Seronegative Arthritis

Question 1

What is spondyloarthritis?

Answer 1

Seronegative arthritis

Question 2

What is seronegative arthritis?

Answer 2

Negative rheumatoid factor
May be associated with HLA- B27
Usually an asymmetric arthritis
Involvement of axial skeleton (spine)
Enthesitis
Extra-articular features- uveitis, inflammatory bowel disease

Question 3

What are the clinical presentations of seronegative arthritis?

Answer 3

Ankylosing Spondylitis
Psoriatic arthritis
Bowel related arthritis (Crohn’s, UC)
Reactive arthritis
Others

Question 4

What are entheses?

Answer 4

The connective tissue between tendon or ligament and bone

Question 5

Ankylosing spondylitis

Answer 5

Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses
HLA B27 not diagnostic but positive in majority of patients

Question 6

AS clinical features

Answer 6

Inflammatory back pain
Limitation of movements in antero-posterior as well as lateral planes at lumbar spine
Limitation of chest expansion
Bilateral sacroiliitis on X-rays

Question 7

Management of AS

Answer 7

Physiotherapy
NSAIDs
DMARDs- Sulfasalazine
Anti-TNF
Anti-IL-17 
Treatment of osteoporosis
Surgery- joint replacements & spinal surgery

Question 8

What is reactive arthritis?

Answer 8

Sterile synovitis after a distant infection
Usually mono or oligoarthritis
Skin and mucous membrane involvement

Question 9

Treatment of reactive arthritis

Answer 9

NSAID
Antibiotics in chlamydia infection
DMARD

Question 10

Enteropathic arthritis

Answer 10

Commonly associated with inflammatory bowel disease (Crohn’s or UC)
Rarely seen with infectious enteritis, Whipple’s disease and Coeliac disease
Can present with both peripheral and/or axial disease
Enthesopathy commonly seen

Question 11

Treatment for most arthritis

Answer 11

NSAIDs
Sulfasalazine
Methotrexate
Anti-TNF
Steroids