Seronegative Arthritis (Spondyloarthritis) Flashcards
1
Q
What is seronegative arthritis?
A
- -ve rheumatoid factor
- assossiated with HLA-B27
- usually asymetric arthritis
- involes spine
- enthesitis
- uveitis, IBD
2
Q
What are the different clinical presentations of seronegative arthritis?
A
- ankylosing spondylitis
- psoriatic arthritis
- bowel related arthritis (IBD)
- reactive arthritis
- others
3
Q
What is ankylosing spondylitis?
A
- preliminary version of axial spondyloarthritis
- chronic inflammatory rheumatic disorder
- 2nd/3rd decade
- M>F
4
Q
What are the clinical features of ankylosing spondylitis?
A
- inflammatory back pain
- limited movements (anteroposterior and lateral planes, at lumbar spine)
- limited chest expansion
- bilateral sacroiliitis on XR
5
Q
What are the different grades of radiographic sacroiliitis?
A
- grade 0- normal
- grade 1- suspiscious changes
- grade 2- minimal abnormality (small localised areas with erosion or sclerosis, without alteration in the joint width)
- grade 3- unequivocal abnormality (moderate/advanced sacroiliitis + one/more: erosions, sclerosis, widening, narrowing, partial ankylosis
- grade 4- total ankylosis
6
Q
What are other features of ankylosing spondylitis?
A
- peripheral joints
- achilles tendonitis, dactylitis
- uveitis
- aortic incompetence, heart block
- pulmonary restrictive disease, apical fibrosis
- IBD
- osteoporosis, spinal fractures
- atlantoaxial dislocation, cauda equina syndrome
- secondary amyloidosis
7
Q
What is the management of ankylosing spondylitis?
A
- physiotherapy
- NSAIDs
- DMARDs (sulfasalazine)
- anti-TNF
- anti-IL-17
- treat osteoporosis
- joint replacement, spinal surgery
8
Q
What are the clinical subtypes of psoriatic arthritis?
A
- arthritis with DIP joint involvement
- symmetric polyarthritis
- asymmetric oligoarticular arthritis
- arthritis mutilans
- predominant spondylitis
9
Q
What is the treatment for psoriatic arthritis?
A
- sulfasalazine
- methotrexate
- leflunomide
- cyclosporin
- anti-TNF therapy
- anti-IL17 and IL-23
- steriods
- physiotherapy + OT
* axial disease treated similar to AS
10
Q
What is reactive arthritis?
A
- sterile synovitis after distant infection (throat, GI, urogenital)
- salmonella, shigella, yersina, campylobacter, chlamydia trachomatis/pneumoniae, borrelia, neisseria, streptococci
- disease may be systemic
- usually mono/oligoarthritis
- dactylitis/enthesitis
- skin + mucous membrane involvement
11
Q
What are the prognostic signs of reactive arthritis?
A
- hip/heel pain
- high ESR
- family history
- HLA-B27 +ve
12
Q
What is the treatment of reactive arthritis?
A
Acute:
- NSAIDs
- joint injection (if infection excluded)
- antibiotics (if chlamydia)
Chronic:
- NSAIDs
- DMARD (sulphasalazine, methotrexate)
13
Q
What is enteropathic arthritis?
A
- associated with IBD
- with peripher and/or axial disease
- enthesopathy common
14
Q
What is the treatment for enteropathic arthritis?
A
- NSAIDs
- sulphasalazine
- steroids
- methotrexate
- anti-TNF
- bowel resection (peripheral disease)
