Seronegative Spondyloarthropathies

Question 1

• ankylosing spondylities
• psoriatic arthritis
• reactive arthritis
• enteropathic arthritis: chrons and ulcerative colitis

Answer 1

Spondylarthropathies

Question 2

what are common features of SS?

Answer 2

• seronegative (i.e rheumatoid is absent)
• rheumatoid nodules are absent
• frequent association of HLA-B27
• a tendency to occur in the same family
• inflammatory axial arthirits, generally sacroiliitis and spondylitis
• oligoarthritis generally with asymmetrical presentation
• enthesitis
• extra articular features

Question 3

• onset of back discomfort before age 40
• insidious onset
• duration longer than 3 months
• associated with morning stiffness
• improvement with exercise

is an inflammatory disorder of unknown cause that primarily affects the axial skeleton, peripheral joints and extra articular structures

Answer 3

ankylosing spondylitis

Question 4

clinical manifestations of ankylosing spondylitis

Answer 4

• symptoms of the disease are usually first noticed in late adolescence or early adulthood- median age being 23
• initial presentation of AS generally occurs in the SI joints, involvement of the SI joints is required to establish diagnosis
• SI joint involvement is followed by involvement of the diskovertebral, apophyseal, costovertebral and costotransverse joints
• initial symptoms is usually dull aching pain, insidious onset, felt deep in the lower lumbar or gluteal region, accompanied by low-back morning stiffness

Question 5

• most common extra-articular manifestation of AS occuring in 20-30% of patients
• usually acute, unilateral and non-granulomatous

Answer 5

Uveitis

Question 6

Cardiovascular involvement in AS?

Answer 6

• aortitis of the ascending aorta resulting in aortic valve insufficiency
• mitral valve insufficiency
• atrioventricular block

Question 7

grades of sacroilitis according to the New York criteria?

Answer 7

• Grade 0- normal
• grade 1- suspicious changes at the left sacoiliac joint in the form of slightly irregular joint facets
• grade 3- manifest abnormalities in the form of erosion and sclerosis in addition to widening of the middle part of both sacroiliac joints
• grade 4- total ankylosis of both sacroiliac joints

Question 8

pulmonary involvement of AS?

Answer 8

• restrictive lung disease
• bilaterial apical pulmonary fibrosis

Question 9

what are patterns of arthritis in PSA?

Answer 9

• DIP involement
• pauciarticular
• polyarticular (RA)
• Spondylitis
• arthritis mutilans, highly destructive form of disease

More info from slides state

• arthritis of the DIP joints
• asymmetric oligoarthritis
• symmetric polyarthritis similar to RA
• axial involvement (spine and sacroiliac joints)
• arthritis mutilans, a highly destructive form of disease

Question 10

Classic triad- Reiter’s

• Arthritis, urethritis, conjunctivitis

Venereal post chlamydia/ ureaplasma
dysentery- post shigella, salmonella, campylobacter, yersinia

Seronegative asymmetric arthritis following:

• urethritis or cervicitis
• infectioius diarrhea

often associated with

• inflammatory eye disease
• non-infectious urethritis
• enthesopathy
• skin rash; circinate balanitis, keratoderma

Answer 10

reactive arthritis

Question 11

how to treat reactive arthritis?

Answer 11

• most patients with reactive arthritis benefit to some degree from high dose NSAIDs
• indomethacin 75-150mg/d in divided doses is the initial treatment of choice, but other NSAIDS may be tried
• pts with reactive arthritis due to chlamydia benefited significantly from a 6 month course of rifampin 300mg daily plus azithromycin 500mg daily for 5 days then twice week or 6 months of rifampin 300mg daily pluse doxycycline 100mg twice daily

Question 12

• ulcerative colitis/chrons
• axial disease like AS, thin syndesmophytes, prgress regardless of bowel disease activity
• peripheral- periarticular, markedly inflammatory, correlates with GI disease activity
• two types of involement: peripheral arthritis, sacroiliitis and spondylitis (sacroiliitis shows no temporal relationship to gastrointestinal inflammation and its course is unaffected by treatment of the bowel disease

Answer 12

Enteropathic arthritis

Question 13

treatment of enteropathic arthritis?

Answer 13

• peripheral disease- RA path ways (SSZ, MTX, TNF inhibitors, IL-17 inhibitors)
• axial disease- TNF inhibitors, IL-17 inhibitors posture and exercise also extremely important

Question 14

• approved for psoriatic arthritis and ankylosing spondylitis
• paradoxically can cause IBD

Answer 14

cosentyx

Question 15

• symptoms suggestive of SPA/AS but no radiographic findings
• MRI may be helpful but may also confuse the picture (bone edema)

Answer 15

non-radiographicaxial SPA