spondyloarthritis (seronegative arthritis)

Question 1

what is

Answer 1

group of chronic inflammatory diseases that primarily affect the axial skeleton (spine) and peripheral joints

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis
juvenile ankylosing spondylitis

negative rheumatoid factor

Question 2

spondyloarthritis is associated with what gene

Answer 2

HLA-B27 maybe

Question 3

presents usually

Answer 3

asymmetric
involvement of spine
enthesitis- inflammation of where tendon/ligament attaches to bone

Question 4

ankylosing spondylitis

Answer 4

chronic inflammatory rheumatic disorder that affects axial skeleton and entheses the most
onset in late teens, 20s
males>females
can progress to fusion of the spine and sacroiliac joints.- “bamboo spine”

Question 5

AS clinical features

Answer 5

stiffness first thing better with activity
limitation of movement in spine
limitations of chest expansion
gradual lower back pain and stiffness and sacroiliac pain
worse at night, better with activity
may wake them in sleep

bilateral sacroiliitis on xrays (can be picked up on MRI earlier) progresses into syndesmophytes

Question 6

ASAS classification criteria of axial spondyloarthritis

Answer 6

patients with 3 or more months of back pain and age at onset <45 years
sacroiliitis on imaging plus 1 or more SpA features
HLAB27 plus 2 or more SpA features

Question 7

SpA features

Answer 7

back pain
arthritis
enthesitis
dactylitis
uveitis
psoriasis
crohns
family history
good response to NSAIDs
elevated CRP

Question 8

management of AS

Answer 8

physio
NSAIDs
sulfasalazine
anti TNF
anti IL 17
treatment of osteoporosis
surgery

Question 9

investigations for AS

Answer 9

schobers test- bend over and measure
inflammatory markers
HLAB27 genetic test
xray of spine and sacrum and MRI

Question 10

what is psoriatic arthritis PsA

Answer 10

occurs in individuals with psoriasis
involves inflammation of the joints, entheses (sites where tendons or ligaments attach to bone), and skin

Question 11

clinical features of psoriatic arthritis

Answer 11

joint pain- large joints more common
swelling
skin plaques
nail changes- necrolysis, pitting, onycholysis
dactylitis
enthesitis
conjunctivitis
anterior uveitis
aortitis
amyloidosis

can develop into arthritis mutilans

Question 12

types/patterns of psoriatic arthritis

Answer 12

symmetric polyarthritis- similar to RA in presentation apart from MCP joints arent commonly affected
asymmetric oligoarticular arthritis- mainly digits and feet
arthritis mutilans

severity of joint disease does not correlate to extent of skin disease. (look behind hair and ears)

Question 13

investigations for psoriatic arthritis

Answer 13

psoriasis epidemiological screening tool PEST- for anyone with psoriasis
x ray

Question 14

management for PsA

Answer 14

similar to rheumatoid

NSAIDs for pain
DMARDs- sulfasalazine, methotrexate, leflunomide
biologics if dont respond well- infliximab
anti IL-17 and IL23
steroids
physio
axial treated similar to AS

Question 15

what is reactive arthritis

Answer 15

sterile synovitis after distant infection
commonly in the gastrointestinal, throat or genitourinary tract
aka reiters syndrome

Question 16

infections that commonly cause reactive arthritis

Answer 16

chlamydia trachomatis (commonly reoccurs), salmonella, campylobacter, shigella, yersinia

Question 17

presentation of reactive arthritis

Answer 17

usually monoarthritis in lower limb

joint pain
swelling, warm
eye inflammation (conjunctivitis/uveitis)
urethritis
circinate balanitis
infection symptoms local or systemic

Question 18

signs that high prognosis of developing chronic reactive arthritis

Answer 18

hip/heel pain
high ESR
family history and HLA B27 positive

Question 19

treatment of reactive arthritis

Answer 19

NSAIDs, antibiotics in chlamydia, joint injection if infection excluded (septic arthritis)
chronic- NSAIDs and DMARDs

give antibiotics until septic arthritis is excluded
most resolve in 6 months and dont revur

Question 20

enteropathic arthritis

Answer 20

associated with inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis.
It primarily affects the peripheral joints but can involve the axial skeleton as well
Symptoms include joint pain, swelling, and stiffness, along with signs and symptoms related to IBD.

Question 21

treatment of enteropathic arteritis

Answer 21

NSAIDs hard to use due to bowl disease
sulfasalazine
steroids
methotrexate
anti TNF
bowel resection