Seronegative Arthropathies Flashcards
What makes a seronegative arthritis?
Associated with HLA-B27 but RF -ve
Describe the general presentation of Seronegative arthropathies?
Generally Asymmetric
Involves spine
Common extra-articular features e.g. uveitis, enthesitis or IBD
Types of Seronegative Spondyloarthropathies?
Psoriatic Arthritis
Ankylosing Spondylitis
Enteropathic Arthritis
Reactive Arthritis
How is Psoriatic Arthritis Characterised?
- Dactylitis &Enthesitis
- Nail pitting of psoriasis
Also look for a h/o or Fh/o Psoriasis
How is psoriatic arthritis treated?
DMARDs Cyclosporin Biologics (e.g. Anti-TNFalpha or Anti-ILs) Steroids Physio & OT
How is enteropathic arthritis characterised?
Peripheral or axial disease alongside IBD (sometimes infectious enteritis, whipple’s disease/ coealiac)
How do we treat Enteropathic Arthritis?
Usually improves with treatment of bowel disease.
- DMARDs
- Steroids
- Anti-TNFalpha
- NSAIDs
- Bowel Resection (can help with peripheral disease)
Define Reactive Arthritis?
The arthiritis and other clinical presentation occurs as a response to an infection somewhere else in the body
What infections commonly cause Reactive Arthritis?
Salmonella Shigella Yersinia Campylobacter Chlamydia Trachomatis or Pneumoniae Borellia Neisseria Streptococci
How does Reactive Arthritis present?
H/o infection Involves skin & mucous membranes: - Keratoderma Blenorrhagica - Circinate Balanitis - Urethritis - Conjunctivits - Iritis
What is Reiter’s Syndrome?
A specific presentation of Reactive Arthritis:
- Arthritis + Urethritis + Conjunctivitis
how is reactive arthritis treated acutely?
NSAIDs & Joint Injection
IF Chlamydia give Abx
How is chronic reactive arthritis treated?
NSAIDs
DMARDS e.g. Sulfasalazine & methotrexate
Define Ankylosing Spondylitis?
Chronic inflammation of the spine or sacro-iliac joints of unknown aetiology
Who gets AS?
- Men more than women
- Generally onsets in 2nd–>3rd decade
- Risk increases with relatives
- Mostly people of northern european descent
What criteria are required to be termed Ankylosing Spondylitis?
The New York Clinical Criteria:
- Inflammatory back pain
- Limited movement at lumbar spine (AP & lateral planes)
- Limited Chest Expansion
- Bilateral Sacroilitis on X-ray
How do we grade Sacroilliitis?
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)
How do we treat AS?
PHysio NSAIDs DMARDs (Sulfasalazine) Biologics (e.g. Anti-TNFalpha Infliximab) Joint replacement or Spinal Surgery
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?
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
What are the SpA (Spondyloarthropathy) features?
Inflammatory back pain Arthritis Enthesitis (mostly in heel) Uveitis Psoriasis Dactylitis IBD Responds to NSAIDs FH of SpA HLA-B27 Elevated CRP
What makes back pain “inflammatory”?
Worse at night
Better on exercise
Insidious onset
Subtypes of psoriatic arthirris
- Arthritis with DIP joint involvement
- Symmetric polyarthritis- similar to RA
- Asymmetric oligoarticular arthritis
- Arthritis mutilans
what is ankylosis
ankylosis is the stiffening of a joint due to fusion of the bones. In this case caused by the SA
What are some of the peripheral presentation of axial spondyloarthirtis
- 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
