Seronegative arthritis Flashcards
What is rheumatoid factor?
Immune cells that attack healthy cells in the body
What are general features of seronegative arthritis?
Negative rheumatoid factor May be associated with HLA-B27 Usually asymmetric Involvement of axial skeleton Enthesitis Extra-articular features - uveitis, IBD
What are different clinical presentations of seronegative arthritis?
Ankylosing spondylitis
Psoriatic arthritis
Bowel related arthritis (Crohn’s, UC)
Reactive arthritis
What is spondyloarthropathy?
Disease of the joints of the vertebral column
What is ankylosing spondylitis?
Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses
What is an enthesis?
Connective tissue between tendon/ligament and bone
What is the normal age of onset for ankylosing spondylitis?
Second to third decade of life
Is ankylosing spondylitis more common in males or females?
Males
What is the Modified Schober Test?
Mark a line connecting both posterior superior iliac spines
Make a mark 10cm above this line
Patient bends forward maximally - distance between 2 marks is measured
Report increase to the nearest 0.1cm
Best of two tries
How is lateral spinal flexion assessed?
Heels and back against a wall - no flexion in knees and no bending forward
Place a mark on the thigh, bend sideways without bending knees or lifting heels, without moving shoulders or hip
Place a second mark and record the difference
Best of 2 tries on each leg
How is occiput/tragus to wall measured for spinal mobility?
Heels and back rest against wall
Chin at normal level
Maximal effort to move the head against the wall
Report best of 2 tries for occiput to wall distance and mean of left and right tragus to wall distance
How is cervical rotation assessed?
Patient sits on a chair, chin at usual level, hands on knees
Assessor places a goniometer at top of head in line with the nose
Patient rotates neck maximally to one side, followed with goniometer
Angle between sagital plane and new plane is recorded
2 readings are taken for each side
The mean of each side is recorded
What are 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 is grading for Radiographic sacroiliitis?
Grade 0 - normal
Grade 1 - suspicious change
Grade 2 - Minimal abnormality - small localised areas with erosion or sclerosis without alteration in joint width
Grade 3 - unequivocal abnormality - moderate or advanced sacroiliitis with one or more of: Erosions, evidence of sclerosis, widening, narrowing, or partial ankylosis
Grade 4 - severe abnormality - total ankylosis
What are features of ankylosing spondylitis outside of the axial skeleton?
Peripheral joints - hips, shoulders, knees
Achilles tendonitis, dactylitis
Uveitis
Cardiac - aortic incompetence, heart block
Pulmonary - Restrictive disease, apical fibrosis
GI - IBD
Osteoperosis and spinal fractures
Neurological - autoimmune autistic disorder, cauda equina syndrome
Renal - secondary amyloidosis
