Seronegative spondyloarthropathies

Question 1

What are the patterns of joint disease in Psoriatic arthritis?

Answer 1

Asymmetrical oligoarthritis - most common
Distal arthritis in distal interpharlangeal joints - classical
Symmetical polyarthritis - like RA BUT involves DIPJs (RA DIPJ sparing!)
Spinal arthritis - like AS

Question 2

How common is Psoriatic arthritis?

Answer 2

Occurs in 10-40% of patients with Psoriasis

May predate skin disease

Question 3

What are some of the other features of Psoriatic arthritis?

Answer 3

Psoriatic plaques
Nail changes - Pitting, Subungual hyperkeratosis, onchyolysis (Separation of nail from nail bed)
Achilles tendonitis
Plantar fasciitis
Dactylitis - inflammation of whole digit

Question 4

What changes are seen on X ray in Psoriatic arthritis?

Answer 4

Pencil in cup deformity due to periarticular erosions and bone reabsorption

Question 5

What is the treatment for Psoriatic arthritis?

Answer 5

NSAIDs
Sulfasalazine
Methotrexate
Ciclosporin
Anti TNF

Question 6

What is Reactive arthritis?

Answer 6

Sterile arthritis 1-4 weeks after urethritis or dysentery eg chlamydia, campylobacter, salmonella

Question 7

How does Reactive arthritis present?

Answer 7

Asymmetrical
Oilgoarthritis eg knee
Iritis
Conjunctivitis
Enthesitis (Inflammation where tendons/ligamanets insert into bone eg plantar fasciitis)

Question 8

What investigations can be done in a patient with suspected Reactive arthritis?

Answer 8

Increased ESR/CRP
Urine to test for chlamydia
Stool sample if patient had diarrhoea

Question 9

What is the management of Reactive arthritis?

Answer 9

NSAIDs
Local steroids
Sulfsalazine or Methotrexate if relapse

Question 10

What is Enteropathic arthritis?

Answer 10

Occurs in 15% of p’s with UC/Crohns
Asymmetrical
Oligoarthritis
Mainly effects lower limbs and sacroiliac joints

Question 11

How do you treat Enteropathric arthritis?

Answer 11

Treat IBD
NSAIDs
Articular steroids