Seronegative Arthropathies Flashcards
What makes a seronegative arthritis?
Associated with HLA-B27 but RF -ve
Describe the general presentation of Seronegative arthropathies?
Generally Asymmetric
Involves spine
Common extra-articular features e.g. uveitis, enthesitis or IBD
Types of Seronegative Spondyloarthropathies?
Psoriatic Arthritis
Ankylosing Spondylitis
Enteropathic Arthritis
Reactive Arthritis
How is Psoriatic Arthritis Characterised?
By Dactylitis & Enthesitis along with nail pitting of psoriasis
Also look for a h/o or Fh/o Psoriasis
How is psoriatic arthritis treated?
DMARDs
Cyclosporin
Biologics (e.g. Anti-TNFalpha or Anti-ILs)
Steroids
Physio & OT
How is enteropathic arthritis characterised?
Peripheral or axial disease alongside IBD
How do we treat Enteropathic Arthritis?
DMARDs
Steroids
Anti-TNFalpha
NSAIDs
Bowel Resection (can help with peripheral disease)
Define Reactive Arthritis?
Sterile Synovitis following a distant infection (i.e. throat, urogenital or GI)
What infections commonly cause Reactive Arthritis?
Salmonella
Shigella
Yersinia
Campylobacter
Chlamydia Trachomatis or Pneumoniae
Borellia
Neisseria
Streptococci
Whats special about Chlamydia induced Reactive Arthritis?
Often recurrent attacks rather than a single episode
How does Reactive Arthritis present?
H/o infection
Involves skin & mucous membranes:
- Keratoderma Blenorrhagica
- Circinate Balanitis
- Urethritis
- Conjunctivits
- Iritis
What is Reiter’s Syndrome?
A specific presentation of Reactive Arthritis:
- Arthritis + Urethritis + Conjunctivitis
how is reactive arthritis treated acutely?
NSAIDs & Joint Injection
IF Chlamydia give Abx
How is chronic reactive arthritis treated?
NSAIDs
DMARDS e.g. Sulfasalazine & methotrexate
Define Ankylosing Spondylitis?
A chronic inflammatory rheumatic disorder with predilection for axial skeleton and entheses
Probably the largest and most important Seronegative Spondyloarthropathy
Who gets AS?
Men more than women
Generally onsets in 2nd–>3rd decade
Mostly people of northern european descent
What criteria are required to be termed Ankylosing Spondylitis?
The New York Clinical Criteria:
- Inflammatory back pain
- Limited movement at lumbar spine (AP & lateral planes)
- Limited Chest Expansion
- Bilateral Sacroilitis on X-ray
How do we grade Sacroilliitis?
0-4 based on X-ray:
- 0 = normal
1 = suspicious changes
2 = Minimal abnormality (no altered joint width)
3 = Unequivocal abnormality
4 = Severe abnormality (total ankylosis)
How do we treat AS?
PHysio
NSAIDs
IA CCS
DMARDs (Sulfasalazine)
Biologics (e.g. Anti-TNFalpha Infliximab)
Joint replacement or Spinal Surgery
If back pain doesn’t meet the NY criteria for AS then it could be another form of Spondyloarthritis with axial involvement, what criteria must it meet for this?
ASAS criteria for Axial Spondyloarthritis:
- 3 or more months of back pain
- <45yrs of age
- Sacroiliitis on X-ray + 1 SpA feature OR HLA-B27 +ve + 2 SpA features
What are the SpA (Spondyloarthropathy) features?
Inflammatory back pain
Arthritis
Enthesitis (mostly in heel)
Uveitis
Psoriasis
Dactylitis
IBD
Responds to NSAIDs
FH of SpA
HLA-B27
Elevated CRP
What makes back pain “inflammatory”?
Worse at night
Better on exercise
Insidious onset
