Spondyloarthropathy

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Spondyloarthropathy
SpecialtyRheumatology Edit this on Wikidata

Spondyloarthropathy or spondyloarthrosis refers to any

joint disease of the vertebral column. As such, it is a class or category of diseases rather than a single, specific entity. It differs from spondylopathy
, which is a disease of the vertebra itself, but many conditions involve both spondylopathy and spondyloarthropathy.

Spondyloarthropathy with inflammation is called axial spondyloarthritis.[1] In the broadest sense, the term spondyloarthropathy includes joint involvement of vertebral column from any type of joint disease, including rheumatoid arthritis and osteoarthritis, but the term is often used for a specific group of disorders with certain common features, which are often specifically termed seronegative spondylarthropathies. They have an increased incidence of HLA-B27, as well as negative rheumatoid factor and ANA. Enthesopathy is also sometimes present in association with seronegative spondarthritides[clarify].

Non-vertebral signs and symptoms of degenerative or other not directly infected inflammation, in the manner of spondyloarthropathies, include asymmetric

lower back pain is the most common clinical presentation of the causes of spondyloarthropoathies; this back pain is unique because it decreases with activity.[citation needed
]

Seronegative spondyloarthropathy

Seronegative spondyloarthropathy (or seronegative spondyloarthritis) is a group of diseases involving the axial skeleton[2] and having a negative serostatus.

"Seronegative" refers to the fact that these diseases are negative for rheumatoid factor,[3] indicating a different pathophysiological mechanism of disease than is commonly seen in rheumatoid arthritis.

Conditions

The following conditions are typically included in the group of seronegative spondylarthropathies:

Condition Percent of people with the
condition who are HLA-B27 positive
Axial spondyloarthritis (including ankylosing spondylitis)[4][5]
  • Caucasians: 92%[6]
  • African-Americans: 50%
Reactive arthritis[4][5] 60–80%
Enteropathic arthropathy or spondylitis associated with

inflammatory bowel disease[4][5] (including Crohn's disease and ulcerative colitis)

60%
Psoriatic arthritis[4][5] 40–50%
Isolated acute
anterior uveitis
50%
Juvenile idiopathic arthritis (subtype: late-onset oligoarticular JIA)
Undifferentiated spondyloarthropathy[4][5] (USpA) 20–25%

Some sources also include Behçet's disease[citation needed] and Whipple's disease.[7]

Common characteristics

These diseases have the following conditions in common:

Classification

Assessment of Spondylarthritis International Society (ASAS) criteria is used for classification of axial spondyloarthritis (to be applied for patients with back pain greater than or equal to 3 months and age of onset less than 45 years).[11] It is of two broad types:[12][13]

  1. Sacroiliitis on imaging plus one SpA feature, or
  2. HLA-B27 plus two other SpA features

Sacroiliitis on imaging:[11]

  • Active (acute) inflammation on MRI highly suggestive of SpA-associated sacroiliitis and/or
  • Definite radiographic sacroiliitis

SpA features:[11]

  • Inflammatory back pain
  • Arthritis
  • Enthesitis
  • Anterior uveitis
  • Dactylitis
  • Psoriasis
  • Crohn's disease or ulcerative colitis
  • Good response to NSAIDs
  • Family history of SpA
  • HLA-B27
  • Elevated CRP

Treatment

Many patients have more than one of the spondyloarthritis disease manifestations. Some immunosuppressive drugs have shown efficacy in more than one of the diseases, e.g. tumor necrosis factor (TNF) inhibitors. But some of the immunosuppressive drugs are particularly effective for a specific inflamed tissue and approved in only one or two of the disease entities,[14] so an interdisciplinary approach is required.

Epidemiology

Worldwide prevalence of spondyloarthropathy is approximately 1.9%.[15]

References

  1. ^ Mosby's Medical Dictionary, 8th edition. © 2009
  2. PMID 17364081
    .
  3. ^ "Seronegative Spondyloarthropathies: Joint Disorders: Merck Manual Professional". Retrieved 2008-12-15.
  4. ^
    S2CID 21358459
    .
  5. ^ .
  6. ^ Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Workup Author: Lawrence H Brent. Chief Editor: Herbert S Diamond. Updated: Apr 19, 2011
  7. PMID 11874851
    .
  8. .
  9. .
  10. ^ The Free Dictionary (2009). "Enthesitis". Retrieved 2010-11-27.
  11. ^ .
  12. .
  13. .
  14. .
  15. .

External links