Seronegative Spondyloarthrides Flashcards
What do Seronegative spondylopathies all have in common ? (2)
They are rheumatoid factor negative and anti-CCP negative
What is the aetiological
factor for Seronegative spondylopathies ?
HLA B27
What is the mnemonic for the four types of Seronegative spondylopathies ?
PAIR
What are the 4 types of seronegative spondylopathies?
Psoriatic arthritis
Ankylosing spondylitis
IBD related arthropathy
Reactive Arthritis
What is the mnemonic for the features that the Seronegative spondylopathies have in common ? (5)
JED PA
What are the features that the Seronegative spondylopathies have in common ? (5)
- Joint ankylosing
- Enthesitis
- Davtylitis (sausage shaped finger common in psoriatic arthritis)
- Plantar fasciitis
- Achilles tendinitis
What … presents usually as episodic inflammation and stiffening of the sacroiliac joints in young adults (18-30) ?
Ankylosing spondylitis
What is the mnemonic for the symptoms of Ankylosing spondylitis?
GMP: God’s My Peace
What are the features of Ankylosing spondylitis? (3)
- Gradual onset of INTERMITTENT lower back/buttock pain which improves with exercise and is worse in the morning
- Morning stiffness lasting longer than one hour
- Pleuritic chest pain/ costochondritis
What are the signs on examination For ankylosing spondylitis with regards to the following:
- Look (2)
- feel (1)
- move (2)
- special tests (1)
Look: 1. Question mark posture during spinal flexion (early sign)
2. Paraspinal muscle wasting
Feel: 1. Tender sacroiliac joints
move: (2) limited lateral flexion and forward flexion of the spine
Special tests: shober’s test less than 5cm
What other joints may be involved ?
- Asymmetrical hip/shoulder joints
2. Other peripheral joints (rare)
What are the 4 extra-articulations manifestations of Ankylosing spondylitis? 😭
4A
- Anterior uvetis
- Apical pulmonary fibrosis
- Aortic regurgitation
- AV node block
- Amyloidosis
What investigations would you do for Ankylosing spondylitis with regards to the following:
- Bloods (4)
- Basic Imaging (2)
Bloods (4): FBC, ESR, CRP and HLA-B27
- Basic Imaging (2):
spinal x-Ray (2): 1. Squaring of vertebral bodies
2. Bamboo spine: Rigid spine due to formation syndesmophtyes: ossified ligaments
Pelvic X-Ray: bilateral sacroilitis: narrowing of joint space between the SIJs, eventually leading to fusion
What is the management for ankylosing spondylitis with regards to the following:
- conservative
- medical
- surgical ?
- conservative: exercise and physiotherapy
- medical:
full dose NSAIDs: first line
2 NSAIDs: second line
Biological therapy: etanercept; avoid infliximab
-surgical: is affecting hip: THR
With regards to psoriatic arthritis, which occurs first the skin disease or arthritis
Skin disease can present prior/after arthritis
What are the 5 types of psoriatic arthritis?
- Symmetrical polyarthritis (similar to RA but affects DIPs) in the hands
- Asymmetrical oligoarthritis: Often one large joint and several small hand/foot joints
- DIP predominant disease:
Nail charges: pitting, onycholosis, subungal hyperkeratosis
- dactylitis: sausage finger - Spondylitis: affecting spine with/without SIJs (often unilateral)
- Arthritis Motilans: marked joint deformity and telescoping of the digits
What is the main investigation performed for psoariatic arthritis and explain the findings ?
X Ray changes: pencil in cup deformity due to central erosions
What is the management for psoriatic arthritis with regards to the following:
- one joint affected
- multiple joint affectEd
one joint affected: oral NSAIDS + PPI with/without intra-articulations steroid injections
- multiple joint affected: Treat like RA: Oral NSAID (+PPI) + oral DMARD
What … causes acute asymmetrical lower limb arthritis which usually occurs after 4-40 days following an infection usually GI/GU
Reactive arthritis causes acute asymmetrical lower limb arthritis which usually occurs after 4-40 days following an infection usually GI/GU
What is the Classical triad of reactive arthritis ?
Can see, can’t pee or climb a tree
- Conjunctivitis/Iritis
- Dysuria due to urethritis and discharge
- Lower limb arthritis particularly in KNEE
What must you not forget to ask about in a patient with reactive arthritis ?
Hx of unprotected sex/illness and Foreign travel
What are the 3 extra-articulations manifestations of reactive arthritis ?
- May develop sacroilitis or spondylitis
- Enthesitis associated with plantar fasciitis and Achilles Tendinitis
- Skin changes: keratoderma and Balantitis
What does the management of reactive arthritis Involve ?
NSAIDs with/without steroid injections: 1st line;
Sulphasalazine for more extensive disease
What are the features of IBD associated arthropathy ? (2)
- Asymmetrical lower limb arthritis
2. May have sacroilitis or spondylitis
What is the treatment of IBD related spondylopathy?
MDT approach:
- Treat IBD
- NSAIDs + intra-articular steroids for
