Seronegative arthropathies

Question 1

What are seronegative arthropathies?

Answer 1

A family of inflammatory arthritides characterized by involvement of both the spine and joints

Question 2

What are some of the features of seronegative arthropathies?

Answer 2

Sacroiliac and spinal involvement
Enthesitis
Inflammatory arthritis
Dactylitis (sausage digits)

Question 3

What is enthesitis?

Answer 3

Inflammation of the enthuses, the sites where ligament or tendon insert into the bone

Question 4

What are some extra-articular features of seronegative arthropathies?

Answer 4

Ocular involvement e.g. conjunctivitis
Mucocutaneous lesions
Aortic incompetence
Heart block

Question 5

Which gene are seronegative arthropathies associated with?

Answer 5

HLA B27

Question 6

When is the typical period of onset for ankylosing spondylitis?

Answer 6

Late teens/early adulthood

Question 7

What are the symptoms of ankylosing spondylitis?

Answer 7

Back pain and stiffness that improves with exercise and isn’t relieved by rest
Pain and swelling elsewhere e.g. hips, knees and ribs
Fatigue

Question 8

What are some of the treatments for ankylosing spondylitis?

Answer 8

Home exercises
Physiotherapy
Occupational therapy
NSAID 
Corticosteroids 
Anti TNF treatment – Infliximab, adalimumab

Question 9

Which joints are usually affected in ankylosing spondylitis?

Answer 9

Sacroiliac joints

Question 10

What is Schober’s test?

Answer 10

A test used to assess the patient’s ability to flex their back
The distance between two fingers placed on the lower back is measured while standing
The patient is then asked to touch their toes, and the increase in distance between fingers is measured

Question 11

What is psoriatic arthritis?

Answer 11

Arthritis associated with psoriasis

Only in a small number of cases does the arthritis precede the psoriasis

Question 12

What is onycholysis?

Answer 12

The separating of the nail from the nail bed

Question 13

What are the features of psoriatic arthritis?

Answer 13

Sacroiliitis
Nail involvement - pitting, onycholysis
Achilles tendinitis
Plantar fasciitis
Dactylitis
Skin disease
Eye involvement

Question 14

In which seronegative arthropathy can “whiskering” and/or a “pencil in cup” deformity be seen on Xray?

Answer 14

Psoriatic arthritis

Question 15

What is reactive arthritis?

Answer 15

An autoimmune disease which causes arthritis to develop in response to an infection from elsewhere (cross-reactivity)

Question 16

What are the most common causative organisms for reactive arthritis?

Answer 16

Chlamydia
Salmonella
Shigella
Yersinia

Question 17

What are some of the clinical features of reactive arthritis?

Answer 17

General Symptoms (fever, fatigue, malaise)
Asymmetrical monoarthritis or oligoarthritis
Enthesitis
Mucocutaneous lesions

Question 18

What are some examples of mucocutaneous lesions?

Answer 18

Keratodema blenorrhagica (vesicular lesions on palms and soles)
Circinate balanitis (dermatitis on penis)
Painless oral ulcers
Hyperkeratotic nails

Question 19

What is the triad of Reiter’s syndrome?

Answer 19

Arthritis
Urethritis
Conjuntivitis

Question 20

What extra-articular features are involved in ankylosing spondylitis?

Answer 20

Aortic regurgitation
Apical fibrosis
Anterior uveitis
AV node block
Achilles tendonitis
Axial arthritis
Amyloidosis/IgA nephropathy

Question 21

Which gender is more commonly affected in ankylosing spondylitis?

Answer 21

Male

Question 22

Which gender is more commonly affected in psoriatic arthritis?

Answer 22

No gender preference

Question 23

What is the treatment for psoriatic arthritis?

Answer 23

NSAIDs
Corticosteroids/joint injections
DMARDs
Anti TNF – etanercept

Question 24

What blood tests would indicate psoriatic arthritis?

Answer 24

Negative rheumatoid factor

Raised inflammatory parameters

Question 25

When do symptoms of reactive arthritis occur?

Answer 25

4-5 weeks following infection

Question 26

What is the treatment for reactive arthritis?

Answer 26

NSAIDs
Corticosteroids (once sepsis ruled out): intra-articular, oral or eye drops
Antibiotics
DMARDs (sulphasalazine) if resistant/chronic