Seronegative Arthropathies

Question 1

What is ankylosing spondylitis?

Answer 1

Seronegative inflammatory arthopathy affecting the spine and sacro-iliac joints

It eventually causes fusion of

• adjacent vertebrae
• sacro-iliac joints

Question 2

How does ankylosing spondylitis present?

Answer 2

Commonly in young adult males

Back pain/stiffness
Fatigue

Question 3

What conditions are associated with the seronegative arthopathies?

Answer 3

Enthesitis (plantar fasciitis, Achilles tendonitis)

Question 4

What does untreated ankylosing spondylitis progress to?

Answer 4

Fusion of vertebra and sacro-iliac joints causing

• loss of spinal movement
• loss of lumbar lordosis and increased throacic kyphosis (quaestion mark spine)
• reduced chest expansion

Question 5

What clinical examination can be useful in the diagnosis of ankylosing spondylitis and how do you perform it?

Answer 5

Schober’s test

Mark 5cm below and 10cm above lumbosacral junction

Patient bends over and measure distance between marks

Normal result - >20cm
Ankylosing spondylitis - <20cm

Question 6

What gene are seronegative arthropathies associated with?

Answer 6

HLA-B27 (90% ankylosing spondylitis sufferers positive)

Question 7

What is the classical x-ray sign for late ankylosing spondylitis?

Answer 7

Bamboo spine (syndesmophytes fuse across vertebral bodies)

Question 8

How is ankylosing spondylitis treated?

Answer 8

Physiotherapy and NSAIDs

Aggressive disease may need biologic therapy

Question 9

What are ankylosing spondylitis patients at risk from?

Answer 9

Cervical spine fracture

Question 10

How do you manage cervical spine fracture in a patient with ankylosing spondylitis?

Answer 10

Immobilise in their natural position (don’t use collars as they may worsen condition)

CT scan

Question 11

What is psoriatic arthritis?

Answer 11

Seronegative inflammatory arthopathy of the small joints in the hand affecting 30% os people with skin psoriasis

Don’t need skin psoriasis to have this condition

Question 12

How does psoriatic arthritis present?

Answer 12

Joint pain associated with

dactylitis (inflammation of whole digit) and psoriatic nail disease

Question 13

What is the classical sign of psoriatic arthritis on x-ray?

Answer 13

Pencil in cup appearance

Periarticular bone erosion/resorption causes bones to look like pencil going into cup

Question 14

How is psoriatic arthritis treated?

Answer 14

NSAIDs, steroid injections, DMARDs, biologics if severe

Question 15

What is enteropathic arthritis?

Answer 15

Seronegative inflammatory arthropathy occurring in patients with IBD

Question 16

How is enteropathic arthritis treated?

Answer 16

Managing the IBD controls the arthritis

Question 17

What drug should be avoided in enteropathic arthritis and why?

Answer 17

NSAIDs

Can exacerbate IBD

Question 18

What treatment is licensed for use in inflammatory arthritis and in IBD?

Answer 18

Anti-TNF

Question 19

What is the eponymous name for reactive arthritis?

Answer 19

Reiter’s syndrome

Question 20

What is reactive arthritis?

Answer 20

Seronegative inflammatory arthropathy which occurs after an infection

Question 21

What is the classic presentation of reactive arthritis?

Answer 21

Arthritis, conjunctivitis and urethritis occurring after an infection

Question 22

What must be ruled out in reactive arthritis and how is this done?

Answer 22

Rule out septic arthritis with joint fluid analysis

Question 23

How is reactive arthritis treated?

Answer 23

Most cases are self limiting

Some become chronic/relapsing and these are treated with NSAIDs/steroids and antibiotics