Seronegative Arthritis Flashcards
What is seronegative arthritis?
Arthritis with negative rheumatoid factor
seronegative arthritis is associated with what?
HLA-B27
Asymmetric arthritis
Axial skeleton
Extra-articular features
What extra articular features is seronegative arthritis associated with?
Uveitis
Inflammatory bowel disease
What is the DDx of seronegative arthritis?
Ankylosing spondylitis
Psoriatic arthritis
Bowel-related arthritis
Reactive arthritis
What is Ankylosing Spondylitis?
Chronic inflammatory rheumatic disorder
Axial skeleton and entheses
When does Ankylosing Spondylitis onset?
Males ++
2nd/3rd decade
How is Ankylosing Spondylitis assessed?
Schober test
Spinal mobility (lateral spinal flexion)
Cervical rotation
What are the clinical features of Ankylosing Spondylitis?
Inflammatory back pain
Limited movements in antero-posterior/lateral lumbar planes
Limited chest expansion
Bilateral sacroiliitis on x-rays
How is Sacroiliitis graded radiographically?
Grade 0 - 4 (increasing abnormality)
How is Axial Spondyloarthritis diagnosed?
> 3mo back pain
Age <45
Sacroilitis on imaging OR HLA-B27+ve
HLA-B27 is associated with what conditions?
Ankylosing Spondylitis
Axial Spondyloarthritis
What are the features of Axial Spondyloarthritis?
Inflammatory back pain Arthritis Uveitis Dactylitis Psoriasis Crohns Good response to NSAIDs FH HLA-B27 Raised CRP
How is Ankylosing Spondylitis managed?
Physiotherapy NSAIDs DMARDs (sulfasalazine) Anti-TNF Anti-IL-17 Surgery (joint replacement)
Psoriatic Arthritis affects which joints?
Neck
All of arm/hand
Base of spine
All of leg/foot
Name 2 subtypes of Psoriatic Arthritis?
Arthritis with DIP involvement
Symmetric polyarthritis
Arthritis mutilans
How is Psoriatic Arthritis treated?
Sulfasalazine Methotrexate Leflunomide Cyclosporine Anti-TNF/IL-17 Steroids
What is reactive arthritis?
Sterile synovitis after distant infection
Reactive arthritis is associated with which infections?
Salmonella Shigella Yersina Campylobacter Chlamydia Trachomatis (throat, urogenital, GI)
How does Reactive arthritis present?
Mono/oligoarthritis May be systemic Post-infection Dactylitis Enthesitis Urethritis Conjunctivitis
What are the prognostic signs of Chronic Reactive arthritis?
Hip/heel pain
High ESR
FH
HLA-B27+ve
What is the treatment for acute Reactive arthritis?
NSAIDs
Joint injection
Antibiotics (chlamydia)
What is the treatment for chronic Reactive arthritis?
NSAIDs
DMARDs
What is Enteropathic Arthritis?
Arthritis associated with IBD, Infectious enteritis, Coeliac’s disease
Peripheral/axial disease
How is Enteropathic Arthritis treated?
Sulfasalazine
Steroids
Methotrexate
Anti-TNF
