Seronegative Arthritis Flashcards
Define seronegative arthritis and its different features
Group of inflammatory rheumatic disease with common clinical + aetiological features: Negative rheumatoid factor (+CCP), May be associated with HLA-B27 (antigen), Usually an asymmetric arthritis, Involvement of the axial skeleton (spine), Enthesitis, Extra-articular features – uveitis, IBD.
What are the different types of sero-negative arthritis?
Ankylosing Spondylitis. Psoriatic arthritis. Bowel related arthritis (Crohn’s, UC). Reactive arthritis. Others.
What is ankylosing spondylitis?
Chronic inflammatory rheumatic disorder with a predilection for axial skeleton (attacks spine, spondyloarthritis, over time may cause bones to fuse) and etheses (connective tissue between tendon/ligament + bone). Onset in 2nd to 3rd decade of life. M>F.
What are clinical features of ankylosing spondylitis?
Inflammatory back pain. Limitation of movements in antero-posterior as well as lateral planes at lumbar spine. Limitation of chest expansion. Bilateral sacroiliitis (inf. Of sacroiliac joints) on X-rays.
How would you treat AS?
Physiotherapy. NSAIDs. DMARDS – sulfasalazine. Anti-TNF. Anti-IL-17. Treatment of osteoporosis. Surgery – joint replacements & spinal surgery.
What is psoriatic arthritis?
Type of arthritis developing in patients with psoriasis. Typically causes pain, inflammation and stiffness to the affected joint. Severity of joint disease does not correlate to extent of skin disease.
What are the clinical subtypes of psoriatic arthritis?
- Arthritis with DIP joint involvement
- Symmetrical polyarthritis – similar to RA
- Asymmetric oligoarticular arthritis
- Arthritis mutilans
- Predominant spondylitis
Also characterised by dactylitis (severe inf. Of finger and toe joints) + enthesitis. Nail pitting seen.
How would you treat psoriatic arthritis?
Sulfasalazine. Methotrexate. Leflunomide. Cyclosporine. Anti-TNF therapy. Anti-IL-17 and IL-23. Steroids. Physiotherapy and occupational therapy. Axial disease treated similar to AS.
What is reactive arthritis and its causes?
AKA Reiter’s syndrome. Painful form of inflammatory arthritis, affects joints (arthritis), eyes (conjunctivitis) + urethra (urethritis). [Can’t see, pee or bend the knee]. Sterile synovitis after distant infection. Infections include: Urogenital – chlamydia; GI - Salmonella, Shigella, Yersina, Campylobacter. May also be throat infection (strep). Usually mono or oligoarthritis (2-4 joints). Dactylitis or enthesitis also seen.
Detail skin and mucous membrane involvement in reactive arthritis?
Keratoderma blenorrhagica (skin lesions). Circinate balanitis (penis skin). Urethritis. Conjunctivitis. Iritis.
What are the prognostic signs for chronicity in reactive arthritis?
Hip/heel pain. High ESR. FH + HLA-B27 +ve.
What is the treatment for reactive arthritis?
Acute – NSAID, Joint injection (if infection excluded), antibiotics in chlamydia infection (contacts as well).
Chronic – NSAID, DMARD (e.g. sulphasalazine, methotrexate).
What is enteropathic arthritis?
A form of chronic, inflammatory arthritis affecting spine and other joints and associated with occurrence of IBD such as UC and Crohn’s.
What are the features of enteropathic arthritis?
Commonly associated with IBD. Rarely seen with infectious enteritis, Whipple’s disease + coeliac disease. Can present with both peripheral and/or axial disease. Enthesopathy (disorder of enthesis) commonly seen.
What is the treatment of enteropathic arthritis?
NSAIDs difficult to use. Sulfasalazine. Methotrexate. Steroids. Anti-TNF. Bowel resection may alleviate peripheral disease.
