Week 2 - H - Seronegative Inflammatory arthropathies - Ankylosing Spondylitis, Psoriatic / Enteropathic / Reactive arthritis Flashcards
What does the term seronegative inflammatory arthropathies encompass? Why are they known as seronegative?
The term seronegative inflammatory arthropathies encompasses four main conditions
* Ankylosing spondylitis
* Psoriatic arthritis
* Enteropathic arthritis
* Reactive arthritis
They are known as sernoegative due to the absence of the antibody rheumatoid factor in the blood tests
What joints are involved in the seronegative inflammatory arthopathies?
They are often characterised by inflammation and/or arthritic disease of the spine - known as spondyloarthropathy and an asymmetric oligoarthritis
What joints are involved in the seronegative inflammatory arthopathies? What exttra-articular manifestations also occur?
Extra-articular manifestations
* Sacroilitis
* Uveitis - inflammation of the uvea of the eye
* Dactylitis
* Enthesopathies are also common
What does dactylitis mean? Which entheses are more commonly involved in the seronegative inflammatory arthropathies?
Dactylitis means inflammation of a digit
Enthesopathies - especially achilles insertion tendonitis and plantar fasciits
What HLA is associated with the seronegative inflammatory arthropathies? What else is usually elevated in the blood?
HLA B27 is often positive
CRP and ESR are usually elevated also
Try and state roughly the percentage of patients HLA-B27 is positive in for each of the seronegative inflammatory arthropathies?
Anklyosing spondylitis - 90% of patients HLA-B27 positive
Psoriatic arthritis - approx 60% HLA B27 positive
Enteropathic arthritis - approx 60% HLA B27 positive
Reactive arthitis - approx 60% HLA B27 positive
Ankylosing spondylitis is a chronic inflammatory disease Which joints are most commonly affected in anklyosing spondylitis? Which sex is more commonly affected and hwat is the typical age of onset?
Joints most commonly affected are the spine and sacroiliac joints
Males are more commonly affected and
age of onset is typically between 20-40 years (think Murner)
What can the spinal and sacroiliac joint inflammation lead to?
This can lead to eventual fusion of the intervetebral and sacro-iliac joints due to syndesmophyte formation
What is the term known as due to syndesmopyte formation causing loss of spinal movement?
Term is known as question mark spine aka bamboo spine
It is due to loss of lumbar lordosis and increased thoracic kyphosis
What test is carried out to measure lumbar spine flexion in Ankylosing spondylitis? How is this carried out?
Lumbar spine flexion can be measured using Schobers test.
This involves measuring 5cm below the posterior superior iliac crests and 10cm above, whilst the patient is upright.
Then asking them to bend forwards and remeasuring the distance.
In normal situations it should extend beyond 20cm
What may the Xray’s of the ankylosing spondylitis show?
If still suspecting ank spond despite xray, would do an MRI scan
Xray’s may show fusion of the sacroiliac joints and bony spurs from the vertebral bodies known as syndesmophytes - which can bridge producing a bamboo spine
It is common for Xrays to be normal however
What are the associated extra-articular manifestations of ankylosing spondylitis?
Uveitis - inflammation of the uvea of the eye
Enthesopathies are also common - particularly of achilles tendon and plantar fasciitis
Also associated with pulmonary fibrosis
What are the non-pharmacological management options of ankylosing spondylitis? What are the 1st line drugs given with the non-pharmacological management?
Treatment consists of physiotherapy, exercise and NSAIDs as 1st line management of the disease
What is given to patients with more aggressive disease? When may DMARDs be used?
In patients with more aggressive disease, anti-TNF inhibitors eg infliximab, etanercept or adalimumab are indicated
DMARDs do not have any impact on spinal disease but may be used if there is peripheral joint inflammation
When is surgery used in patients with ankylosing spondylitis?
Surgery is mainly reserved for hip and knee arthritis
* and rarely spinal surgery to straighten out the spine - although this is controversial and carries considerable risk
What are the common features in the nail bed in psoriatic arthritis?
Patients usually have nail changes including pitting and onycholysis (lifting of the nail from its nailbed) -
some patients have a prediliction for arthritis of the DIP joints of the fingers and /or toes
What is the most severe and destructive form of psoriatic arthritis known as? Where does it affect?
Psoriatic arthritis mutilans is a rare form of psoriatic arthritis - it typically affects the hands and feet
PsA mutilans occurs when PsA becomes severe, and the resulting inflammation attacks bone tissue and causes it to break down.
The body then reabsorbs the bone.
What is the deformity in the fingers often seen on Xray in psoriatic arthitis known as?
Known as the pencil in cup deformity - The end of the bone has eroded into a sharpened pencil shape.
What is the triad of symptoms that may sometimes arise in patients with reactive arthritis? What is this triad known as?
Reiter’s syndrome - triad of
* urethreitis - can’t pee
* uveitis / conjunctivitis - can’t see
* Arthritis - can’t climb a tree
