Podcast
Questions and Answers
What is the most common extra-articular feature of ankylosing spondylitis in males?
What is the most common extra-articular feature of ankylosing spondylitis in males?
Which of the following diagnostic features is NOT associated with ankylosing spondylitis?
Which of the following diagnostic features is NOT associated with ankylosing spondylitis?
In what way does reactive arthritis often present?
In what way does reactive arthritis often present?
Which treatment is most likely to be recommended for peripheral arthritis in ankylosing spondylitis if initial treatments are ineffective?
Which treatment is most likely to be recommended for peripheral arthritis in ankylosing spondylitis if initial treatments are ineffective?
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Which subtype of psoriatic arthritis is characterized by severe deformities particularly affecting the hands and feet?
Which subtype of psoriatic arthritis is characterized by severe deformities particularly affecting the hands and feet?
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What common feature is associated with psoriatic arthritis but not with ankylosing spondylitis?
What common feature is associated with psoriatic arthritis but not with ankylosing spondylitis?
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What is the hallmark radiological finding for diagnosing ankylosing spondylitis?
What is the hallmark radiological finding for diagnosing ankylosing spondylitis?
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What type of joint involvement is more commonly observed in reactive arthritis compared to ankylosing spondylitis?
What type of joint involvement is more commonly observed in reactive arthritis compared to ankylosing spondylitis?
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What is not a common cause of enthesitis in ankylosing spondylitis?
What is not a common cause of enthesitis in ankylosing spondylitis?
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Which of the following conditions is associated with sterile synovial fluid upon aspiration?
Which of the following conditions is associated with sterile synovial fluid upon aspiration?
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Study Notes
Seronegative Arthritis
- Ankylosing Spondylitis: More common in males, HLA-B27 positive in 90% of cases, affects axial joints more than peripheral joints. Presentation includes back pain in patients younger than 40, inflammatory peripheral arthritis (e.g., hip, shoulder), and extra-articular features like anemia, anterior uveitis, apical fibrosis, aortic valve disease, amyloidosis, osteoporosis, and prostatitis. Diagnosis involves history, physical exam (reduced chest expansion, Schober test), and imaging (X-ray or MRI, sacroiliitis, and enthesitis). Treatment includes NSAIDs for axial arthritis, and NSAIDs +/- steroids, Sulfasalazine or methotrexate, or Anti-TNFx if not effective for peripheral arthritis.
Reactive Arthritis
- Presentation: History of GI or UTI infection (2-4 weeks prior), arthritis, conjunctivitis, urethritis, and skin rashes (circinate balanitis, keratoderma blenorrhagica). Synovial fluid aspiration is typically sterile. Stool, urine, or vaginal cultures can be helpful for diagnosis and identifying etiology. Affects peripheral joints more than axial, with lower joints affected more than upper joints. Treatment is similar to peripheral Ankylosing Spondylitis: NSAIDs with or without steroids, methotrexate, Sulfasalazine, or Anti-TNFx as needed.
Psoriatic Arthritis
- Equal prevalence in men and women; affects peripheral joints more than axial joints. Subtypes include polyarthritis (similar to RA), asymmetrical oligoarthritis, and arthritis mutilans (severe deforming arthritis of hands and feet). Presentation involves nail pitting, psoriasis, and skin changes. Radiologically, erosions and new bone formation are seen. Diagnosis includes history, physical exam (including nail changes), and X-rays looking for erosions and new bone formation. Treatment for axial PA includes NSAIDs, and Anti-TNFx if ineffective. For peripheral PA, methotrexate, and/or anti-TNFx, if ineffective, anti-IL-17.
Enteropathic Arthritis
- More common in males. Two types of peripheral arthritis: type 1: acute and oligoarthritis, correlated with inflammatory bowel disease (IBD) activity; and type 2: chronic, unrelated to IBD activity and characterized by polyarthritis and positive for HLA-B27. Extra-articular features include pyoderma gangrenosum, aphthous stomatitis, inflammatory eye disease (acute anterior uveitis), and erythema nodosum. Treatment options include peripheral: Sulfasalazine, and Anti-TNFx; axial: NSAIDs and Anti-TNFX (except etanercept), with NSAIDs potentially exacerbating IBD, especially ulcerative colitis.
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Description
This quiz delves into the details of seronegative arthritis, covering Ankylosing Spondylitis and Reactive Arthritis. It explores symptoms, diagnostic methods, treatment options, and extra-articular features associated with these conditions. Test your understanding of these inflammatory joint diseases.
