Seronegative arthropathies

Question 1

What is reactive arthritis (reiter’s syndrome)? how is it managed?

Answer 1

• arthritis (oligoarthritis of the lower limbs), conjunctivitis and urethritis
• can’t see, can’t wee, can’t climb a tree (some weird handfoot rash keratoderma, balanitis)
• caused in response to an unknown pathogen - 4 weeks post infection & can last 4-6 months
• NSAIDs, analgesia & intra-articular steroids
• sulfasalazine or MTX if bad

Question 2

Psoriatic arthritis, when does it happen with the skin thing?

Answer 2

• 20% of patients

- particularly in those with nail bed changes

Question 3

There’s 5 types of psoriatic arthritis, give me em?

Answer 3

• DIPJ only (asymmetrical involvement of the small joints on the hand)
• Symmetrical seronegative polyarthritis – RA like (symmetrical, affecting the small joints)
• Large joint asymmetrical oligoarthritis (affects 2-4 joints)
• Axial (Affects the central skeleton – spine and rib cage) – e.g. sacroilititis
• Arthritis mutilans – a severe form with destruction of the small bones in the hands and feet

BIG BAD BOY SAUSAGE FINGERS dactylitis

Question 4

What are the seronegative spondylarthropathies associated with?

Answer 4

HLA B27

Question 5

What are the 2 catergories of pathogens that can causes reactive arthritis?

Answer 5

• Dysenteric pathogens - that wot makes you shit (campylobacter, shigella, salmonella)
• STIs - that wot makes you not horny (chlamydia)

Question 6

Treatment of psoriatic arthritis?

Answer 6

treated as RA but has better prognosis

Question 7

What investigations do you do for reactive arthitis?

Answer 7

• joint aspiration - looking for crystals
• ureteral swab - STI
• stool sample - causative pathogen

Question 8

What’s a good acronym for thinking about spondylarthroptathies?

Answer 8

SPINE ACHE

Sausage digits/seronegative (RF -ve)
Psoriasis
Inflammatory back pain 
NSAIDs - good response to
Enthesitis 

Arthritis
Chrons/colitis/CRP high
HLA B27
Eye uvitits

Question 9

what is ankolysing spondylitis?

Answer 9

• spinal arthritis

- stiffening and eventual fusion of the sacroilliac joints

Question 10

What’s the presentation of ank spond?

Answer 10

• insidious back pain
• stiffness in the morning, better on exercise
• night pain better on getting out of bed
• progressive loss of spinal movement
• tenderness around pelvis and chest wall

Question 11

What are non-back pain presentation of ank spond?

Answer 11

5 As

• Aortic regurgitation
• apical lung fibrosis
• anterior uveitis
• Achilles tendonitis
• AV node block

Question 12

Xray findings for ank spond?

Answer 12

• Sacro-ilitis – sclerosis, erosion, loss of joint space, fusion, subchondral erosions (plain XR of sacroiliac joints are the most useful radiological Ix)
• Squaring of lumbar vertebrae
• Syndesmophytes – bony lesions from the healing of enthesitis
• Bamboo spine - late and uncommon

Question 13

Treatment of ank spond?

Answer 13

• NSAIDs (at night) first line + physio + exercise
• Methotrexate + other DMARDS
• TNF inhibitors 4