Seronegative Arthropathies Flashcards

1
Q

What makes a seronegative arthritis?

A

Associated with HLA-B27 but RF -ve

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2
Q

Describe the general presentation of Seronegative arthropathies?

A

Generally Asymmetric
Involves spine
Common extra-articular features e.g. uveitis, enthesitis or IBD

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3
Q

Types of Seronegative Spondyloarthropathies?

A

Psoriatic Arthritis
Ankylosing Spondylitis
Enteropathic Arthritis
Reactive Arthritis

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4
Q

How is Psoriatic Arthritis Characterised?

A

By Dactylitis & Enthesitis along with nail pitting of psoriasis
Also look for a h/o or Fh/o Psoriasis

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5
Q

How is psoriatic arthritis treated?

A
DMARDs
Cyclosporin 
Biologics (e.g. Anti-TNFalpha or Anti-ILs)
Steroids
Physio & OT
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6
Q

How is enteropathic arthritis characterised?

A

Peripheral or axial disease alongside IBD

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7
Q

How do we treat Enteropathic Arthritis?

A

DMARDs

Steroids

Anti-TNFalpha

NSAIDs

Bowel Resection (can help with peripheral disease)

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8
Q

Define Reactive Arthritis?

A

Sterile Synovitis following a distant infection (i.e. throat, urogenital or GI)

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9
Q

What infections commonly cause Reactive Arthritis?

A
Salmonella
Shigella
Yersinia
Campylobacter
Chlamydia Trachomatis or Pneumoniae
Borellia
Neisseria
Streptococci
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10
Q

Whats special about Chlamydia induced Reactive Arthritis?

A

Often recurrent attacks rather than a single episode

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11
Q

How does Reactive Arthritis present?

A
H/o infection
Involves skin & mucous membranes:
- Keratoderma Blenorrhagica
- Circinate Balanitis
- Urethritis
- Conjunctivits
- Iritis
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12
Q

What is Reiter’s Syndrome?

A

A specific presentation of Reactive Arthritis:

- Arthritis + Urethritis + Conjunctivitis

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13
Q

how is reactive arthritis treated acutely?

A

NSAIDs & Joint Injection

IF Chlamydia give Abx

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14
Q

How is chronic reactive arthritis treated?

A

NSAIDs

DMARDS e.g. Sulfasalazine & methotrexate

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15
Q

Define Ankylosing Spondylitis?

A

A chronic inflammatory rheumatic disorder with predilection for axial skeleton and entheses
Probably the largest and most important Seronegative Spondyloarthropathy

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16
Q

Who gets AS?

A

Men more than women
Generally onsets in 2nd–>3rd decade
Mostly people of northern european descent

17
Q

What criteria are required to be termed Ankylosing Spondylitis?

A

The New York Clinical Criteria:

  • Inflammatory back pain
  • Limited movement at lumbar spine (AP & lateral planes)
  • Limited Chest Expansion
  • Bilateral Sacroilitis on X-ray
18
Q

How do we grade Sacroilliitis?

A
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)
19
Q

How do we treat AS?

A
PHysio
NSAIDs
IA CCS
DMARDs (Sulfasalazine)
Biologics (e.g. Anti-TNFalpha Infliximab)
Joint replacement or Spinal Surgery
20
Q

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?

A

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
21
Q

What are the SpA (Spondyloarthropathy) features?

A
Inflammatory back pain
Arthritis
Enthesitis (mostly in heel)
Uveitis
Psoriasis
Dactylitis
IBD
Responds to NSAIDs
FH of SpA
HLA-B27
Elevated CRP
22
Q

What makes back pain “inflammatory”?

A

Worse at night
Better on exercise
Insidious onset