Seronegative Inflammatory Arthropathies Flashcards
Symptoms suggestive of inflammatory arthropathies?
Joint pain & swelling Morning stiffness Improvement in symptoms with exercise Synovitis on examination Raised inflammatory markers - CRP, PV Extra-articular symptoms
Main treatment options for inflammatory arthropathies
analgesia
anti-inflammatory medications: steroids & NSAIDs
steroid injections
DMARDs
Characteristics of seronegative inflammatory arthropathies
Inflammation +/0
arthritic disease of the spine (spondyloarthropathy)
asymmetric oligoarthritis
Common intra&extra-articular manifestations of seronegative inflammatory arthropathies:
Sacroiliitis
Uveitis
Dactylitis
Enthesopathies (especialyl achilles tendonitis & plantar fasciitis)
What are seronegative inflammatory arthropathies?
Ankylosing Spondylitis
Psoriatic Arthritis
Enteropathic Arthritis
Reactive Arthritis
What is the pathogenesis of Ankylosing Spondylitis
Chronic inflammatory disease of the spine & sacro-iliac joints –> fusion of spine & sacroiliac joints
M:F ratio, age of Ankylosing Spondylitis
M:F is 3:1
20-40y
What gene is common in Anklyosing Spondylitis
90% are HLA-B27 positive
Signs & Symptoms of Ankylosing Spondylitis
spinal pain and stiffness (morning stiffness marked, improves with exercise)
over time: loss of spinal movement, question mark spine (loss of lumbar lordosis & increased thoracic kyphosis)
may also develop knee & hip arthritis
Schoebers test: should extend beyond 20cm
Associated conditions of Ankylosing Spondylitis
Anterior uveitis
Aortitis
Pulmonary fibrosis
Amyloidosis
Investigations of Ankylosing Spondylitis
X-Ray: sclerosis & fusion of SI joint, syndesmophytes (bony spurs from vertebral vodies) can bridge IV disc –> bamboo spine (X-Ray can be normal at time of presentation)
MRI: can detect earlier features - bone marrow oedema, enthesitis of spinal ligaments
Treatment of Ankylosing Spondylitis
NSAID & Physiotherapy
if more agessive: anti-TNF inhibitors, DMARDs impact on spinal disease (may be used if there is peripheral joint inflammation)
Surgery in Ankylosing Spondylitis is reserved for
hip arthritis
knee arthritis
kyphoplasty - controversial!
% of people with arthritis who have skin psoriasis
30%
Pathology of psoriatic arthritis
asymmetrical oligoarthritis (may affect hands in similar pattern to RA)
Signs & Symptoms of Psoriatic Arthritis
asymmetrical oligarthritis spondylitis dactylitis enthesitis nail: pitting, onchylosis some have predilection for arthritis of DIP
What is arthritis mutilans
aggressive &destructive form of psoriatic arthritis, 5% of patients with PA have it
Pathology of Enteropathic Arthritis
Inflammatory arthritis of peripheral joints & sometimes the spine
% of IBD patients with Enteropathic Arthritis
10-20%
Symptoms of Enteropathic Arthritis
large joint asymmetrical oligoarthritis
Treatment of Enteropathic arthritis
Medication to manage both underlying condition & arthritis
Pathology of Reactive Arthritis
Reactive Arthritis develops in response to infection in other parts of the body - the infection triggers an autoimmune arthropathy
What infections can bring about Reactive Arthritis?
GU: Chlamydia, Neisseria
GI: Salmonella, Campylobacter
Signs & Symptoms of Reactive Arthritis
large joints (e.g. knee inflammed) 1-3 weeks following infection
triad of symptoms - Reiter’s syndrome (urethritis, uveitis/conjunctivitis, arthritis)
self-limiting (15-30% chronic, frequent relapses)
Reiters Syndrome
Urethritis
Uveitis/Conjunctivitis
Arthritis
Treatment of Reactive Arthritis
Treat underlying infectious cause
Symptomatic relief: steroid (IA/IM injection)
if chronic: occasionally DMARDs
