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Flashcards in Seronegative Arthritis Deck (29)
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1

What is seronegative arthritis?

-A group of arthritic conditions which are negative for rheumatoid factor
-May be associated with HLA-B27
-Usually asymmetric and spinal involvement
-Enthesitis and extra-articular features

2

What extra-articular features can occur in seronegative arthritis?

-Uveitis
-IBD
-Psoriasis

3

What are the different clinical presentations of seronegative arthritis?

-Ankylosing Spondylitis
-Psoriatic arthritis
-Bowel related arthritis (Crohn’s, UC)
-Reactive arthritis
-Others

4

What is ankylosing spondylitis?

-A chronic inflammatory rheumatic disorder with a predilection for axial skeleton and enthuses

5

Who is affected by ankylosing spondylitis?

-M>F
-2nd to 3rd decade
-Prevalence varies worldwide

6

How can spinal mobility be tested/measured?

-Modified Schober test
-Lateral spinal flexion
-Occiput to wall and tragus to wall
-Cervical rotation

7

What surface antigen is associated with ankylosing spondylitis?

HLA-B27

8

What are the clinical features of ankylosing spondylitis?

-Inflammatory back pain (worse in the morning, better after activity and insidious onset)
-Limitation of movements in antero-posterior as well as lateral planes at lumbar spine
-Limitation of chest expansion
-Bilateral sacroiliitis on X-rays

9

How is radiographic sacroiliitis graded?

Grade 0
-Normal

Grade1
-Suspicious changes

Grade 2
-Minimal abnormality

Grade 3
-Unequivocal abnormality

Grade 4
-Severe abnormality

10

How does axial spondyloarthritis progress?

Non-radiographic stage
-Back pain and sacroiliitis on MRI

Radiographic stage
-Back pain and radiographic sacroiliitis
-Back pain and syndesmophytes
-Modified New York Criteria used

11

What is the ASAS classification criteria for axial spondyloarthritis?

In patients with 3 months or more history of back pain and age of onset <45
-Sacroillitis on imapging pulse 1 or mor SpA features OR
-HLA-B27 plus 2 or more SpA features

12

What are the SpA features?

-Inflammatory back pain
-Arthritis
-Enthesitis (heel)
-Uveitis
-Dactylitis
-Psoriasis
-Crohn's/colitis
-Good response to NSAIDs
-Family history
-HLA-B27
-Elevated CRP

13

What are the systemic features of SpA?

-Achilles tendonitis, dactylitis
-Uveitis
-Cardiac- Aortic incompetence, heart block
-Pulmonary- restrictive disease, apical fibrosis
-GI- IBD
-Osteoporosis and spinal fractures
-Neurological- AAD & cauda equina syndrome
-Renal- secondary amyloidosis

14

How is ankylosing spondylitis managed?

-Physiotherapy (mainstay)
-NSAIDs
-DMARDs- Sulfasalazine
-Anti-TNF
-Anti-IL-17
-Treatment of osteoporosis
-Surgery- joint replacements & spinal surgery

15

What joints are commonly affected by psoriatic arthritis?

-Neck
-Shoulders
-Elbows
-Wrists
-All joints of the digits
-Ankles
-Knees
-Spine

16

What are the clinical subtypes of psoriatic arthritis?

-Arthritis with DIP joint involvement
-Symmetric polyarthritis- similar to RA
-Asymmetric oligoarticular arthritis
-Arthritis mutilans
-Predominant spondylitis

17

How is psoriatic arthritis treated?

-Sulfasalazine
-Methotrexate
-Leflunomide
-Cyclosporine
-Anti-TNF therapy
-Anti- IL-17 and IL-23
-Steroids (oral, IM, IA etc.)
-Physiotherapy and occupational therapy
-Axial disease treated similar to AS

18

What is reactive arthritis?

A painful form of arthritis which occurs after a distant infection

19

What organisms have been implicated in reactive arthritis?

-Salmonella
-Shigella
-Yersinia
-Campylobacter
-Chlamydia trachomatis/penumoniae
-Borrelia
-Neisseria
-Streptococci

20

What are the features of reactive arthritis?

-Disease may be systemic
-Usually mono or oligiarthritis
-Dactylitis or enthesitis may be seen
-Associated with throat, urogenital and GI infections

21

What skin and mucosal involvement can occur in reactive arthritis?

-Keratoderma blenorrhagica
-Circinate balanitis
-Urethritis
-Conjunctivitis
-Iritis

22

What is the triad of Reiter's syndrome (reactive arthritis)?

-Arthritis
-Urethritis
-Conjunctivitis

23

What are the prognostic signs for chronicity of reactive arthritis?

-Hip/heel pain
-High ESR
-Family history and HLA-B27 positive

24

When are recurrent reactive arthritis attacks common?

In chlamydia induced arthritis

25

How is reactive arthritis treated?

Acute
-NSAID
-Joint injection (if infection excluded)
-Antibiotics in chlamydia infection (contacts as well)

Chronic
-NSAID
-DMARD (e.g. sulphasalazine, methotrexate)

26

What is enteropathic arthritis commonly associated with?

IBD (Crohn's or colitis)

27

When can enteropathic arthritis rarely be seep?

-Enteritis
-Whipple's disease
-Coeliac disease

28

How does enteropathic arthritis present?

-Can present with both peripheral and/or axial disease
-Enthesopathy commonly seen

29

What is the treatment for enteropathic arthritis?

-NSAIDs difficult to use
-Sulfasalazine
-Steroids
-Methotrexate
-Anti-TNF
-Bowel resection may alleviate peripheral disease