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Seronegative arthritis Flashcards

1
Q

What is seronegative arthritis?

A

The diagnosis of rheumatoid arthritis without the presence of certain antibodies in the patient’s blood

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2
Q

What is the other name for seronegative arthritis?

A

Spondyloarthritis

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3
Q

What does a patient with seronegative arthritis lack in their blood?

A

Negative rheumatoid factor

Negative anti-CCP antibodies

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4
Q

Is seronegative arthritis usually symmetric or asymmetric?

A

Asymmetric

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5
Q

What HLA is seronegative arthritis sometimes associated with?

A

HLA-B27

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6
Q

What part of the skeleton does seronegative arthritis particular affect?

A

Axial (spine)

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7
Q

What are extra-articular features of seronegative arthritis?

A

Uveitis

IBD

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8
Q

How can seronegative arthritis present differently clinically?

A 
Ankylosing spondylitis
Psoriatic arthritis
Bowel related arthritis
Reactive arthritis
Other
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9
Q

What is ankylosing spondylitis?

A

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

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10
Q

How common is HLA B27 in patients with AS?

A

80-95% patients

NOT diagnostic

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11
Q

What is the Modified Schober test?

A

Reflect the lumbar ROM during flexio

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12
Q

What does the Modified Schober test usually screen for?

A

Ankylosing spondylitis

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13
Q

How does the Modified Schober test work?

A

Patient stands erect
Measure distance and mark between two lumber vertebrae, get patient to bend forward maximally, measure different between two marks

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14
Q

What are tests for spinal mobility?

A

Modified Schober test
Lateral spinal flexion
Occiput to wall and tragus to wall
Cervical rotation

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15
Q

What are the clinical features of AS?

A

Inflammatory back pain
Limitation of movements in antero-posterior as well as lateral planes at lumbar spine
Limitation of chest expansion
Bilateral sacroilitis on XR

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16
Q

What conditions are associated with seronegative arthritis?

A

Spondyloarthritis conditions including AS

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17
Q

What criteria can be used when diagnosing AS?

A

NY criteria

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18
Q

How is radiographic sacroilitis graded?

A

Grade 0-4

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19
Q

What are the grades for radiographic sacrolilitis?

A

Grade 0: normal
Grade 1: suspicious changes
Grade 2: minimal abnormality (small localised areas)
Grade 3: Unquivocal abnormality (moderate/advanced sacroilitis)
Grade 4: severe abnormality (total ankylosis)

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20
Q

What is sacroilitis?

A

Painful condition where either one or both of the sacroiliac joints become inflamed

21
Q

What are the main symptoms of sacroilitus?

A

Pain in buttocks, lower back, back of one or both legs
Slight fever
Stiffness in hips/lower back

22
Q

What is DISH?

A

Diffuse idiopathic skeletal hyperostosis (DISH)

23
Q

What happens in DISH?

A

Bony hardening of ligaments in areas where they attach to your spine

24
Q

What is the classification criteria for axial spondyloarthritis (SpA)?

A

ASAS classification criteria

25
Q

What is the criteria in the ASAS classification criteria for axial spondyloarthritis (SpA)?

A

> 3 months back pain and age of onset <45yrs
Sacroilitis on imaging plus >1SpA feature
OR
HLA B27 plus >2 other SpA features

26
Q

What are SpA features according to the ASAS classification criteria for axial spondyloarthritis (SpA)?

A 
Inflammatory back pain
Arthritis
Enthesitis
Uveitis
Dactylitis
Psoriasis
Crohn's/colitis
Good response to NSAIDs
FHx SpA
HLA-B27
Elevated CRP
27
Q

What are other systemic features of axial spondyloarthritis (SpA)?

A 
Peripheral joints affected
Achilles tendonitis/dactylitis
Uveitis
Cardiac: aortic incompetence, heart block
Pulmonary: restrictive disease, apical fibrosis
GI: IBD
Osteoporosis and spinal fractures
Neurological: cauda equina syndrome
Renal: secondary amyloidosis
28
Q

What is the management of AS?

A 
Physio
NSAIDs
DMARDs (sulfasalazine)
Anti-TNF
Anti-IL-17
Treatment of osteoporosis
Surgery - joint replacements and spinal surgery
29
Q

What is psoriasis?

A

An autoimmune condition which affects the skin and joints

30
Q

Why is psoriatic arthritis classed as one of the spondyloarthritides?

A

Inflammatory arthritis that is seronegative for rheumatoid factor (and/or does not fit the criteria for diagnosis as RA))

31
Q

What are the skin changes seen in psoriatic arthritis?

A

Inflammation
Production excess skin
Silvery plaques - knees and elbows

32
Q

What are the nail changes seen in psoriatic arthritis?

A 
Psoriatic nail dystrophy
Discolouration
Onycholysis
Pitting
Subungal hyperkeratosis
Ridging
33
Q

What is onycholysis?

A

The loosening or separation of a fingernail or toenail from its nail bed

34
Q

What joints are commonly affected by psoriatic arthritis?

A 
Neck
Shoulder
Elbows
Base of spine
Wrist
All hand joints
Knees
All toes joints
Ankles
35
Q

What are the clinical subtypes of psoriatic arthritis?

A 
Arthritis with DIP joint involvement
Symmetric polyarthritis (similar to RA)
Asymmetric oligoarticular arthritis
Arthritis mutilans
Predominant spondylitis
36
Q

What is the treatment for psoriatic arthritis?

A 
Sulfasalazine
Methotrexate
Other DMARD's
Anti-TNF therapy
Steroids
Physio
OT
Axial disease treated similar to AS
37
Q

What is reactive arthritis?

A

Sterile synovitis after distant infection

38
Q

What infections are most associated with reactive arthritis?

A

STIs

Acute diarrhoea e.g. salmonella

39
Q

What other signs are seen in reactive arthritis?

A

Dactylitis

Enthesitis

40
Q

What is the classic triad for reactive arthritis?

A
  1. Conjunctivitis - can’t see
  2. Non specific urethritis - can’t pee
  3. Acute arthritis - can’t bend the knee
41
Q

Is reactive arthritis usually symmetrical or asymmetrical?

A

Asymmetric

42
Q

What is the skin and mucous membrane involvement in reactive arthritis?

A 
Keratoderma blenorrhagica
Circinate balanitis
Urethritis
Conjunctivitis
Iritis
43
Q

What is keratoderma blenorrhagica?

A

Keratinous brown plaques on soles and palms

44
Q

What is circinate balanitis?

A

A serpiginous ring-shaped dermatitis of the glans penis

45
Q

What are prognostic signs for chronicity in reactive arthritis?

A

Hip/heel pain
High ESR
FHx
HLA B27 +ve

46
Q

What is the treatment for reactive arthritis?

A

Acute: NSAID, joint injection, antibiotics if infection
Chronic: NSAID, DMARD (sulphasalazine)

47
Q

What is enteropathic arthritis commonly associated with?

A

IBD

48
Q

How can enteropathic arthritis present?

A

Both peripheral and/or axial disease

Enthesopathy commonly seen

49
Q

What is the treatment for enteropathic arthritis?

A 
Sulphasalazine
Steroids
Methotrexate
Anti-TNF
Bowel resection may alleviate peripheral disease

MSK (17 decks)

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