Seronegative Spondyloarthritis 2 Flashcards
What is reactive arthritis?
a sterile arthritis, typically affecting the lower limb 1-4 weeks after urethritis or dysentry
may be chronic or relapsing
What illnesses commonly occur before the onset of reactive arthritis?
sexual transmitted infection
non specific urethritis (NSU) in males
non specific cervicitis in the female
What are the clinical features of reactive arthritis?
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
What are the cardinal symptoms are reactive arthritis to remember?
lower limb oligoarthritis
conjunctivitis
dysuria
What are the extra articular features of reactive arthritis?
enthesitis (plantar fasciitis or Achilles tendon enthesitis) sterile conjunctivitis acute anterior uveitis skin lesions resembling psoriasis reiters disease aorititis
What is Reiter’s disease?
triad
urethritis
arthritis
conjunctivitis
in a patient with dysentery
Describe the pathology of reactive arthritis
Sterile synovitis occurs following an infection (urethritis or dysentery). HLA-B27 is present in 80% of affected individuals. Commonly affects the knee or ankle.
What radiological changes are seen in reactive arthritis?
early stages - normal radiographs
synovial joint, symphyses and enthuses are affected
periarticular osteoporosis is seen in acute episodes of arthritis
Which sites does reactive arthritis commonly affect?
small joints of the foot calcaneus ankle knee sacroiliac joint
What is enteric arthropathy?
occurs in 10-15% of those with IBD
symmetrical arthritis affecting predominantly the lower limbs
sacroiliitis or spondylitis in 5% with IBD
What are the differences between UC and Crohns in enteric arthropathy?
remission in UC leads to remission of joint disease but arthritis will persist even in well controlled crohns
What is the cause of enteric arthropathy?
selective mucosal leakiness may expose the antigens that trigger synovitis
What radiological changes are seen in enteric arthropathy?
bilateral sacroiliitis usually symmetrical
spine may show syndesmophytes and apophyseal joint involvement
bamboo spin is uncommon
What are the clinical features of anterior uveitis?
acute pain photophobia blurred vision lacrimation circumcorneal redness small pupils
What are the clinical features of conjunctivitis?
conjunctival redness with itching, burning and lacrimation, photophobia, purulent discharge and buccal ulceration
What are the clinical features of urethritis?
dysuria and discharge
What are the clinical features of prostatitis?
perineal pain
symptoms of outflow obstruction
tender on PR
What are the clinical features of bowel ulceration?
abdominal pain, melaena, variable symptoms depending on site
What are the clinical features of pustular skin lesions?
vesicles filled with caseous materials similar to pustular psoriasis on the soles of the feet and palms, on the penis and the mouth
What are the nail changes seen?
psoriatic changes including thimble pitting, hyperkeratosis and oncholysis
What are the clinical features of aortic incompetence?
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
What are the clinical features of erythema nodosum?
Painful, palpable, dusky blue nodules or plaques commonly on the shins and calves
What are the extra-articular features of AS?
anterior uveitis and conjunctivis prostatitis CV disease amyloidosis atypical upper lobe pulmonary fibrosis
What are the extra-articular features of reactive arthritis?
circinate balanitis
buccal erosions
keratoderma blennorrhagia skin lesions
What are the extra-articular features of psoriatic arthritis?
skin lesions
nail changes
conjunctivitis and uveitis
What investigations can be used when considering seronegative spondyloarthritis?
bloods - ESR/CRP are raised
HLA testing - rarely of value
X-ray
MRI - if no obvious radiological changes
How is reactive arthritis managed?
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.
How is enteric arthropathy managed?
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
