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MSK- Rheumatology > Seronegative Inflammatory Arthropathies > Flashcards

Seronegative Inflammatory Arthropathies Flashcards

1
Q

What are the 4 seronegative inflammatory arthropathies?

A

Ankylosing Spondylitis
Psoriatic arthritis
Enteropathic arthritis
Reactive arthritis

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2
Q

What are the main features of seronegative inflammatory arthropathies?

A

Sponyloarthropathy and asymmetric oligoarthritis

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3
Q

What makes individuals genetically predisposed to seronegative inflammatory arthropathies?

A

Being HLA-B27 positive

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4
Q

What is a spondyloarthropathy?

A

Inflammation/arthritic disease of the spine

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5
Q

What conditions is HLA B27 associated with?

A
  • Ankylosing Spondylitis
  • Crohn’s Disease
  • Uveitis
  • Reactive Arthritis
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6
Q

Where in the world in HLA-B27 most prevalent?

A

Northern countries

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7
Q

If you are HLA-B27 +, does this mean you will definitely have one of the conditions it is associated with?

A

No

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8
Q

What type of pain is associated with seronegative inflammatory arthropathies?

A

Inflammatory pain

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9
Q

Describe mechanical pain?

A

Worsened by activity, better at the end of the day/with rest

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10
Q

Describe inflammatory pain?

A

Worse with rest, better with activity, significant early morning stiffness

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11
Q

What are six shared features of the spondyloarthropathies?

A
  • Sacroiliac and spinal involvement
  • Enthesitis
  • Dactylitis
  • Ocular inflammation
  • Mucocutaneous lesions
  • Rare aortic impotence or heart block
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12
Q

What is enthesitis? Give two examples.

A

Inflammation at the insertion of tendons into bones (e.g. Achilles tendonitis, plantar fasciitis)

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13
Q

What is an enthesis?

A

Site of insertion of a tendon, ligament or articular capsule into a bone

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14
Q

What is enthesopathy?

A

An alteration at the site of an enthesis

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15
Q

What type of inflammatory arthritis usually occurs in the seronegative inflammatory arthropathies (excluding back)?

A

Asymmetric, predominantly lower limb

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16
Q

What is dactylitis?

A

‘Sausage digits’- inflammation of an entire digit

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17
Q

What are some examples of ocular involvement in the seronegative inflammatory arthropathies?

A

Anterior uveitis, conjunctivitis

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18
Q

What are the 4 most important things to know about the seronegative inflammatory arthropathies?

A
  • Associated with HLA-B27
  • Affects the spine and other joints
  • Causes enthesitis
  • Causes extra-articular features
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19
Q

Ankylosing spondylitis is a chronic systemic inflammatory disorder primarily affecting where?

A

The spine and sacroiliac joints

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20
Q

What can chronic inflammation of the spine and sacroiliac joints lead to?

A

Eventual fusion of the intervertebral joints and SI joints

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21
Q

Is peripheral arthritis common in ankylosing spondylitis?

A

No

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22
Q

When does ankylosing spondylitis usually present? Which sex is it most common in?

A

Late adolescence or early adulthood (ranging 20-40)

More common in men 3:1

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23
Q

What is the main complaint of patients with ankylosing spondylitis?

A

Pain and stiffness in the back, and possible hip/knee arthritis

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24
Q

What improves morning stiffness in ankylosing spondylitis?

A

Exercise

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25
Q

What happens to the spine over time in ankylosing spondylitis?

A

Loss of movement and development of a question mark spine

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26
Q

What happens in a question mark spine?

A

Loss of lumbar lordosis

Increased thoracic kyphosis

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27
Q

What are the main criteria you muse always have for ASAS classification of ankylosing spondylitis?

A

3 or more months of back pain, less than 45 years of age

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28
Q

If you have the major criteria, what are the next two steps on the ASAS classification for ankylosing spondylitis?

A
  • Sacroiliitis on imaging and 1 or more SpA features

- HLA B27 positive and 2 or more SpA features

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29
Q

What are the SpA features used for the ASAS classification of ankylosing spondylitis?

A
  • Inflammatory back pain
  • Arthritis
  • Enthesitis
  • Uveitis
  • Dactylitis
  • Psoriasis
  • Crohn’s disease
  • Good response to NSAIDs
  • Family history
  • Elevated CRP
  • HLA B27
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30
Q

What are some extra-articular features of ankylosing spondylitis?

A

CV, pulmonary or neurological involvement, mucosal inflammation, amyloidosis

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31
Q

What are the features of ankylosing spondylitis using the rule of A’s?

A
  • Anterior uveitis
  • Aortic regurgitation
  • Achilles tendonitis/plantar fasciitis
  • Atypical fibrosis
  • Amyloidosis
  • IgA nephropathy
32
Q

What are some tests which may be useful in an examination of possible ankylosing spondylitis?

A
  • Occiput to wall (big gap if AS)
  • Chest expansion (may be reduced in AS)
  • Schober’s test
33
Q

What does the Schober’s test test?

A

Lumbar spinal flexion

34
Q

How is the Schober’s test performed?

A

Measure 5cm below the iliac crests and 10cm above and then ask the patient to bend forward and remeasure the distance which should be beyond 20cm

35
Q

What blood tests may be useful for ankylosing spondylitis?

A
  • Inflammatory markers (CRP, PV)

- HLA-B27

36
Q

What are some x-ray features of ankylosing spondylitis?

A
  • Can be normal
  • Sacroiliitis
  • Bamboo spine
  • Syndesmophytes
37
Q

What are syndesmophytes?

A

Bony spurs from vertebral bodies

38
Q

Why are MRIs preferred over x-rays?

A

Safer and more accurate

39
Q

What features can MRI detect that x-rays cannot?

A
  • Bone marrow oedema

- Enthesitis of spinal ligaments

40
Q

How can you tell ankylosing spondylitis from osteoarthritis?

A

AS is inflammatory while OA is not

AS will cause reduced bone density while OA will be normal or increased

41
Q

What are the main treatments for ankylosing spondylitis?

A

NSAIDs, physiotherapy, occupational therapy, exercise

42
Q

What role do DMARDs have in ankylosing spondylitis?

A

No role in spinal disease but can be used if there is peripheral joint inflammation

43
Q

Are biologics ever used for ankylosing spondylitis?

A

Yes, if there is aggressive disease. You would use anti-TNF e.g. infliximab or anti-IL17 e.g. sucukinumab

44
Q

What % of patients with psoriasis get an inflammatory arthritis?

A

30%

45
Q

What % of patients have psoriatic arthritis without psoriasis?

A

10%

46
Q

What are 5 possible features of psoriatic arthritis?

A
  • Sacroiliitis (often asymmetric) and maybe spondylitis
  • Nail involvement
  • Datylitis
  • Enthesitis
  • Extra articular features e.g. eye disease
47
Q

What are 2 examples of nail involvement in psoriatic arthritis?

A

Pitting and onycholysis

48
Q

Psoriatic arthritis can be confined to what joints of the hands and feet?

A

DIPs

49
Q

What is arthritis mutilans?

A

A subtype of psoriatic arthritis which is very aggressive and destructive very quickly

50
Q

What are bloods tested for in psoriatic arthritis?

A

Raised inflammatory markers

Negative antibodies

51
Q

What may x-rays show in psoriatic arthritis?

A

Erosions
Osteolysis
Enthesitis

52
Q

Treatment of psoriatic arthritis is similar to what? What is this treatment?

A

Rheumatoid arthritis- DMARDs, usually methotrexate, and anti-TNF if unresponsive

53
Q

What is reactive arthritis?

A

An infection induced systemic illness characterised by synovitis from which viable microorganisms cannot be cultured

54
Q

When do symptoms of reactive arthritis tend to occur?

A

1-4 weeks after the original infection

55
Q

What joints are mostly affected by reactive arthritis?

A

Large joints e.g. knee

56
Q

What are the most common infections to cause reactive arthritis?

A

Uro-genital e.g. chlamydia or enterogenic e.g. salmonella

57
Q

Who does reactive arthritis usually occur in?

A

Young adults (20-40) with equal sex distribution

58
Q

Are individuals with reactive arthritis HLA-B27 positive?

A

Yes

59
Q

What is Reiter’s Syndrome?

A

A form of reactive arthritis made up of a triad of urethritis, conjunctivitis/uveitis/iritis and arthritis

60
Q

What are some clinical features of reactive arthritis?

A
  • General symptoms (fever, malaise, fatigue)
  • Asymmetrical mono/oligoarthritis
  • Enthesitis
  • Mucocutaneous lesions
  • Ocular lesions
  • Visceral manifestations
61
Q

What are bloods tested for in reactive arthritis?

A
  • Inflammatory markers
  • Us + Es, FBCs
  • HLA-B27
62
Q

What investigations are used in reactive arthritis with regards to infection?

A
  • Blood, urine, stool cultures

- Joint fluid analysis

63
Q

Is there normally bacteria in the joint in reactive arthritis?

A

No

64
Q

What is treatment aimed at in reactive arthritis?

A

The underlying infectious cause and symptomatic relief

65
Q

How many cases of reactive arthritis resolve spontaneously?

A

90% of cases within 6 months

66
Q

What medical treatments are used for reactive arthritis?

A
  • NSAIDs
  • Corticosteroids
  • Antibiotics if still infected
67
Q

When are DMARDs used in reactive arthritis?

A

In resistant or chronic cases

68
Q

What is enteropathic arthritis associated with?

A

IBD

69
Q

Enteropathic arthritis patients present with arthritis where?

A

Peripheral joints (knees, ankles, elbows, wrists) and sometimes spine

70
Q

When will symptoms of enteropathic arthritis worsen?

A

During flare ups of IBD

71
Q

What % of IBD patients will experience spine/joint problems?

A

10-20%

72
Q

What are some clinical features of enteropathic arthritis?

A
  • GI features
  • Weight loss, fever
  • Eye involvement
  • Skin involvement
  • Enthesitis
73
Q

What is the name of the skin condition associated with IBD and enteropathic arthritis?

A

Pyoderma gangrenosum

74
Q

How do you treat enteropathic arthritis?

A
  • Treat IBD
  • Analgesia
  • Steroids
  • DMARDs
  • Biologics (anti-TNF)
75
Q

What medication should you not give in enteropathic arthritis and why?

A

NSAIDs- may exacerbate IBD

MSK- Rheumatology (12 decks)

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