Seronegative Spondyloarthropathies Flashcards
Seronegative Spondyloarthropathies
Heterogeneous group of inflammatory diseases with predominant involvement of axial – peripheral joints – enthesitis (inflammation at the site of insertion of tendons and ligaments to bone).
Enthesitis
Inflammation of site of insertion of a tendon, ligament or joint capsule to bone. HALLMARK OF THE DISEASE.
Seronegative Spondyloarthropathies are associated with:
High incidence of HLA-B27. Negative rheumatoid factor (seronegative)
__________ plays a critical role in pathogenesis of Seronegative Spondyloarthropathies.
HLA-B27 (in 90% of cases)
Clinical Features of Ankylosing Spondylitis
Early as affects primarily the lumbar spine. Early syndesmophyte formation is also seen. In late Ankylosing Spondylitis the lumbosacral spine is affected and Syndesmophytes are formed. The spine has a ‘Bamboo’ appearance.
Management of Ankylosing Spondylitis
Early recognition can help to limit disability. Non-steroidal anti-inflammatory drugs (NSAIDs), Sulfasalazine, Methotrexate, Tumor necrosis factor inhibitors and PT/OT.
Labs/Tests for Ankylosing Spondylitis
RF (-), HLA-B27 in 90-95%
Reiter’s Syndrome (Reactive Arthritis)
Aseptic arthritis. Triggered by an infectious agent outside the joint. Tends to begin 1-4 weeks after a genitourinary or gastrointestinal tract infection. Usually affects lower extremities.
Eitology of Reiter’s Syndrome (Reactive Arthritis)
Classic causative organisms include Chlamydia, Ureaplasma, Shigella, Salmonella, Yersinia and Campylobacter. Although just about any organism may result in reactive arthritis.
Signs of Reiter’s Syndrome (Reactive Arthritis)
Clinical Triad: non-gonococcal urethritis, conjunctivitis and arthritis. Characteristic skin rash is keratoderma blenorrhagica. Histologically identical to psoriasis.
Clinical Features of Reiter’s Syndrome (Reactive Arthritis)
Arthritis tends to be oligoarticular (~2-4 joints) and tends to affect the joints of lower extremity. Has an acute onset where joints become painful and swollen, asymmetric distribution. Enthesitis common in the heel. Often self-limited, may become chronic.
Management of Reiter’s Syndrome (Reactive Arthritis)
Early recognition can help to limit disability. Non-steroidal anti-inflammatory drugs (NSAIDs), Sulfasalazine, Methotrexate, Tumor necrosis factor inhibitors and PT/OT.
Labs/Tests of Reiter’s Syndrome (Reactive Arthritis)
HLA-B27 (70-30%); RF (-)
Psoriatic Arthritis
Symmetrical Polyarthritis that effects the joints, spine and entheseal.
Psoriatic Arthritis most commonly affected:
Predominant DIP involvement
Dactylitis
inflammation of an entire digit. Joint and tenosynovial inflammation. “sausage digit”
Clinical Features/Dx of Psoriatic Arthritis
Needs 3 of the following:
- Evidence of psoriasis.
- Psoriatic nail changes.
- RF (-).
- Dactylitis.
- Radiographic changes.
Management of Psoriatic Arthritis
Early recognition can help to limit disability. Non-steroidal anti-inflammatory drugs (NSAIDs), Sulfasalazine, Methotrexate, Tumor necrosis factor inhibitors and PT/OT.
Labs/Tests for Psoriatic Arthritis
RF (-); Radiographs are sensitive and specific. Show destructive arthritis, pencil-in-cup (erosions).
Nail Changes of Psoriatic Arthritis
Psoriatic nail changes: onycholysis, pitting, ridging and hyperkeratosis. TX with topicals, PUVA/UVB, or Biologics
Enteropathic Arthritis (a/w IBD)
Gut wall is a leaky barrier, potential pathogenic microorganisms cross over.
Etiology of Enteropathic Arthritis (a/w IBD)
Associated with inflammatory bowel disease: CD and UC.
Spine (axial) involvement occurs in 10-20%. Spine involvement may be silent or may precede the onset of IBD or occur later. Spine does not correlate with intestinal symptoms.
Progression of Enteropathic Arthritis (a/w IBD)
CD patients with large bowel disease and intestinal complications (fistulas, abscesses) more likely to develop peripheral arthritis than those limited to ileum disease. IBD arthritis tends to be nondestructive and reversible (erosive changes may occur).
Clinical Features of Enteropathic Arthritis (a/w IBD)
Clubbing, uveitis, skin manifestations and CD > UC. Uveitis tends to be bilateral and tends to be chronic. Erythema nodosum > UC. Pyoderma gangrenosum more frequently associated with systemic disease.
