Seronegative Inflammatory Arthropathies Flashcards
What are the 4 seronegative inflammatory arthropathies?
Ankylosing Spondylitis
Psoriatic arthritis
Enteropathic arthritis
Reactive arthritis
What are the main features of seronegative inflammatory arthropathies?
Sponyloarthropathy and asymmetric oligoarthritis
What makes individuals genetically predisposed to seronegative inflammatory arthropathies?
Being HLA-B27 positive
What is a spondyloarthropathy?
Inflammation/arthritic disease of the spine
What conditions is HLA B27 associated with?
- Ankylosing Spondylitis
- Crohn’s Disease
- Uveitis
- Reactive Arthritis
Where in the world in HLA-B27 most prevalent?
Northern countries
If you are HLA-B27 +, does this mean you will definitely have one of the conditions it is associated with?
No
What type of pain is associated with seronegative inflammatory arthropathies?
Inflammatory pain
Describe mechanical pain?
Worsened by activity, better at the end of the day/with rest
Describe inflammatory pain?
Worse with rest, better with activity, significant early morning stiffness
What are six shared features of the spondyloarthropathies?
- Sacroiliac and spinal involvement
- Enthesitis
- Dactylitis
- Ocular inflammation
- Mucocutaneous lesions
- Rare aortic impotence or heart block
What is enthesitis? Give two examples.
Inflammation at the insertion of tendons into bones (e.g. Achilles tendonitis, plantar fasciitis)
What is an enthesis?
Site of insertion of a tendon, ligament or articular capsule into a bone
What is enthesopathy?
An alteration at the site of an enthesis
What type of inflammatory arthritis usually occurs in the seronegative inflammatory arthropathies (excluding back)?
Asymmetric, predominantly lower limb
What is dactylitis?
‘Sausage digits’- inflammation of an entire digit
What are some examples of ocular involvement in the seronegative inflammatory arthropathies?
Anterior uveitis, conjunctivitis
What are the 4 most important things to know about the seronegative inflammatory arthropathies?
- Associated with HLA-B27
- Affects the spine and other joints
- Causes enthesitis
- Causes extra-articular features
Ankylosing spondylitis is a chronic systemic inflammatory disorder primarily affecting where?
The spine and sacroiliac joints
What can chronic inflammation of the spine and sacroiliac joints lead to?
Eventual fusion of the intervertebral joints and SI joints
Is peripheral arthritis common in ankylosing spondylitis?
No
When does ankylosing spondylitis usually present? Which sex is it most common in?
Late adolescence or early adulthood (ranging 20-40)
More common in men 3:1
What is the main complaint of patients with ankylosing spondylitis?
Pain and stiffness in the back, and possible hip/knee arthritis
What improves morning stiffness in ankylosing spondylitis?
Exercise
What happens to the spine over time in ankylosing spondylitis?
Loss of movement and development of a question mark spine
What happens in a question mark spine?
Loss of lumbar lordosis
Increased thoracic kyphosis
What are the main criteria you muse always have for ASAS classification of ankylosing spondylitis?
3 or more months of back pain, less than 45 years of age
If you have the major criteria, what are the next two steps on the ASAS classification for ankylosing spondylitis?
- Sacroiliitis on imaging and 1 or more SpA features
- HLA B27 positive and 2 or more SpA features
What are the SpA features used for the ASAS classification of ankylosing spondylitis?
- Inflammatory back pain
- Arthritis
- Enthesitis
- Uveitis
- Dactylitis
- Psoriasis
- Crohn’s disease
- Good response to NSAIDs
- Family history
- Elevated CRP
- HLA B27
What are some extra-articular features of ankylosing spondylitis?
CV, pulmonary or neurological involvement, mucosal inflammation, amyloidosis