Seronegative Arthritis Flashcards
What is seronegative arthritis
Arthritis with negative rheumatic factor
What gene is seronegative arthritis associated with
HLA-B27
What are the different seronegative conditions
Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic (bowel-related) arthritis
What is Ankylosing Spondylitis
Arthritis affecting the spinal joints, sacroiliac most commonly, can also affect shoulder and hips and other entheses
Peak onset of Ankylosing Spondylitis
20-30 years in MALES > females
Clinical features of AK (NY criteria)
Inflammatory back pain
Limited movement in anteroposterior & lateral lumbar spine
Limited chest expansion
Bilateral sacroilitis on x-ray
What is pain like in AS
A chronic dull pain in the lower back or gluteal region combined with stiffness of the lower back
Individuals often experience pain and stiffness that awakens them in the early morning hours
What can axial SpondyloArthritis be divided into
- Radiographic axial SpondyloArthritis (Ankylosing Spondylitis)
- back pain
- radiographic sacroilitis
- syndesmophytes (later) - Non-radiographic axial SpondyloArthritis (less severe early AS)
ASAS classification for Axial SpondyloArthritis
In patients with >3 months back pain and age of onset <45 years with:
- Sacroilitis on Imaging + >1 SpA feature
OR
- HLA-B27 + >2 other SpA features
What are the SpA features (11)
Inflammatory back pain Arthritis Enthesitis of heel Uveitis Dactylitis Psoriasis Crohn's / Colitis Good response to NSAIDs FH for SpA HLA-B27 Elevated CRP
What spinal mobility tests can assess for AS
Modified Schober test (lumbar flexion)
Lateral spinal flexion
Occiput to wall and Tragus to wall
Cervical Rotation
Grading of radiographic sacroilitis
1 - suspicious changes
2 - small area of erosions or sclerosis
3 - >1 of erosions, sclerosis, pseudo-widening or narrowing of joint space, partial ankylosis
4 - total ankylosis
What is diffuse idiopathic skeletal hyperostosis
A condition causing ligaments to become calcified and hard leading to bones looking overgrown on x-ray.
Commonly confused with AS
Management of AS
Physiotherapy NSAIDs Sulfasalzine (DMARDS) Anti-TNFa Anti IL-17 Treatment of osteoporosis Surgery - joint replacements & spinal surgery
Who benefits most from NSAIDs in treatment of AS
Patients with risk factors for radiographic spinal progression - syndesmophytes and elevated CRP
Treatment of Osteoporosis
Oral bisphosphonates
HRT, SERMS
Denosumab (biologic)
Teriparatide (human parathyroid therapy)
Clinical subtypes of psoriatic arthritis (5)
Arthritis with DIP joint involvement
Symmetrical polyarthritis - similar to RA
Asymmetrical oligoarthritis - <5 joints
Arthritis mutilans - severe, telescoping digits
Predominant spondylitis - spine
Treatment of psoriatic arthritis
DMARDs (sulfasalazine, methotrexate, leflunomide)
Cyclosporine
Anti-TNFa
Anti-IL-17 and IL-23
Steroids
PT and OT
Axial disease as in AS (PT, NSAIDs, sulfasalzine, Anti-TNFa, Anti-IL-17, osteoporosis, surgery)
What is reactive arthritis
Sterile synovitis after other distant infection
- usually mono or oligoarthritis
- Dactylitis and enthesitis common
What infections can cause reactive arthritis
Salmonella Shigella Campylobacter Chlamydia trachomatis or pneumoniae Borrelia Neisseria Streptococci Yersinia
What prognostic factors indicate chronic reactive arthritis
Hip or heel pain
Increased ESR
FH and HLA-B27 +ve
What skin and mucous membrane manifestations are common in reactive arthritis
Keratoderma blenorrhagica Circinate balantitis Urethritis Conjunctivitis Iritis
What is the triad of circinate balantitis (Reiter’s Syndrome)
Nongonococcal urethritis
Conjunctivitis
Arthritis
Treatment of acute reactive arthritis
NSAID
Joint injection (if no infection)
Abx in chlamydia infection
Treatment of chronic reactive arthritis
NSAID
DMARD - methotrexate or sulfasalazine
What is enteropathic arthritis
Arthritis associated with IBD - can be peripheral and / or axial
Treatment of enteropathic arthritis
(NSAID)
Sulfasalazine, methotrexate
Steroid
Anti-TNFa
Bowel resection may alleviate peripheral disease
