Seronegative Spondyloarthropathies

Question 1

Seronegative spondyloarthropies (SNS) acronym?

Answer 1

PEAR

P: psoriatic arthritis
E: enteropathic arthritis
A: ankylosing spondylitis
R: reactive arthritis (reiter’s syndrome)

Question 2

Indications that a PEAR pt has SNS?

Answer 2

Absence of antibodies
RF neg
HLA-B27 
Uveitis 
Males <40

Question 3

Who gets ankylosing spondylitis?

Answer 3

White males <45

Question 4

What is ankylosing spondylitis?

Answer 4

Chronic inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine

Question 5

Describe ankylosing spondylitis

Answer 5

Inflammatory LTB/ascends the spine 
Pain + stiffness in 
- buttocks 
- Low back 
- Chest wall 

Worsens at rest 
Pain at night 
Improves w exercise
Spine changes
Extra-articular manifestation

Question 6

Spine changes with ankylosing spondylitis?

Answer 6

Lumbar spine: loss of lordosis

Peripheral arthritis: hips shoulders, knees

Thoracic spine: kyphosis

Cervical spine: kyphosis, decreased lordosis

Question 7

Extra articular manifestations for ankylosing splondylitis?

Answer 7

Ocular : anterior uveitis
Cardiac : 1st degree av block
- aortic regurg
Pulmonary : upper lung fibrosis

Dactylitis
Psoriasis
IBD

Question 8

MC cardiac presentation of ankylosing splondylitis?

Answer 8

1st degree AV block

Question 9

Clinical diagnosis of ankylosing spondylitis?

Answer 9

1 clinical + 1 radiologic

Clinical

• low back pain/stiffness x 3 months, improves w exercise and not rest
• limitation of motion of the lumbar spine in both the sagittal and frontal planes
• limited chest expansion <2.5cm at 4th ICS

Radiologic
- sacrolitis grade 2+ bilateral; grade 3-4 unilateral

Question 10

Labs for ankylosing spondylitis?

Answer 10

Elevated ESR
neg RF
Anemia
+ HLA-B27

Question 11

PE for ankylosing splondylitis

Answer 11

Abnormal schober test
- <5cm
FABER test

Question 12

Factors that facilitate earlier diagnosis of ankylosing spondylitis?

Answer 12

Back pain >/= 3 moths <45 y/o

And either:
- sacroliitis and >/= 1 SpA feature
Or
HLA-B27 and >/= 2 SpA features

Question 13

Therapy for ankylosing spondylitis?

Answer 13

NSAIDS (1st line)

PT, Exercise, WT loss

DMARDS (ulfasalazine)
TNF inhibitor
- infliximab (remicade)
- entanercept (enbrel)

Surgery

Question 14

Corticosteroids with ankylosing spondylitis

Answer 14

Not recommended

Question 15

Referrals for ankylosing spondylitis?

Answer 15

PT/OT
Rheum
Ortho
Cardiology
Ophthalmology

Question 16

Who gets reactive arthritis?

Answer 16

Young males

Question 17

What causes reactive arthritis?

Answer 17

Well besides chlamydia…

Bacteria

• dysentary-shigela
• salmonella
• yersinia
• campylobacter

NOT VIRALS

Question 18

MC cause of reactive arthritis?

Answer 18

Chlamydia

Question 19

S/s of reactive arthritis?

Answer 19

1-4 weeks post “infection”

Cant see, cant pee, cant climb a tree

Question 20

Post-infectious triad with rheumatology?

Answer 20

• Conjunctivitis/uveitis
• Asymmetric arthritis
• Urethritis

Question 21

Mucocutaneous features of reactive arthritis?

Answer 21

Keratoderma blenorrhagica or circinate balantitis

Systemic: fever, wt loss
Cardiac: carditis and aortic regurg

Question 22

Diagnostics for reactive arthritis?

Answer 22

STI testing
Stool and serologic test for GI bugs

Low yield as the infection is usually cleared before onset (except you chlamydia)

Question 23

Mainstay of therapy for reactive arthritis?

Answer 23

NSAIDS

DMARD if these fail

Question 24

Goal of therapy for reactive arthritis?

Answer 24

Treat the infection(if it is still there)

Early STI/GU tx to prevent

Question 25

Prognosis for reactive arthritis?

Answer 25

Most resolve after 6 months

Small percent become chronic

Question 26

Who gets psoriatic arthritis?

Answer 26

Men = women

Question 27

What precedes arthritis with psoriatic arthritis

Answer 27

Psoriasis (god i hope the questions are like this)

Question 28

5 patterns of psoriatic arthritis?

Answer 28

1. Asymmetric oligoarthritis of hands/feet
2. Symmetric polyartris (mimics RA but RF neg)
3. Fingers DIP w nail pitting
4. Arthritis mutilans
5. Psoriatic spondylitis

Question 29

Sausage digits and psoriatic arthritis?

Answer 29

Mimics RA but is RF neg

Question 30

Labs for psoriatic arthritis?

Answer 30

Elevated ESR
Elevated uric acid
Neg RF

Question 31

Radiographs for psoriatic arthritis?

Answer 31

Pencil in cup - DIP

Periostitis in MCP, MTP, phalanges

Question 32

Tx for psoriatic arthritis?

Answer 32

NSAIDS - 1st line
Methotrexate - 2nd line
Skin treatment (helps arthritis)

Refractory:

• sulfasalazine/leflunomide
• biologic DMARD

Question 33

With psoriatic arthritis you should avoid?

Answer 33

Steroids - postural psoriasis

Antimalarials

Question 34

Enteropathic arthritis is aka?

Answer 34

IBD

Question 35

Who gets enteropathic arthritis?

Answer 35

Men= women

Question 36

Etiology of enteropathic arthritis?

Answer 36

chron’s and Ulcerative colitis

Chron’s is MC

Question 37

Types of enteropathic arthritis?

Answer 37

Peripheral (acute/early)
- non-deforming asymmetric, oligoarthhrits of large joints

Spondylitis
- looks just li,e ankylosing spondylitis

Question 38

Focus of therapy for enteropathic arthritis?

Answer 38

Controlling IBD

Question 39

Meds to treat enteropathic arthritis?

Answer 39

• Salicylates (5-ASA, sulfasalazine)
• Corticosteroids
• Azathioprine
• Biologics (anti-TNF)
• NSAIDS (symptom control)