Seronegative arthritis Flashcards
What is Seronegative Arthritis?
Arthritis types with a negative rheumatoid factor. Can be associated with HLA-B27. Usually presents with asymmetric arthritis. Involvement of the Axial Skeleton (spine) Often associated with enthesitis (inflammation of the entheses, the sites where tendons or ligaments insert into the bone). Extra-articular features - Uveitis, IBD
What are the different clinical presentations of Seronegative Arthritis?
Ankylosing Spondylitis Psoriatic arthritis Bowel related arthritis (Crohn’s, UC) Reactive arthritis Others
Generally outline Ankylosing Spondylitis.
Prototype for axial sponyloarthritis. Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses. Onset in second to third decade of life Males > Females Prevalence varies in different parts of the world.
What are the clinical features of Ankylosing Spondylitis?
Inflammatory back pain Limitation of movements in antero-posterior as well as lateral planes at lumbar spine Limitation of chest expansion Bilateral sacroiliitis on X-rays
Outline the grading of Radiographic Sacroilitis?
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 differences are there between the non-radiographic and radiographic stages of axial spondyloarthritis?
Non-radiographic Stage - Back pain - Sacroiliitis on MRI Radiographic Stage - Back pain - Radiographic sacroiliitis More advanced would see syndesmophytes.
Outline the ASAS Classification Criteria for Axial Spondyloarthritis (SpA)
In patients with more that 3 month duration of back pain at age on onset <45 years. Sacroilitis on imaging plus >1 SpA Feature OR HLA-B27 plus >2 other SpA features. SpA Features: - inflammatory back pain - Arthritis - Enthesitis - Uveitis - Dactylitis - Psoriasis - Crohns/Colitis - Good response to NSAIDS - FH of SpA - HLA-B27 - elevated CRP
What are some of the other features of Axial Spondylarthritis?
Peripheral joints - Hips, shoulders, knees Achilles tendonitis, dactylitis Uveitis Cardiac- Aortic incompetence, heart block Pulmonary- restrictive disease, apical fibrosis GI- IBD Osteoporosis and spinal fractures Neurological- AAD & cauda equina syndrome Renal- secondary amyloidosis
What is the management of Axial Spondyloarthritis?
Physiotherapy NSAIDs DMARDs- Sulfasalazine Anti-TNF Anti-IL-17 Treatment of osteoporosis Surgery- joint replacements & spinal surgery
What is Psoriatic Arthritis?
A type of arthritis that develops in some people with the skin condition psoriasis. It typically causes affected joints to become inflamed (swollen), stiff and painful. Like psoriasis, psoriatic arthritis is a long-term condition that can get progressively worse.
What are the clinical subtypes of psoriatic arthritis?
Arthritis with DIP joint involvement Symmetric polyarthritis- similar to RA Asymmetric oligoarticular arthritis Arthritis mutilans Predominant spondylitis Also characterized by dactylitis & enthesitis Severity of joint disease does not correlate to extent of skin disease. Nail pitting seen
What are the treatment options of psoriatic arthritis?
Sulfasalazine Methotrexate Leflunomide Cyclosporine Anti-TNF therapy Anti- IL-17 and IL-23 Steroids Physiotherapy and occupational therapy Axial disease treated similar to AS
What is reactive arthritis?
a painful form of inflammatory arthritis (joint disease due to inflammation). It occurs in reaction to an infection by certain bacteria. Infections include- Salmonella, Shigella, Yersinia, Campylobacter, Chlamydia trachomatis or pneumoniae, Borrelia, Neisseria and streptococci Infections- throat, urogenital & GI Disease may be systemic Usually mono or oligoarthritis Dactylitis or enthesitis also seen
What are the different types of skin and mucous membrane involvements in reactive arthritis?
Keratoderma blenorrhagica Circinate balanitis Urethritis Conjunctivitis Iritis
In terms of Reactive arthritis: - when are recurrent attacks common? - What is Reiter’s syndrome - - What are the prognostic signs for chronicity?
Recurrent attacks common in chlamydia-induced arthritis Reiter’s syndrome – arthritis, urethritis and conjunctivitis Prognostic signs for chronicity - Hip/heel pain - High ESR - Family history and HLA-B27 +ve
