Seronegative Arthritis Flashcards
What are the features of seronegative arthritis?
Negative rheumatoid factor
May be associated with HLA-B27
Usually asymmetric arthritis compared to symmetric in RA
Predilection for the involvement of axial skeleton (as it progresses it can affect any part of spine)
Enthesitis
Extra-Articular features e.g. uveitis, IBD
What are the 4 main subtypes of seronegative arthritis?
Psoriatic arthritis
Enteropathic arthritis (bowel-related arthritis)
Ankylosing spondylitis
Reactive arthritis
Remember PEAR
There are other subtypes which cannot be classified into these groups
What is the typical presenting complaint of seronegative arthritis?
Patient complaining of pain first thing in the morning or late at night (inflammatory pain rather than mechanical pain)
Being woken up in the second half of the night and first thing in the morning by the pain
Buttock/hip pain
Raised inflammatory markers not seen in most
Seronegative arthritis typically involves inflammation of what joints?
Sacroiliac joints
Inflammation is bilateral in ankylosing spondylitis and unilateral in psoriatic arhtropathy
May be present in different areas, but sacroiliac joints are affected in all subtypes
What are the features of ankylosing spondylitis?
Prototype for axial spondyloarthritis
Chronic inflammatory rheumatic disorder with predilection for the axial skeleton and enthuses
Onset typically in second-third decade of life, although can occur at any age after 16
Males > females
What are the clinical features of ankylosing spondylitis?
Inflammatory back pain
Limitation of movements in anteroposterior as well as lateral planes at lumbar spine
Limitation of chest expansion
Bilateral sacro-iliitis on x-rays
What is the grading of radiographic sacroiliitis (1996)?
Grade 0 - normal
Grade 1 - suspicious changes
Grade 2 - minimal abnormality; small localised areas with erosion or sclerosis without alteration in the joint width
Grade 3 - unequivocal abnormality; moderate or advanced sacroiliitis with one or more of: erosions, evidence of sclerosis, widening, narrowing or partial ankylosis
Grade 4 - severe abnormality, total ankylosis
What are the features of axial spondyloarthritis non-radiographic stage?
Back pain
Sacroiliitis on MRI
What are the features of axial spondyloarthritis radiographic stage?
Back pain
Radiographic sacroiliitis - back pain, syndesmophytes
What are the other features of axial spondyloarthritis?
Peripheral joint involvement - hip very common, shoulders and knees
Achilles tendonitis, dactylitis
Uveitis
Cardiac - aortic incompetence, heart block
Pulmonary - restrictive disease, apical fibrosis
GI - IBD
Osteoporosis and spinal fracture
Neurological - AAD and cauda equina syndrome
Renal - secondary amyloidosis
What is the management of axial spondyloarthritis?
Physiotherapy NSAIDs DMARDs e.g. sulfasalazine Anti-TNF Anti-IL 17 Treatment of osteoporosis Surgery - joint replacement and spinal surgery
What are the clinical subtypes of psoriatic arthritis?
Arthritis with DIP joints involvement Symmetric polyarthritis Asymmetric oligoarticular arthritis Arthritis mutilans Predominant spondylitis
Also characterised by dactylitis and enthesitis
Severity of joint disease does not correlate to extent of skin disease
Nail pitting seen
What is the treatment of psoriatic arthritis?
Sulfasalazine Methotrexate Leflunomide Cyclosporine Anti-TNF therapy Anti IL 17 and Il 23 Steroids - skin can flare if patients are taking high doses of steroids which are then withdrawn Physiotherapy and OT Axial disease treated in similar way to AS
Why is hydroxychloroquine generally avoided in treatment of psoriatic arthritis?
Can make skin psoriasis worse so needs to be used sparingly and patient should be aware of risk of side effects
What is reactive arthritis?
Reaction to an infection elsewhere
Sterile synovitis after distant infection
