Week 2 - Seronegative arthropathies

Question 1

what are the 4 seronegative arthropathies?

Answer 1

ankylosing spondylitis
psoriatic arthritis
enteropathic arthritis
reactive arthritis

Question 2

what are some common shared features of seronegative arthropathies?

Answer 2

spondyloarhtropathy (spine arthritis)
uveitis
dactylitis
sacroiliitis
enthesopathies
usually HLA B27 positive?

Question 3

do all HAL B27 positive people develop seronegative arthropathy?

Answer 3

no

not many go on to develop it so not a good diagnostic test

Question 4

what is ankylosing spondylitis?

Answer 4

chronic inflammatory condition of the spine and sacroiliac joints which can eventually lead to fusion of the spine and SI joints

Question 5

who is ankylosing spondylitis more common in?

Answer 5

men (3:1)

Question 6

what are some common presenting complaints in ankylosing spondylitis?

Answer 6

pain
morning stiffness lasting >30 mins
improves on exercise
can develop knee and hip arthritis
loss of movement in the spine over time

Question 7

how can ankylosing spondylitis change the spine?

Answer 7

causes fusion

can deform the spine to a “question mark” shape by causing loss of lumbar lordosis and exaggeration of thoracic kyphosis

Question 8

how can lumbar spine flexion be tested?

Answer 8

schobers test

Question 9

what are some conditions associated with ankylosing spondylitis?

Answer 9

uveitis
pulmonary fibrosis
amyloidosis
aortitis

Question 10

what is seen on X ray in ankylosing spondylitis?

Answer 10

often normal in early stages
can later show fusion of SI joints, syndesmophytes (bony spurs) from vertebral bodies which bridge the IV discs resulting in fusion which produces a “bamboo” spine

Question 11

what can show earlier changes in ankylosing spondylitis? what is seen?

Answer 11

MRI

shows oedema and enthesitis of spinal ligaments

Question 12

how is ankylosing spondylitis treated?

Answer 12

exercise
physiotherapy
NSAIDs
anti TNF if more severe
surgery if needed

Question 13

are DMARDs used in ankylosing spondylitis?

Answer 13

not really as they don’t have an affect on the spinal disease
can be used if there is peripheral joint inflammation

Question 14

how does psoriatic arthritis generally present?

Answer 14

spondylitis
dactolytis
enthesitis
nail changes
usually asymmetrical oligoarthritis
can affect the hands in a similar pattern to RA (but some can affect the DIP joints)

Question 15

what nail changes occur in psoriatic arthritis?

Answer 15

pitting

oncholysis

Question 16

what is the more aggressive form of psoriatic arthritis?

Answer 16

arthritis mutilans

Question 17

how is psoriatic arthritis treated?

Answer 17

generally the same as RA
- DMARDs (methotrexate 1st line)
\+ steroids (to begin with)
- Anti TNF if no response to DMARD
surgery if needed

Question 18

what is enteropathic arthritis?

Answer 18

inflammatory arthritis occurring in people with IBD

Question 19

where does enteropathic arthritis generally affect?

Answer 19

large joint, asymmetrical oligoarthritis

peripheral joints and sometimes the spine

Question 20

how is enteropathic arthritis treated?

Answer 20

must treat underlying IBD as well as arthritis

Question 21

what is reactive arthritis?

Answer 21

inflammatory arthritis in response to an infection

Question 22

what types of infection most commonly cause a reactive arthritis?

Answer 22

genitourinary - gonorrhoea, chlamydia

GI - salmonella, shigella

Question 23

how long after the initial infection does the arthritis usually begin?

Answer 23

around 3 weeks

Question 24

how does the infection cause an arthritis?

Answer 24

triggers an autoimmune arthropathy

Question 25

what are the symptoms of reactive arthritis?

Answer 25

reiter’s triad

• urethritis
• uveitis
• arthritis

Question 26

how is reactive arthritis treated?

Answer 26

most are self limiting
treatment aimed at treating initial infection
manage symptoms including steroid injections
DMARDs if chronic