Seronegative Arthritis (Spondyloarthritis) Flashcards
what is seronegative arthritis?
- 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
name the different clinical presentations of seronegative arthritis
- Ankylosing Spondylitis
- Psoriatic arthritis
- Bowel related arthritis (Crohn’s, UC)
- Reactive arthritis
what is ankylosing spondylitis?
prototype for axial sponyloarthritis
chronic inflammatory rheumatic disorder with a predilection for axial skeleton and enthese
ankylosing spondylitis age
2nd - 3rd decade
ankylosing spondylitis males or females?
males
with the use of a diagram describe the 3 different HLA-B27 structures and hypotheses and how they might induce ankylosing spondylitis
see notes
describe the modified schober test
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
describe the lateral spinal flexion test
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
describe the spinal mobility (occiput and tragus to wall) test
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
describe the spinal mobility cervical rotation test
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
NY criteria for 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 xrays
grading of radiographic sacroiliitis: 0
normal
grading of radiographic sacroiliitis: 1
suspicious changes
grading of radiographic sacroiliitis: 2
minimal abnormality - small localised areas with erosion or sclerosis, without alteration in the joint width
grading of radiographic sacroiliitis: 3
unequivocal abnormality - moderate or advanced sacroiliitis with one or more of: erosions, evidence of sclerosis, widening, narrowing or partial ankylosis
grading of radiographic sacroiliitis: 4
severe abnormailty - total ankylosis
other features of ankylosing spondylitis
- 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
managemnt of ankylosing spondylitis
- Physiotherapy
- NSAIDs
- DMARDs- Sulfasalazine
- Anti-TNF
- Anti-IL-17
- Treatment of osteoporosis
- Surgery- joint replacements & spinal surgery
joints commonly affected by psoriatic arthritis
neck shoulder elbows wrists all joints of knuckles, fingers, and thumbs ankles all joints of toes knees base of spine
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
treatment of psoriatic arthrtis
- 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?
sterile synovitis after distant infection
organisms causing reactive arthritis
salmonella shigella yersinia campylobacter chlamydia trachomatis or pneumoniae borrelia neisseria strep
infections causing reactive arthritis reactive arthritis
throat
urogenital
GI
features of reactive arthritis
mono or oligoarthritis
dactylitis or enthesitis
skin and mucosal membrane involvement in reactive arthritis
keratoderma blenorrhagica circinate balanitis urethritis conjunctivitis iritis
recurrent attacks are commin in what induced reactive arthritis
chlamydia
what is Reiter’s syndrome?
arthritis
urethritis
conjunctivitis
treatment of reactive arthritis: acute
NSAID
joint injection (if infection excluded)
antibiotics in chlamydia infection (contacts as well)
treatment of reactive arthritis: chronic
NSAID
DMARD
what is enteropathic arthritis commonly associated with?
IBD - crohn’s UC
what is enteropathic arthritis rarely seen with?
infectious enteritis
whipple’s disease
coeliac disease
what can enteropathic arthritis present with
both peripheral and or axial disease
enthesopathy commonly seen
treatment of enteropathic arthritis
- NSAIDs difficult to use
- Sulfasalazine
- Steroids
- Methotrexate
- Anti-TNF
- Bowel resection may alleviate peripheral disease
