SERONEGATIVE SPONDYLOARTHRITIS

Question 1

What is seronegative spondyloarthritis and what does it consist of?

Answer 1

It is a group of related inflammatory joint diseases distinct from rheumatoid arthritis
It consists of
1) Ankylosing spondylitis
2) Reactive arthritis
3) Psoriatic arthritis
4) Arthropathy associated with inflammatory bowel disease

Question 2

Common features of seronegative spondyloarthritis

Answer 2

Assymeterical inflammatory oligoarthritis (< 4 joints)
Lower limb> upper limb
No association with RF
ENTHESITIS i.e inflammation where tendons and ligaments attach to bones
Associated with HLA-B27

Question 3

Define ankylosing spondylitis

Answer 3

It is a chronic inflammatory arthritis predominantly affecting SACROILIAC JOINTS & SPINE

Question 4

Clinical features of ankylosing spondylitis

Answer 4

Inflammatory back pain
Low back pain due to sacroiliatis characterized by (Mnemonic IPAIN)
• Insidious onset
• Pain at night
• Age of onset < 40 yrs (20-30)
• Improves with exercise and hot water
• No improvement with rest
•Morning stiffness > 30 mins
• Flattening of normal lumbar curvature and decreased chest expansion

Question 5

Clinical features of ankylosing spindylitis

Answer 5

•Inflammatory backpain
•Peripheral arthritis-> it is usually assymeterical affecting large joints ,lower limb> upper limb
•Enthesitis -> it is inflammation at the site of tendon of ligaments insertion into bone
Sites = achilles tendon, prepatellar,elbow epicondyles, plantar fasciitis

Question 6

Extraarticular features of ankylosing spondylitis

Answer 6

Mnemonic CANP (2C,3A)
C -> CONJUNCTIVITIS
CARDIAC -> aortic regurgitation,mitral incompetance,AV block,pericarditis
A-> ANTERIOR UVEITIS (MOST COMMON)
AMYLOIDOSIS
ATYPICAL UPPER LOBE PULMONARY FIBROSIS
N -> NEUROLOGICAL COMPLICATIONS-> spinal fractures,cauda equina syndrome
P-> PROSTATITIS (80% in men)

Question 7

Diagnosis of ankylosing spindylitis

Answer 7

ESR & CRP elevated
HLA-B27 POSITIVE
XRAY of sacroiliac joint
Xray of spine -> Bamboo spine i.e fusion of vertebra
MRI spine

Question 8

Best initial test for ankylosing spondylitis

Answer 8

Xray of sacroiliac joint

Question 9

Most accurate test of ankylosing spondylitis

Answer 9

MRI SPINE

Question 10

Treatment of ankylosing spondylitis

Answer 10

1) patient education and physical activity -> daily back extension exercises,Swimming is the ideal exercise, Avoidance of poor posture
2) NSAIDS -> BEST INITIAL TREATMENT
3) ANTI -TNF -> best next therapy after nsaids-> used when there is persistent inflammation
4) DMARDS(METHOTREXATE) -> It is useful for peripheral arthritis,uveitis and extra articular manifestations