

What is Reiter’s syndrome?

Answer 15

Triad of urethritis, arthritis, conjunctivitis

Question 16

What skin lesions may be seen in reactive arthritis?

Answer 16

Oral ulcers, hyperkeratotic nails, keratoderma blenorrhagica (brown pigmentation on soles of feet)