Lecture 103 -Sero-negative arthropathies

Question 1

what are the 4 seronegative arthropathies from this lecture

what is common to all of these disease?

Answer 1

Ankylosing Spondylitis
Reactive Arthritis – arthritis following an infeciton;
Psoriatic Arthritis
Arthritis associated with IBD

common: 
no RF, ant CCP, or ANA 
HLAB27 association 
involvment of the axial skeleton 
Involvment of some extra articular sites

Question 2

Ankylosis spondylitis – classical presentation (articular manifestation)

who is commonly affected

Answer 2

Characterized by slow insidious onset low back pain; worse in the morning and better throughout the day (inflammatory process);

Flattening of the lumbar lordosis

intially involving the SI joints, but is progressive and also has extra-articular manifestations

white males

Question 3

Ankylosis spondylitis

- extra articular manifestations

Answer 3

Uveitis
aortitis – aneurysm leading to aortic regurge/insufficinecy
Conduction blocks
reduced lung expansion / Pulm Fibrosis

Question 4

Ankylosis spondylitis – classic radiology findings

Answer 4

Sacroiliitis – - erosions and eventual fusion of SI joints

Syndesmophoytes – Calcification of annulus fibrosis; linking vertebrae to each other
“bamboo spine”

Question 5

Ankylosis spondylitis – treatment and prognosis

Answer 5

NSAIDs – symptomatic relief; but don’t prevent progression
MTX
Anti TNF
Physical therapy –very important for function before fusion occurs

prognsosis –diability and incrased risk of CVD due to increased inflammation

Question 6

Reiter’s Syndrome – Reactive Arthritis

what is it?
what is the classic triad of symptoms?

Answer 6

Acute non purulent arthritis/enthesitis associated with recent diarrheal or urinary infection

symptoms: Arthritis, Conjunctivitis, Non Purulent Urethritis (can’t pee, can’t see, can’t climb a tree)

Question 7

Reiter’s Syndrome – Reactive Arthritis

what are the typical causaitve agents?

who most commonly gets this

Answer 7

Shigella, Salmonella, Yersinia, Campylobacter, Chlamydia

	Young male

Question 8

Reiter’s Syndrome – Reactive Arthritis

treatment
prognosis

Answer 8

NSAIDS – symptomatic
Abx – if active infection
Cortico steroids – intra-articular use

Prognosis – Rule of 1/3 (Third Reich)
1/3 Isolated attack, 1/3 Recurrent isolated attacks, 1/3 chronic progressive course

Question 9

Psoriatic Arthritis –
what % of people with psoriasis get this?

what is the most common presentation?

what is the classical apperance on imaging?

Answer 9

10% of psoriasis patients

Common presnetation: Asymmetric Oligoarthritis –
DIP – “Sausage toe”

imaigng: Pencil in Cup

Question 10

Arthritis of IBD — what % of IBD patients

what is the treatment?

Answer 10

20% of IBD patients develop peripheral Arthritis

treamtnet:
Some are IBD depdent – therefore if you treat IBD you can control the arhtritis

But some are not