Seronegative Spondyloarthritis 2

Question 1

What is reactive arthritis?

Answer 1

a sterile arthritis, typically affecting the lower limb 1-4 weeks after urethritis or dysentry
may be chronic or relapsing

Question 2

What illnesses commonly occur before the onset of reactive arthritis?

Answer 2

sexual transmitted infection
non specific urethritis (NSU) in males
non specific cervicitis in the female

Question 3

What are the clinical features of reactive arthritis?

Answer 3

acute, asymmetrical lower limb arthritis
occurs days-weeks after the infection
PC may be arthritis is infection is asymptomatic
CARDINAL SYMPTOMS: lower limb oligoarthritis, conjunctivitis, dysuria
sacroiilitis and spondylitis

Question 4

What are the cardinal symptoms are reactive arthritis to remember?

Answer 4

lower limb oligoarthritis
conjunctivitis
dysuria

Question 5

What are the extra articular features of reactive arthritis?

Answer 5

enthesitis (plantar fasciitis or Achilles tendon enthesitis) 
sterile conjunctivitis 
acute anterior uveitis 
skin lesions resembling psoriasis 
reiters disease 
aorititis

Question 6

What is Reiter’s disease?

triad

Answer 6

urethritis
arthritis
conjunctivitis

in a patient with dysentery

Question 7

Describe the pathology of reactive arthritis

Answer 7

Sterile synovitis occurs following an infection (urethritis or dysentery). HLA-B27 is present in 80% of affected individuals. Commonly affects the knee or ankle.

Question 8

What radiological changes are seen in reactive arthritis?

Answer 8

early stages - normal radiographs
synovial joint, symphyses and enthuses are affected
periarticular osteoporosis is seen in acute episodes of arthritis

Question 9

Which sites does reactive arthritis commonly affect?

Answer 9

small joints of the foot 
calcaneus 
ankle 
knee
sacroiliac joint

Question 10

What is enteric arthropathy?

Answer 10

occurs in 10-15% of those with IBD
symmetrical arthritis affecting predominantly the lower limbs
sacroiliitis or spondylitis in 5% with IBD

Question 11

What are the differences between UC and Crohns in enteric arthropathy?

Answer 11

remission in UC leads to remission of joint disease but arthritis will persist even in well controlled crohns

Question 12

What is the cause of enteric arthropathy?

Answer 12

selective mucosal leakiness may expose the antigens that trigger synovitis

Question 13

What radiological changes are seen in enteric arthropathy?

Answer 13

bilateral sacroiliitis usually symmetrical
spine may show syndesmophytes and apophyseal joint involvement
bamboo spin is uncommon

Question 14

What are the clinical features of anterior uveitis?

Answer 14

acute pain 
photophobia 
blurred vision 
lacrimation 
circumcorneal redness 
small pupils

Question 15

What are the clinical features of conjunctivitis?

Answer 15

conjunctival redness with itching, burning and lacrimation, photophobia, purulent discharge and buccal ulceration

Question 16

What are the clinical features of urethritis?

Answer 16

dysuria and discharge

Question 17

What are the clinical features of prostatitis?

Answer 17

perineal pain
symptoms of outflow obstruction
tender on PR

Question 18

What are the clinical features of bowel ulceration?

Answer 18

abdominal pain, melaena, variable symptoms depending on site

Question 19

What are the clinical features of pustular skin lesions?

Answer 19

vesicles filled with caseous materials similar to pustular psoriasis on the soles of the feet and palms, on the penis and the mouth

Question 20

What are the nail changes seen?

Answer 20

psoriatic changes including thimble pitting, hyperkeratosis and oncholysis

Question 21

What are the clinical features of aortic incompetence?

Answer 21

wide pulse pressure 
pulse visible in the carotids 
raised JVP 
dilation of the left ventricle 
early diastolic murmur 
ejection murmur 
signs of LV failure 
angina pectoris

Question 22

What are the clinical features of erythema nodosum?

Answer 22

Painful, palpable, dusky blue nodules or plaques commonly on the shins and calves

Question 23

What are the extra-articular features of AS?

Answer 23

anterior uveitis and conjunctivis
prostatitis 
CV disease 
amyloidosis 
atypical upper lobe pulmonary fibrosis

Question 24

What are the extra-articular features of reactive arthritis?

Answer 24

circinate balanitis
buccal erosions
keratoderma blennorrhagia skin lesions

Question 25

What are the extra-articular features of psoriatic arthritis?

Answer 25

skin lesions
nail changes
conjunctivitis and uveitis

Question 26

What investigations can be used when considering seronegative spondyloarthritis?

Answer 26

bloods - ESR/CRP are raised
HLA testing - rarely of value
X-ray
MRI - if no obvious radiological changes

Question 27

How is reactive arthritis managed?

Answer 27

cultures must be taken and infection treated
sexual partners must be screened
NSAIDS - good for pain
Locally injected or oral steroids are also good for pain

most just have single episode but some develop a relapsing and remitting course. may be treated with sulfasalazine or methotrexate.

Question 28

How is enteric arthropathy managed?

Answer 28

treat the IBD
NSAIDs help symptoms but worsen diarrhoea
monoarthritis is best treated with a steroid injection
sulfasalazine used
Infliximab is used in IBD and can help the arthritis