Seronegative Arthritis Flashcards
What is seronegative arthritis?
Negative rheumatoid factor that may be associated with HLA-B27.
Usually presents with an asymmetric arthritis that involves the spine.
Enthesitis, uveitis and IBS are all other possible features.
What is enthesitis?
Inflammation of the entheses - the site where tendons or ligaments insert into the bone.
What are some different clinical presentations of seronegative arthritis?
Ankylosing Spondylitis
Psoriatic arthritis
Bowel related arthritis (Crohn’s, UC)
Reactive arthritis
What is Ankylosing Spondylitis?
Prototype for axial sponyloarthritis.
It is a chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses.
Onset occurs in second to third decade of life.
M>F
What are some investigations used to asses mobility in seronegative arthritis patients?
Modified Schober test - measures spinal flexion.
Lateral spinal flexion
Occiput to the wall and Tragus to the wall
Cervical rotation
What are the clinical features of Ankylosing Spondylitis?
Inflammatory back pain
Limitation of movements in anterograde-posterior as well as lateral planes at lumbar spine.
Limitation of chest expansion
Bilateral sacroiliitis on x-rays
What are the different grades of sacroiliitis?
0 = normal 1 = suspicious changes 2 = minimal abnormality - small localised areas with erosion or sclerosis without alteration in the joint width. 3 = unequivocal abnormality - moderate or advanced sacroiliitis with 1 or more of erosions, evidence of sclerosis, widening, narrowing or partial ankylosis. 4 = severe abnormality - total ankylosis.
What are some features of diffuse idiopathic skeletal hyperostosis?
Unilateral bulky bringing spondylophytes mimicking mixed syndesmophytes.
Extensive calcification of the anterior spinal ligament.
What is a syndesmophyte?
A bony growth originating within ligament. Commonly seen in ligaments between intervertebral joints leading to vertebral fusion.
What is the ASAS classification criteria for axial spondyloarthritis (SpA)?
In patients with > 3 months back pain and age at onset <45years then sacroiliitis on imaging + >or= 1 SpA feature
OR
HLA-B27 + >or= 2other SpA features.
What are considered the main SpA features?
Inflammatory back pain Arthritis Enthesitis (heel) Uveitis Dactylitis Psoriasis Crohn's/colitis Good response to NSAIDs Family Hx for SpA HLA-B27 Elevated CRP
What are some other features of SpA?
Peripheral joints affected - hips, shoulders, knees Achilles tendonitis Aortic incompetence Heart Block Pulmonary restrictive disease Apical fibrosis IBD Osteoporosis Spinal fractures AAD Cauda equina syndrome Secondary amyloidosis
Was are some management options of Ankylosing Spondylitis?
Physio NSAIDs DMARDs - sulfasalzine Anti-TNF Anti-IL-17 Treatment of osteoporosis Surgery - joint replacement & spinal surgery.
What joints are commonly affected by psoriatic arthritis?
Neck Shoulder Elbows Base of spine Wrists Knuckles, fingers and thumbs Knees Ankles Toes
What are some clinical subtypes of psoriatic arthritis?
Arthritis with DIP involvement Symmetric polyarthritis Asymmetric oligoarticular arthritis Arthritis mutilans Predominant spondylitis
What are the treatment options for psoriatic arthritis?
Sulfasalazine Methotrexate Leflunomide Cyclosporine Anti-TNF therapy Anti-IL-17 and IL-23 Steroids Physio OT Axial disease treated similar to AS.
What is reactive arthritis?
Sterile synovitis after distant infection.
Usually mono or oligoarthrtis with dactylitis or enthesitis also seen.
What are the cause of infections in reactive arthritis and where in the body do they occur?
Salmonella Shigella Yersinia Campylobacter Chlamydia trachomatis/pneumoniae Borrelia Neisseria Streptococci
Occur in throat, urogenital and GI.
How are skin and mucous membranes involved in reactive arthritis?
Keratoderma blenorrhagica Circinate balanitis Urethritis Conjunctivitis Iritis
What is Reiter’s syndrome?
Arthritis
Urethritis
Conjunctivitis
What are some prognostic signs for chronicity in reactive arthritis?
Hip/heep pain
High ESR
Family Hx and HLA-B27 positive.
What is the treatment for acute reactive arthritis?
NSAIDs
Joint injection in infection excluded
Antibiotics in chlamydia infection
What is the treatment for chronic reactive arthritis?
NSAIDs
DMARD e.g sulphasalazine, methotrexate.
What is enteropathic arthritis?
Commonly associated with inflammatory bowel disease (Crohn’s or UC).
Rarely seen with infectious enteritis, Whipple’s disease and Coeliac disease.
Can be present with both peripheral and/or axial disease.
Enthesopathy commonly seen.
What is the treatment for enteropathic arthritis?
NSAIDs are difficult to use. Sulfasalazine Steroids Methotrexate Anti-TNF Bowel resection may alleviate peripheral disease.
