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MSK > Seronegative Arthropathies > Flashcards

Seronegative Arthropathies Flashcards

1
Q

What makes a seronegative arthritis? [1]

Genetic etiology

A

Clinical picture of arthritis but no rheumatoid factor

Associated with HLA-B27

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2
Q

Describe the general presentation of Seronegative arthropathies?
Site of involvement
Associated with
Extra-articular features [2]

A 
Asymmetric
Axial skeleton
Associated with enthesitis
Common extra-articular features
-uveitis
- IBD
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3
Q

Types of Seronegative Spondyloarthropathies? [4]

A

Psoriatic Arthritis
Ankylosing Spondylitis
Enteropathic Arthritis
Reactive Arthritis

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4
Q

Psoriatic Arthritis
What are the 2 types and what are the difference in presentation between the 2?
Which is more common *

Explain psoriasis in relation to the presentation of this disease

What other presentations could you expect? [3]

A
  1. Rheumatoid-like symmetrical poly-arthritis*: DIP joints
  2. Asymmetric oligoarticular: dactylitis
  • correlates poorly with cutaneous psoriasis and often precedes the development of skin lesions
  • Enthesitis, nail pitting
  • Spondylitis
  • Palmar-plantar pustulosis
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5
Q 
How is psoriatic arthritis treated?
4 DMARDs
2 Biologics
3 other drugs
2 non rx mx
A 
4 DMARDs
Sulfasalazine
Methotrexate
Leflunomide
Cyclosporin

Anti-TNF alpha
Anti IL-17

NSAIDs
Steroids
PDE4

Non Rx management:

  • physiotherapy
  • occupational therapy
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6
Q

Enteropathic arthritis
Peripheral and/or axial disease, enthesopathy
associated with 4 inflammatory diseases

A

IBD: UC, Crohns
Infectious enteritis
Whipples disease
Celiac disease

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7
Q

How do we treat Enteropathic Arthritis?
2 DMARDs
3 other drugs
1 surgical mx

A 
Sulfasalazine 
Methotrexate
NSAIDs - difficult to use
Steroids
Anti-TNF alpha
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? [3]

A

Post STI: chlamydia trachomatis, Neisseria
Post dysenteric: shigella, salmonella typhi, Yersinia, campylobacter
Post throat infections: staphylococcus

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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?
3 features
Extra-articular features (skin and mucous membranes involvement) [5]

A
  • Systemic symptoms
  • Arthritis
  • Dactylitis, enthesitis
    Involves skin & mucous membranes:
  • Keratoderma Blenorrhagica
  • Circinate Balanitis
  • Urethritis
  • Conjunctivits
  • Iritis
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12
Q

What is Reiter’s Syndrome?

can’t see, pee or climb a tree

A

Chlamydia trachomatis infection causing triad:

  • arthritis
  • urethritis/cervicitis
  • conjunctivitis
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13
Q

How is reactive arthritis treated acutely? [3]

A

NSAIDs
Joint Injection
IF infection give Abx

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14
Q

How is chronic reactive arthritis treated? [3]

A

NSAIDs
DMARDS (sulfasalazine, MTX)
Anti-TNF alpha

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15
Q

Define Ankylosing Spondylitis?
NB Probably the largest and most important Seronegative Spondyloarthropathy
Sites 3

A

A chronic inflammatory rheumatic disorder with predilection for axial skeleton and entheses
Sites: spine, costovertebral joints, SI joints

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16
Q

AS epidemiology
gender distribution
age distribution
ethnic distribution

A

M > F
Generally onsets in 2nd–>3rd decade
Mostly people of northern european descent

17
Q

What criteria are required to be termed Ankylosing Spondylitis? [4]
NB NY criteria

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? [6]
Whats the mainstay of treatment
What drug shows reduced syndesmophytes on radiograph?

A
  1. Physiotherapy - mainstay tx as it keeps muscles moving
  2. NSAIDs - less syndesmophytes
  3. DMARDs eg Sulfasalazine for peripheral arthritis
  4. Biologics
  5. Treat concominant osteoporosis
  6. 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?
[3]

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? [10]
Clue: PC, extra-articular inflammation, associated inflammatory conditions, responsiveness to tx, genetic etiology, lab ix

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

What are the features of inflammatory back pain in AS
[5]
Clue: onset, responsiveness to tx

A 
Worse in morning
Better after activity eg walking, running
Waking them up in early hours of morning
Onset: insidious with no ppt trauma
Responsive to NSAIDS within 24-48 hours
23
Q

Common presentation of enthesitis in AS

A

Achilles tendonitis

24
Q

Dx of AS
NB Assessment of spinal mobility
[3]

A

Modified Schober’s test
Test spinal movements - thoracic and cervical
Radiographic imaging - sacroilitis
CXR for apical fibrosis

25
Q

When is spinal surgery indicated in AS?

NB CES decompression

A

Cervical spine instability

26
Q

In AS, when does nail pitting present?

A

5-10 years after diagnosis

27
Q

AS
Presentation of uveitis
NB Difficult to treat problem as can be resistant
90% of uveitis affected patients are HLA-B27 positive

A 
Uveitis:
Site: within choriod
Sx: painful red eye, photophobic
Accompanying sx: systemically unwell 
Visual acuity affected
28
Q 
AS [fibrosis related conditions]
Osteoporosis and spinal fractures are complications of AS:
Cardiac manifestations [2]
Pulm manifestation
GI manifestation
Neurological
Renal
A

Cardiac:
Aortic incompetence
Heart block - due to fibrosis

Pulmonary - restrictive disease > apical fibrosis

GI - IBD

Neuro: CES

Renal: amyloidosis

29
Q

AS Treatment
Biologics [3]
When are biologics indicated?

A

TNF alpha inhibitor Adalimumab, Etanercept
IL17a
Indication: if 2 different NSAIDs have been tried and meets criteria for active disease on 2 occasions 12 weeks apart

30
Q

Psoriatic arthritis radiography signs [3]

A

Mild erosion at cartilage edge
Pencil-in-cup deformity
Plantar spur

31
Q

What is arthritis mutilans [3]

A

Rare and severe form of psoriatic arthritis
Resorption of terminal phalanx
Telescopic digit appearance

MSK (28 decks)

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