seronegative spondyloarthritides Flashcards
What are they and what are their shared features
A group of diseases involving the axial skeleton and being negative for Rh factor (most of the time)
SEA SHED
S - Seronegativity
E - Enthesitis = inflammation at the site of tendon or ligament insertion eg. plantar fasciitis
A - Asymmetrical large joint oligoarthritis (<5) or monoarthritis
S - Spine and SI joints
H - HLA-b27 association
E - Extra-articular features (iritis, rash, oral ulcers, aortic valve incompetence, IBD)
D - Dactylitis = inflammation of the entire digit
What are the 4 common ones
- Ankylosing Spondyloarthritis
- Psoriatic Arthritis
- Reactive Arthritis
- Enteropathic Arthritis
Hx and Examination for Ank Spon
Hx
- Low back pain worse at night with morning stiffness that is relieved by exercise. Typicaly affects young men
- Progressive loss of spinal movements
- peripheral arthritis can occur
- symptoms of enthesitis and iritis
Examination
- Sacroiliitis
- deformity = kyphosis and neck hyperextension
- Enthesitis
- Eyes = iritis
- Heart for AR
- Lungs for apical pulmonary fibrosis
Ix and management for Ank Spon
Bloods - normocytic anaemia , raised ESR CRP
HLA-B27
IMAGING - MRI = SI erosion/sclerosis and ligament calcification
Management
- Exercise and NSAIDs
- TNF-alpha blockers (adalimumab)
- local steroid injections for short term
- surgery including hip replacement and rarely spinal osteotomy
Psoriatic Arthritis is?
arthropathy affecting 10-40% of those with psoriasis, in 25% the arthropathy precedes the skin changes
- Symmetrical polyarthropathy or asymmetrical oligoarthropathy
- can affect DIP’s and axial skeleton
- psoriatic arthritis mutilans (rare 3%)
- skin and nail changes
Exam:
- affected joints
- Skin = extensor surfaces, scalp, umbilicus
- nails = onycholysis
- fingers = dactylitis
Ix:
- erosive changes
Management:
- NSAIDs
- Methotrexate/sulfasalazine
- Anti-TNF agents
Reactive Arthritis
- sterile arthritis affecting lower limb
- 1-4 weeks following urethritis (often chlamydia) or dysentry
- Reiter’s syndrome = urethritis, arthritis, conjunctivitis
- may be CHRONIC or RELAPSING
Ix:
- raised ESR and CRP
- stool culture, infectious serology, sexual health review
- X-ray or USS may show enthesitis with periosteal reaction
Management:
- Rest ans splint affected joints
- NSAIDs and local steroid
- consider methotrexate or sulfasalazine - if chronic
Enteropathic arthritis
Joint pain associated with IBD and GI bypass
