Seronegative Arthropathies

Question 1

What is another name for the seronegative arthropathies?

Answer 1

Spondylo-arthropathies

Question 2

What are the cardinal symptoms of the spondylo-arthropathies?

Answer 2

Inflammatory back pain
Asymmetrical oligoarthritis
Often HLA B27 positive
Sacroiliitis
Anterior uveitis
Dactylitis
Enthesitis
Conjunctivitis
Mucocutaneous lesions

Question 3

What are the features of inflammatory back pain?

Answer 3

Worse with rest
Better with activity
Morning stiffness > 30 minutes

Question 4

What is enthesitis?

Answer 4

Inflammation at the insertion of a tendon into bone

e.g. Achilles tendonitis, plantar fasciitis

Question 5

What is the pathophysiology of ankylosing spondylitis?

Answer 5

Chronic inflammation of spine + sacro-iliac joints

• -> eventual fusion of the intervertebral joints + SI joints
• -> loss of movement = ‘question mark spine’

Question 6

What would be seen on examination of the spine in ankylosing spondylitis?

Answer 6

Reduced lumbar flexion on Schobers Test

Question 7

What are the clinical features of ankylosing spondylitis?

Answer 7

'A' Disease:
Axial arthritis
Anterior uveitis
Aortic regurgitation/Aortitis
Apical fibrosis
Amyloidosis/IgA nephropathy
Achilles tendonitis
plAntar fasciitis

Question 8

Which blood test is often positive in ankylosing spondylitis?

Answer 8

HLA B27

Question 9

What features might been seen on xray in ankylosing spondylitis?

Answer 9

Commonly normal at presentation
Sclerosis + fusion of SI joints
Bony spurs from vertebral bodies –> ‘bamboo spine’

Question 10

Which investigation might be useful in suspected ankylosing spondylitis if xray is normal, and what might it show?

Answer 10

MRI

- bone marrow oedema + enthesitis of spinal ligaments

Question 11

What is the treatment for ankylosing spondylitis?

Answer 11

Physiotherapy + exercise
NSAIDs
Anti-TNF if more aggressive disease
(DMARDs don’t help spinal disease)

Question 12

What is the pattern of joint involvement in psoriatic arthritis?

Answer 12

Asymmetrical oligoarthritis

but may affect hands in similar pattern to RA

Question 13

What are some of the extra-articular features of psoriatic arthritis?

Answer 13

Almost always have psoriatic nail changes
Skin psoriasis
Spondylitis
Dactylitis
Enthesitis

Question 14

Which complication of psoriatic arthritis results in extensive joint destruction?

Answer 14

Arthritis mutilans

Question 15

Which xray features may be seen in psoriatic arthritis?

Answer 15

Marginal erosions
Whiskering
Pencil in cup deformity

Question 16

What is the treatment for psoriatic arthritis?

Answer 16

Methotrexate first line
Other DMARDs
NSAIDs
Steroid injections
Anti-TNF if resistant

Question 17

What is the definition of reactive arthritis?

Answer 17

Infection induced systemic illness –> inflammatory synovitis from which nothing grows on culture

Question 18

What are the most common causes of reactive arthritis?

Answer 18

Genital chlamydia

Enteric salmonella, shigella, campylobacter

Question 19

When does the arthritis develop in relation to the infection in reactive arthritis?

Answer 19

1-4 weeks post infection

Question 20

What is Reiter’s syndrome?

Answer 20

Urethritis + uveitis/conjunctivitis + reactive arthritis

Question 21

What are the clinical features of reactive arthritis?

Answer 21

Fever, fatigue, malaise
Asymmetrical mono or oligoarthritis
Enthesitis
Mucocutaneous lesions
Ocular inflammation

Question 22

What is the treatment for reactive arthritis?

Answer 22

Symptomatic/treat the cause
NSAIDs
Intra-articular steroids

90% resolve spontaneously within 6 months

Question 23

What is enteropathic arthritis?

Answer 23

Large joint, asymmetrical oligoarthritis occurring in IBD patients

(20% of Crohn’s patients have sacroiliitis)

Question 24

What is the treatment for enteropathic arthritis?

Answer 24

Treat IBD
Paracetamol/co-codamol for analgesia
Steroids (IM, IA, oral)
DMARDs/Anti-TNF –> discuss with GI

Question 25

Which drugs should be avoided in the management of enteropathic arthritis?

Answer 25

NSAIDs –> worsen IBD