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E - MSK > Seronegative Arthritis > Flashcards

Seronegative Arthritis Flashcards

1
Q

What is seronegative arthritis

A

Arthritis with negative rheumatic factor

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2
Q

What gene is seronegative arthritis associated with

A

HLA-B27

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3
Q

What are the different seronegative conditions

A

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic (bowel-related) arthritis

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4
Q

What is Ankylosing Spondylitis

A

Arthritis affecting the spinal joints, sacroiliac most commonly, can also affect shoulder and hips and other entheses

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5
Q

Peak onset of Ankylosing Spondylitis

A

20-30 years in MALES > females

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6
Q

Clinical features of AK (NY criteria)

A

Inflammatory back pain
Limited movement in anteroposterior & lateral lumbar spine
Limited chest expansion
Bilateral sacroilitis on x-ray

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7
Q

What is pain like in AS

A

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

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8
Q

What can axial SpondyloArthritis be divided into

A
  1. Radiographic axial SpondyloArthritis (Ankylosing Spondylitis)
    - back pain
    - radiographic sacroilitis
    - syndesmophytes (later)
  2. Non-radiographic axial SpondyloArthritis (less severe early AS)
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9
Q

ASAS classification for Axial SpondyloArthritis

A

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

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10
Q

What are the SpA features (11)

A 
Inflammatory back pain 
Arthritis 
Enthesitis of heel 
Uveitis 
Dactylitis
Psoriasis 
Crohn's / Colitis 
Good response to NSAIDs
FH for SpA
HLA-B27
Elevated CRP
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11
Q

What spinal mobility tests can assess for AS

A

Modified Schober test (lumbar flexion)
Lateral spinal flexion
Occiput to wall and Tragus to wall
Cervical Rotation

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12
Q

Grading of radiographic sacroilitis

A

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

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13
Q

What is diffuse idiopathic skeletal hyperostosis

A

A condition causing ligaments to become calcified and hard leading to bones looking overgrown on x-ray.
Commonly confused with AS

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14
Q

Management of AS

A 
Physiotherapy 
NSAIDs
Sulfasalzine (DMARDS)
Anti-TNFa
Anti IL-17
Treatment of osteoporosis 
Surgery - joint replacements &amp; spinal surgery
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15
Q

Who benefits most from NSAIDs in treatment of AS

A

Patients with risk factors for radiographic spinal progression - syndesmophytes and elevated CRP

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16
Q

Treatment of Osteoporosis

A

Oral bisphosphonates
HRT, SERMS
Denosumab (biologic)
Teriparatide (human parathyroid therapy)

17
Q

Clinical subtypes of psoriatic arthritis (5)

A

Arthritis with DIP joint involvement
Symmetrical polyarthritis - similar to RA
Asymmetrical oligoarthritis - <5 joints
Arthritis mutilans - severe, telescoping digits
Predominant spondylitis - spine

18
Q

Treatment of psoriatic arthritis

A

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)

19
Q

What is reactive arthritis

A

Sterile synovitis after other distant infection

  • usually mono or oligoarthritis
  • Dactylitis and enthesitis common
20
Q

What infections can cause reactive arthritis

A 
Salmonella 
Shigella
Campylobacter
Chlamydia trachomatis or pneumoniae
Borrelia Neisseria 
Streptococci 
Yersinia
21
Q

What prognostic factors indicate chronic reactive arthritis

A

Hip or heel pain
Increased ESR
FH and HLA-B27 +ve

22
Q

What skin and mucous membrane manifestations are common in reactive arthritis

A 
Keratoderma blenorrhagica 
Circinate balantitis 
Urethritis 
Conjunctivitis 
Iritis
23
Q

What is the triad of circinate balantitis (Reiter’s Syndrome)

A

Nongonococcal urethritis
Conjunctivitis
Arthritis

24
Q

Treatment of acute reactive arthritis

A

NSAID
Joint injection (if no infection)
Abx in chlamydia infection

25
Q

Treatment of chronic reactive arthritis

A

NSAID

DMARD - methotrexate or sulfasalazine

26
Q

What is enteropathic arthritis

A

Arthritis associated with IBD - can be peripheral and / or axial

27
Q

Treatment of enteropathic arthritis

A

(NSAID)
Sulfasalazine, methotrexate
Steroid
Anti-TNFa

Bowel resection may alleviate peripheral disease

E - MSK (29 decks)

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