Seronegative Spondyloarthritis

Question 1

Etiology of reactive arthritis

Answer 1

Autoimmune reaction initiated after infection by: ShY ChiCS

Shigella, yersinia, chlamydia, campylobacter, salemonella

Question 2

Seronegative spondyloarthritis most associated w/ dactylitis

Answer 2

Psoriatic arthritis

Question 3

Common skin findings associated w/ reactive arthritis

Answer 3

Keratoderma blennorhagica

Circinate balantis

Question 4

How is arthritic process of psoriatic arthritis different from the other spondyloarthrities?

Answer 4

Instead of reactive bone growth, it is an erosive arthritis (can cause pencil in cup deformities)

Question 5

HLA association w/ spondyloarthritis

Answer 5

HLA-B27

Question 6

Signs + sx of inflammatory back pain

Answer 6

1) Insidious onset
2) Back pain/stiffness worse in AM or periods of inactivity that improve w/ exercise
3) Schober test- limited spinal ROM
4) Deformities- loss of lumbar lordosis + accentuation of thoracic kyphosis
5) occurs in younger individuals

Question 7

Enlargement due to reactive bone formation with warm and tenderness at insertion sites of ligaments, tendons, joint capsule

Answer 7

Enthesitis

Question 8

Articular manifestations of psoriatic arthritis

Answer 8

1) Dactylitis ****
2) Enthesitis
3) Peripheral polyarthritis (DIP most common)

Question 9

Can reactive arthrtiis be treated with antibiotics?

Answer 9

No; pathogenesis is autoimmune reaction and not due to the infectious organism (individuals may test negative by the time they present w/ reactive arthritis sx)

Question 10

Most common joints affected in psoriatic arthritis

Answer 10

Polyarthritis of small joints (DIP of hands most commonly affected)

Asymmetric oligoarthritis of lower extremities

Question 11

Extra-articular manifestations of psoriatic arthritis

Answer 11

Psoriasis

Nail lesions (pitting + oncholysis)

Question 12

Distribution of arthritis in akylosing spondylitis

Answer 12

Gradual symmetrical involvement from sacroiliac joint to axial spine, ultimately resulting in ankylosis

Question 13

Articular manifestations of ankylosing spondylitis

Answer 13

Inflammatory back pain

Enthesitis

Peripheral arthritis

Question 14

Extra-articular manifestations of ankylosing spondylitis

Answer 14

Anterior uveitis

Aortic regurgitation (aortitis)

Restrictive lung disease (limited chest wall expansion due to ankylosis)

keratoderma blennorrhagicum

Question 15

Tenosynovitis (inflammatino of tendon sheath) of flexor digits, leading to swelling of digits

Answer 15

Dactyltitis

Question 16

Keratoderma blennorhagicum

Answer 16

Tiny blisters/pustules usualyl on soles of feet that coalesce, leading to skin that’s thick and itchy; most commonly associated w/ anklyosing spondylitis + psoriatic arthritis

Question 17

3 most common features of seronegative spondyloarthritis

Answer 17

1) Lack of rheumatoid factor
2) Strong association w/ HLA-B27
3) Axial skeleton inflammation (spine + sacroiliac disease)

Question 18

Nail pitting + oncholysis

Answer 18

Psoriatic arthritis

Question 19

Bamboo spine + bilateral symmetrical sacroilitis (sclerosis of bone + ankylosis of joint)

Answer 19

Ankylosing spondylitis

Question 20

3 classic sx of reactive arthritis

Answer 20

1) Conjunctivitis
2) Urethtritis
3) Arthritis- migratory peripheral/sacroilitis

Question 21

4 types of seronegative spondyloarthritis

Answer 21

PAIR

P: Psoriatic arthritis

A: Ankylosing spondyloarthritis

I: IBD

R: Reactive arthritis

Question 22

Pencil in cup deformity on imaging

Answer 22

Psoriatic arthritis

Question 23

Pattern of spondylitis vs. asymmetric lower extremity arthritis in IBD associated arthritis

Answer 23

spondylitis is indepdent of GI disease while asymmetric lower extremity arthritis tracks w/ GI disease (flares)

Question 24

Distribution of arthritis of reactive arthritis

Answer 24

Migratory peripheral arthritis

Sacoilitis