Flashcards in Seronegative Arthritis Deck (29)
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
What extra-articular features can occur in seronegative arthritis?
What are the different clinical presentations of seronegative arthritis?
-Bowel related arthritis (Crohn’s, UC)
What is ankylosing spondylitis?
-A chronic inflammatory rheumatic disorder with a predilection for axial skeleton and enthuses
Who is affected by ankylosing spondylitis?
-2nd to 3rd decade
-Prevalence varies worldwide
How can spinal mobility be tested/measured?
-Modified Schober test
-Lateral spinal flexion
-Occiput to wall and tragus to wall
What surface antigen is associated with ankylosing spondylitis?
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
How is radiographic sacroiliitis graded?
How does axial spondyloarthritis progress?
-Back pain and sacroiliitis on MRI
-Back pain and radiographic sacroiliitis
-Back pain and syndesmophytes
-Modified New York Criteria used
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
What are the SpA features?
-Inflammatory back pain
-Good response to NSAIDs
What are the systemic features of SpA?
-Achilles tendonitis, dactylitis
-Cardiac- Aortic incompetence, heart block
-Pulmonary- restrictive disease, apical fibrosis
-Osteoporosis and spinal fractures
-Neurological- AAD & cauda equina syndrome
-Renal- secondary amyloidosis
How is ankylosing spondylitis managed?
-Treatment of osteoporosis
-Surgery- joint replacements & spinal surgery
What joints are commonly affected by psoriatic arthritis?
-All joints of the digits
What are the clinical subtypes of psoriatic arthritis?
-Arthritis with DIP joint involvement
-Symmetric polyarthritis- similar to RA
-Asymmetric oligoarticular arthritis
How is psoriatic arthritis treated?
-Anti- IL-17 and IL-23
-Steroids (oral, IM, IA etc.)
-Physiotherapy and occupational therapy
-Axial disease treated similar to AS
What is reactive arthritis?
A painful form of arthritis which occurs after a distant infection
What organisms have been implicated in reactive arthritis?
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
What skin and mucosal involvement can occur in reactive arthritis?
What is the triad of Reiter's syndrome (reactive arthritis)?
What are the prognostic signs for chronicity of reactive arthritis?
-Family history and HLA-B27 positive
When are recurrent reactive arthritis attacks common?
In chlamydia induced arthritis
How is reactive arthritis treated?
-Joint injection (if infection excluded)
-Antibiotics in chlamydia infection (contacts as well)
-DMARD (e.g. sulphasalazine, methotrexate)
What is enteropathic arthritis commonly associated with?
IBD (Crohn's or colitis)
When can enteropathic arthritis rarely be seep?
How does enteropathic arthritis present?
-Can present with both peripheral and/or axial disease
-Enthesopathy commonly seen