Seronegative arthritis Flashcards
What are the types of seronegative arthritis?
PAIR
- Psoriatic arthritis -> dactylitis
- Ankylosing spondylitis -> spinal involvement
- IBD associated
- Reactive arthritis -> follows GI-GU infections
What are the characteristic of ankylosing spondylitis?
inflammatory changes at the sacroiliac joints & spinal ankylosis
What are the clinical features of ankylosing spondylitis?
- onset < 45 years
- insidious onset of dull pain that progresses slowly
- morning stiffness > 30 mins but improves with activity
- pain persists with rest & at night
- tenderness over sacroiliac joints
- reduced spinal mobility
What are the extra-articular manifestations of ankylosing spondylitis?
- anterior uveitis
- fatigue, weakness, fever, & weight loss
- restrictive pulmonary disease
- prostatitis
- GI symptoms
- aortic inflammation & aortic valve insufficiency
What are the tests that are preformed to help in diagnosis of ankylosing spondylitis?
- FABER test -> pain in sacroiliac joint
- Schober test -> decreased spinal mobility
- kyphosis
What lab investigations are used in diagnosis of ankylosing spondylitis?
- elevated CRP & ESR
- positive HLA-B27
- anemia
What is the best initial test in ankylosing spondylitis?
X-RAY
- symmetrical findings in sacroiliac joints
- dagger sign -> ossification of vertebral ligaments
- bamboo sign -> fusion of intervertebral joints
- shiny corner sign -> reactive sclerosis pf superior & inferior margins of vertebrae
How is ankylosing spondylitis managed?
1- NSAIDs
2- TNF-a inhibitors
What are the complications of ankylosing spondylitis?
- restrictive lung disease
- cauda equina syndrome
- spine fractures
What are the bacterial infections associated with reactive arthritis?
ShY ChiCS
POSTURETHRITIS
- Chlamydia
- ureaplasma urealyticum
POSTENTERITIS
- Shigella
- Yersinia
- Salmonella
- Campylobacter
bartonella henselae -> in immunocompromised
What are the clinical features of reactive arthritis?
- oligoarthritis
- conjunctivitis or iritis
- urogenital tracts symptoms
- balanitis circinata -> skin lesions of glans
- keratoderma blenorrhagicum -> hyperkeratinization of palms & soles
- oral ulcers
What are the diagnostics of reactive arthritis?
- increased ESR & CRP
- stool urine & culture
- urethral swab
- HIV testing in patients with persisting symptoms
- arthrocentesis -> increased WBC, gram stain & cultures are negative
How is reactive arthritis managed?
NSAIDS
What are the clinical features of psoriatic arthritis?
- oligoarthritis
- asymmetric involvement of DIP & PIP
- DACTYLITIS (sausage fingers)
- enthesitis
- tenosynovitis
- arthritis mutilans (telescoping fingers)
What are the diagnostics & treatment for psoriatic arthritis?
X-RAY
- joint destruction & ankylosis
- pencil in cup deformity pf DIP
Management
- Mild -> NSAIDS
- moderate to severe -> DMARDS
