seronegative arthritis

Question 1

what is seronegative arthritis ?

Answer 1

negative rheumatoid factor
usually asymmetric arthritis
involvement of axial skeleton
enthetitis
extra-articular features - uveitis, IBD
associated with HLA-B27

Question 2

what are some different clinical presentations of SNA ?

Answer 2

ankylosing spondylitis
psoriatic arthritis
bowel related IBD
reactive arthritis

Question 3

what is ankylosing spondylitis ?

Answer 3

chronic inflammatory rheumatic disorder focused on axial skeleton and entheses
onset 20-30
males>females

Question 4

what is a common gene of AS and is it diagnostic ?

Answer 4

HLA-B27
NOT diagnostic
positive in 80-95%

Question 5

how is spinal mobility measured ?

Answer 5

modified Schober - iliac spines
lateral spine flexion
occiput to wall and tragus to wall
cervical rotation

Question 6

what are the clinical features of AS and what is the criteria for scoring ?

Answer 6

NY criteria

inflammatory back pain - worse in morning, better with exercise
limitation of movements in anterograde-psoterior aswell as lateral planes at lumbar spine
limitation of chest expansion
bilateral sacroilitpis on xray

Question 7

what are the grades of radiograph sacroilitiis ?

Answer 7

grade 0 - normal
grade 1 - suspicious change
grade 2 - minimal abnormality, small localised area
grade 3 - unequivocal abnormality - moderate or advanced sacroilitis
grade 4 - sever abnormality - total ankylosis

Question 8

what is diffuse idiopathic skeletal hyperostosis ?

Answer 8

unilateral bulky bridging spondylophytes

extensive calcification of anterior spinal ligament

Question 9

what is the classification criteria for axial SpondyloArthritis ?

Answer 9

ASAS criteria

sacroilitis on imaging + 1+ SpA feature (systemic stuff)
OR
HLA-B27 + 2+ SpA features

Question 10

what are other features of spondyloarthritis ?

Answer 10

peripheral joints - hips, shoulders,knees
tendonitis
uveitis
CV- aortic incompetence, heart block
pulmonary - restrictive disease
IBD
osteoporosis
neuro - cauda equina

Question 11

what is the management of AS ?

Answer 11

physio
NSAIDs 
DMARDs - sulfasalazine
Anti-TNF
anti-IL-17
treat osteoporosis
surgery - joint replacement and spinal surgery

Question 12

what are features of psoriatic arthritis ?

Answer 12

various joints can be affected
spondylitis
dactylics and enthesitis
nail pitting seen

Question 13

how do you treat psoriatic arthritis ?

Answer 13

DMARDs - sulfasalazine, methotrexate
cyclosporin
anti-TNF
steroids
physio and OT

Question 14

what is reactive arthritis ?

Answer 14

sterile synovitis after distant infection
usually throat, urogenital, GI
may be systemic
mono or oligoarthritis

Question 15

what infections usually cause reactive arthritis ?

Answer 15

salmonella, shigella, yersinia, campylobacter
chlamydia, neisseria
pneumonia, streptococci

Question 16

what skin and mucous membrane involvement is seen in reactive arthritis ?

Answer 16

keratoderma blenorrhagica
circinate balanitis
urethritis
conjunctivitis
iritis

Question 17

what is Reiter’s syndrome ?

Answer 17

arthritis
urethritis
conjunctivitis

Question 18

what signs predict chronicity of reactive arthritis ?

Answer 18

hip/heel pain
high ESR
FHx and HLA-B27 positive

recurrent attacks common in chlamydia induced arthritis

Question 19

how do you treat reactive arthritis ?

Answer 19

acute - NSAIDs, joint injection, Abx

chronic - NSAID, DMARD

Question 20

what is enteropathic arthritis ?

Answer 20

commonly associated with IBD
can present with peripheral and/or axial disease
enthesopathy commonly seen

Question 21

how do you treat enteropathic arthritis ?

Answer 21

sulfasalazine/methotrexate
steroids
anti-TNF