Seronegative Arthritis

Question 1

what is seronegative arthritis?

Answer 1

> asymmetric arthritis
negative rheumatoid factor
extra-articular features
may be associated with HLA-B27

Question 2

what is ankylosing spondylitis?

Answer 2

chronic inflammatory rheumatic disorder with predilection for axial skeleton and entheses

Question 3

how does ankylosing spondylitis present?

Answer 3

> inflammatory back pain
> limitation of movement in the lateral plane of the lumbar spine and the antero-posterior plane of the spine
> limited chest expansion
> bilateral sacroiliitis on x rays
> other features
 - achilis tendonitis
 - dactylitis
 - uveitis
 - heart block
 - atypical fibrosis
 - IBD
 - osteoporosis
 - cauda equina syndrome
 - secondary amyloidosis

Question 4

what would you check on examination of ankylosing spondylitis?

Answer 4

> cervical rotation
tragus to wall
occiput to wall
lateral spinal flexion

Question 5

what investigation would you carry out in someone with suspected ankylosing spondylitis?

Answer 5

xray

Question 6

what does xray criteria 1 represent in ankylosing spondylitis?

Answer 6

changes present

Question 7

what does xray criteria 2 represent in ankylosing spondylitis?

Answer 7

> minimal abnormalities
erosions
sclerosis
no alteration of joint width

Question 8

what does xray criteria 3 represent in ankylosing spondylitis?

Answer 8

> sacroiliitis
sclerosis
partial ankylosis
widening or narrowing

Question 9

what dies x ray criteria 4 represent in ankylosing spondylitis?

Answer 9

total ankylosis

Question 10

what is the classification criteria of ankylosing spondylitis?

Answer 10

> age less than 45years
more than 3 months of back pain
sacroiliitis plus more SpA features
HLA-B27 plus 2 or more SpA features

Question 11

what is the management of ankylosing spondylitis?

Answer 11

> physiotherapy
> NSAIDs
> anti- IL-T7
> surgery (spinal or joint replacement)
> treat osteoporosis
> anti-TNF
> DMARDs [sulfasalazine]

Question 12

what different types of psoriatic arthritis are there?

Answer 12

> systemic polyarthritis
asymmetric oligoarticular arthritis
arthritis mutilans
predominant spondylitis

Question 13

how does psoriatic arthritis present?

Answer 13

> enthesitis
dactylitis
nail pitting

Question 14

what is the treatment for psoriatic arthritis?

Answer 14

> leflunomide
> methotrexate
> sulfasalazine
> physiotherapy
> occupational therapy
> steroids
> Anti-TNF therapy
> cyclosporine

Question 15

how does enteropathic arthritis present?

Answer 15

> peripheral and/or axial disease

> associated with IBD

Question 16

how is enteropathic arthritis managed?

Answer 16

> sulphasalazine
> bowel resection may alleviate peripheral disease
> anti-TNF
> methotrexate
> steroids

Question 17

what is reactive arthritis?

Answer 17

sterile synovitis after infection

Question 18

what infections cause reactive arthritis?

Answer 18

> borrelia
> shigella
> salmonella
> Neisseria
> trachomatis
> chlamydia
> campylobacter

Question 19

how does infective arthritis present?

Answer 19

> systemic
> mono/oligoarthritis
> dactylitis
> enthesitis
> keratoderma blenorrhagica
> circinate balanitis
> urethritis
> iritis
> conjunctivitis
> recurrent attacks (chlamydia)
> reiters syndomre

Question 20

what is reiters syndrome?

Answer 20

> uveitis
conjunctivitis
arthritis

Question 21

what are the prognostic features for chronicity?

Answer 21

> pain (hip or healing)
high ESR
family history
HLA-B27 positive

Question 22

what is the management of acute reactive arthritis?

Answer 22

> NSAIDs
joint injection
antibiotics (chlamydia)

Question 23

what is the management for chronic reactive arthritis?

Answer 23

> NSAIDs

> DMARD [sulphasalizine] [methotrexate]