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MSK > Seronegative Arthritis > Flashcards

Seronegative Arthritis Flashcards

1
Q

What is seronegative arthritis also known as?

A

Spondylitis

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2
Q

What characterises seronegative arthritis?

A
  • Negative rheumatoid factor

* May be associated with HLA- B27

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3
Q

How does SA present?

A
  • Usually an asymmetric arthritis
  • Involvement of axial skeleton (spine)
  • Enthesitis - inflammation of entheses
  • Extra-articular features - uveitis, inflammatory bowel disease
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4
Q

What are the different clinical presentations of seronegative arthritis?

A
  • Ankylosing Spondylitis
  • Psoriatic arthritis
  • Bowel related arthritis (Crohn’s, UC)
  • Reactive arthritis
  • Others
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5
Q

What is ankylosing (fusing) spondylitis (inflammation in vertebrae)?

A
  • Prototype for axial spondyloarthritis

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

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6
Q

What is the epidemiology of ankylosing spondylitis?

A
  • Onset in second to third decade of life
  • Males > Females
  • Prevalence varies in different parts of the world
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7
Q

How many different HLA-B27 structures and hypotheses as to how AS might be induced are there are there?

A 
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"
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8
Q

What is the clinical test used to check for ankylosing spondylitis?

A

Modified Schober

SAVED AS MODIFIED SCHOBER

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9
Q

How is lateral spinal flexion tested?

A

Very similar to Schober but on legs

SAVED AS LATERAL SPINAL FLEXION

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10
Q

What 2 other measurements are taken to assess AS?

A
  • Occiput and tragus
  • Cervical rotation

SAVED AS AS1 AND 2

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11
Q

What are the clinical features of ankylosing spondylitis?

A
  • 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)
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12
Q

How is AS graded?

A

AS GRADING

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13
Q

How is Axial Spondylitis classified?

A

AXIAL SPONDYLITIS CLASSIFICATION

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14
Q

What are some other features of AS?

A
  • 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
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15
Q

How is AS managed?

A
  • Physiotherapy
  • NSAIDs
  • DMARDs - Sulfasalazine
  • Anti-TNF
  • Anti-IL-17
  • Treatment of osteoporosis
  • Surgery - joint replacements & spinal surgery
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16
Q

Which therapy do patient patients with risk factors for radiographic spinal progression (syndesmophytes and elevated CRP) benefit most from?

A

NSAIDs

17
Q

What 2 stages are there of axial spondyloarthritis are there?

A
  • Non-radiographic

* Radiographic

18
Q

What characterises the non-radiographic stage?

A
  • Back pain

* Sacroiliitis on MRI

19
Q

What characterises the radiographic stage?

A
  • Back pain

* Radiographic sacroiliitis -> syndesmophytes

20
Q

What is psoriatic arthritis?

A

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

21
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
  • Also characterized by dactylitis & enthesitis
  • Severity of joint disease does not correlate to extent of skin disease
  • Nail pitting seen
22
Q

How is psoriatic arthritis treated?

A
  • DMARD - sulfasalazine, methotrexate, leflunomide, cyclosporine
  • Biologics - Anti-TNF, Anti- IL-17 and IL-23
  • Steroids
  • Physiotherapy and OP
  • Axial disease treated similarly to AS
23
Q

What is reactive arthritis?

A

•Sterile synovitis after distant infection

24
Q

What infections can cause reactive arthritis?

A

•Salmonella, Shigella, Yersinia, Campylobacter, Chlamydia trachomatis or pneumoniae, Borrelia, Neisseria and streptococci

25
Q

Where may the causative infection of RA originate?

A
  • Throat, urogenital & GI

* Disease may be systemic

26
Q

How does RA present?

A
  • Usually mono/oligo-arthritis

* Dactylitis or enthesitis also seen

27
Q

How does the skin and mucous membrane involvement in reactive arthritis present?

A
  • Keratoderma blennorrhagica - commonly on palms and soles
  • Circinate balanitis - ring-shaped dermatitis of glans penis
  • Urethritis
  • Conjunctivitis
  • Iritis
28
Q

What RA-related infections causes recurrent attacks?

A

Chlamydia

29
Q

What is Reiter’s syndrome?

A

Arthritis, urethritis and conjunctivitis

30
Q

What signs give prognosis of chronicity?

A
  • Hip/heel pain
  • High ESR
  • Family history and HLA-B27 +ve
31
Q

How is acute reactive arthritis treated?

A
  • NSAIDs
  • Joint injection (if infection excluded)
  • Antibiotics in chlamydia infection
32
Q

How is chronic reactive arthritis?

A
  • NSAIDs

* DMARDs - sulphasalazine, methotrexate

33
Q

What is enteropathic arthritis?

A
  • Commonly associated with inflammatory bowel disease (Crohn’s or UC)
  • Rarely seen with infectious enteritis, Whipple’s disease and Coeliac disease
34
Q

How does enteropathic arthritis present?

A
  • Can present with both peripheral and/or axial disease

* Enthesopathy commonly seen (disorder in attaching ligament or ligament to bone)

35
Q

How is enteropathic arthritis treated?

A
  • NSAIDs difficult to use
  • DMARDs - Sulfasalazine, Methotrexate
  • Steroids
  • Anti-TNF
  • Bowel resection may alleviate peripheral disease

MSK (28 decks)

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