Seronegative arthritis Flashcards
what is seronegative arthritis?
negative rheumatic factor
asymmetric arthritis
involvement of axial skeleton
enthesitis
what extra articular features are associated with seronegative arthritis?
uveitis
inflammatory bowel disease
what gene is associated with seronegative arthritis?
HLA-B27
what are the different types of seronegative arthritis?
ankylosing spondylitis
psoriatic arthritis
bowel related arthritis (crowns, UC)
reactive arthritis
what is enthesitis?
inflammation of the entheses with is the attachment of ligament or tendon to the bone
what is ankylosing spondylitis?
it is a type of seronegative arthritis
chronic inflammatory rheumatic disorder
it mainly affects the axial skeleton and entheses
when is the onset of ankylosing spondylitis?
2nd to 3rd decade
males > females
what is the familial association with HLA B27?
1st degree relative 8.2%
parent - child 7.8%
how is someones spinal mobility assessed in ankylosing spondylitis?
modified schober test measure 10cm above sacroiliac joint and 5cm below - lateral flexion - cervical rotation - OCCIPUT TO WALL AND TRAGUS TO WALL
What are the clinical features of ankylosing spondylitis?
inflammatory back pain
limitations of movements in the anterograde-posteiror as well as lateral planes at lumber
limitation of chest expansion
bilateral sacroilitis on x-rays
what is the criteria for axial spondyloarthritis?
patients with > 3 months back pain and at age of onset < 45yrs
sacroilitis on image plus >1 SpA feature
HLA-B27 plus >2 SpA features
what are the other features of ankylosing spondylitis ?
peripheral joints- hips, shoulders, knees
achillies tendonitis, dactylitis
uveitis
cardiac- arctic regurgitation, heart block
pulmonary - apical fibrosis, restrictive disease
IBD
osteoporosis and spinal fractures
atlanto axial dislocation
cauda equina syndrome
secondary amyloidosis
management of ankylosing spondylitis.
physiotherapy NSAIDS sulfazalazine anti-TNF anti IL-17 surgery joint replacement
where does psoriatic arthritis most commonly affect?
distal interphalangeal joints
what are the clinical subtypes of psoriatic arthritis?
arthritis with distal interphalangeal joint involvement symmetric polyarthritis (similar to rheumatoid arthritis) also characterised by dactylitis and ethensitis
what is the treatment for psoriatic arthritis?
sulfazalazine methotrexate leflunomide anti-TNF therapy steroids physiotherapy
what is reactive arthritis?
sterile synovitis after distant infection
recurrent attacks common in chlamydia induced arthritis
usually mono or oligoarthritis
what infections can cause reactive arthritis?
salmonella shigella yersinia campylobactera chlamydia neisseria streptococci
what is Reiter’s syndrome?
found in reactive arthritis
- arthritis
- urethritis
- conjunctivitis
what are prognostic signs for chronic reactive arthritis?
heel/hip pain
HLA B27 +
family history
high ESR
what is the reactive arthritis treatment?
NSAIDS
joint injection
antibiotic in chlamydia infection
chronic: NSAIDS, DMARD
what is enteropathic arthritis?
a form of chronic inflammatory arthritis with occurrence of an inflammatory bowel disease
can present with peripheral or axial disease
enthesopathy
where does enteropathic arthritis commonly affect?
axial and/or peripheral
what is the treatment for enteropathic arthritis?
NSAIDS sulfasalazine steroids methotrexate anti-TNF bowel resection
what is characteristic in the history of someone with ankylosing spondylitis?
inflammatory back pain
early morning stiffness
improvement with activity
what is Reiter’s syndrome?
arthritis
urethritis
conjunctivitis
what are the features of a bamboo spine in ankylosing spondylitis?
squaring of vertebral bodies
subchondral sclerosis
syndesmophytes
ossification of ligaments, joints and discs
fusion of facets, sacroiliac and costovertabral joints
