spondyloarthritis (seronegative arthritis) Flashcards
what is
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
spondyloarthritis is associated with what gene
HLA-B27 maybe
presents usually
asymmetric
involvement of spine
enthesitis- inflammation of where tendon/ligament attaches to bone
ankylosing spondylitis
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”
AS clinical features
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
ASAS classification criteria of axial spondyloarthritis
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
SpA features
back pain
arthritis
enthesitis
dactylitis
uveitis
psoriasis
crohns
family history
good response to NSAIDs
elevated CRP
management of AS
physio
NSAIDs
sulfasalazine
anti TNF
anti IL 17
treatment of osteoporosis
surgery
investigations for AS
schobers test- bend over and measure
inflammatory markers
HLAB27 genetic test
xray of spine and sacrum and MRI
what is psoriatic arthritis PsA
occurs in individuals with psoriasis
involves inflammation of the joints, entheses (sites where tendons or ligaments attach to bone), and skin
clinical features of psoriatic arthritis
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
types/patterns of psoriatic arthritis
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)
investigations for psoriatic arthritis
psoriasis epidemiological screening tool PEST- for anyone with psoriasis
x ray
management for PsA
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
what is reactive arthritis
sterile synovitis after distant infection
commonly in the gastrointestinal, throat or genitourinary tract
aka reiters syndrome
infections that commonly cause reactive arthritis
chlamydia trachomatis (commonly reoccurs), salmonella, campylobacter, shigella, yersinia
presentation of reactive arthritis
usually monoarthritis in lower limb
joint pain
swelling, warm
eye inflammation (conjunctivitis/uveitis)
urethritis
circinate balanitis
infection symptoms local or systemic
signs that high prognosis of developing chronic reactive arthritis
hip/heel pain
high ESR
family history and HLA B27 positive
treatment of reactive arthritis
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
enteropathic arthritis
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.
treatment of enteropathic arteritis
NSAIDs hard to use due to bowl disease
sulfasalazine
steroids
methotrexate
anti TNF
bowel resection
