Seronegative Spondyloarthritis Flashcards
What are the Seronegative Spondyloarthritides?
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
IBD-related arthropathy
What joints are involved in Seronegative Spondyloarthritides?
Spine
Proximal large joints
Joint involvement more limited than in RA
What deformities are more commonly seen in Seronegative Spondyloarthritides?
Joint ankylosis
Joint enthesitis
Dactylitis (sausage finger)
What is the aetiology of Seronegative Spondyloarthritides?
All HLA B27 + -all RF neg -generally anti-CCP neg Male preponderance 3:1 18-30yrs
How does Ankylosing Spondylitis present?
Episodic pain/stiffness in lower back/buttocks
-worse in morning, may wake from sleep
-relieved by exercise
-pain alternates b/w buttocks
Asymptomatic b/w episodes
What are the signs on examination of Ankylosing Spondylitis?
LOOK - question mark posture (early), paraspinal wasting (later)
FEEL - pain on pressure over SIJs
MOVE - limited lat/forward flexion of lumbar spine
Shober’s +ve
What causes a question mark posture in Ankylosing Spondylitis?
Retention of lumbar lordosis during spinal flexion
What is Shober’s test?
Line drawn along midline 10cm above & 5cm below L5
Distance b/w two lines should increase >5cm when pt bends forward
Which joints are commonly involved in Ankylosing Spondylitis?
Sacroiliac
Hip/shoulder (asymmetrically)
Peripheral joints
Chostocondral joints (chest pain)
What are the extra-articular manifestations of Ankylosing Spondylitis?
Ant uveitis (20%) Pulmonary (apical) fibrosis AV node block Aortitis Amyloidosis
What investigations may be appropriate in suspected Ankylosing Spondylitis?
ESR (normal in 50%) Pelvis XR (bilat sacroilitis) Spinal XR (bamboo spine)
What are the spinal XR findings of Ankylosing Spondylitis?
Vertebral bodies squared
Annulosus fibrosus/interspinous ligaments ossified
-leads to inflexible/rigid spine
What is a Syndesmophyte?
Ossified ligament
What is the management of Ankylosing Spondylitis?
Full dose NSAIDs (6wks)
Biologics
-started if no improvement on 2 diff NSAIDs
What is Psoriatic Arthritis?
Seronegative arthropathy seen in psoriasis
- 8% of psoriasis pts
- equal female/male incidence
What are the five subtypes of Psoriatic Arthritis?
Symmetrical polyarthritis (40%) Asymmetrical oligoarticulararthritis (30%) DIPJ predominant disease (10%) Spondylitis Arthritis mutilans
Describe Symmetrical Polyarthritis
Presents similarly to RA
DIPJ involvement
Less severe deformities
Describe Asymmetrical Oligoarticulararthritis
<5 joints involved
-often one large joint plus several smaller hand/foot joints
Describe DIPJ Predominant Disease
Associated w/ nail changes
- pitting
- onchylolysis
- sausage finger
Describe Spondylitis
Affects spine +/- SIJs as per AS
Describe Arthritis Mutilans
Severe form (5%) Marked joint destruction/deformity -telescoping of digits
What are the radiological signs of Psoriatic Arthritis?
Erosions similar to RA
- minimal osteopenia
- more central erosions (pencil in a cup)
What joints are involved in Psoriatic Arthritis?
Sacroiliac (usually unilateral)
Early DIPJ involvement (specific to PA)
What are the management options for Psoriatic Arthritis?
If one joint involved -full dose NSAIDs +/- steroid injections If multiple joints involved -treat as per RA, better prognosis -methotrexate also helps skin -DMARDs do not help spinal sx
What is Reactive Arthritis (Reiter’s Syndrome)?
Acute, asymmetrical lower limb arthritis occurring 4-40 days following an infection (GI/GU)
-can then develop into chronic arthritis
What are the common causative pathogens causing Reactive Arthritis?
Chlamydia
Salmonella
Campylobacter
How does Reactive Arthritis present?
Classical triad (can't see, pee or climb a tree) -conjunctivitis -dysuria -lower-limb oligoarthritis Sacroilitis/spondylitis Enthesitis -associated plantar fasciitis or Achilles tendonitis Skin lesions
What skin lesions are common in Reactive Arthritis?
Keratoderma blenorrhagica
Balantitis
What causes Reactive Arthritis?
Disease process due to antigenic stimulation of inflammatory response
What are the management options for Reactive Arthritis?
Full dose NSAIDs +/- steroid injections
Sulfasalazine 2nd line
-for more extensive disease
How common is IBD-related arthropathy?
10-15% of those w/ IBD develop an arthropathy
How does IBD-related arthropathy present?
Symmetrical arthritis affecting lower limb joints
-5% have spinal/SIJ involvement
What are the management options for IBD-related arthropathy?
Remission of UC = remission of joint disease
Arthritis persists in well controlled Chron’s
MDT management w/ gastroenterologists
In what arthritides are Anterior Uveitis common?
HLA B27 +
- ankylosing spondylitis
- psoriatic arthritis
How does Anterior Uveitis present?
Acute pain & photophobia
Constricted pupil, poss irregular due to ant/post synechiae
Circumcorneal redness
How is Anterior Uveitis managed?
Topical steroids
Dilating eye drop
In what arthritides are Scleritis/Episcleritis common?
Rheumatoid Arthritis
How does Scleritis/Episcleritis present?
Conjunctival congestion
- w/ tenderness = episcleritis
- w/ extreme pain = scleritis
How are Scleritis/Episcleritis managed?
Anti-inflammatory eye drops
