Seronegative spondyloarthritides Flashcards
What are the seronegative spondyloartritides
5
Ankylosing spondylitis Reactive arthritis/Reiter's syndrome Psoriatic arthritis Arthropathy of IBD Undifferentiated spondyloarthropathy
What are the general characteristics of the SnSas
1) RF negative- ‘seronegative’
2) Strong HLA B27 association, frequent family history
3) Axial athritis - favoring the spine, shoulder and pelvic girdles
4) Asymmetrical large joint symptoms
5) Enthesitis: inflammation of the thendon ro ligament insertions to bones.
6) Dactylitis: ‘sausage digits’ inflammation of the whole finger or toe soft tissue from edema
7) Extra-joint manifestations
Ankylosing spondylitis diagnostic criteria
1) Bilateral sacroiliitis plus: inflammatory back pain, arthritis enthesitis of achilles or supraspinatus uveitis dactylitis psoriasis IBD Resonsive to NSAIDs Family history of SpA HLA-B27 positive Elevated CRP or
2) HLA-B27 positive plus:
Active acute inflammation of sacroiliac joint on MRI
Definite radiographic sacroiliitis
Typical patient with SpA
A young adult male, with low back pain and stiffness, and possibly neck pain/stiffness.
3:1 male/female
Family history SpA or Inflammatory Bowel Disease
Extra-articular symptoms of SpA
Acute anterior uveitis is the most common. Inf of the iris and cilliary body.
- Unilateral
- Spontaneous remission
- Recurrent
IBD, Crohns disease
Nail breaking/flaking in psoriatic SpA patients, as well as skin sporiasis.
Joint symptoms of SpA
Bilateral sacroilliitis and eventual ankylosis/fusion
Episodes of acute, asymmetric inflammation of large joints, especially the knees.
Enthesitis - tendon/ligament insertion inflammation
Ascending vertebral inflammation and fusion.
1) Sclerosis at the edges of vertebral bodies
2) syndesmophyte formation, outgrowths near the edges of vertebrae
4) Bridging syndesmosis and fusion of the bodies and facet joints. ‘bamboo spine’
Weakening of the vertebrae, and high potential for spine fracture and SCI.
Treatment of SpA
Exercise and physical therapy to maintain flexibility and motion, despite pain, will actually improve pain and slow progression. This is critical.
NSAIDs for acute symptom relief and possibly slowing of progression
TNF-blocking biologics indicated for severe active SpA.
Local corticosteroids and/or analgesics for acute inflammation of joints, knees.
Hip surgery if hips are involved severely.
What is Reiter’s syndrome?
The classic triad of conjunctivitis, urethritis, and arthritis occurring after an infection.
Can’t see, can’t pee, can’t climb a tree
What is reactive arthritis?
The new term replacing Reiter’s syndrome.
More descriptive
What infections commonly cause Reactive arthritis?
Chlamydia,
Campylobacter
Yersinia
Salmonell and Shigella
What is an undifferentiated spondyloarthropathy
A patient with features of reactive arthritis with no evidence of infection
Therapy for undifferentiated or reactive arthritis
NSAIDs 1st
Sulfasalazine 2nd. unclear MoA but immunosuppression
treat infection
