Seronegative Inflammatory Arthropathies

Question 1

Symptoms suggestive of inflammatory arthropathies?

Answer 1

Joint pain & swelling
Morning stiffness
Improvement in symptoms with exercise
Synovitis on examination
Raised inflammatory markers - CRP, PV
Extra-articular symptoms

Question 2

Main treatment options for inflammatory arthropathies

Answer 2

analgesia
anti-inflammatory medications: steroids & NSAIDs
steroid injections
DMARDs

Question 3

Characteristics of seronegative inflammatory arthropathies

Answer 3

Inflammation +/0
arthritic disease of the spine (spondyloarthropathy)
asymmetric oligoarthritis

Question 4

Common intra&extra-articular manifestations of seronegative inflammatory arthropathies:

Answer 4

Sacroiliitis
Uveitis
Dactylitis
Enthesopathies (especialyl achilles tendonitis & plantar fasciitis)

Question 5

What are seronegative inflammatory arthropathies?

Answer 5

Ankylosing Spondylitis
Psoriatic Arthritis
Enteropathic Arthritis
Reactive Arthritis

Question 6

What is the pathogenesis of Ankylosing Spondylitis

Answer 6

Chronic inflammatory disease of the spine & sacro-iliac joints –> fusion of spine & sacroiliac joints

Question 7

M:F ratio, age of Ankylosing Spondylitis

Answer 7

M:F is 3:1

20-40y

Question 8

What gene is common in Anklyosing Spondylitis

Answer 8

90% are HLA-B27 positive

Question 9

Signs & Symptoms of Ankylosing Spondylitis

Answer 9

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

Question 10

Associated conditions of Ankylosing Spondylitis

Answer 10

Anterior uveitis
Aortitis
Pulmonary fibrosis
Amyloidosis

Question 11

Investigations of Ankylosing Spondylitis

Answer 11

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

Question 12

Treatment of Ankylosing Spondylitis

Answer 12

NSAID & Physiotherapy

if more agessive: anti-TNF inhibitors, DMARDs impact on spinal disease (may be used if there is peripheral joint inflammation)

Question 13

Surgery in Ankylosing Spondylitis is reserved for

Answer 13

hip arthritis
knee arthritis
kyphoplasty - controversial!

Question 14

% of people with arthritis who have skin psoriasis

Answer 14

30%

Question 15

Pathology of psoriatic arthritis

Answer 15

asymmetrical oligoarthritis (may affect hands in similar pattern to RA)

Question 16

Signs & Symptoms of Psoriatic Arthritis

Answer 16

asymmetrical oligarthritis
spondylitis
dactylitis
enthesitis
nail: pitting, onchylosis
some have predilection for arthritis of DIP

Question 17

What is arthritis mutilans

Answer 17

aggressive &destructive form of psoriatic arthritis, 5% of patients with PA have it

Question 18

Pathology of Enteropathic Arthritis

Answer 18

Inflammatory arthritis of peripheral joints & sometimes the spine

Question 19

% of IBD patients with Enteropathic Arthritis

Answer 19

10-20%

Question 20

Symptoms of Enteropathic Arthritis

Answer 20

large joint asymmetrical oligoarthritis

Question 21

Treatment of Enteropathic arthritis

Answer 21

Medication to manage both underlying condition & arthritis

Question 22

Pathology of Reactive Arthritis

Answer 22

Reactive Arthritis develops in response to infection in other parts of the body - the infection triggers an autoimmune arthropathy

Question 23

What infections can bring about Reactive Arthritis?

Answer 23

GU: Chlamydia, Neisseria
GI: Salmonella, Campylobacter

Question 24

Signs & Symptoms of Reactive Arthritis

Answer 24

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)

Question 25

Reiters Syndrome

Answer 25

Urethritis
Uveitis/Conjunctivitis
Arthritis

Question 26

Treatment of Reactive Arthritis

Answer 26

Treat underlying infectious cause
Symptomatic relief: steroid (IA/IM injection)
if chronic: occasionally DMARDs