Seronegative Inflammatory Arthropathies

Question 1

what are the 4 seronegative inflammatory arthropathies

Answer 1

1. Ankylosing spondylitis 2. Psoriatic arthritis 3. Enteropathic arthritis 4. Reactive arthritis

Question 2

what gene is associated with these conditions

Answer 2

HLA B27

Question 3

what is ankylosing spondylitis

Answer 3

chronic inflammatory disease of spine + sacroiliac joints - can lead to fusion of intervertebral joints + S1 joints if untreated

Question 4

who gets ankylosing spondylitis

Answer 4

males, aged 20-40

Question 5

symptoms of ankylosing spondylitis

Answer 5

spinal pain morning stiffness - improves with exercise sacroiliac tenderness

Question 6

what is the question mark posture seen in ankylosing spondylitis

Answer 6

loss of lumbar lordosis increased thoracic kyphosis

Question 7

what does schobers test measure

Answer 7

lumbar spine flexion - in normal situations should extend beyond 20cm

Question 8

list the 5 A’s associated with ankylosing spondylitis

Answer 8

Anterior uveitis

Autoimmune bowel disease: Crohns/UC

Apical lung fibrosis

Aortic regurgitation

Amyloidosis

Question 9

XRAY features in ankylosing spondylitis

Answer 9

sclerosis + fusion of sacroiliac joints

syndesmophytes - bondy spurs from verebral body

bamboo spine - disk fusion

Question 10

what imaging is more sensitive in the early stages of ankylosing spondylitis ?

what might be seen?

Answer 10

MRI

• bone marrow oedema
• Enthesitis of the spinal ligaments

Question 11

what markers are raised in ankylosing spondylitis

Answer 11

increase ESR + CRP

increased alk phos

Question 12

management of ankylosing sponylitis

Answer 12

• Pysiotherapy
• NSAIDS: ibuprofen, diclofenac, naproxen + PPI
• Steroid injections for short term relief
• Anti- TNF if there is high disease activity + CRP/radiographic sigsn of inlammation + 2 nsaids have failed

Question 13

features of psoriatic arthritis

Answer 13

asymmetrical oligoarthritis most common pattern

can present as symetrical polyarthritis, similar to RA (but affects DIP joints)

Question 14

nail features psoriatic arthritis

Answer 14

onycholysis - yellow/brown discolouration

pitting

dactylitis - sausage fingers/toes

Question 15

XRAY finding in psoriatic arthritis

Answer 15

‘pencil in cup’ - DIP erosion

Question 16

treatment of psoriatic arthrits

Answer 16

same as RA

• methotrexate first line
• steroid injections for monoarthritis

Question 17

what is enteropathic arthritis

Answer 17

inflammatory arthritis occuring in patients with inflammatory bowel disease

• tends to be large joint asymmetrical oligoarthritis
• can affect spine

Question 18

what is reactive arthritis

Answer 18

post-infectious autoimmune joint inflammation

• typically affects large joints e.g. knee
• occurs 1-3 weeks post infections

Question 19

what conditions commonly lead to reactive arthritis

Answer 19

Genitourinary- chlamydia, neisseria

GI- campylobacter, salmonella

Question 20

what is reiters syndrome

Answer 20

triad of reactive arthritis, urethritis, uveitis/conjunctivitis

Question 21

treatment for reactive arthritis

Answer 21

• treat underlying cause e.g. infection
• Symptomatic relief e.g. NSAIDs, Intra-articular steroids
• DMARDs in chronic cases