Seronegative Spondyloarthropathies

Question 1

Is UE or LE usually more involved in reactive arthritis?

Answer 1

Lower extremity

Question 2

First site of involvement in ankylosing spondylitis

Answer 2

SI joint

Question 3

Most common site of fractures in AS?

Answer 3

Lower cervical and lumbar spine

Question 4

What medication works best for psoriatic arthritis

Answer 4

The biologics such as anti-TNF antibodies adalimumab and infliximab

Question 5

What other disease can reactive arthritis progress to?

Answer 5

3-10% can progress to ankylosing spondylitis

Question 6

What kind of spine exercises do you prescribe for ankylosing spondylitis

Answer 6

Extension-based

Question 7

Triad of reiter’s

Answer 7

1. Conjunctivitis
2. Nongonococcal urethritis
3. Arthritis

Question 8

What joints are involved in psoriatic arthritis associated with HIV?

Answer 8

Foot and ankle

Question 9

5 main HLA-B27 diseases

Answer 9

1. Psoriatic arthritis
2. Ankylosing spondylitis
3. Reactive arthritis
4. Enteropathic arthritis
5. Pauciarticular JRA

Question 10

What joints are affected in enteropathic arthropathy?

Answer 10

Large joints such as knees, ankles, feet

Question 11

What lab test is seen in enteropathic arthropathy not seen in other seronegative spondyloarthropathies?

Answer 11

ANCA

Question 12

Preferred NSAID for ankylosing spondylitis

Answer 12

Indomethacin

Question 13

How can the fingers manifest in reactive arthritis?

Answer 13

dactylitis (sausage digits)

Question 14

How many joints are usually affected in reactive arthritis?

Answer 14

4 or fewer joints

Question 15

What is the usual etiology of reactive arthritis?

Answer 15

GU = chlamydia
GI = campylobacter, shigella, salmonella

Question 16

What part of the spine is the last to be ankylosed in ankylosing spondylitis?

Answer 16

Cervical spine - after 16 years

Question 17

What skin manifestation is seen on the palms and soles of feet in reactive arthritis?

Answer 17

Keratoderma blennorhagica - hypertrophic skin lesions on palms and soles of feet

Question 18

What radiographic finding of the feet is seen in reactive arthritis?

Answer 18

Erosions at insertion of plantar fascia and Achilles’ tendon (“Lover’s heel”)

Question 19

Color, viscosity, WBC, protein and glucose seen in reactive arthritis synovial fluid

Answer 19

Color = turbid
Viscosity = low
WBC = 5-50,000 PMNs
Protein = increased
Glucose = normal

Question 20

What medications do you not want to use to treat psoriatic arthritis in someone with HIV?

Answer 20

No steroids or MTX

Question 21

What physical exam test is used to diagnose ankylosing spondylitis?

Answer 21

Schober’s test

Question 22

Arthritis mutilans

Answer 22

Osteolysis of the phalanges and metacarpals of the hand seen in psoriatic arthritis fresulting in telescoping of the hand, where there is shortening of the involved fingers.

Question 23

Most common extraskeletal manifestation in ankylosing spondylitis

Answer 23

Iridocyclitis/acute iritis

Question 24

In psoriatic arthritis, which joint usually demonstrates the pencil in cup deformity

Answer 24

DIP joint

Question 25

What does bamboo spine refer to?

Answer 25

Ossification of spinal ligaments and ankylosis of facet joints leading to fusion of spine

Question 26

How do you do schober’s test?

Answer 26

Measure point 5cm below iliac crest line and 10cm above iliac crest. Have patient flex forward and line should increase by more than 5 cm. If it doesn’t increase by more than 5cm, then there is restriction in lumbar flexion

Question 27

Auspitz’s sign

Answer 27

Scraping of psoriatic lesion causes pinpoint bleeding

Question 28

What skin manifestations can be seen in ulcerative colitis and Crohn’s disease?

Answer 28

Pyoderma gangrenosum - UC

Erythema nodosum - Chron’s

Question 29

4 main classes of medications used to treat AS

Answer 29

1. NSAIDs
2. Steroids
3. Muscle relaxants
4. DMARDs