Seronegative arthritis Flashcards
Seronegative arthritis - what makes it negative?
negative rheumatoid factor
gene association with seronegative arthritis
HLA-B27
seronegative arthritis - usually symmetric or asymmetric?
asymmetric
enthesitis
inflammation at the sites where tendons/ligaments insert into bone
Extra-articular features of seronegative arthritis
uveitis, IBD
What part of skeleton usually affected in seronegative arthritis?
axial - spine
4 types of spondyloarthropathies
ankylosing spondylitis
psoriatic arthropathy
reactive arthropathy
intestinal/bowel related
Ankylosing spondylitis
chronic inflammatory rheumatic disorder affecting the axial skeleton and entheses
Epidemiology of Ankylosing spondylitis
2nd to 3rd decade of life and affects more males
geographic distribution
4 spinal mobility tests used in Ankylosing spondylitis
modified Schober
lateral spine flexion
occiput to wall and tragus to wall
cervical rotation
describe the modified Schober test
patient stand erect and form line connecting post.sup.iliac spines and mark 10cm above this
bend forward maximally and record difference to 0.1cm
best of 2 tries
lateral spine flexion
stand straight - mark on thigh, bend sideways and record 2nd mark - mean of best of 2 tries for both sides
occiput and tragus to wall
stand straight, max effort to move head against wall - best of 2 tries and mean of left and right tragus to wall
cervical rotation
sit straight, goniometer, ask to rotate neck - best of 2 reading and mean of left and right
Criteria used for clinical features of Ankylosing spondylitis
new York
NY criteria
inflammatory back pain
limited chest expansion
limited ROM in antero-posterior and lateral planes
bilateral SI on x-ray
grading of radiographic SI
0 - normal
1 - suspicious change
2 - minimal, localised areas - no change in joint width
3 - unequivocal, erosions, sclerosis, widening, ankylosis
4 - severe - total ankylosis
DISH
bony hardening of ligaments where they attach to spine and calcification
spondylophytes
non radiographic stage of Ankylosing spondylitis
back pain
SI on MRI
Radiographic stage of Ankylosing spondylitis
modified NY criteria 1984
back pain and radiographic SI
back pain syndesmophyes
ASAS classification for Ankylosing spondylitis applies to who?
under 45 with 3 or more months of back pain
ASAS classification for Ankylosing spondylitis
SI on imaging and 1 or more SPA features
HLA-B27 plus 2 or more other SPA features
11 SPA features (ASAS)
HLA-B27 FH inflammatory back pain IBD uveitis arthritis dactylitis enthesitis increased CRP psoriasis good response to NSAIDs
other features of Ankylosing spondylitis
peripheral joints eg hip, knee, shoulder
cardiac - aortic incompetence and heart block
osteoporosis
cauda equina syndrome
achilles tendonitis
Management of Ankylosing spondylitis
physio - NSAIDS - DMARDs eg sulfasalazine - anti TNF - treat osteoporosis - surgery - anti IL-17
Joints commonly affected in psoriatic arthritis
neck, shoulder, wrist, elbow, hand, ankle, feet, base of spine, knees
psoriatic arthritis
dactylitis and enthesitis
nail pitting
joint disease and skin disease no correlation on severe
Treating psoriatic arthritis
sulfasalazine - cyclosporine - methotrexate - steroids - physio - anti TNF - anti IL 17/23
Reactive arthritis
sterile synovitis after distant infection
mono or oligoarthritis with dactylitis/enthesitis
infections in reactive arthritis
eg salmonella, chlamydia, shigella, Neisseria, strep
GI/uro/throat
Skin and mucous membranes affected in reactive arthritis
urethritis, uveitis, conjunctivitis, balantitis
What type of reactive arthritis are recurrent attacks common?
chlamydia
Reiter’s syndrome
arthritis, uveitis and conjunctivitis
Prognostic indicators for chronicity of reactive arthritis
hip/heel pain
raised ESR
HLA-B27
FH
acute treatment of reactive arthritis
antibiotics for chlamydia
NSAID
joint injection
chronic treatment for reactive arthritis
NSAID, DMARD
What is enteropathic arthritis commonly associated with?
IBD - rarely coeliac, infectious enteritis etc
Treating enteropathic arthritis
NSAID difficult to use steroids sulfasalazine anti-TNF bowel resection methotrexate
