Spondyloarthropathy
Spondyloarthropathy | |
---|---|
Specialty | Rheumatology |
Spondyloarthropathy or spondyloarthrosis refers to any
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
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] |
|
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:
- Seronegative (i.e. rheumatoid factor is not present)[5]
- They are in relation to HLA-B27[8]
- Inflammatory axial arthritis, generally sacroiliitis and spondylitis[5]
- Oligoarthritis, generally with asymmetrical presentation[5]
- entheses, the sites where tendons or ligaments insert into the bone.[9][10]), e.g. Plantar fasciitis, Achilles tendinitis, costochondritis.
- Familial aggregation occurs[5]
- Extra-articular features, such as involvement of eyes (anterior uveitis), skin, genitourinary tract,[5] and aortic regurgitation
- Overlap is likely between several of the causative conditions
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]
- Sacroiliitis on imaging plus one SpA feature, or
- 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
- ^ Mosby's Medical Dictionary, 8th edition. © 2009
- PMID 17364081.
- ^ "Seronegative Spondyloarthropathies: Joint Disorders: Merck Manual Professional". Retrieved 2008-12-15.
- ^ S2CID 21358459.
- ^ ISBN 978-0-7817-7153-5.
- ^ Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Workup Author: Lawrence H Brent. Chief Editor: Herbert S Diamond. Updated: Apr 19, 2011
- PMID 11874851.
- S2CID 32666163.
- PMID 16777577.
- ^ The Free Dictionary (2009). "Enthesitis". Retrieved 2010-11-27.
- ^ .
- S2CID 34185040.
- PMID 19297344.
- S2CID 229300462.
- PMID 25375291.