Seronegative arthropathies Flashcards
What are seronegative arthropathies?
A family of inflammatory arthritides characterized by involvement of both the spine and joints
What are some of the features of seronegative arthropathies?
Sacroiliac and spinal involvement
Enthesitis
Inflammatory arthritis
Dactylitis (sausage digits)
What is enthesitis?
Inflammation of the enthuses, the sites where ligament or tendon insert into the bone
What are some extra-articular features of seronegative arthropathies?
Ocular involvement e.g. conjunctivitis
Mucocutaneous lesions
Aortic incompetence
Heart block
Which gene are seronegative arthropathies associated with?
HLA B27
When is the typical period of onset for ankylosing spondylitis?
Late teens/early adulthood
What are the symptoms of ankylosing spondylitis?
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
What are some of the treatments for ankylosing spondylitis?
Home exercises Physiotherapy Occupational therapy NSAID Corticosteroids Anti TNF treatment – Infliximab, adalimumab
Which joints are usually affected in ankylosing spondylitis?
Sacroiliac joints
What is Schober’s test?
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
What is psoriatic arthritis?
Arthritis associated with psoriasis
Only in a small number of cases does the arthritis precede the psoriasis
What is onycholysis?
The separating of the nail from the nail bed
What are the features of psoriatic arthritis?
Sacroiliitis Nail involvement - pitting, onycholysis Achilles tendinitis Plantar fasciitis Dactylitis Skin disease Eye involvement
In which seronegative arthropathy can “whiskering” and/or a “pencil in cup” deformity be seen on Xray?
Psoriatic arthritis
What is reactive arthritis?
An autoimmune disease which causes arthritis to develop in response to an infection from elsewhere (cross-reactivity)
What are the most common causative organisms for reactive arthritis?
Chlamydia
Salmonella
Shigella
Yersinia
What are some of the clinical features of reactive arthritis?
General Symptoms (fever, fatigue, malaise)
Asymmetrical monoarthritis or oligoarthritis
Enthesitis
Mucocutaneous lesions
What are some examples of mucocutaneous lesions?
Keratodema blenorrhagica (vesicular lesions on palms and soles)
Circinate balanitis (dermatitis on penis)
Painless oral ulcers
Hyperkeratotic nails
What is the triad of Reiter’s syndrome?
Arthritis
Urethritis
Conjuntivitis
What extra-articular features are involved in ankylosing spondylitis?
Aortic regurgitation Apical fibrosis Anterior uveitis AV node block Achilles tendonitis Axial arthritis Amyloidosis/IgA nephropathy
Which gender is more commonly affected in ankylosing spondylitis?
Male
Which gender is more commonly affected in psoriatic arthritis?
No gender preference
What is the treatment for psoriatic arthritis?
NSAIDs
Corticosteroids/joint injections
DMARDs
Anti TNF – etanercept
What blood tests would indicate psoriatic arthritis?
Negative rheumatoid factor
Raised inflammatory parameters
When do symptoms of reactive arthritis occur?
4-5 weeks following infection
What is the treatment for reactive arthritis?
NSAIDs
Corticosteroids (once sepsis ruled out): intra-articular, oral or eye drops
Antibiotics
DMARDs (sulphasalazine) if resistant/chronic
