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Year 3 > Seronegative Arthritis (Spondyloarthritis) > Flashcards

Seronegative Arthritis (Spondyloarthritis) Flashcards

1
Q

what is seronegative arthritis?

A
  • Negative rheumatoid factor
  • May be associated with HLA- B27
  • Usually an asymmetric arthritis
  • Involvement of axial skeleton (spine)
  • Enthesitis
  • Extra-articular features- uveitis, inflammatory bowel disease
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2
Q

name the different clinical presentations of seronegative arthritis

A
  • Ankylosing Spondylitis
  • Psoriatic arthritis
  • Bowel related arthritis (Crohn’s, UC)
  • Reactive arthritis
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3
Q

what is ankylosing spondylitis?

A

prototype for axial sponyloarthritis

chronic inflammatory rheumatic disorder with a predilection for axial skeleton and enthese

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4
Q

ankylosing spondylitis age

A

2nd - 3rd decade

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5
Q

ankylosing spondylitis males or females?

A

males

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6
Q

with the use of a diagram describe the 3 different HLA-B27 structures and hypotheses and how they might induce ankylosing spondylitis

A

see notes

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7
Q

describe the modified schober test

A

patient standing erect
mark an imaginary line connecting both PSIS
a next mark is placed 10cm above
the patient bends forward maximally, measure the difference between the two marks
report the increase
best of two

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8
Q

describe the lateral spinal flexion test

A

heels and back rest against the wall, no flexion in the knees, no bending forward
place a mark on the thigh, bend sidewards without bending knees or lifting heels, and without moving the shoulders or hips, place a second mark and record the difference
best of two
calculate mean of right and left

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9
Q

describe the spinal mobility (occiput and tragus to wall) test

A

heels and back rest against the wall
chin at usual carrying level
maximal effort to move the head against the wall
best of two for occiput to wall distance and the mean of left and right for the tragus to wall

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10
Q

describe the spinal mobility cervical rotation test

A

the patient sites straight on a chair, chin at usual carrying level, hands on the knees
the assessor places a goniometer at the top of the head in line with the nose
the assessor asks to rotate the neck maximally to the left, follows with goniometer, and recorts the angle between the sagital plane and the new plane
best of two
repeat on right
mean

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11
Q

NY criteria for 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 xrays

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12
Q

grading of radiographic sacroiliitis: 0

A

normal

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13
Q

grading of radiographic sacroiliitis: 1

A

suspicious changes

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14
Q

grading of radiographic sacroiliitis: 2

A

minimal abnormality - small localised areas with erosion or sclerosis, without alteration in the joint width

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15
Q

grading of radiographic sacroiliitis: 3

A

unequivocal abnormality - moderate or advanced sacroiliitis with one or more of: erosions, evidence of sclerosis, widening, narrowing or partial ankylosis

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16
Q

grading of radiographic sacroiliitis: 4

A

severe abnormailty - total ankylosis

17
Q

other features of ankylosing spondylitis

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 & cauda equina syndrome
  • Renal- secondary amyloidosis
18
Q

managemnt of ankylosing spondylitis

A
  • Physiotherapy
  • NSAIDs
  • DMARDs- Sulfasalazine
  • Anti-TNF
  • Anti-IL-17
  • Treatment of osteoporosis
  • Surgery- joint replacements & spinal surgery
19
Q

joints commonly affected by psoriatic arthritis

A 
neck
shoulder
elbows
wrists
all joints of knuckles, fingers, and thumbs
ankles
all joints of toes
knees
base of spine
20
Q

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

21
Q

treatment of psoriatic arthrtis

A
  • Sulfasalazine
  • Methotrexate
  • Leflunomide
  • Cyclosporine
  • Anti-TNF therapy
  • Anti- IL-17 and IL-23
  • Steroids
  • Physiotherapy and occupational therapy
  • Axial disease treated similar to AS
22
Q

what is reactive arthritis?

A

sterile synovitis after distant infection

23
Q

organisms causing reactive arthritis

A 
salmonella
shigella
yersinia
campylobacter
chlamydia trachomatis or pneumoniae
borrelia
neisseria
strep
24
Q

infections causing reactive arthritis reactive arthritis

A

throat
urogenital
GI

25
Q

features of reactive arthritis

A

mono or oligoarthritis

dactylitis or enthesitis

26
Q

skin and mucosal membrane involvement in reactive arthritis

A 
keratoderma blenorrhagica
circinate balanitis
urethritis
conjunctivitis
iritis
27
Q

recurrent attacks are commin in what induced reactive arthritis

A

chlamydia

28
Q

what is Reiter’s syndrome?

A

arthritis
urethritis
conjunctivitis

29
Q

treatment of reactive arthritis: acute

A

NSAID
joint injection (if infection excluded)
antibiotics in chlamydia infection (contacts as well)

30
Q

treatment of reactive arthritis: chronic

A

NSAID

DMARD

31
Q

what is enteropathic arthritis commonly associated with?

A

IBD - crohn’s UC

32
Q

what is enteropathic arthritis rarely seen with?

A

infectious enteritis
whipple’s disease
coeliac disease

33
Q

what can enteropathic arthritis present with

A

both peripheral and or axial disease

enthesopathy commonly seen

34
Q

treatment of enteropathic arthritis

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

Year 3 (164 decks)

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