Seronegative Spondyloarthopathies Flashcards
What is the definition of a seronegative spondyloarthropathies?
inflammatory conditions of the spine and sacroiliac joints without the presence of RF
what are the types of seronegative spondyloarthropathies?
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
IBD-related arthropathy
what are some features more specific to seronegative spondyloarthropathies when compared to rheumatoid arthritis
dactylitis
Joint ankylosis - stiffening due to joint fusion
enthesitis
how does ankylosing spondylitis present
Episodes of pain/stiffness in lower back/buttocks worse in the morning, relieved by exercise
Otherwise asymptomatic
Pain in buttock may alternate between sides
May cause awakening from sleep in the second half of the night
what do you find on examination with ankylosing spondylitis
lumbar lordosis with a ‘question mark’ posture
pain on pressure over SIJ
limited lateral and forward flexion of the lumbar spine
reduced shobers test (<5cm)
what are some extra articular manifestations for ankylosing spondylitis
Anterior uveitis
Pulmonary fibrosis - Apical
AV node block
Aortitis - Leading to aortic regurgitation and fibrosis
Amyloidosis
what investigations should be done in ankylosing spondylitis
ESR - normal in 50%
pelvic XR - bilateral sacroiliitis
Spinal XR - bamboo spine (ossification of annulus fibrosis), squaring of vertebral bodies,
how do you manage ankylosing spondylitis
Full dose NSAID 6 weeks
Clinical effectiveness measured with DAS score
No improvement on 2 full does NSAIDs = biologics
e.g. Etanercept, Infliximab (not in US)
what is the prognosis for ankylosing spondylosis
80% remain in long term employment with long term chronic generalised back stiffness
what % of patients with psoriasis get psoriatic arthritis
8%
what are the 5 subtypes of psoriatic arthritis
Symmetrical polyarthritis (40%)
Asymmetrical oligoarticular arthritis (30%)
DIPJ predominant disease (10%)
Spondylisis
Arthritis mutilans (5%)
what are features of psoriatic symmetrical polyarthritis
Similar to RA
DIPJ involvement instead
Less severe deformity
what are features of psoriatic asymmetrical oligoarticular arthritis
<5 joints
Often one large joint plus smaller hand/foot joints
what are features of psoriatic DIPJ predominant disease
Typical, associated with psoriatic nail changes
Pitting
Subungal hyperkeratosis
Onicholysis
Rarely disabling
May cause dactylitis
what are features of psoriatic spondylisis
Affecting spine
+/- SIJs as per AS
what are features of arthritis mutilans
Severe form
Marked joint destruction
Marked deformity
Classically involving telescoping of the finger joints
what are radiological signs of arthritis mutilans
Erosions, similar to RA but with comparatively little osteopenia
Erosions tend to be more central than RA leading to a ‘pencil in a cup’ appearance
what joint involvement is specific to psoriatic arthritis
early DIPJ involvement
how do you manage psoriatic arthritis
1 joint
Full dose NSAIDS +/- steroid injections
Multiple joints
Treat as per RA but prognosis is better
Methotrexate is useful as it helps skin psoriasis
DMARDS tend not to help spinal symptoms
what is the usual history of a reactive arthritis
Acute asymmetrical lower limb arthritis 4-40 days following a bacterial infection, usually a GU or GI infection
what common pathogens cause reactive arthritis
Chlamydia
Salmonella
Campylobacter
how does reactive arthritis present
‘cant see can’t pee cant climb a tree’ - classic triad
conjunctivitis
dysuria
lower limb oligoarthritis
enthesitis also common skin lesions (Keratoderma blenorrhaggia - psoriasis-like plaques, Balantitis in the uncircumcised male) also common
whats the management of reactive arthritis
Full dose NSAIDS +/- steroids
Sulfasalazine is second line for more extensive disease
whats the prognosis of reactive arthritis
30-50% have chronic arthritis
Reactive arthritis lasts from anywhere from 3-12 months
what % of patients with IBD get IBD-related arthropathy
10-15%
how does IBD related arthropathy present
symmetrical arthritis affecting lower limb joints
5% have SIJ involvement
how does IBD related arthropathy change with effective IBD treatment
UC = remission of disease leads to remission of joint disease
crohns = remission of gut disease does not lead to remission of joint disease
how is IBD related arthopathy treated
MDT related
Discussion between rheumatologists and gastroenterologis
what conditions have anterior uveitis as an extra articular feature
psoriatic arthritis
ankyosing spondylitis
what are symptoms of anterior uveitis
Acute pain
Photophobia
Constricted pupil
Possibly irregular due to anterior/posterior synechiae
Circumcorneal redness
Treated with topical steroids and a dilating eye drop
what causes more pain, episcleritis or scleritis
scleritis = extreme pain
episcleritis = tenderness
what is the treatment for extra articular disease affecting the eye
anti-inflammatory eye drops
