Seronegative Arthritis Flashcards
What are the characteristics of seronegative arthritis?
- Negative rheumatoid factor
- May have association with HLA-B27 gene
- Usually asymmetric arthritis
- Potential involvement of whole spine
- Enthesitis (can be initial lesion, inflammation can start here and spread to joints)
- Extra-articular features- uveitis, inflammatory bowel disease
What are the possible clinical presentations of seronegative arthritis?
- Ankylosing Spondylitis
- Psoriatic arthritis
- Bowel related arthritis (Crohn’s, UC)
- Reactive arthritis
- Others
What is ankylosing spondylitis?
A chronic inflammatory rheumatic disorder affecting the axial skeleton and entheses
Onset is usually in second to third decade
More common in males than females
Prevalence varies throughout the world
What gene is associated with seronegative arthritis?
HLA B-27
Not diagnostic of either seronegative arthritis or ankylosing spondylitis but most patients of these conditions are positive of the gene
How can spinal mobility be assessed?
- Modified Schober
- Lateral spinal flexion
- Occiput to wall or tragus to wall
- Cervical rotation
What are the clinical features of ankylosing spondylitis?
- 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
What are the less common features of ankylosing spondylitis?
- Peripheral joints - Hips, shoulders, knees
- Achilles tendonitis, dactylitis
- Uveitis
- Cardiac- Aortic incompetence, heart block
- Pulmonary- restrictive disease, apical fibrosis
- GI- IBD
- Osteoporosis and spinal fractures
- Neurological- AAD & cauda equina syndrome
- Renal- secondary amyloidosis
How is ankylosing spondylitis managed?
- Physiotherapy (most important)
- NSAIDs
- DMARDs- Sulfasalazine
- Anti-TNF
- Anti-IL-17
- Treatment of osteoporosis
- Surgery- joint replacements & spinal surgery
What joints are commonly affected by psoriatic arthritis?
- Neck
- Shoulder
- Back of spine
- Elbow
- Wrist
- All joints of hand
- Knees
- Ankles
- All joints of feet
What are the clinical subtypes of psoriatic arthritis?
- Arthritis with DIP joint involvement
- Symmetric polyarthritis- similar to RA
- Asymmetric oligoarticular arthritis
- Arthritis mutilans
- Predominant spondylitis
What is the treatment of psoriatic arthritis?
- Sulfasalazine
- Methotrexate
- Leflunomide
- Cyclosporine
- Anti-TNF therapy
- Anti- IL-17 and IL-23
- Steroids
- Physiotherapy and occupational therapy
- Axial disease treated similar to AS
What are the characteristics of reactive arthritis?
Sterile synovitis after a distant infection
Infections can include salmonella, shigella, campylobacter, chlamydia or pneumoniae
Common infection sites are the throat, urinary tract and gastrointestinal tract
Skin and mucous membranes can also be involved
What are the prognostic indicators for chronicity in reactive arthritis?
High ESR
Heel or hip pain
Family history
How is reactive arthritis treated?
• Acute
– NSAID
– Joint injection (if infection excluded)
– antibiotics in chlamydia infection (contacts as well)
• Chronic
– NSAID
– DMARD (e.g. sulphasalazine, methotrexate)
What are the characteristics of enteropathic arthritis?
Commonly associated with IBD
Can be present with either axial or peripheral disease
Enthesopathy also commonly seen
Rarely seen with coeliac disease, Whipples disease or infectious arthritis
