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msk soh > Seronegative inflammatory arthropathies > Flashcards

Seronegative inflammatory arthropathies Flashcards

1
Q

Name 4 seronegative inflammatory arthropathies

A

Ankylosing Spondylitis
Psoriatic arthritis
Enteric arthritis
Reactive arthritis

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2
Q

Genetic predisposition

A

HLA-B27 +ve (not all HLA-B27 +ve patients will develop a disease)

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3
Q

Ankylosing spondylitis - definition

A

Chronic systemic inflammatory disorder that commonly affects the spine and sacro-iliac joints. This can lead to eventual fusion of the joints

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4
Q

Ankylosing spondylitis - epidemiology

A

More common in males

Late adolescence - early adulthood

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5
Q

Ankylosing spondylitis - pathogenesis

A

Vertebrae are usually separated by intervertebral discs for mobility
Inflammatory disease results in extra bone which fuses the vertebrae together - resulting in a limited range of movement

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6
Q

Ankylosing spondylitis - clinical features

A 
Spinal pain 
Radiation of pain to buttocks 
Stiffness
Loss in spinal movement over time 
Improvement of pain with exercise 
Enthesitis - inflammation of insertion of tendons into bones (e.g. plantar fasciitis, achiles tendonitis) 
Uveitis, psoriasis, crohn's, UC
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7
Q

Ankylosing spondylitis - examination

A 
Look
- question mark spine
- increased thoracic kyphosis 
- loss of lumbar lordosis 
Feel 
- reduced chest expansion 
Move 
- Schober's test: Measures lumbar spine flexion. In normal patients, the distance stretched should exceed 20cm. In ank spon due to reduced movement of vertebrae, this number is smaller 
- Wall test: patient puts back to wall, measure distance between wall and head
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8
Q

Ankylosing spondylitis - investigations

A 
Bloods 
- Raised inflammatory markers 
- HLA-B27 
X-rays
- no initial abnormalities but eventually show: 
- Sclerosis 
- fusion of SI joints and vertebrae 
- Bamboo spine 
MRI
- Detects early features 
- Bone marrow oedema (evidence of inflammation)
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9
Q

Ankylosing spondylitis - management

A

Physio
NSAIDs

Severe disease:
Biologics - Anti-TNF treatment

If involvement of peripheral joints:
DMARDs

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10
Q

Psoriatic arthritis - definition

A

Inflammatory arthritis associated with arthritis

some people may develop it without psoriasis

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11
Q

Psoriatic arthritis - symmetrical or asymmetrical?

A

Asymmetrical

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12
Q

Psoriatic arthritis - clinical features

A

Mainly peripheral involvement - hands, feet
Spondylitis - inflammation of spine
Nail involvement (onycholysis)
Dactylitis - inflammation of entire digit
Enthesitis - plantar fasciitis, achiles tendonitis

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13
Q

Psoriatic arthritis - investigations

A 
Bloods
- raised inflammatory markers 
X-rays
- No initial changes
- Marginal erosions and whispering 
- Osteolysis
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14
Q

Psoriatic arthritis - management

A 
Physio
NSAIDs
Steroids - for flare ups 
DMARDs 
Biologics (Anti-TNF) - if severe
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15
Q

Enteropathic arthritis - definition

A

Inflammatory arthritis in patients with IBD

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16
Q

Enteropathic arthritis - commonly affected areas

A

Large joints (knees, elbows, ankles, wrists)

17
Q

Enteropathic arthritis - clinical features

A 
Symptoms worsen during IBD flare-up 
Joints settle when IBD is controlled 
Arthritis in joints 
Uveitis 
Pyoderma gangrenosum 
Enthesitis (plantae fasciitis, achilles tendonitis)
18
Q

Enteropathic arthritis - investigations

A

Bloods
- raised inflammatory markers
GI endoscopy with biopsy
Joint aspirate

19
Q

Enteropathic arthritis - management

A

Treat IBD to control arthritis

do not use NSAIDs as these may worsen symptoms

20
Q

Reactive arthritis - definition

A

Inflammatory arthritis in response to an infection in another part of the body

21
Q

Reactive arthritis - epidemiology

A

Young adults

Most common infections: urogenital (chlamydia), GI infections

22
Q

Reactive arthritis - pathogenesis

A

Over activation of the immune system in response to infection

23
Q

Reactive arthritis - clinical features

A

Onset: 1-4 weeks after infection

Asymmetrical distribution

24
Q

Reactive arthritis - most common form

A

Reiter’s syndrome

  • urethritis
  • conjunctivitis/uveitis
  • arthritis
25
Q

Reactive arthritis - investigations

A 
Bloods
- raised inflammatory markers
Stool culture 
Joint aspiration
- to rule out infection
26
Q

Reactive arthritis - management

A

Most resolve spontaneously

NSAIDs
Steroids
Antibiotics - for underlying infection

msk soh (24 decks)

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