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MSK > Seronegative Arthritis (Spondyloarthrosis) > Flashcards

Seronegative Arthritis (Spondyloarthrosis) Flashcards

1
Q

Another name for seronegative arthritis

A

Spondyloarthrosis

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2
Q

Features of seronegative arthritis

A 
Negative rheumatoid factor
may be associated with HLA-B27 
usually asymmetric arthritis
involvement of axial skeleton 
enthesis
extraarticular features 
- uveitis
- IBD
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3
Q

What does seronegative arthritis mean?

A

The absence of the antibody called rheumatoid factor

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4
Q

Different clinical presentations of seronegative arthritis (the spondyloarthropathies)

A

ankylosing spondylitis
psoriatic arthritis
bowel related arthritis (crohns, UC)
Reactive arthritis

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5
Q

What is ankylosing spondylitis?

A

Chronic inflammatory rheumatoid disorder with a predilection for axial skeleton and entheses

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6
Q

Who gets ankylosing spondylitis?

A

M > F

2-3rd decade

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7
Q

What antigens are present and related to ankylosing spondylitis?

A

HLA-B27

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8
Q

What examination techniques are used to look at the mobility of the spine?

A

Bending over
Lateral spine flexion
Occiput to wall and tragus to wall
Cervical rotation

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9
Q

Criteria for ankylosing spondylitis

A

Inflammatory back pain
Limitation of movements in antero-posterior as well as lateral plates at lumbar spine
limitation of chest expansion
bilateral sacroiliitis on x ray (pelvis)

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10
Q

Grading of radiographic sacroilitis

A

Grade 0 - normal
Grade 1 - suspicious changes
Grade 2 - MINIMAL abnormality - small localised areas of erosion or sclerosis, without alteration or joint width
Grade 3 - UNEQUIVOCAL abnormality - moderate or advanced sacroiliitis with 1 or more of erosions, sclerosis, widening, narrowing, or partial ankylosis
Grade 4 - SEVERE abnormality - total ankylosis

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11
Q

Stages of axial spondylosis

A
  1. non radiographic stage
    - back pain
    - sacroiliitis on MRI
  2. Radiographic stage
    - back pain
    - radiographic sacrolitis
    - syndesmophytes
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12
Q

Classification criteria for axial spondyoarthritis

A

in patients with >_ 3 months back pain and age at onset of <45 years
sacroiliitis on imaging plus >_ 1 SpA feature OR HLA-B27 plus >_2 SpA features

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13
Q

SpA features

A 
inflammatory back pain 
arthritis
enthesitis (heel)
uveitis
dactylitis
psoriasis 
chrons/colitis
good response to NSAIDs
FH for SpA 
HLA-B27
Elevated CRP
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14
Q

On MRI imaging, what is highly suggestive of sacroiliitis associated with SpA?

A

Active (acute) inflammation

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15
Q

Features (as well as SpA criteria features) of ankylosing spondylitis

A 
peripheral joints (hip, shoulders, knees)
achilles tendonitis, dactylitis 
uveitis 
aortic incompetence
heart block 
restrictive pulmonary disease
pulmonary apical fibrosis
IBD
Osteoporosis and spinal fractures 
AAD
Cauda equina syndrome
renal; secondary amyloidosis
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16
Q

Management of ankylosing spondylitis

A

Physio
Encourage regular exercise such as swimming
NSAIDs - 1st line
DMARDs - sulfasalazine (useful when peripheral joint involvement)
Anti-TNF, Anti-IL-17 (if persistent high disease activity despite other treatments)
treatment of osteoporosis
surgical
- spinal
- joint replacements

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17
Q

Joints commonly affected in psoriatic arthritis

A 
neck 
shoulders
elbows
base of spine
wrists
all joints of knees, fingers and thumbs 
knees
ankles
all joints of the toes
18
Q

Clinical subtypes of psoriatic arthritis

A 
Arthritis with DIP joint involvement 
Symmetric polyarthritis (similar to RA)
asymmetric oligoarticular arthritis 
Arthritis mutilans 
Predominant spondylitis
19
Q

Relation of joint disease and skin disease in psoriatic arthritis

A

Severity of joint disease does not correlate to the extent of skin disease

20
Q

Presentation of psoriatric arthritis

A

Arthritis
Psoriasis
Nail pitting skin

21
Q

Treatment of psoriatric arthritis

A 
Sulfasalazine
Methotrexate 
Leflunomide
Cyclosporin 
Anti-TNF therapy 
Anti-LF-17 and IL-23
steroids 
physio and OT
Axial disease treated similar to AS
22
Q

What is reactive arthritis?

A

sterile synovitis after distant infection

23
Q

Infections included in reactive arthritis

A 
salmonella
shigella
campylobacter 
chlamydia 
pneumoniae
Neisseria 
streptococci 
throat infections
urogenital infections
GI infections
24
Q

Presentation of reactive arthritis

A 
Systemic disease 
Mono or oligoarthritis 
skin and mucous membrane involvement 
- keratoderma blenhorrhagica 
- circinate balantis 
- urethritis 
- conjunctivitis
- iritis 
Reiters syndrome
25
Q

Features of Reiter’s Syndrome

A

Arthritis
Urethritis
Conjunctivis

26
Q

Prognostic factors for chronicity of reactive arthritis

A

Hip/heel pain
High ESR
FH
HLA-B27

27
Q

Treatment of reactive arthritis

A 
acute
- NSAID
- joint injection (if infection excluded) 
- Antibiotics in chlamydia infection 
Chronic
- NSAID 
- DMARD 
e.g. sulphasalazine, methotrexate
28
Q

What is enteropathic arthritis seen in?

A 
IBC (CRONHS OR UC) !!!
rarely 
- infectious entereritis
- whippels disease
- coeliac disease
29
Q

Presentation of enteropathic arthritis

A

Both peripheral and/or axial disease

Enthesopathy

30
Q

Treatment of enteropathic arthritis

A 
sulfasaline
steroids
methotrexate
Anti-TNF
Bowel resection may alleviate peripheral disease 
NSAIDs difficult to use
31
Q

Extra-articular features of spondyloarthrosis

A

Uveitis

IBD

32
Q

What does a bamboo spine indicate?

A

Ankylosing spondylitis

33
Q

Investigation of ankylosing spondylitis

A

ESR and CRP raised
HLA-B27
XRAY

34
Q

What can be seen on Xray in ankylosing spondylitis?

A 
Sacroiliitis; subchondral erosions, sclerosis
Squaring of lumbar vertebrae 
Bamboo spine (late and uncommon)
Syndesmosphytes 
Atypical fibrosis on CXR
35
Q

HLA allele of reiters syndrome

A

HLA-B27

36
Q

What is one of the earliest signs of ankylosing spondylitis?

A

Reduced lateral flexion of the lumbar spine

37
Q

1st line management for AS

A

Exercise regimes + NSAIDs

38
Q

What chest sign may be seen in late AS?

A

Apical fibrosis

39
Q

What are typical Xray deformities found in psoriatic arthritis?

A

Plantur spur

Pencil and cup

40
Q

What value of schobers test suggests ankylosing spondylitis and what does it indicate?

A

< 5cm

Reduced lumbar flexion

MSK (25 decks)

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