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MSK > Seronegative Arthropathies > Flashcards

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
  • Dactylitis &Enthesitis
  • 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 (sometimes infectious enteritis, whipple’s disease/ coealiac)

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7
Q

How do we treat Enteropathic Arthritis?

A

Usually improves with treatment of bowel disease.

  • DMARDs
  • Steroids
  • Anti-TNFalpha
  • NSAIDs
  • Bowel Resection (can help with peripheral disease)
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8
Q

Define Reactive Arthritis?

A

The arthiritis and other clinical presentation occurs as a response to an infection somewhere else in the body

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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

How does Reactive Arthritis present?

A 
H/o infection
Involves skin & mucous membranes:
- Keratoderma Blenorrhagica
- Circinate Balanitis
- Urethritis
- Conjunctivits
- Iritis
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11
Q

What is Reiter’s Syndrome?

A

A specific presentation of Reactive Arthritis:

- Arthritis + Urethritis + Conjunctivitis

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12
Q

how is reactive arthritis treated acutely?

A

NSAIDs & Joint Injection

IF Chlamydia give Abx

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13
Q

How is chronic reactive arthritis treated?

A

NSAIDs

DMARDS e.g. Sulfasalazine & methotrexate

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14
Q

Define Ankylosing Spondylitis?

A

Chronic inflammation of the spine or sacro-iliac joints of unknown aetiology

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15
Q

Who gets AS?

A
  • Men more than women
  • Generally onsets in 2nd–>3rd decade
  • Risk increases with relatives
  • Mostly people of northern european descent
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16
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
17
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)
18
Q

How do we treat AS?

A 
PHysio
NSAIDs
DMARDs (Sulfasalazine)
Biologics (e.g. Anti-TNFalpha Infliximab)
Joint replacement or Spinal Surgery
19
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

AND
- Sacroiliitis on X-ray + 1 SpA feature
OR
-HLA-B27 +ve + 2 SpA features

20
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
21
Q

What makes back pain “inflammatory”?

A

Worse at night
Better on exercise
Insidious onset

22
Q

Subtypes of psoriatic arthirris

A
  • Arthritis with DIP joint involvement
  • Symmetric polyarthritis- similar to RA
  • Asymmetric oligoarticular arthritis
  • Arthritis mutilans
23
Q

what is ankylosis

A

ankylosis is the stiffening of a joint due to fusion of the bones. In this case caused by the SA

24
Q

What are some of the peripheral presentation of axial spondyloarthirtis

A
  • Peripheral joints - Hips, shoulders, knees
  • Achilles tendonitis, dactylitis
  • Uveitis
  • Cardiac- Aortic incompetence, heart block
  • Pulmonary- restrictive disease, apical fibrosis
  • GI- IBD
  • Osteoporosis and spinal fractures
  • Neurological- AAD & cauda equina syndrome
  • Renal- secondary amyloidosis

MSK (40 decks)

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