Seronegative Arthropathies Flashcards
What is another name for the seronegative arthropathies?
Spondylo-arthropathies
What are the cardinal symptoms of the spondylo-arthropathies?
Inflammatory back pain Asymmetrical oligoarthritis Often HLA B27 positive Sacroiliitis Anterior uveitis Dactylitis Enthesitis Conjunctivitis Mucocutaneous lesions
What are the features of inflammatory back pain?
Worse with rest
Better with activity
Morning stiffness > 30 minutes
What is enthesitis?
Inflammation at the insertion of a tendon into bone
e.g. Achilles tendonitis, plantar fasciitis
What is the pathophysiology of ankylosing spondylitis?
Chronic inflammation of spine + sacro-iliac joints
- -> eventual fusion of the intervertebral joints + SI joints
- -> loss of movement = ‘question mark spine’
What would be seen on examination of the spine in ankylosing spondylitis?
Reduced lumbar flexion on Schobers Test
What are the clinical features of ankylosing spondylitis?
'A' Disease: Axial arthritis Anterior uveitis Aortic regurgitation/Aortitis Apical fibrosis Amyloidosis/IgA nephropathy Achilles tendonitis plAntar fasciitis
Which blood test is often positive in ankylosing spondylitis?
HLA B27
What features might been seen on xray in ankylosing spondylitis?
Commonly normal at presentation
Sclerosis + fusion of SI joints
Bony spurs from vertebral bodies –> ‘bamboo spine’
Which investigation might be useful in suspected ankylosing spondylitis if xray is normal, and what might it show?
MRI
- bone marrow oedema + enthesitis of spinal ligaments
What is the treatment for ankylosing spondylitis?
Physiotherapy + exercise
NSAIDs
Anti-TNF if more aggressive disease
(DMARDs don’t help spinal disease)
What is the pattern of joint involvement in psoriatic arthritis?
Asymmetrical oligoarthritis
but may affect hands in similar pattern to RA
What are some of the extra-articular features of psoriatic arthritis?
Almost always have psoriatic nail changes Skin psoriasis Spondylitis Dactylitis Enthesitis
Which complication of psoriatic arthritis results in extensive joint destruction?
Arthritis mutilans
Which xray features may be seen in psoriatic arthritis?
Marginal erosions
Whiskering
Pencil in cup deformity
What is the treatment for psoriatic arthritis?
Methotrexate first line Other DMARDs NSAIDs Steroid injections Anti-TNF if resistant
What is the definition of reactive arthritis?
Infection induced systemic illness –> inflammatory synovitis from which nothing grows on culture
What are the most common causes of reactive arthritis?
Genital chlamydia
Enteric salmonella, shigella, campylobacter
When does the arthritis develop in relation to the infection in reactive arthritis?
1-4 weeks post infection
What is Reiter’s syndrome?
Urethritis + uveitis/conjunctivitis + reactive arthritis
What are the clinical features of reactive arthritis?
Fever, fatigue, malaise Asymmetrical mono or oligoarthritis Enthesitis Mucocutaneous lesions Ocular inflammation
What is the treatment for reactive arthritis?
Symptomatic/treat the cause
NSAIDs
Intra-articular steroids
90% resolve spontaneously within 6 months
What is enteropathic arthritis?
Large joint, asymmetrical oligoarthritis occurring in IBD patients
(20% of Crohn’s patients have sacroiliitis)
What is the treatment for enteropathic arthritis?
Treat IBD
Paracetamol/co-codamol for analgesia
Steroids (IM, IA, oral)
DMARDs/Anti-TNF –> discuss with GI
Which drugs should be avoided in the management of enteropathic arthritis?
NSAIDs –> worsen IBD
