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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
What is the criteria in the ASAS classification criteria for axial spondyloarthritis (SpA)?
>3 months back pain and age of onset <45yrs Sacroilitis on imaging plus >1SpA feature OR HLA B27 plus >2 other SpA features
26
What are SpA features according to the ASAS classification criteria for axial spondyloarthritis (SpA)?
``` Inflammatory back pain Arthritis Enthesitis Uveitis Dactylitis Psoriasis Crohn's/colitis Good response to NSAIDs FHx SpA HLA-B27 Elevated CRP ```
27
What are other systemic features of axial spondyloarthritis (SpA)?
``` 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
What is the management of AS?
``` Physio NSAIDs DMARDs (sulfasalazine) Anti-TNF Anti-IL-17 Treatment of osteoporosis Surgery - joint replacements and spinal surgery ```
29
What is psoriasis?
An autoimmune condition which affects the skin and joints
30
Why is psoriatic arthritis classed as one of the spondyloarthritides?
Inflammatory arthritis that is seronegative for rheumatoid factor (and/or does not fit the criteria for diagnosis as RA))
31
What are the skin changes seen in psoriatic arthritis?
Inflammation Production excess skin Silvery plaques - knees and elbows
32
What are the nail changes seen in psoriatic arthritis?
``` Psoriatic nail dystrophy Discolouration Onycholysis Pitting Subungal hyperkeratosis Ridging ```
33
What is onycholysis?
The loosening or separation of a fingernail or toenail from its nail bed
34
What joints are commonly affected by psoriatic arthritis?
``` Neck Shoulder Elbows Base of spine Wrist All hand joints Knees All toes joints Ankles ```
35
What are the clinical subtypes of psoriatic arthritis?
``` Arthritis with DIP joint involvement Symmetric polyarthritis (similar to RA) Asymmetric oligoarticular arthritis Arthritis mutilans Predominant spondylitis ```
36
What is the treatment for psoriatic arthritis?
``` Sulfasalazine Methotrexate Other DMARD's Anti-TNF therapy Steroids Physio OT Axial disease treated similar to AS ```
37
What is reactive arthritis?
Sterile synovitis after distant infection
38
What infections are most associated with reactive arthritis?
STIs | Acute diarrhoea e.g. salmonella
39
What other signs are seen in reactive arthritis?
Dactylitis | Enthesitis
40
What is the classic triad for reactive arthritis?
1. Conjunctivitis - can't see 2. Non specific urethritis - can’t pee 3. Acute arthritis - can't bend the knee
41
Is reactive arthritis usually symmetrical or asymmetrical?
Asymmetric
42
What is the skin and mucous membrane involvement in reactive arthritis?
``` Keratoderma blenorrhagica Circinate balanitis Urethritis Conjunctivitis Iritis ```
43
What is keratoderma blenorrhagica?
Keratinous brown plaques on soles and palms
44
What is circinate balanitis?
A serpiginous ring-shaped dermatitis of the glans penis
45
What are prognostic signs for chronicity in reactive arthritis?
Hip/heel pain High ESR FHx HLA B27 +ve
46
What is the treatment for reactive arthritis?
Acute: NSAID, joint injection, antibiotics if infection Chronic: NSAID, DMARD (sulphasalazine)
47
What is enteropathic arthritis commonly associated with?
IBD
48
How can enteropathic arthritis present?
Both peripheral and/or axial disease | Enthesopathy commonly seen
49
What is the treatment for enteropathic arthritis?
``` Sulphasalazine Steroids Methotrexate Anti-TNF Bowel resection may alleviate peripheral disease ```

MSK (17 decks)

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