Seronegative arthritis

Question 1

What is seronegative arthritis?

Answer 1

Typically an asymmetrical arthritis may be associated with HLA-B27
Can involve the axial skeletom and have extra articular features such as uveitis, IBD

Question 2

How can seronegative arthritis present?

Answer 2

Ankylosing spondylitis
Psoriatic arthritis
Bowel related arthritis (crohn’s, UC)
Reactive arthritis

Question 3

What is ankolysisng spondylitis

Answer 3

Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses. Onset in second to third decade of life
Prevalence varies in different parts of the world

Question 4

What tests can be done to assess if a patient has ankylosing spondylitis?

Answer 4

Spinal mobility- flex spine and measure distance between the PSIS
Lateral spinal flexion. Keeping everything in the lower limbs extended, reach as far down each side
Occipital process to wall
Cervical rotation- done above the patient with a curvy ruler

Question 5

What are the clinical features of ankylosing spondylitis

Answer 5

Inflmammatory back pain
Limitation of movement in antero-posterior as well as lateral planes at lumbar spines
limitation of chest expansion
Bilateral sacroilitis on x-rays

Question 6

What are the grades of axial spondyloarthritis

Answer 6

Back pain, sacroilitis on MRI- stage 1
Back pain, radiographic sacroilitis
Back pain, syndesmophytes

Question 7

How do you classify patients with axial spondyloarhtirtis

Answer 7

Sacroilitis on imaging plus one or more SPA feature

HLA-B27 gene plus 2 or more SpA features?

Question 8

What are SpA features?

Answer 8

Inflammaotry back pain
Arthritis
Uveitis
Psoriaisi
Crohns/colitis
Good repsonse to NSAIDS
family history
elevated CRP

Question 9

How do you manage Ankolysing spondylitis?

Answer 9

Physiotherapy
NSAIDS
DMARDs-sulfasalazine
Anti- TNF
Anti-IL-17
Treatment of osteoperosis
Surgery- joint replacements ad spinal surgery.

Question 10

What is psoriatic arthritis

Answer 10

Arthritis with DIP joint involvement
Symmetric polyarthritis- similar to RA
asymmetric oligoarticular athritis
Athritis mutilans
Predominant spondylitis

Question 11

What is the treatment of psoriatic athritis?

Answer 11

Sulfasazine
Methotrexate
Leflunomide
Cyclosporine
Anti-TNF therapy
Anti-IL-17 and IL-23
Steroids
Physio

Question 12

What is reactive athritis

What can cause it?

Answer 12

Sterile synovitis after distant infection

Salmonella, shigella, yersinia, campylobacter, chlamydia, streptococci
Throat urogenital and GI infections

Question 13

Reactive arthritis can cause rashes.What can be seen in the skin and mucous membrane?

Answer 13

Keratoderma blenorrhagica
Circinate balantis
Urethritis
Conjuctivitis
Iritis

Question 14

When are recurrent attacks common in reactive arthritis?

What is reiter’s syndrome

What are prognostic signs for chronicity

Answer 14

Chlamydia induced athritis

Arthritis, urethritis and conjunctivitis

Hip/heel pain, high ESR, FH and HLA-B27 positive

Question 15

How do you treat reactive arthritis

Answer 15

Acute-NSAIDS, joint injection, antibiotics

Chronic- NSAIDS, DMARD (e.g. sulphasalazine, methotrexate)

Question 16

What is enteropathic arthrits

Answer 16

Commonly associated with IBD
Rarely seen with infectious enteritis, whipples disease and coeliac disease
Can present with both peripheral and/or axial disease
Enthesopathy commonly seen

Question 17

How do you treat enteropathic arthiritis

Answer 17

NSAIDS difficult
Sulfasalazine 
Streoids
Methotrexate
ANTI-TNF
bowel resection may alleviate peripheral disease