Seronegative inflammatory arthropathies Flashcards
Name 4 seronegative inflammatory arthropathies
Ankylosing Spondylitis
Psoriatic arthritis
Enteric arthritis
Reactive arthritis
Genetic predisposition
HLA-B27 +ve (not all HLA-B27 +ve patients will develop a disease)
Ankylosing spondylitis - definition
Chronic systemic inflammatory disorder that commonly affects the spine and sacro-iliac joints. This can lead to eventual fusion of the joints
Ankylosing spondylitis - epidemiology
More common in males
Late adolescence - early adulthood
Ankylosing spondylitis - pathogenesis
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
Ankylosing spondylitis - clinical features
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
Ankylosing spondylitis - examination
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
Ankylosing spondylitis - investigations
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)
Ankylosing spondylitis - management
Physio
NSAIDs
Severe disease:
Biologics - Anti-TNF treatment
If involvement of peripheral joints:
DMARDs
Psoriatic arthritis - definition
Inflammatory arthritis associated with arthritis
some people may develop it without psoriasis
Psoriatic arthritis - symmetrical or asymmetrical?
Asymmetrical
Psoriatic arthritis - clinical features
Mainly peripheral involvement - hands, feet
Spondylitis - inflammation of spine
Nail involvement (onycholysis)
Dactylitis - inflammation of entire digit
Enthesitis - plantar fasciitis, achiles tendonitis
Psoriatic arthritis - investigations
Bloods - raised inflammatory markers X-rays - No initial changes - Marginal erosions and whispering - Osteolysis
Psoriatic arthritis - management
Physio NSAIDs Steroids - for flare ups DMARDs Biologics (Anti-TNF) - if severe
Enteropathic arthritis - definition
Inflammatory arthritis in patients with IBD
Enteropathic arthritis - commonly affected areas
Large joints (knees, elbows, ankles, wrists)
Enteropathic arthritis - clinical features
Symptoms worsen during IBD flare-up Joints settle when IBD is controlled Arthritis in joints Uveitis Pyoderma gangrenosum Enthesitis (plantae fasciitis, achilles tendonitis)
Enteropathic arthritis - investigations
Bloods
- raised inflammatory markers
GI endoscopy with biopsy
Joint aspirate
Enteropathic arthritis - management
Treat IBD to control arthritis
do not use NSAIDs as these may worsen symptoms
Reactive arthritis - definition
Inflammatory arthritis in response to an infection in another part of the body
Reactive arthritis - epidemiology
Young adults
Most common infections: urogenital (chlamydia), GI infections
Reactive arthritis - pathogenesis
Over activation of the immune system in response to infection
Reactive arthritis - clinical features
Onset: 1-4 weeks after infection
Asymmetrical distribution
Reactive arthritis - most common form
Reiter’s syndrome
- urethritis
- conjunctivitis/uveitis
- arthritis
Reactive arthritis - investigations
Bloods - raised inflammatory markers Stool culture Joint aspiration - to rule out infection
Reactive arthritis - management
Most resolve spontaneously
NSAIDs
Steroids
Antibiotics - for underlying infection
