seronegative arthritis Flashcards
what is another term for seronegative arthritis
spondyloarthritis
what is the difference between seronegative arthritis and seropositive arthritis
in seronegative arthritis, no serological markers can be found in the patient
describe that characteristic pattern of seronegative arthritis
it is usually asymmetric in nature and involves the spine - enthesitis can also occur in seronegative arthritis and this is when there is inflammation where the tendons/ligaments insert onto bones
name some extra-articular features that usually occur in zero-negative arthritis
- enthesitis
- IBD
- uveitis
name some different types of seronegative arthritis
- ankylosing spondylitis (inflammation of the spine)
- psoriatic arthritis
- bowel related arthritis
- reactive arthritis
what is ankylosing spondylitis
this is a chronic condition where the spine becomes inflamed. It is more common in men and the onset usually occurs between 20-30 years old
what tests are used to assess the mobility of the spine
modified schooners test - 2 fingers are placed between the 2 posterior superior iliac spines and a mark is placed 10cm above this point. The patient then bends forwards and you keep you fingers in place and measure the increase in length to the mark
lateral spinal flexion test - the patient puts their hands by their side and you mark then ask them to lean to the side and mark the difference in length to the new finger mark
occiput to wall and triages to wall can be used to assess the curvature of the spine
cervical rotation - used to assess the mobility of the cervical spine
name some of the clinical features of analysing spondylitis
- inflammatory back pain
- limited chest expansion
- limited spinal movements
- bilateral sacroiliitis
(known as the NY criteria)
name the different grades of sacroiliitis
- Grade 0 = normal
- Grade 1 = suspicious changes
- Grade 2 = minimal abnormality
- Grade 3 = moderate or advanced
- Grade 4 = severe abnormaility
what is meant by diffuse idiopathic skeletal hyperostosis (DISH)
this is when there is calcification of the ligaments where they attach to the spine
what is another term for diffuse idiopathic skeletal hyperostosis
Forestier’s disease
what are the common clinical signs of diffuse idiopathic skeletal hyperostosis
the most common symptom is stiffness of the upper back and unilateral bulking of the vertebrae bodies
what is spondyloarthritis
this is a group of inflammatory diseases that affect eh spine and analysing spondylitis is the biggest member
what is the classification for the diagnosis of axial spondyloarthritis
1) > 3 month history of back pain
2) <45 years old
3) sacroiliitis on imaging + 1 SpA feature OR HLA-B27 + two SpA features
SpA features include:
- inflammatory back pain
- arthritis
- enthesitis
- uveitis
- dactylics
- psoriasis
- Chron’s/colitis
- family history of SpA
- elevated CRP
what is the difference between the non-radiographic and the radiographic stage of axial spondyloarthritis
the non-radiographic changes is when the sacroiliitis can be seen on MRI but not on radiographs. In the radiographic stages, there may be syndesmophytes (this is a bony growth through the ligaments in the spine and it leads to the fusion of the vertebra bodies in the spine)
how is ankylosing spondylitis managed
- physiotherapy
- NSAIDs
- Anti-TNF
- DMARDs
- joint and spinal surgery
what is ankylosing spondylitis
this is chronic inflammatory condition of the spine. Men are most commonly affected and the onset usually occurs between 20-30 years old
what are the clinical features of psoriatic arthritis
the clinical features of psoriatic arthritis depend on the type of psoriatic arthritis
what are the different types of psoriatic arthritis
- distal/DIP joint involvement
- symmetric
- asymmetric
- arthritis mutilans (most severe form)
what is the cause of psoriatic arthritis
the cause is unknown but it seems to run in families and up to 1/3 of those with psoriasis will get psoriatic arthritis - the extent of the skin disease does not always correlate to the extent of the bone disease
what can be seen on X-ray in those with psoriatic arthritis
- pencil in a cup images
what is the treatment for psoriatic arthritis
- DMARDs (methotrexate and sulfasalazine)
- steroids
- physiotherapy
- anti-TNF therapy
- occupational therapy
- immunosuppressants (cyclosporin)
what is meant by reactive arthritis
this is inflammation of the synovial fluid following a distant infection. Dactylitis and enthesitis is found. Examples of infection usually include salmonella, shigella and campylobacter)
what is meant by Reiter’s syndrome
this is when there is a trio of arthritis, urethritis and conjunctivitis
name some characteristics of reactive arthritis that suggest it is going to be chronic
- hip/heel pain
- high ESR
- family history
- HLA-B27 positive
how is reactive arthritis treated
Acute reactive arthritis = NSAIDs, joint injections, antibiotics (in chlamydia infections)
Chronic reactive arthritis = NSAIDs and DMARDs (methotrexate and sulphasalazine)
what is entheropathic arthritis
this is a type of arthritis that has a very strong association with IBD - large joints are usually affected and it usually comes on in parallel with the IBD and improves as the bowel symptoms improve
what is the treatment of the entheropathic arthritis
- DMARDs
- Anti-TNF
- steroids
- bowel resection (the arthritis usually parallels the IBD and therefore this would reduce the frequency of events)
- NSIADs
