Seronegative arthritis Flashcards

1
Q

Seronegative arthritis - what makes it negative?

A

negative rheumatoid factor

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2
Q

gene association with seronegative arthritis

A

HLA-B27

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3
Q

seronegative arthritis - usually symmetric or asymmetric?

A

asymmetric

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4
Q

enthesitis

A

inflammation at the sites where tendons/ligaments insert into bone

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5
Q

Extra-articular features of seronegative arthritis

A

uveitis, IBD

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6
Q

What part of skeleton usually affected in seronegative arthritis?

A

axial - spine

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7
Q

4 types of spondyloarthropathies

A

ankylosing spondylitis
psoriatic arthropathy
reactive arthropathy
intestinal/bowel related

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8
Q

Ankylosing spondylitis

A

chronic inflammatory rheumatic disorder affecting the axial skeleton and entheses

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9
Q

Epidemiology of Ankylosing spondylitis

A

2nd to 3rd decade of life and affects more males

geographic distribution

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10
Q

4 spinal mobility tests used in Ankylosing spondylitis

A

modified Schober
lateral spine flexion
occiput to wall and tragus to wall
cervical rotation

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11
Q

describe the modified Schober test

A

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

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12
Q

lateral spine flexion

A

stand straight - mark on thigh, bend sideways and record 2nd mark - mean of best of 2 tries for both sides

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13
Q

occiput and tragus to wall

A

stand straight, max effort to move head against wall - best of 2 tries and mean of left and right tragus to wall

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14
Q

cervical rotation

A

sit straight, goniometer, ask to rotate neck - best of 2 reading and mean of left and right

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15
Q

Criteria used for clinical features of Ankylosing spondylitis

A

new York

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16
Q

NY criteria

A

inflammatory back pain
limited chest expansion
limited ROM in antero-posterior and lateral planes
bilateral SI on x-ray

17
Q

grading of radiographic SI

A

0 - normal
1 - suspicious change
2 - minimal, localised areas - no change in joint width
3 - unequivocal, erosions, sclerosis, widening, ankylosis
4 - severe - total ankylosis

18
Q

DISH

A

bony hardening of ligaments where they attach to spine and calcification
spondylophytes

19
Q

non radiographic stage of Ankylosing spondylitis

A

back pain

SI on MRI

20
Q

Radiographic stage of Ankylosing spondylitis

A

modified NY criteria 1984
back pain and radiographic SI
back pain syndesmophyes

21
Q

ASAS classification for Ankylosing spondylitis applies to who?

A

under 45 with 3 or more months of back pain

22
Q

ASAS classification for Ankylosing spondylitis

A

SI on imaging and 1 or more SPA features

HLA-B27 plus 2 or more other SPA features

23
Q

11 SPA features (ASAS)

A
HLA-B27 
FH 
inflammatory back pain 
IBD 
uveitis 
arthritis 
dactylitis 
enthesitis 
increased CRP 
psoriasis
good response to NSAIDs
24
Q

other features of Ankylosing spondylitis

A

peripheral joints eg hip, knee, shoulder
cardiac - aortic incompetence and heart block
osteoporosis
cauda equina syndrome
achilles tendonitis

25
Management of Ankylosing spondylitis
physio - NSAIDS - DMARDs eg sulfasalazine - anti TNF - treat osteoporosis - surgery - anti IL-17
26
Joints commonly affected in psoriatic arthritis
neck, shoulder, wrist, elbow, hand, ankle, feet, base of spine, knees
27
psoriatic arthritis
dactylitis and enthesitis nail pitting joint disease and skin disease no correlation on severe
28
Treating psoriatic arthritis
sulfasalazine - cyclosporine - methotrexate - steroids - physio - anti TNF - anti IL 17/23
29
Reactive arthritis
sterile synovitis after distant infection | mono or oligoarthritis with dactylitis/enthesitis
30
infections in reactive arthritis
eg salmonella, chlamydia, shigella, Neisseria, strep | GI/uro/throat
31
Skin and mucous membranes affected in reactive arthritis
urethritis, uveitis, conjunctivitis, balantitis
32
What type of reactive arthritis are recurrent attacks common?
chlamydia
33
Reiter's syndrome
arthritis, uveitis and conjunctivitis
34
Prognostic indicators for chronicity of reactive arthritis
hip/heel pain raised ESR HLA-B27 FH
35
acute treatment of reactive arthritis
antibiotics for chlamydia NSAID joint injection
36
chronic treatment for reactive arthritis
NSAID, DMARD
37
What is enteropathic arthritis commonly associated with?
IBD - rarely coeliac, infectious enteritis etc
38
Treating enteropathic arthritis
``` NSAID difficult to use steroids sulfasalazine anti-TNF bowel resection methotrexate ```