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Year 3 MSK (JK) > Seronegative arthritis > Flashcards

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
Q

Management of Ankylosing spondylitis

A

physio - NSAIDS - DMARDs eg sulfasalazine - anti TNF - treat osteoporosis - surgery - anti IL-17

26
Q

Joints commonly affected in psoriatic arthritis

A

neck, shoulder, wrist, elbow, hand, ankle, feet, base of spine, knees

27
Q

psoriatic arthritis

A

dactylitis and enthesitis
nail pitting
joint disease and skin disease no correlation on severe

28
Q

Treating psoriatic arthritis

A

sulfasalazine - cyclosporine - methotrexate - steroids - physio - anti TNF - anti IL 17/23

29
Q

Reactive arthritis

A

sterile synovitis after distant infection

mono or oligoarthritis with dactylitis/enthesitis

30
Q

infections in reactive arthritis

A

eg salmonella, chlamydia, shigella, Neisseria, strep

GI/uro/throat

31
Q

Skin and mucous membranes affected in reactive arthritis

A

urethritis, uveitis, conjunctivitis, balantitis

32
Q

What type of reactive arthritis are recurrent attacks common?

A

chlamydia

33
Q

Reiter’s syndrome

A

arthritis, uveitis and conjunctivitis

34
Q

Prognostic indicators for chronicity of reactive arthritis

A

hip/heel pain
raised ESR
HLA-B27
FH

35
Q

acute treatment of reactive arthritis

A

antibiotics for chlamydia
NSAID
joint injection

36
Q

chronic treatment for reactive arthritis

A

NSAID, DMARD

37
Q

What is enteropathic arthritis commonly associated with?

A

IBD - rarely coeliac, infectious enteritis etc

38
Q

Treating enteropathic arthritis

A 
NSAID difficult to use 
steroids 
sulfasalazine 
anti-TNF 
bowel resection 
methotrexate

Year 3 MSK (JK) (30 decks)

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