Spondyloarthropathies — MCQs
Bamboo spine with sacroilitis -
Which of the following is true about psoriatic arthritis
Seronegative spondarthritides includes all EXCEPT
False about Reactive arthritis
Most common form of psoriatic arthritis
All are seronegative spondyloarthritides with ocular manifestations, except
All of the following are true regarding ankylosing spondylitis except:
Following are listed as (SpA) spondyloarthritis features except
Which of the following is not seen in autism?
All are features of seronegative spondyloarthropathies except -
Spondyloarthropathies Indian Medical PG Practice Questions and MCQs
Question 1: Bamboo spine with sacroilitis -
- A. Psoriatic arthritis
- B. Ankylosing spondylitis (Correct Answer)
- C. OA
- D. RA
Explanation: ***Ankylosing spondylitis*** - **Bamboo spine** is a classic radiographic finding in advanced **ankylosing spondylitis**, resulting from ossification of the anulus fibrosus and spinal ligaments [1]. - **Sacroiliitis**, inflammation of the sacroiliac joints, is another hallmark feature and often the earliest radiographic sign of the disease [1], [3]. *Psoriatic arthritis* - While psoriatic arthritis can involve the spine and cause sacroiliitis, it typically presents with **asymmetric involvement** [2] and is less commonly associated with the widespread, progressive ossification characteristic of true "bamboo spine" [4]. - It often also involves **skin psoriasis** and **nail changes**, which are not indicated as the primary finding here [4]. *OA* - **Osteoarthritis (OA)** is a degenerative joint disease characterized by cartilage loss and osteophyte formation, often seen in weight-bearing joints and the spine [2]. - While OA can affect spinal joints and cause stiffness, it does **not cause inflammatory sacroiliitis** or the specific syndesmophyte formation that leads to "bamboo spine." *RA* - **Rheumatoid arthritis (RA)** primarily affects peripheral joints, particularly small joints of the hands and feet, and typically spares the sacroiliac joints and the thoracolumbar spine [2]. - Spinal involvement in RA is usually limited to the **cervical spine**, leading to atlantoaxial subluxation, and does not cause "bamboo spine" or widespread sacroiliitis.
Question 2: Which of the following is true about psoriatic arthritis
- A. Sacroiliitis is a common feature
- B. Pencil in cup deformity is a radiological finding
- C. Involves distal joints of hand and foot and proximal interphalangeal joints
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Psoriatic arthritis** is a seronegative spondyloarthropathy [2] that can manifest with a wide range of joint involvement, including **sacroiliitis**, characteristic radiological changes like **pencil-in-cup deformity**, and involvement of both **distal** and **proximal interphalangeal joints** [1]. *Sacroiliitis is a common feature* - **Sacroiliitis** occurs in approximately 20-40% of patients with psoriatic arthritis, contributing to inflammatory back pain. - It is often **asymmetrical** and can be detected radiographically [1], distinguishing it from the typically symmetrical sacroiliitis of ankylosing spondylitis. *Pencil in cup deformity is a radiological finding* - This characteristic radiological finding, known as **arthritis mutilans**, is seen in a severe subtype of psoriatic arthritis where there is **osteolysis** of the phalanx and telescoping of the digit [2]. - It results from severe bone erosion at the joint margins, creating a "pencil-in-cup" appearance. *Involves distal joints of hand and foot and proximal interphalangeal joints* - **DIP joint involvement** (distal interphalangeal) is a classic feature of psoriatic arthritis, distinguishing it from rheumatoid arthritis [1], [2]. - Involvement of the **PIP joints** (proximal interphalangeal) and other peripheral joints is also common [1], along with **dactylitis** (sausage digits) and **enthesitis**.
Question 3: Seronegative spondarthritides includes all EXCEPT
- A. Reiter's syndrome
- B. Rheumatoid arthritis (Correct Answer)
- C. Ankylosing spondylitis
- D. Psoriatic arthritis
Explanation: ***Rheumatoid arthritis*** - Rheumatoid arthritis (RA) is characterized by the presence of **rheumatoid factor (RF)** and/or **anti-cyclic citrullinated peptide (anti-CCP) antibodies**, making it a **seropositive** arthropathy. [1] - While it causes an inflammatory arthritis, its serological markers differentiate it from the seronegative spondyloarthropathies. *Reiter's syndrome* - Reiter's syndrome, now commonly referred to as **reactive arthritis**, is a classic example of a seronegative spondyloarthropathy. [1] - It is often triggered by an infection and is typically **RF-negative** and **HLA-B27 positive**. *Ankylosing spondylitis* - **Ankylosing spondylitis (AS)** is a prototypical seronegative spondyloarthropathy, characterized by inflammation primarily affecting the **spine and sacroiliaciac joints**. [1] - It is defined by the **absence of RF** and **anti-CCP antibodies**, though it is strongly associated with **HLA-B27**. *Psoriatic arthritis* - **Psoriatic arthritis (PsA)** is another member of the seronegative spondyloarthropathies, occurring in individuals with **psoriasis**. [1] - Like other conditions in this group, patients with PsA are typically **negative for RF** and **anti-CCP antibodies**.
Question 4: False about Reactive arthritis
- A. Enthesitis of Achilles tendon
- B. Precipitated by chlamydia
- C. Acute purulent arthritis (Correct Answer)
- D. Indomethacin is the initial treatment of choice
Explanation: ***Acute purulent arthritis*** - Reactive arthritis is a **sterile inflammatory arthritis**, meaning there is no bacterial infection in the joint fluid. - **Purulent arthritis** indicates a bacterial infection within the joint, which is not characteristic of reactive arthritis. *Enthesitis of Achilles tendon* - **Enthesitis**, particularly involving the Achilles tendon, is a common feature of **spondyloarthropathies**, including reactive arthritis [1]. - It refers to inflammation at the insertion sites of tendons, ligaments, or joint capsules into bone [1]. *Precipitated by chlamydia* - Reactive arthritis is frequently triggered by **genitourinary infections**, such as those caused by *Chlamydia trachomatis* [1]. - It falls under the category of **post-infectious arthritis**, where the infection precedes the joint symptoms [1]. *Indomethacin is the initial treatment of choice* - **Nonsteroidal anti-inflammatory drugs (NSAIDs)**, such as indomethacin, are the **first-line treatment** for managing pain and inflammation in reactive arthritis. - They help reduce joint pain, stiffness, and swelling, providing symptomatic relief.
Question 5: Most common form of psoriatic arthritis
- A. Symmetric oligoarthritis
- B. Polyarthritis
- C. Asymmetric polyarthritis
- D. Asymmetric oligoarthritis (Correct Answer)
Explanation: Asymmetric oligoarthritis - This is the most common presentation of psoriatic arthritis, affecting fewer than five joints, often with an asymmetric pattern [1]. - It frequently involves the distal interphalangeal (DIP) joints of the hands and feet [1]. Symmetric oligoarthritis - While oligoarthritis (affecting 2-4 joints) can occur, a symmetric pattern is less common. - Symmetrical involvement is more typical of polyarticular forms or other types of inflammatory arthritis like rheumatoid arthritis [1]. Polyarthritis - Polyarticular psoriatic arthritis affects five or more joints, which can be symmetric or asymmetric [1]. - These forms are less frequent than oligoarticular presentations. Asymmetric polyarthritis - This form involves five or more joints in an asymmetric distribution [1]. - While it does occur, it is not the most prevalent type of psoriatic arthritis compared to asymmetric oligoarthritis.
Question 6: All are seronegative spondyloarthritides with ocular manifestations, except
- A. Psoriatic arthritis
- B. Rheumatoid arthritis (Correct Answer)
- C. Ankylospondylitis
- D. Reiter's disease
Explanation: ***Rheumatoid arthritis*** - While rheumatoid arthritis can have **ocular manifestations** (e.g., **scleritis**, **keratoconjunctivitis sicca**) [1], it is categorized as a **seropositive** arthritis due to the presence of **rheumatoid factor** and **anti-CCP antibodies** in most cases. - The question specifically asks for a condition that is *not* a seronegative spondyloarthritide. *Psoriatic arthritis* - This is a **seronegative spondyloarthritide** and can present with various **ocular manifestations**, including **conjunctivitis** and **uveitis**. - It lacks **rheumatoid factor** and typically involves the skin and joints. *Ankylospondylitis* - This is a classic example of a **seronegative spondyloarthritide**, strongly associated with **HLA-B27** [2]. - **Acute anterior uveitis** is a common ocular complication, affecting up to 40% of patients [2]. *Reiter's disease* - Now more commonly referred to as **reactive arthritis**, it is a **seronegative spondyloarthritide** by definition. - Ocular manifestations are prominent and include **conjunctivitis** and **anterior uveitis**, often part of the classic triad (arthritis, urethritis, conjunctivitis) [2].
Question 7: All of the following are true regarding ankylosing spondylitis except:
- A. 50% of patients may have urinary infection (Correct Answer)
- B. Involvement of sacroiliac joint
- C. Bamboo spine may be a radiological feature
- D. Most of people are HLAB27 positive
Explanation: ***50% of patients may have urinary infection*** - Urinary tract infections are **not a characteristic feature** or a common complication of **ankylosing spondylitis**. - This statement is incorrect as there is no significant epidemiological or pathophysiological link between AS and a high incidence of UTIs. *Involvement of sacroiliac joint* - **Sacroiliitis**, inflammation of the sacroiliac joints, is one of the **hallmark features** and often the earliest sign of ankylosing spondylitis [1]. - It is typically **bilateral and symmetrical**, and its presence is crucial for diagnosis [1]. *Bamboo spine may be a radiological feature* - **Bamboo spine** is a characteristic late radiological finding in ankylosing spondylitis, resulting from **syndesmophyte formation** (ossification of spinal ligaments) and fusion of vertebral bodies [1]. - This appearance signifies severe spinal rigidity and advanced disease. *Most of people are HLAB27 positive* - The **HLA-B27 allele** is strongly associated with ankylosing spondylitis, being present in around **90% of Caucasian patients** [1]. - While not diagnostic on its own, its presence significantly increases susceptibility and supports the diagnosis in the right clinical context.
Question 8: Following are listed as (SpA) spondyloarthritis features except
- A. Cervical sprain (Correct Answer)
- B. Dactylitis
- C. Enthesitis
- D. HLA B27
Explanation: **Cervical sprain** - A **cervical sprain** is an injury to the ligaments in the neck, typically caused by trauma or sudden movements, and is not a defining characteristic or feature of spondyloarthritis. - Sprains involve the stretching or tearing of soft tissues, whereas spondyloarthritis is a group of **inflammatory conditions** primarily affecting the spine and peripheral joints. *Dactylitis* - **Dactylitis**, or "sausage digits," refers to the **inflammation of an entire digit** (finger or toe) and is a characteristic feature of spondyloarthritis, particularly **psoriatic arthritis** and **reactive arthritis** [1]. - It results from inflammation of both the joints and the tendons within the affected digit [1]. *Enthesitis* - **Enthesitis** is the **inflammation of the entheses**, which are the sites where tendons or ligaments insert into bone [1]. - This is a hallmark feature of spondyloarthritis, commonly seen at sites like the **Achilles tendon insertion** or the plantar fascia [1]. *HLA B27* - **HLA-B27** is a human leukocyte antigen that is strongly associated with spondyloarthritis [1]. - Its presence is a significant genetic marker found in a high percentage of patients with **ankylosing spondylitis** and other forms of spondyloarthritis [1].
Question 9: Which of the following is not seen in autism?
- A. 1/3rd patients have intellectual disability
- B. Poor eye contact
- C. Abnormal dermatoglyphics (Correct Answer)
- D. Language is impaired
Explanation: ***Abnormal dermatoglyphics*** - **Abnormal dermatoglyphics** (fingerprint patterns) are not a characteristic feature of autism spectrum disorder. - While dermatoglyphics can be altered in some genetic syndromes, they are not consistently found or used as a diagnostic marker for autism. *1/3rd patients have intellectual disability* - Approximately **one-third (30-40%) of individuals with autism** have co-occurring intellectual disability (ID with IQ <70). - This comorbidity impacts the level of support and interventions required. - The prevalence has decreased over time due to improved diagnostic criteria and recognition of high-functioning autism. *Poor eye contact* - **Poor eye contact** is a cardinal feature and a key diagnostic criterion for autism spectrum disorder. - It reflects difficulties in social communication and interaction, a core deficit in autism. *Language is impaired* - **Language impairment** is a common feature of autism, ranging from delayed language development to complete absence of speech in some cases. - Challenges in both receptive and expressive language are characteristic, affecting social communication. - However, not all individuals with autism have language impairment, particularly those with high-functioning autism or Asperger's syndrome.
Question 10: All are features of seronegative spondyloarthropathies except -
- A. RA factor positive (Correct Answer)
- B. Uveitis
- C. Occur in young age
- D. HLA-B27 positive
Explanation: ***RA factor positive*** - Seronegative spondyloarthropathies are specifically defined by the **absence of rheumatoid factor (RF)** in the blood. - Therefore, a positive RA factor would exclude a diagnosis of seronegative spondyloarthropathy. *Uveitis* - **Uveitis**, particularly **anterior uveitis**, is a common extra-articular manifestation of several seronegative spondyloarthropathies, such as ankylosing spondylitis and reactive arthritis [1]. - Its presence is a characteristic feature, not an exclusion criterion. *Occur in young age* - Seronegative spondyloarthropathies, such as **ankylosing spondylitis** and **reactive arthritis**, typically present in younger individuals, often before the age of 40. - This is a distinguishing feature compared to other arthropathies that might manifest later in life. *HLA-B27 positive* - **HLA-B27 positivity** is a strong genetic association with many seronegative spondyloarthropathies, particularly ankylosing spondylitis and reactive arthritis [1]. - While not universally present in all cases, it is a hallmark feature that aids in diagnosis [2].
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