Seronegative spondylarthritis Flashcards
What joints are affected in AS?
Sacroiliac joints and joints of vertebral column
What are the features of AS?
Typically young men (20-30yr olds)
Insidious onset of lower back pain and stiffness
Worse at rest but improves with movement
Worse at night and morning
Pain disrupts sleep
Takes >30mins for stiffness to improve and gets better with activity during the day
What associated features can be present in AS?
The A's: Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis and plantar fasciitis (both due to enthesitis) AV node block Amyloidosis Anaemia Aortitis
Cauda equina syndrome
Peripheral arthritis
Chest pain related to costovertebral and costosternal joint
IBD
Systemic symptoms e.g. weight loss and fatigue
What clinical examination findings are present in AS?
Reduced lateral flexion
Reduced flexion - Schober’s test, AS patient distance is <20cm on flexion
Reduced chest expansion
What investigations are carried out in AS?
Inflammatory markers - ESR and CRP typically raised
HLA-B27 genetic marker
X-ray of spine and sacrum
MRI of spine - shows bone marrow oedema early in disease before X-ray changes
What changes are present on X-ray in AS?
Bamboo spine - fusion of spine
Sacroiliitis - subchondral erosions, sclerosis
Squaring of lumbar vertebrae bodies
Ossification of ligaments, disc and joints
Syndesmophytes - ossification of outer fibres of annulus fibrosis leads to fusion of vertebrae
What may be seen on chest x-ray in AS?
Apical fibrosis
What is the management for AS?
1st line = NSAIDs
DMARDs are only useful if there is peripheral joint involvement
Anti-TNF therapy - if patient having consistently high disease activity despite conventional treatment
Exercise
Physiotherapy
What infections can trigger reactive arthritis?
Gastroenteritis
STI (Chlamydia most common)
What are the features of reactive arthritis?
Classic triad - can’t see, can’t pee, can’t climb a tree:
Conjunctivitis
Urethritis
Arthritis
Asymmetrical oligoarthritis of lower limb
Warm, swollen and painful joints
Dactylitis
Symptoms of urethritis
Eye - conjunctivitis, anterior uveitis
Skin - Circinate balanitis (ring-shaped dermatitis around head of penis), keratoderma blenorrhagica (waxy yellow/ purple papule on palms and soles)
What is the management for reactive arthritis?
If symptomatic:
Analgesia
NSAIDs
Intra-articular steroids
Most resolve within 6 months and don’t recur
If recurrent, may need DMARDs or Anti-TNF
What are the different types of psoriatic arthritis?
Symmetrical polyarthritis:
More common in women
Hands, wrists, ankles and DIP joints are affects
MCP joints less commonly affected (unlike RA)
Asymmetrical oligoarthritis:
Affects fingers, toes and feet
Spondylitic:
More common in men
Back stiffness, scaroiliitis and atlanto-axial joints involvement
Arthritis mutilans:
Most severe form of psoriatic arthritis
Occurs in phalanx
Osteolysis of phalanx bones around joint, leading to progressive shortening of digits
Skin folds as digits shortens, leading “telescopic fingers”
What are the features of psoriatic arthritis?
Psoriasis plaques on skin Pitting of the nails Onycholysis Dactylitis Enthesitis
What other conditions may be associated with psoriatic arthritis?
Eye - conjunctivitis, anterior uveitis
Aortitis
Amylodiosis
What is used to screen people with psoriasis for psoriatic arthritis?
Psoriasis Epidemiological Screening Tool (PEST)
High score = referral to rheumatologist
