Seronegative Arthritis

Question 1

What is seronegative arthritis?

Answer 1

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

Question 2

What extra-articular features are associated with seronegative arthritis?

Answer 2

Uveitis, IBD

Question 3

What are the different clinical presentations of seronegative arthritis?

Answer 3

Ankylosing spondylitis, 
Juvenile ankylosing spondylitis,
Psoriatic arthritis, 
Bowel related arthritis,
Reactive arthritis

Question 4

What is ankylosing spondylitis?

Answer 4

Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses

Question 5

What is the common onset of ankylosing spondylitis?

Answer 5

2nd-3rd decade

Question 6

Is HLA B27 diagnostic of ankylosing spondylitis?

Answer 6

No,

But is +ve in 80-95% of patients with AS

Question 7

Does the risk of ankylosing spondylitis increase if a family member has it

Answer 7

Yes,
Monozygotic twins risk is 63%,
1st degree relative is 8.2%

Question 8

What is the spinal mobility- modified schober test?

Answer 8

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

Question 9

What is the spinal mobility- lateral spinal flexion test?

Answer 9

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

Question 10

What are the spinal mobility tests?

Answer 10

Modified schober,
Lateral spinal flexion,
Occiput to wall and tragus to wall,
Cervical rotation

Question 11

What are the clinical features of Ankylosing spondylitis?

Answer 11

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

Question 12

What are the grades of radiographic sacroiliitis?

Answer 12

Grade 0- normal 
Grade 1- suspicious changes
Grade 2- minimal abnormality 
Grade 3- unequivocal abnormality
Grade 4- sever abnormality

Question 13

What is classed as minimal abnormality on the radiographic sacroiliitis scale?

Answer 13

Small localised areas with erosion or sclerosis, without alteration in the joint width

Question 14

What is classed as unequivocal abnormality on the radiographic sacroiliitis scale?

Answer 14

Moderate or advanced sacroiliitis with one or more of: erosions, evidence of sclerosis, widening, narrowing, or partial ankylosis

Question 15

What is classed as severe abnormality on the radiographic sacroiliitis scale?

Answer 15

Total ankylosis

Question 16

What is diffuse idiopathic skeletal hyperostosis?

Answer 16

bony hardening of ligaments in areas where they attach to your spine

Question 17

What are the 2 stages of axial spondyloarthritis?

Answer 17

Non-radiographic stage:
Back pain and sacroiliiitis on MRI

Radiographic stage:
Back pain, radiographic sacroiliitis
Back pain, syndesmophytes

Question 18

What is the ASAS classification criteria for Axial spondyloarthritis (SpA)

Answer 18

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

Question 19

Axial spondyloarthritis features?

Answer 19

Inflammatory back pain,
Arthritis,
Enthesitis,
Uveitis,
Dactylitis,
Psoriasis,
IBD

Question 20

Signs of Axial spondyloarthritis?

Answer 20

Good response to NSAIDs,
Family history,
HLA-B27,
Elevated CRP

Question 21

Axial spondyloarthritis cardiac features?

Answer 21

Aortic incompetence, heart block

Question 22

Axial spondyloarthritis pulmonary features?

Answer 22

Restrictive disease, apical fibrosis

Question 23

Axial spondyloarthritis GI features?

Answer 23

IBD

Question 24

Axial spondyloarthritis bone features?

Answer 24

Osteoporosis and spinal fractures

Question 25

Axial spondyloarthritis neurological features?

Answer 25

Cauda equine syndrome,

Atlantoaxial dislocation

Question 26

Axial spondyloarthritis renal features?

Answer 26

Secondary amyloidosis

Question 27

Management of Axial spondyloarthritis?

Answer 27

Physiotherapy,
NSAIDs,
DMARDs (sulfasalazine),
Anti-TNF, 
Anti-IL-17,
Treatment of osteoporosis,
Surgery-joint replacement and spinal surgery

Question 28

What is enthesitis?

Answer 28

Inflammation of site of insertion of tendon or ligament into bone