Seronegative Spondyloarthropathy Flashcards
What is seronegative spondyloarthropathy?
Group of inflammatory rheumatic diseases without the presence of rheumatoid factor
Tends to affect spine and proximal large joints
What is Ankylosing Spondylitis (AS)?
Stiffness and inflammation of vertebra
Inflammation of ligaments around the vertebra which heals by dense ossification and fibrosis of the ligaments
Spine eventually becomes fused, inflexible and rigid
What are the symptoms of AS?
Episodic pain and stiffness in back/buttocks-worse in the morning and relieved by exercise
Asymptomatic between episodes
Pain can alternate between sides of buttocks
What are signs of AS?
Question mark posture due to lumbar lordosis
Shobers test
- draw line across midline 10cm above and 5cm below L5
- distance should increase >5cm when patient bends forwards
SI stress test
-bring knee to contralateral shoulder- pain in SI area
Paraspinal muscle wasting- late sign
What are extra-articular manifestations of SA?
Anterior uveitis Pulmonary fibrosis AV node block Amyloidosis Aortitis- inflammation of aortic root
What investigations are needed for AS?
Bloods
-ESR=normal
XR
- pelvic= narrowing of SI joint line and fusion
- Spinal= squaring of vertebral bodies and bamboo spine appearance
How is AS diagnosed?
Based on the following
- Low back pain >3months improved by exercise and not relieved by rest
- limited lumbar spine movement
- limited chest expansion
- sacroiliitis on XR
Definite- Radiological criteria PLUS one clinical
Probably- 3 clinical OR one radiological
What is the management of AS?
Conservative
- patient education= no cure, symptomatic relief
- mobilise, exercise
- support groups
- stop smoking
Medical
- NSAIDs for 6wks
- if no improvement on 2 different NSAIDs and high DAS score then biologics e.g. etanercept
What is Psoriatic Arthritis (PA)?
Seronegative arthritis associated with psoriasis
What are symptoms of PA?
Early DIPJ involvement
SI involvement is unilateral
5 subtypes recognised
What are the 5 subtypes of PA?
1) Symmetrical polyarthritis
- presentation similar to RA
- more DIPJ involvement and less severe deformities
2) Asymmetrical oligoarticular
- <5joints
- often one large joint an dsmaller joints
3) DIPJ prominant disease
- significant nail changes e.g. pitting
- can lead to sausage finger(dactylitis)
4) Spondylitis
- similar to SA
5) Arthritis Mutilans
- severe form
- joint destruction and deformity
What are extra-articular symptoms of PA?
Anterior uveitis
- acute pain and photophobia
- constricted pupil
- ciliary flushing
What investigations are needed for PA?
XR
-erosions similar to RA
Pencil in cup appearance
-Arthritis mutilans can cause telescoping of fingers- soft tissue accumulation at base
What is the management of PA?
If one joint affected
-full dose NSAIDs +/-steroid injections
If multiple
- treat as RA
- Methotrexate good as helps psoriasis
- DMARDs do not help spinal symptoms
What is Reactive Arthritis?
Acute asymmetrical lower limb arthritis occurring 4-40 day post infection normally GI/GU
