Seronegative spondyloarthritides Flashcards
What are some types seronegative spondyloarthritides?
Axial spondyloarthritis- ankylosing spondylitis is a subtype
Psoriatic arthritis
Enteropathic arthritis
Reiter’s syndrome
What are the common features of seronegative spondyloarthritides?
RF - Associated w HLA B27 Asymmetric Sacroilitis, spondylitis, enthesitis Ant uveitis
What is axial spondyloarthritis?
Umbrella term
Chronic auto-inflammatory diseases affecting mainly the axial skeleton
What is the most known type of axial spondyloarthritis?
ankylosing spondylitis
What is the presentation of axial spondyloarthritis?
Articular- inflammatory back pain, arthritis, enthesitis
Extra articular- ant uveitis, dactylics
What conditions are associated with axial spondyloarthritis?
Psoriasis
IBD
Restrictive lung disease
What are the diagnostic criteria for axial spondyloarthritis?
> 3 months back pain with onset <45yo + 1 of
- sacroilitis on XR and >1 feature
- HLA B27 plus >2 features
What investigations are done for axial spondyloarthritis?
RF, HLA B27
XR
MRI
What is the management of axial spondyloarthritis?
Rhysio NSAIDs DMARD= sulfasalazine Anti TNF= infliximab Surgery- joint replacement, spinal surgery
Who is ank spond seen in?
Men, late teens to early 20s
What is the presentation of ank spond?
Inflammatory back pain Enthesitis Bilateral sacroilitis Kyphosis Ant uveitis Dyspnoea
What are the features of back pain in ank spond?
Insidious onset Worse i morning Improves with exercise Loss of lumbar lordosis Can progress to complete fusion i.e. bamboo spine
What causes dyspnoea in ank spond?
Costochondral joit involvement limiting chest expansion
Apical pulmonary fibrosis
What is the management of ank spond?
Physio and NSAIDs- generally good response
Biologic- Anti TNF- if 2 anti inflammatories have failed
What is psoriatic arthritis?
Inflammatory autoimmune arthritis
What is the presentation of psoriatic arthritis
Pain and stiffness- hot red and swollen over affected joints Enthesitis- esp of achilles Dactylitis Psoriatic skin and nail changes PMH/FH psoriasis/psoriatic arthritis
What joints are commonly affected in psoriatic arthritis?
DIP= characteristic
PIP, MCP and wrist
Sacroiliac joints
What investigations are done for psoriatic arthritis?
Bloods- RF -, HLA B27, CRP and ESR
XR- pencil in cup and plantar spur deformities
What is the management of psoriatic arthritis?
Physio NSAIDs Steroids DMARDs Biologics Surgery
What is reactive arthritis?
Sterile inflammatory arthritis that develops in response to distant infection
What are the common causative organisms associated with reactive arthritis?
Chlamydia trachomatis= most common
Salmonella
Shigella
Campylobacter
What is the presentation of reactive arthritis?
Reiter’s syndrome= arthritis, uveitis, urethritis/cervicitis
Arthritis= often knee or sacroiliac, 1-4 joints involved
Dactylitis
Enthesitis
Skin and mucous membrane involvement- keratoderma blenorrhagica, circulate balanitis
What investigations are done for reactive arthritis?
CRP and ESR
HLA B27
XR
Aspiration
What is the management of acute reactive arthritis?
Ongoing infection= antibiotics
NSAIDs
What is the management of chronic reactive arthritis?
NSAIDs
DMARDs- Sulfasalazine/methotrexate
What is enteropathic arthritis associated with?
Common= IBD Less= infectious enteritis, Whipple's disease, coeliac
What is the presentation of enteropathic arthritis?
Arthritis- often leg or axial spine, flares with bowel disease flares
Enthesitis
What investigations are done for enteropathic arthritis?
ESR, CRP
HLA B27
XR
What is the management of enteropathic arthritis?
NSAIDs
Steroids
Biologic- anti TNF- infliximab
DMARDs- sulfasalazine/methotrexate
