seronegative spondyloarthropathies Flashcards
what are the seronegative spondyloarthropathies
group of -inflammatory joint diseases that share the HLA-B27 antigen and are negative RF and ACPA
5 seronegative spondyloarthropathies
ank spond axial spond reactive arthritis psoriatic arthritis arthropathy assoc. to IBD
pathogenesis of seronegative spondyloarthropathies
inflammatory enthesitis
and synovitis
what type of arthritis are ss
asymmetrical
oligoarthritis
extra-articular features of SS 9
- mucosal inflammation
- conjunctivitis
- urethritis
- nail dystrophy
- uveitis
- erythema nodosum
- psoriasis
- IBD
- aortic incompetence
what joint is predominantly affected by ank spond
sacroiliac joint progresses to bony fusion of spine
ank spond name for fusion of bony spine
bamboo spine
male to female ratio for ank spond and age of onset
3:1
Often young males in teens to early 20s
Rare after 50
clinical features of ank spond -bone
lower back pain early morning stiffness worse on inactivity relieved by movement reduced lumbar motion fatigue kyphosis
extra-articular features of ank spond 8
dactylitis uveitis conjunctivits aortic incompetence urethritis amyloidosis tendonitis of achilles and plantar
how many ank spond % have peripheral arthritis and what joints
40%
large joints
asymmetrical
10% have peripheral before spinal
disease score for ank spond and components
BASDAI-bath
- fatigue /`10
- pain/10
- pain and swelling of other joints /10
- level of discomfort from tender areas /10
- discomfort from wake up time /10
- morning stiffness last 0-2 hrs
difference in diagnosis of axial and ank spond
axial=sacroilitis on mri only not on x-ray
ank spond= bilateral sarcroilitis on x-ray
diagnosis of ank spond and axial spond criteria
back pain >3 months improved by exercise not relieved by resr insidious onset night pain (>45 for axial)
differences between axial and ank spond
- axial responds to nsaid not ank
- no fhx for ank spond
biomarkers for ank spond
esr and crp raised
negative antibodies
hla b 27
x-ray signs of ank spond in sc joint 3
loss of cortical margins
widening of joint space
sclerosis
joint space narrowing and fusion
x-ray of ank spond thoracolumbars spine 3 signs
- ant. squarring of veretbrae due to erosion
- bridging syndesmophytes-calcification bony growth into intervetebral joint space into the ligament
- ossification of ant. longitudinal ligament= bamboo spine
management of ank spond
- nsaid
- analgesia
- exercise
- DMARDS only for peripheral (no effect on spine)
- anti-tnf (other biologics don’t work)
- steroids for enteropathies
basdai score for anti-TNF
> 4
male to female ratio for reactive arthritis
15:1
what is the most common cause of inflammatory arthritis in males 16-35
reactive arthritis
what is a risk factor for reactive arthrtis
HLA b27
classic triad of Reiter
non specific urethritis
reactive arthritis
conjunctivitis
extra-articular features of Reactive arthritis 12
circinate balantis (20-50%)-penis nail dystrophy keratoderma blennorhagica 15% buccal erosions 10% conjunctivitis uveitis pustular psoriasis aortic incompetence pericarditis neuropathy seizures
5 main pathogens in reactive arthritis
salmonella shigella campylobacter yersinia chlamydia (sexually active)
cause of reactive arthritis
after having food poisoning or sti- get arthralgia in joint
clinical features of reactive arthritis
oligoarthritis asymmetrical lower limbs can be single joint systemic: fever and weight loss achilles tenonditis/ plantar fasciitis
what should reactive arthritis always be assumed as initially
septic arthritis
risk of recurrence of reactive arthritis
> 60%
investigation of reactive arthritis
- joint aspiration (leucocyte rich- multinucleated macrophages Reiter cells)
- raised esr and crp
- 2 glass test urethritis- mucoid on 1st, clears by second
- high vaginal swabs
- serum agglutinin test for phx dysentry
- antibodies-
- x-ray
x-ray signs of recurrent reactive arthritis
joint space narrowing eerosion perositis asymmetrical sacroiliits rather than bilateral in AS syndesmophytes
management reactive arthritis
- start for septic
- nsaid and anlagesia
- steroid
- antibiotics targeted
what should be given for chlamydial urethritis
doxycycline or azithromycin
what should be given for severe keratoderma
DMARD or anti-tnf
criteria for psoriatic arthritis CASPAR
inflammatory articular disease (joint or enthesis) with >3
- current psoriasis
- hx of psoriasis in 1st/2nd degree relative
- psoriatic nail dystrophy
- negative IgM Rheumatoid factor
- current dactylitis
- hx of dactylitis
- juxta-articular new bone
genes assoc. to psoriatic arthritis
hla-b and hla c genes strongest
clinical features psoriatic arthritis
pain and stiffness
tendons, joints and entheses
5 types of psoriatic arthritis
1=asymmetrical inflammatory oligoarthritis 2=symmetrical polyarthritis 3=DIP joint arthritis 4= psoriatic spondylitis 5=arthritis mutilans
what is arthritis mutilans
deforming erosive arthritis of fingers and toes
- enthesitis predominant
- pitting
- oncholysis
where does psoriatic arthritis usually affect
dip and pip joints of hand, entheses and larger joints
management of psoriatic arthritis
- nsaid and analgesia
- steroid injection
- splint and rest
- DMARD persistent synovitis
- anti TNF
- IL17
first choice dmard for psoriasis rash and other beneficial treatment
methotrexate as effective for psoriasis
uv and sunlight helps psoriasis
enteropathic spondyloarthropathies what are they and % involvement
IBD patients
20%
what joints are typically targeted by enteropathic spondyloarthropathies
larger lower limb joints
what treatment to avoid for enteropathic spondyloarthropathies 2
nsaids= worsen IBD etanercept= no efficacy in IBD
