Seronegative arthritis

Question 1

what is seronegative arthritis?

Answer 1

negative rheumatic factor
asymmetric arthritis
involvement of axial skeleton
enthesitis

Question 2

what extra articular features are associated with seronegative arthritis?

Answer 2

uveitis

inflammatory bowel disease

Question 3

what gene is associated with seronegative arthritis?

Answer 3

HLA-B27

Question 4

what are the different types of seronegative arthritis?

Answer 4

ankylosing spondylitis
psoriatic arthritis
bowel related arthritis (crowns, UC)
reactive arthritis

Question 5

what is enthesitis?

Answer 5

inflammation of the entheses with is the attachment of ligament or tendon to the bone

Question 6

what is ankylosing spondylitis?

Answer 6

it is a type of seronegative arthritis
chronic inflammatory rheumatic disorder
it mainly affects the axial skeleton and entheses

Question 7

when is the onset of ankylosing spondylitis?

Answer 7

2nd to 3rd decade

males > females

Question 8

what is the familial association with HLA B27?

Answer 8

1st degree relative 8.2%

parent - child 7.8%

Question 9

how is someones spinal mobility assessed in ankylosing spondylitis?

Answer 9

modified schober test 
measure 10cm above sacroiliac joint and 5cm below 
- lateral flexion
- cervical rotation
- OCCIPUT TO WALL AND TRAGUS TO WALL

Question 10

What are the clinical features of ankylosing spondylitis?

Answer 10

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

Question 11

what is the criteria for axial spondyloarthritis?

Answer 11

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

Question 12

what are the other features of ankylosing spondylitis ?

Answer 12

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

Question 13

management of ankylosing spondylitis.

Answer 13

physiotherapy
NSAIDS
sulfazalazine 
anti-TNF 
anti IL-17
surgery joint replacement

Question 14

where does psoriatic arthritis most commonly affect?

Answer 14

distal interphalangeal joints

Question 15

what are the clinical subtypes of psoriatic arthritis?

Answer 15

arthritis with distal interphalangeal joint involvement 
symmetric polyarthritis (similar to rheumatoid arthritis) 
also characterised by dactylitis and ethensitis

Question 16

what is the treatment for psoriatic arthritis?

Answer 16

sulfazalazine 
methotrexate 
leflunomide
anti-TNF therapy 
steroids
physiotherapy

Question 17

what is reactive arthritis?

Answer 17

sterile synovitis after distant infection
recurrent attacks common in chlamydia induced arthritis
usually mono or oligoarthritis

Question 18

what infections can cause reactive arthritis?

Answer 18

salmonella
shigella
yersinia
campylobactera
chlamydia
neisseria
streptococci

Question 19

what is Reiter’s syndrome?

Answer 19

found in reactive arthritis

• arthritis
• urethritis
• conjunctivitis

Question 20

what are prognostic signs for chronic reactive arthritis?

Answer 20

heel/hip pain
HLA B27 +
family history
high ESR

Question 21

what is the reactive arthritis treatment?

Answer 21

NSAIDS
joint injection
antibiotic in chlamydia infection
chronic: NSAIDS, DMARD

Question 22

what is enteropathic arthritis?

Answer 22

a form of chronic inflammatory arthritis with occurrence of an inflammatory bowel disease
can present with peripheral or axial disease
enthesopathy

Question 23

where does enteropathic arthritis commonly affect?

Answer 23

axial and/or peripheral

Question 24

what is the treatment for enteropathic arthritis?

Answer 24

NSAIDS
sulfasalazine 
steroids
methotrexate
anti-TNF
bowel resection

Question 25

what is characteristic in the history of someone with ankylosing spondylitis?

Answer 25

inflammatory back pain
early morning stiffness
improvement with activity

Question 26

what is Reiter’s syndrome?

Answer 26

arthritis
urethritis
conjunctivitis

Question 27

what are the features of a bamboo spine in ankylosing spondylitis?

Answer 27

squaring of vertebral bodies
subchondral sclerosis
syndesmophytes
ossification of ligaments, joints and discs
fusion of facets, sacroiliac and costovertabral joints