Seronegative Arthritis PDF

# Seronegative Arthritis ## Ankylosing Spondylitis - More common in males than females - HLA-B27 is positive in 90% of cases but not diagnostic - Affects axial joints more than peripheral joints - **Presentation of Case:** - Age less than 40 years old - Inflammatory back pain - Enthesi...

# Seronegative Arthritis ## Ankylosing Spondylitis - More common in males than females - HLA-B27 is positive in 90% of cases but not diagnostic - Affects axial joints more than peripheral joints - **Presentation of Case:** - Age less than 40 years old - Inflammatory back pain - Enthesitis - Peripheral arthritis (eg, hip, shoulder) - **Extra-articular Features of AS:** - Anemia - Anterior uveitis - Apical fibrosis in apex of lung - Aortic valve disease - Amyloidosis - Osteoporosis - Prostatitis (because it's most common in males) - **Diagnosis:** - History and Examination - Reduced chest expansion - Schober test decreased - Hip fixed flexion - Loss of lordosis of lumbar spine - Lordosis of cervical spine - Sacroiliac joint on X-ray or MRI - Sacroiliitis - Enthesitis - Syndesmophytes - Considered as hallmark - **Treatment:** - Axial arthritis: - NSAIDs, then Anti-TNFx - Peripheral arthritis: - NSAIDs +/- Steroids - If not effective: Sulfasalazine or methotrexate - If not effective: Anti-TNFx ## Reactive Arthritis - There is a history of gastrointestinal (GIT) or urinary tract infection (UTI) infection (2-4 wks) - **Presentation:** Arthritis + Conjunctivitis + Urethritis with or without skin rashes (circinate balanitis, keratoderma blennorrhagica) - **On aspiration of synovial fluid:** Sterile - We do stool culture, urine culture, or urethral or high vaginal culture to detect the etiology according to the patient's history - Peripheral joints more affected than axial - Lower more than upper - Treatment is same as peripheral AS - NSAIDs with or without steroids - If not effective: methotrexate or sulfasalazine - If not effective: Anti-TNFx ## Psoriatic Arthritis - Men and women are equally affected - Peripheral joints more than axial - **There are subtypes of PA:** - Polyarthritis like RA (symmetrical) - Asymmetrical oligoarthritis - Arthritis mutilans (severe deforming affects hands and feet) - Predominant DIP associated with nail changes - Axial (isolated) - **Diagnosis:** - History and Examination: - Nail pitting - Psoriasis - Onycholysis - Psoriatic rash: scaly on scalp, extensor surface of knee, elbow - Radiological signs; Erosions and new bone formations - Mouse ear shape - **Treatment:** - Axial PA: - NSAIDs, if not effective: Anti-TNFx (Secukinumab), Anti-IL-17 - Peripheral PA: - Methotrexate, if not effective: Anti-TNFx or Anti-IL-17 (for skin and joint) ## Enteropathic Arthritis - More common in males. - We have two types: - Peripheral arthritis: - Two types: - Type I: Acute + oligoarthritis + correlated with the disease activity, HLA-B27 positive - Type II: Chronic + polyarthritis, not related to disease activity, HLA-B27 positive - Axial arthritis (similar to AS) - **EA happens in Crohn's or ulcerative colitis (IBD)** - **Extra-articular Features of EA (PAIN):** - Pyoderma gangrenosum - Aphthous stomatitis - Inflammatory eye disease (acute anterior uveitis) - Erythema nodosum (most common one) - **Treatment:** - Peripheral: - Sulfasalazine: If not effective, Anti-TNFx - Axial: - NSAIDs, if not effective, Anti-TNFx (except etanercept). - **NSAIDS exacerbates IBD especially UC**