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MSK > Seronegative Arthritis > Flashcards

Seronegative Arthritis Flashcards

1
Q

Describe seronegative arthritis

A
  • -ve RF
  • May be assoc. with HLA-B27
  • Usually asymmetrical arthritis
  • Involvement of axial skeleton (spine)
  • Enthesitis
  • Extra-articular features (uveitis, IBD)
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2
Q

4 types of seronegative arthritis

A
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Reactive arthritis
  • Enteropathic arthritis
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3
Q

Describe ankylosing spondylitis

A
  • Chronic inflammatory rheumatic disorder w/ a predilection for axial skeleton + entheses
  • Onset in 2nd-3rd decade of life
  • Males>Females
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4
Q

How to assess spinal mobility

A

Modified schober’s test

  • Patient standing erect
  • Mark a line connecting both post. sup. iliac spines
  • Mark 10cm above that mark
  • Patients bend forward maximally, measure diff. of both marks
  • Report increase
  • Best of 2 tries is recorded
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5
Q

How to assess spinal lateral flexion

A
  • Heels + back rest against wall. No flexion or knees or bending forward
  • Place mark on thigh(where the longest finger rests), bend sideways, record diff.
  • best of 2 is recorded for left + right separately
  • Mean of left + right is calculated
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6
Q

How to assess cervical rotation

A
  • Patient sits straight on a chair
  • Place a goniometer at top of head, in line with nose
  • Patient rotates head maximally to left. Record the angle with goniometer.
  • Repeat procedure on right side
  • Mean of left + right is calculated
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7
Q

Clinical features of ankylosing spondylitis

A
  • Inflammatory back pain
  • Limitation of movements in antero-posterior + lateral planes of lumbar spine
  • Limitation of chest expansion
  • Bilateral sacroiliitis on X-rays
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8
Q

2 types of axial spondyloarthritis

A
  • Non-radiographic stage (back pain + sacroiliitis on MRI)

- Radiographic stage (Back pain + Radiographic sacroiliitis)

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9
Q

Management of AS

A
  • NSAIDs
  • DMARDs (sulfasalazine)
  • Anti-TNF
  • Treatment of osteoporosis
  • Surgery (joint replacement & spinal surgery)
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10
Q

Joints commonly affected by psoriatic arthritis

A
  • Neck + base of spine
  • Shoulder
  • Elbow
  • Wrist
  • All joints of knuckles, finger and thumbs
  • Knees
  • Ankles
  • All joints of the toes
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11
Q

5 clinical subtypes of psoriatic arthritis

A
  • Arthritis with DIP joint involvement
  • Symmetric polyarthritis (similar to RA)
  • Arthritis mutilans
  • Predominant spondylitis

Also characterised by dactylitis + enthesitis

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12
Q

How does the extent of skin disease relate to the severity of joint disease

A

No correlation

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13
Q

Rx for psoriatic arthritis

A
  • Sulfasalazine
  • Methotrexate
  • Cyclosporine
  • Anti-TNF
  • Steroids
  • Physio + occ therapy
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14
Q

Describe reactive arthritis

A
  • Sterile synovitis after a distant infection (salmonella, campylobacter, chlamydia trachomatis or pneumoniae
  • Disease may be systemic
  • Usually mono or oligoarthritis
  • Dactylitis or enthesitis also seen
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15
Q

How is the are skin and mucous membranes involved in reactive arthritis

A
  • Conjunctivitis
  • Urethritis
  • Iritis
  • Keratoderma blenorrhagica
  • Circinate balanitis
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16
Q

What is common in reactive arthritis caused by chlamydia

A

Recurrent attacks

17
Q

What conditions make up reiter’s syndrome

A

-Arthritis
-Urethritis
-Conjunctivitis
Assoc. with reactive arthritis

18
Q

Rx of reactive arthritis

A

Acute

  • NSAID
  • Joint injection (if infection excluded)
  • Antibiotics if chlamydia infection (contacts as well)

Chronic

  • NSAID
  • DMARD (sulphasalazine, methotrexate)
19
Q

What is enteropathic arthritis commonly and not commonly assoc. with

A
  • Commonly assoc. with IBD (crohn’s or UC)
  • Rarely seen w/ infectious enteritis, whipple’s disease and coeliac disease
  • Enthesopathy commonly seen
20
Q

Does enteropathic arthritis present axially or peripherally

A

Can be both

21
Q

Rx of enteropathic arthritis

A
  • Sulphasalazine
  • Steroids
  • Methotrexate
  • Anti-TNF
  • Bowel resection may alleviate peripheral disease

MSK (28 decks)

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