Seronegative Arthritis Flashcards
What is it?
- Negative rheumatoid factor
- May be associated with HLA- B27
- Usually an asymmetric arthritis
- Involvement of axial skeleton (spine)
- Enthesitis – inflammation of the area where a tendon or ligament attaches to bone e.g. achiles tendon or around the elbow
- Extra-articular features- uveitis, inflammatory bowel disease
More common in larger joints
what is Enthesitis?
inflammation of the area where a tendon or ligament attaches to bone e.g. achiles tendon or around the elbow
what are some Different clinical presentations?
- Ankylosing Spondylitis – key one, presents with inflammatory back pain
- Psoriatic arthritis
- Bowel related arthritis (Crohn’s, UC) – inflammatory arthritis
- Reactive arthritis – inflammatory arthritis triggered by various pathogens, usually GI infections
- Others
what is Ankylosing Spondylitis?
Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the small bones in your spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture
- Prototype for axial sponyloarthritis
- Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses
whoa nd when does Ankylosing Spondylitis occur in?
- Onset in second to third decade of life
- Males > Females (One of the few rheumatological conditions that effects males more than females)
- Prevalence varies in different parts of the world
is HLA B27 diagnostic and how common is it?
- NOT diagnostic of AS/SpA
- Positive in 80 to 95% of patients with AS (so can still be negative adn have AS)
- In Europe - Approx 10% population are positive and only a Prevelance of AS 1%
- Risk of AS increased in relatives
- Monozygotic twins 63%
- 1st degree relative 8.2%
- Parent – child 7.8%
three different HLA-B27 strucutres
HLA-B27 may be misfolded in some way
spinal mobility - how is modified schober test done?
Measurement of how stiff their spine is
spinal mobility - how is lateral spinal flexion measures?
spinal mobility - how is tragus to wall measured?
Helps to measure the amount of thoracic kyphosis
spinal mobility - how is cervical rotation measured?
Gives a score to indicate how severe someone’s spinal restriction is
what are the clinical features of AS?
- Inflammatory back pain - a lot of stiffness particularly in the morning and gets better with exercise
- Limitation of movements in antero-posterior as well as lateral planes at lumbar spine
- Limitation of chest expansion
- Bilateral sacroiliitis on X-rays (can take many years to develop on normal x-ray but can be picked up earlier on MRI)
what is the grading of radiographic sacroiliitis? (Grading of the x-ray changes) (an inflammation of one or both of your sacroiliac joints — situated where your lower spine and pelvis connect)
Fused spine
On lateral x ray you can see vertebrae are more square in AS
In axial spondyloarhtritis, what are the different stages?
Tend to diagnose more in the non-radiographic stage now due to MRI to pick up sacroiliitis
Radiographic means there is x-ray changes
what is shown here?
Inflammation around on of the sacroiliac joints on the right hand side of the screen, other one looks okay
what is the classification criteria for axial spondyloarthritis?
Benefit of NSAIDs
People who have a higher intake of NSAID have a lower spinal damage score
what is the longterm clinical efficacy of TNF-alpha lbockers in AS?
Percentage improvement
what is Psoriatic arthritis?
Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin patches appear
(nail changes seen in photograph)
what joints are commonly affected by psoriatic arthritis?
Large joints more common than small joints
