Seronegative Arthritis Flashcards
What is seronegative arthritis also known as?
Spondylitis
What characterises seronegative arthritis?
- Negative rheumatoid factor
* May be associated with HLA- B27
How does SA present?
- Usually an asymmetric arthritis
- Involvement of axial skeleton (spine)
- Enthesitis - inflammation of entheses
- Extra-articular features - uveitis, inflammatory bowel disease
What are the different clinical presentations of seronegative arthritis?
- Ankylosing Spondylitis
- Psoriatic arthritis
- Bowel related arthritis (Crohn’s, UC)
- Reactive arthritis
- Others
What is ankylosing (fusing) spondylitis (inflammation in vertebrae)?
- Prototype for axial spondyloarthritis
* Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses
What is the epidemiology of ankylosing spondylitis?
- Onset in second to third decade of life
- Males > Females
- Prevalence varies in different parts of the world
How many different HLA-B27 structures and hypotheses as to how AS might be induced are there are there?
3 •HLA-B27 trimolecular complex •HLA-B27 free heavy chain monomers •Components of HLA-B27 molecules not yet properly assembled and folded inside the cell SAVED AS "HLA-B27 AS"
What is the clinical test used to check for ankylosing spondylitis?
Modified Schober
SAVED AS MODIFIED SCHOBER
How is lateral spinal flexion tested?
Very similar to Schober but on legs
SAVED AS LATERAL SPINAL FLEXION
What 2 other measurements are taken to assess AS?
- Occiput and tragus
- Cervical rotation
SAVED AS AS1 AND 2
What are the 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 on X-rays (sacroiliac joint inflammation)
How is AS graded?
AS GRADING
How is Axial Spondylitis classified?
AXIAL SPONDYLITIS CLASSIFICATION
What are some other features of AS?
- Peripheral joints - Hips, shoulders, knees
- Achilles tendonitis, dactylitis
- Uveitis
- Cardiac - Aortic incompetence, heart block
- Pulmonary - restrictive disease, apical fibrosis
- GI - IBD
- Osteoporosis and spinal fractures
- Neurological - AAD (atlantoaxial disclocation) & cauda equina syndrome
- Renal - secondary amyloidosis
How is AS managed?
- Physiotherapy
- NSAIDs
- DMARDs - Sulfasalazine
- Anti-TNF
- Anti-IL-17
- Treatment of osteoporosis
- Surgery - joint replacements & spinal surgery
Which therapy do patient patients with risk factors for radiographic spinal progression (syndesmophytes and elevated CRP) benefit most from?
NSAIDs
What 2 stages are there of axial spondyloarthritis are there?
- Non-radiographic
* Radiographic
What characterises the non-radiographic stage?
- Back pain
* Sacroiliitis on MRI
What characterises the radiographic stage?
- Back pain
* Radiographic sacroiliitis -> syndesmophytes
What is psoriatic arthritis?
Psoriatic arthritis is a type of arthritis that affects some people with the skin condition psoriasis. It typically causes affected joints to become swollen, stiff and painful
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
- Also characterized by dactylitis & enthesitis
- Severity of joint disease does not correlate to extent of skin disease
- Nail pitting seen
How is psoriatic arthritis treated?
- DMARD - sulfasalazine, methotrexate, leflunomide, cyclosporine
- Biologics - Anti-TNF, Anti- IL-17 and IL-23
- Steroids
- Physiotherapy and OP
- Axial disease treated similarly to AS
What is reactive arthritis?
•Sterile synovitis after distant infection
What infections can cause reactive arthritis?
•Salmonella, Shigella, Yersinia, Campylobacter, Chlamydia trachomatis or pneumoniae, Borrelia, Neisseria and streptococci
