Seronegative Arthritis Flashcards
What is seronegative arthritis?
Condition that has tested negative for rheumatoid factor, can be associated with HLA-B27 and is commonly an asymmetric arthritis with involvement of the axial skeleton and extra-articular features
What extra-articular features are associated with seronegative arthritis?
Uveitis, IBD
What are the different clinical presentations of seronegative arthritis?
Ankylosing spondylitis, Juvenile ankylosing spondylitis, Psoriatic arthritis, Bowel related arthritis, Reactive arthritis
What is ankylosing spondylitis?
Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses
What is the common onset of ankylosing spondylitis?
2nd-3rd decade
Is HLA B27 diagnostic of ankylosing spondylitis?
No,
But is +ve in 80-95% of patients with AS
Does the risk of ankylosing spondylitis increase if a family member has it
Yes,
Monozygotic twins risk is 63%,
1st degree relative is 8.2%
What is the spinal mobility- modified schober test?
Patient stands straight and 2 dots are drawn connecting the posterior iliac spine, the next mark is placed 10cm above and the patient bends forward and the difference between the 2 marks is measured. Best of 2 tries is recorded
What is the spinal mobility- lateral spinal flexion test?
Heels and back are against the wall,
There is a mark on the thigh, they bend sideways without bending knees or lifting heels,
They place a second mark and record the difference,
Best of 2 tries are recorded,
A mean is calculated
What are the spinal mobility tests?
Modified schober,
Lateral spinal flexion,
Occiput to wall and tragus to wall,
Cervical rotation
What are the clinical features of Ankylosing spondylitis?
Inflammatory back pain,
Limitations of movement in antero-posterior plane at lumbar spine,
Limitations of movement in lateral planes at lumbar spine,
Limitation of chest expansion,
Bilateral sacroiliitis on xrays
What are the grades of radiographic sacroiliitis?
Grade 0- normal Grade 1- suspicious changes Grade 2- minimal abnormality Grade 3- unequivocal abnormality Grade 4- sever abnormality
What is classed as minimal abnormality on the radiographic sacroiliitis scale?
Small localised areas with erosion or sclerosis, without alteration in the joint width
What is classed as unequivocal abnormality on the radiographic sacroiliitis scale?
Moderate or advanced sacroiliitis with one or more of: erosions, evidence of sclerosis, widening, narrowing, or partial ankylosis
What is classed as severe abnormality on the radiographic sacroiliitis scale?
Total ankylosis
What is diffuse idiopathic skeletal hyperostosis?
bony hardening of ligaments in areas where they attach to your spine
What are the 2 stages of axial spondyloarthritis?
Non-radiographic stage:
Back pain and sacroiliiitis on MRI
Radiographic stage:
Back pain, radiographic sacroiliitis
Back pain, syndesmophytes
What is the ASAS classification criteria for Axial spondyloarthritis (SpA)
Patients with >/= 3 months back pain and age of onset <45years with:
Sacroiliitis on imaging + >/=1 axial spondyloarthritis feature OR
HLA-B27 + >1 other SPA feature
Axial spondyloarthritis features?
Inflammatory back pain, Arthritis, Enthesitis, Uveitis, Dactylitis, Psoriasis, IBD
Signs of Axial spondyloarthritis?
Good response to NSAIDs,
Family history,
HLA-B27,
Elevated CRP
Axial spondyloarthritis cardiac features?
Aortic incompetence, heart block
Axial spondyloarthritis pulmonary features?
Restrictive disease, apical fibrosis
Axial spondyloarthritis GI features?
IBD
Axial spondyloarthritis bone features?
Osteoporosis and spinal fractures
Axial spondyloarthritis neurological features?
Cauda equine syndrome,
Atlantoaxial dislocation
Axial spondyloarthritis renal features?
Secondary amyloidosis
Management of Axial spondyloarthritis?
Physiotherapy, NSAIDs, DMARDs (sulfasalazine), Anti-TNF, Anti-IL-17, Treatment of osteoporosis, Surgery-joint replacement and spinal surgery
What is enthesitis?
Inflammation of site of insertion of tendon or ligament into bone
