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Musculo-skeletal > Seronegative Arthritis > Flashcards

Seronegative Arthritis Flashcards

1
Q

What are the features of seronegative arthritis?

A
  • Negative rheumatoid factor
  • May be associated with HLA-B27
  • Usually asymmetric
  • Involvement of axial skeleton (spine)
  • Enthesitis (inflamm of where the tendon or ligament inserts into the bone)
  • Extra articular features: uveitis and IBD
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2
Q

What are the different types of seronegative arthritis?

A
  • Ankylosing Spondylitis
  • Psoriatic arthritis
  • Bowel related arthritis (IBD)
  • Reactive arthritis
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3
Q

What is ankylosing spondylitis?

A

Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses

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4
Q

Which groups of patients are most likely to be affected by ankylosing spondylitis?

A
  • Onset 20-30s

- Males > females

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5
Q

Is HLA B27 diagnostic of ankylosing spondylitis?

A

No - whilst it is positive in most patients with AS it is also present in approx. 10% of the general population of which only 1% have AS

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6
Q

Which tests can be used to assess a patient’s spinal mobility?

A
  • Modified Schober
  • Lateral Spine Flexion
  • Occiput to wall and tragus to wall
  • Cervical rotation
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7
Q

What are the clinical features of AS (NY criteria)?

A
  • Inflammatory back pain
  • Limitation of movements in antero-posterior as well as lateral planes at the lumbar spine
  • Limitation of chest expansion
  • Bilateral sacroiliitis on X-rays
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8
Q

How is radiographic sacroiliitis graded?

A 
Grade 0: normal
Grade 1: suspicious changes
Grade 2: minimal abnormality
Grade 3: Unequivocal abnormality
-Grade 4: Severe abnormality (total ankylosis)
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9
Q

What are the features of axial spondlyoarthritis (SpA)?

A
  • Inflammatory back pain
  • Arthritis
  • Enthesitis (heel)
  • Uveitis
  • Dactylitis
  • Psoriasis
  • Crohn’s/colitis
  • Good response to NSAIDs
  • FH
  • HLA-B27
  • Elevated CRP
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10
Q

What are the ASAS classification criteria for SpA?

A
  • Patients with > 3 months back pain
  • Age of onset < 45yrs
  • Sacroiliitis on imaging + 1 or more SpA features OR
  • HLA-B27 + 2 other SpA features
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11
Q

Name some of the other features of SpA

A
  • Peripheral joint involvement (hips/shoulders/knees)
  • Achilles tendonitis, dactylitis
  • Aortic incompetence, heart block
  • Restrictive lung disease, apical fibrosis
  • Neuro: AAD and cauda equina syndrome
  • Renal: secondary amyloidosis
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12
Q

What are the management options for AS?

A
  • Physio
  • NSAIDs
  • DMARDs - sulfasalazine
  • Anti-TNF
  • Anti-IL-17
  • Treatment of osteoporosis
  • Surgery: joint replacements and spinal surgery
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13
Q

Which joints are commonly affected by psoriatic arthritis?

A

Neck, shoulder, elbows, wrists, all joints of knuckles/thumbs/fingers, base of spine, knees, ankles and all joints of the toes

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14
Q

What are the clinical subtypes of psoriatic arthritis?

A
  • Arthritis with DIP joint involvement
  • Symmetric polyarthritis
  • Asymmetric oligoarticular arthritis
  • Arthritis mutilans
  • Predominant spondylitis
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15
Q

What are the treatment options for psoriatic arthritis?

A
  • Sulfasalazine
  • Methotrexate
  • Leflunomide
  • Cyclosporine
  • Anti-TNF therapy
  • Anti-IL-17 and IL-23
  • Steroids
  • Physio and OT
  • Axial disease is treated similar to AS
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16
Q

What is reactive arthritis?

A

Sterile synovitis after distant infection

17
Q

Which organisms are most likely the cause of reactive arthritis?

A

Salmonella, shigella, yersinia, campylobacter, chlamydia trachomatis or pneumoniae, borellia, neisseria and strep

18
Q

Which skin and mucous membrane features may be seen in reactive arthrits?

A
  • Keratoderma blenorrhagica (skin lesions on the palm and soles)
  • Circinate balanitis (ring shaped dermatitis on the glans penis)
  • Conjunctivitis
  • Iritis
19
Q

What are the features of Reiter’s syndrome?

A

Arthritis, urethritis and conjunctivitis

20
Q

What are the prognostic signs for the chronicity of reactive arthritis?

A
  • Hip/heel pain
  • High ESR
  • FH history and positive HLA-B27
21
Q

What are the treatment options for acute reactive arthritis?

A
  • NSAIDs
  • Joint injection (if infection excluded)
  • Antibiotics in chlamydia infection
22
Q

What are the treatment options for chronic reactive arthritis?

A
  • NSAIDs

- DMARD (e.g. sulphasalazine, methotrexate)

23
Q

Which conditions are associated with enteropathic arthritis?

A
  • Commonly: IBD

- Rarely: infectious enteritis, Whipple’s disease and coeliac disease

24
Q

How does enteropathic arthritis present?

A
  • Peripheral and/or axial disease

- Enthesopathy

25
Q

What are the treatment options for enteropathic arthritis?

A
  • Sulfasalazine
  • Steroids
  • Methotrexate
  • Anti-TNF
  • Bowel resection may alleviate peripheral disease
  • NSAIDs difficult to use

Musculo-skeletal (27 decks)

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