spondyloarthritis/ seronegative

Question 1

definition

Answer 1

negative rheumatoid factor
maybe assoc. HLA B27 (important)
usually asymmetric
involvement of axial skeleton
enthesitis
extra articular- uveitis, IBD

Question 2

different clinical presentations

Answer 2

ankylosing spondylitis
psoriatic arthritis
bowel related arthritis
reactive arthritis

Question 3

ankylosing spondylitis

Answer 3

Chronic inflammatory rheumatic disorder with inclination for axial skeleton and entheses
onset 20s to 30s

Question 4

Clinical features

Answer 4

inflammatory back pain
limitation of movements in antero-posterior lateral plans at lumbar spine
limitation of chest expansion
bilateral sacroiliitis on xray

Question 5

grading of radiographic sacrolitis

Answer 5

1- suspicious change
2- minimal abnormality- sclerosis or erosion
3- unequivocal abnormality-moderate/advance sacroilitis
4- severe abnormality (total ankylosis (abnormal stiffening due to bone fusion)

Question 6

Axial spondyloarthritis

Answer 6

non radiographic

radiographic-radiographic sacroilitis- syndesmophtes

Question 7

Ankylosis Spondylitis

Answer 7

Inflammatory back pain
arthritis
enthesisits (heel)
uveitis (eye)
dactylitis
psoriasis
crohn's/ colitis
good response to NSAIDS
HLA-B27 
FHx
elevated CRP
cardiac- aortic incompetence, heart block
secondary amyloidosis

Question 8

management

Answer 8

physiotherapy
NSAIDs
DMARDs
Anti TNF
Osteoporosis treatment
joint replacement

Question 9

Psoriatic arthritis

Answer 9

DIP joint involvement
symmetric polyarthritis
asymmetric oligoarticular arthritis
arthritis mutilans 
predominant spodylitis
dactylitis & enthesitis
severity of join doesnt correlate to skin.

Question 10

treatment

Answer 10

sulfasalazine
methotrexate
leflunomide
cyclosporine
anti TNF
Anti Il17 and IL23
steroids
physio

Question 11

reactive athritis

Answer 11

sterile synovitis after distant infection
such as salmonella, shigella, yersinia, campylobacter
infection- throat, urogenital & GI
systemic maybe
usually mono or oligo
dactylitis and enthesitis
skin and mucous membrane involvement
-keratoderma blenorrhagica
circinate balanitis
urethritis
conjunctivitis
iritis
recurrent attacks common in chlamydia
hip/heel pain
high ESR
family Hx

Question 12

Reiter’s syndrome

Answer 12

arthritis, urethritis and conjunctivitis

Question 13

treatment

Answer 13

Acute
NSAID, joint injection
antibiotics in chlamydia
Chronic
NSAID
DMARD

Question 14

Enteropathic arthritis

Answer 14

associated with IBD (crohn or uC
enthesopathy common
present with both peripheral and axial disease
NSAIDs,
Sulfasalazine
steroids
methotrexate
Anti TNF
bowel resection