Seronegative spondyloarthritis
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Seronegative spondyloarthritis Main Page |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]
Overview
Seronegative spondyloarthritis (SpA) are a group of chronic inflammatory arththropathies which are inter-related to each other. "Seronegative" refers to the fact that autoimmune antibodies are not found in these diseases. SpA primarily affects axial skeleton but may also have peripheral as well as extra-articular involvement. Individuals affected with seronegative SpA are generally genetically predisposed to have positive major histocompatibility complex (MHC) class I molecule HLA-B27. As the diseases feature overlap, it is difficult to make a precise diagnosis; hence, the diseases are monitored and treated on the basis of clinical presentation. Common clinical manifestations includes sacroiliitis, peripheral arthritis, and enthesitis. Extra-articular involvement depends on the disease such as skin manifestations for psoriatic arthritis, gastrointestinal tract manifestations for enteropathy associated arthritis, and ocular and genitourinary manifestations for reactive arthritis.
Classification
| Seronegative Spondyloarthritis (SpA) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Axial SpA including Ankylosing spondylitis | Peripheral SpA | Psoriatic arthritis | Reactive arthritis | Inflammatory bowel disease related arthritis | Juvenile spondyloarthritis | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Classification Criteria
ASAS classification criteria for axial spondyloarthritis (axial SpA)
The Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (axial SpA) include:[2]
- Patient with back pain ≥ 3 months and age of onset <45 years should fulfill either of the two criteria:
- Sacroiliitis on imaging* plus ≥ 1 feature of SpA**
- HLA-B27 plus ≥ 2 feature of SpA**
- *Sacroiliitis on imaging:
- Active (acute) inflammation on MRI highly suggestive of sacroiliitis associated with SpA
- OR
- Definite radiographic sacroillitis accorging to modified New York criteria
- **SpA features:
- Inflammatroy back pain
- Arthritis
- Enthesitis (heel)
- Uveitis
- Dactylitis
- Psoriasis
- Crohn's disease or ulcerative colitis
- Good response to NSAIDs
- Family history for SpA
- HLA-B27
- Elevated CRP
- *Sacroiliitis on imaging:
ASAS classification criteria for peripheral spondyloarthritis
- The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis (peripheral SpA) include:[3]
- Arthritis or Enthesitis or Dactylitis
- PLUS ≥ 1 of:
- Psoriasis
- Inflammatory bowel disease
- Preceding infection
- HLA-B27
- Uveitis
- Sacroiliitis on imaging (radiograph or MRI)
- PLUS ≥ 2 of:
- Arthritis
- Enthesitis
- Dactylitis
- Inflammatory back pain in the past
- Positive family history of SpA
Differential Diagnosis
| Arthritis Type | Clinical Features | Body Distribution | Key Signs | Laboratory Abnormalities | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symmetric joint involvement | Asymmetric joint involvement | Enthesopathy | Dactylitis | Nail Dystrophy | Upper extremity-hands | Lower extremity | Sacroiliac joints | Spine | Osteopenia | Joint Space | Ankylosis | Periostitis | Soft tissue swelling | ESR | Rheumatoid factor (RF) | HLA-B27 | |
| Psoriatic arthritis[4] | + | ++ | + | + | + | +++ (DIP/PIP) | +++ | ++ (Unilateral) | ++ | - | ++ (Widening) | ++ | +++ (Fluffy) | ++ | + | - | 30-75% |
| Rheumatoid arthritis[5] | ++ | + | - | - | - | +++ | +++ | + (Unilateral) | ++(Cervical) | +++ | +++ (Narrowing) | + | + (Linear) | +++ | +++ | +++ | 6-8% |
| Ankylosing spondylitis[6] | +++ | - | + | - | - | + | + | +++ (Bilateral) | +++ | +++ | ++ (Narrowing) | +++ | +++ (Fluffy) | + | +++ | - | 90% |
| Reactive arthritis (Reiter's syndrome)[7] | +++ | - | + | + | - | ++ | +++ | ++ (Unilateral) | + | + | + (Narrowing) | - | +++ (Fluffy) | ++ | ++ | - | 75% |
| Inflammatory bowel disease-related arthritis | - | ++ | + | + | - | ++ | ++ | +++ (Bilateral) | + | + | ++ (Widening) | + | + | + |
++ |
- | 50-75% |
| Juvenile ankylosing spondyloarthritis[8] | - | ++ | ++ | + | + | + | +++ | +++ | ++ | - | - | +++ | - | ++ | + | - | 90% |
Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
References
- ↑ Dougados M, Baeten D (2011). "Spondyloarthritis". Lancet. 377 (9783): 2127–37. doi:10.1016/S0140-6736(11)60071-8. PMID 21684383.
- ↑ Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J; et al. (2009). "The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection". Ann Rheum Dis. 68 (6): 777–83. doi:10.1136/ard.2009.108233. PMID 19297344.
- ↑ Zeidler H, Amor B (2011). "The Assessment in Spondyloarthritis International Society (ASAS) classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general: the spondyloarthritis concept in progress". Ann Rheum Dis. 70 (1): 1–3. doi:10.1136/ard.2010.135889. PMID 21163805.
- ↑ Brockbank J, Gladman D (2002). "Diagnosis and management of psoriatic arthritis". Drugs. 62 (17): 2447–57. PMID 12421102.
- ↑ Pham T, Gossec L, Fautrel B, Combe B, Flipo RM, Goupille P; et al. (2005). "Physical examination and laboratory tests in the management of patients with rheumatoid arthritis: development of recommendations for clinical practice based on published evidence and expert opinion". Joint Bone Spine. 72 (3): 222–8. doi:10.1016/j.jbspin.2004.10.010. PMID 15850993.
- ↑ Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J; et al. (2009). "The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection". Ann Rheum Dis. 68 (6): 777–83. doi:10.1136/ard.2009.108233. PMID 19297344.
- ↑ Keat A (1983). "Reiter's syndrome and reactive arthritis in perspective". N Engl J Med. 309 (26): 1606–15. doi:10.1056/NEJM198312293092604. PMID 6358890.
- ↑ Prakken B, Albani S, Martini A (2011). "Juvenile idiopathic arthritis". Lancet. 377 (9783): 2138–49. doi:10.1016/S0140-6736(11)60244-4. PMID 21684384.