The seronegative spondylarthropathies

Question 1

give egs of the seronegative spondylarthropathies

Answer 1

ankylosing spondylitis
psoriatic arthritis
reactive arthritis (sexually acquired, Reiters disease)
post-dysenteric reactive arthritis
enteropathic arthritis

Question 2

clinical features shared by the seronegative spondylarthropathies

Answer 2

• axial (spinal & sacroiliac) inflammation
• asymmetrical peripheral arthritis
• absence of rheumatoid factor, hence ‘seronegative’
• inflammation of enthesis (the connective tissue between tendon or ligament and bone)
• a strong association with HLA-B27

Question 3

ankylosing spondylitis

Answer 3

inflammatory disorder of the spine

Question 4

who does ankylosing spondylitis affect?

Answer 4

mainly young adults

more common and more severe in men

Question 5

ankylosing spondylitis presents w

Answer 5

presents w inc pain and prolonged morning stiffness in lower back and buttocks

Question 6

ankylosing spondylitis clinical features

Answer 6

pain and stiffness improves with exercise
progressive loss of spinal movement
achilles tendonitis
tenderness around the pelvis and chest wall

Question 7

investigations ankylosing spondylitis

Answer 7

ESR CRP raised
Xray = normal or erosion / sclerosis of margins of sacroiliac joints

Blurring of upper/lower vertebral rims at thoracolumbar junction caused by enthesitis at the insertion of the intervertebral ligaments. This heals with new bone formation = bony growths inside the ligament called syndesmophytes = bamboo spine - sacroiliac joints fuse

Question 8

management ankylosing spondylitis

Answer 8

early diagnosis and rx = essential to prevent syndesmorphytes and calcification
morning exercises
slow release NSAIDs taken at night
tnf-a blocking drugs

Question 9

psoriatic arthritis

Answer 9

arthritis occurs in 20% of pts w psoriasis

Question 10

clinical features psoriatic arthritis

Answer 10

• asymmetrical involvement of the small joints of the hand incl DIPJ
• symmetrical seronegative polyarthritis resembling RA
• arthritis mutilans = destruction of the small bones in hands and feet
• sacroilitis unilateral or bilateral

Question 11

investigations psoriatic arthritis

Answer 11

blood tests unhelpful
xrays = pencil in a cup deformity in IPJs - bone erosions create a pointed appearance & the articulating bone is concave

Question 12

rx psoriatic arthritis

Answer 12

• analgesia and NSAIDs
• local synovitis responds to intra-articular steroid injections
• methotrexate or TNF blocking drugs in severe disease

Question 13

reactive arthritis what is it and when does it occur

Answer 13

reactive arthritis is a sterile synovitis, occurs following:

• GI infection
• STI, urethritis in M or cervicitis in F from chlamydia trachomatis

persistent bacterial antigen in the inflamed synovium of affected joints drives the inflam process

Question 14

clin features reactive arthritis

Answer 14

typical case = young man w acute arthritis after enteric or STI
asymmetrical lower joint arthritis
skin lesions resemble psoriasis
classic triad of Reiter’s syndrome: urethritis, reactive arthritis and conjunctivitis

Question 15

investigations reactive arthritis

Answer 15

diagnosis is clinical
ESR raised at acute stage
aspirated synovial fluid is sterile w high neutrophil count

Question 16

management reactive arthritis

Answer 16

• NSAIDs and local corticosteroid injections
• persistent infec = antibiotics
• relapsing cases are treated w sulfasalazine (DMARD) or methotrexate & TNF blocking drugs in severe cases

Question 17

enteropathic arthritis

Answer 17

large joint asymmetrical
10-15% of pts w ulcerative colitis or crohn’s
parallels the activity of the inflam bowel disease so improves as bowel symps improve