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__NOTOC__
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{{CMG}}; {{AE}}
{{Seronegative spondyloarthritis}}
{{CMG}}; {{AE}}{{Anmol}}


==Overview==
==Overview==
"Seronegative" refers to the fact that these diseases are negative for [[Rheumatoid factor]] and CCP in the serum.
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, class I-related|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 [[Enteropathic arthropathy|enteropathy associated arthritis]], and ocular and genitourinary manifestations for [[reactive arthritis]].


==Classsiication==
==Classification==
<div style="text-align: center;">'''Algorithm showing classification of seronegative spondyloarthritis'''<ref name="pmid21684383">{{cite journal| author=Dougados M, Baeten D| title=Spondyloarthritis. | journal=Lancet | year= 2011 | volume= 377 | issue= 9783 | pages= 2127-37 | pmid=21684383 | doi=10.1016/S0140-6736(11)60071-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21684383  }} </ref></div>
<div style="text-align: center;">'''Algorithm showing classification of seronegative spondyloarthritis'''<ref name="pmid21684383">{{cite journal| author=Dougados M, Baeten D| title=Spondyloarthritis. | journal=Lancet | year= 2011 | volume= 377 | issue= 9783 | pages= 2127-37 | pmid=21684383 | doi=10.1016/S0140-6736(11)60071-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21684383  }} </ref>
</div>
{{Family tree/start}}
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | A01=Seronegative Spondyloarthritis (SpA)}}
{{Family tree | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | A01=Seronegative Spondyloarthritis (SpA)}}
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==Classification Criteria==
==Classification Criteria==
===ASAS classification criteria for axial spondyloarthritis (axial SpA)===
===ASAS classification criteria for axial spondyloarthritis (axial SpA)===
The Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (axial SpA) include:<ref name="pmid19297344">{{cite journal| author=Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J et al.| title=The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. | journal=Ann Rheum Dis | year= 2009 | volume= 68 | issue= 6 | pages= 777-83 | pmid=19297344 | doi=10.1136/ard.2009.108233 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19297344  }} </ref>
The Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (axial SpA) include:<ref name="pmid19297344">{{cite journal| author=Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J et al.| title=The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. | journal=Ann Rheum Dis | year= 2009 | volume= 68 | issue= 6 | pages= 777-83 | pmid=19297344 | doi=10.1136/ard.2009.108233 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19297344  }} </ref>
*Patient with back pain ≥ 3 months and age of onset <45 years should fulfill either of the two criteria:
*Patient with back pain ≥ 3 months and age of onset <45 years should fulfill either of the two criteria:
*# Sacroiliitis on imaging<sup>'''*'''</sup> plus ≥ 1 feature of SpA<sup>'''**'''</sup>
*# [[Sacroiliitis]] on imaging<sup>'''*'''</sup> plus ≥ 1 feature of SpA<sup>'''**'''</sup>
*# HLA-B27 plus ≥ 2 feature of SpA<sup>'''**'''</sup>
*# [[HLA-B27]] plus ≥ 2 feature of SpA<sup>'''**'''</sup>


:::<sup>'''*'''</sup>'''Sacroiliitis on imaging:'''
:::<sup>'''*'''</sup>'''Sacroiliitis on imaging:'''
:::*Active (acute) inflammation on MRI highly suggestive of sacroiliitis associated with SpA
:::*Active (acute) [[inflammation]] on [[MRI]] highly suggestive of [[sacroiliitis]] associated with SpA
:::::::OR
:::::::OR
:::*Definite radiographic sacroillitis accorging to modified New York criteria
:::*Definite radiographic [[sacroillitis]] accorging to modified New York criteria
:::<sup>'''**'''</sup>'''SpA features:'''
:::<sup>'''**'''</sup>'''SpA features:'''
:::*Inflammatroy back pain
:::*Inflammatroy [[back pain]]
:::*Arthritis
:::*[[Arthritis]]
:::*Enthesotos (heel)
:::*[[Enthesitis]] (heel)
:::*Uveitis
:::*[[Uveitis]]
:::*Dactylitis
:::*[[Dactylitis]]
:::*Psoriasis
:::*[[Psoriasis]]
:::*Crohn's disease or ulcerative colitis
:::*[[Crohn's disease]] or [[ulcerative colitis]]
:::*Good response to NSAIDs
:::*Good response to [[NSAIDs]]
:::*Family history for SpA
:::*Family history for SpA
:::*HLA-B27
:::*[[HLA-B27]]
:::*Elevated CRP
:::*Elevated [[CRP]]


===ASAS classification criteria for peripheral spondyloarthritis===
===ASAS classification criteria for peripheral spondyloarthritis===
*The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis (peripheral SpA) include:<ref name="pmid21163805">{{cite journal| author=Zeidler H, Amor B| title=The Assessment in Spondyloarthritis International Society (ASAS) classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general: the spondyloarthritis concept in progress. | journal=Ann Rheum Dis | year= 2011 | volume= 70 | issue= 1 | pages= 1-3 | pmid=21163805 | doi=10.1136/ard.2010.135889 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21163805  }} </ref>
*The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis (peripheral SpA) include:<ref name="pmid21163805">{{cite journal| author=Zeidler H, Amor B| title=The Assessment in Spondyloarthritis International Society (ASAS) classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general: the spondyloarthritis concept in progress. | journal=Ann Rheum Dis | year= 2011 | volume= 70 | issue= 1 | pages= 1-3 | pmid=21163805 | doi=10.1136/ard.2010.135889 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21163805  }} </ref>
:'''Arthritis or Enthesitis or Dactylitis'''
:'''Arthritis or Enthesitis or Dactylitis'''


: '''PLUS ≥ 1 of:'''
: '''PLUS ≥ 1 of:'''
:*Psoriasis
:*[[Psoriasis]]
:*Inflammatory bowel disease
:*[[Inflammatory bowel disease]]
:*Preceding infection
:*Preceding [[infection]]
:*HLA-B27
:*[[HLA-B27]]
:*Uveitis
:*[[Uveitis]]
:*Sacroiliitis on imaging (radiograph or MRI)
:*[[Sacroiliitis]] on imaging (radiograph or MRI)


: '''PLUS ≥ 2 of:'''
: '''PLUS ≥ 2 of:'''
:*Arthritis
:*[[Arthritis]]
:*Entheistis
:*[[Enthesitis]]
:*Dactylitis
:*[[Dactylitis]]
:*Inflammatory back pain in the past
:*Inflammatory [[back pain]] in the past
:*Positive family history of SpA
:*Positive family history of SpA


==Differential==
==Differential Diagnosis==
{| class="wikitable"
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features
! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities
|-
|-
|
|'''History'''
|'''Symmetric [[joint]] involvement'''
|'''Symmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
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|'''[[HLA-B27]]'''
|'''[[HLA-B27]]'''
|-
|-
|'''[[Psoriatic arthritis]]'''
|'''[[Psoriatic arthritis]]'''<ref name="pmid12421102">{{cite journal| author=Brockbank J, Gladman D| title=Diagnosis and management of psoriatic arthritis. | journal=Drugs | year= 2002 | volume= 62 | issue= 17 | pages= 2447-57 | pmid=12421102 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12421102  }}</ref>
|
| +
| +
| ++
| ++
Line 106: Line 105:
|30-75%
|30-75%
|-
|-
|'''[[Rheumatoid arthritis]]'''
|'''[[Rheumatoid arthritis]]'''<ref name="pmid15850993">{{cite journal| author=Pham T, Gossec L, Fautrel B, Combe B, Flipo RM, Goupille P et al.| title=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. | journal=Joint Bone Spine | year= 2005 | volume= 72 | issue= 3 | pages= 222-8 | pmid=15850993 | doi=10.1016/j.jbspin.2004.10.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15850993  }}</ref>
|
| ++
| ++
| +
| +
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|6-8%
|6-8%
|-
|-
|'''[[Ankylosing spondylitis]]'''
|'''[[Ankylosing spondylitis]]'''<ref name="pmid192973442">{{cite journal| author=Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J et al.| title=The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. | journal=Ann Rheum Dis | year= 2009 | volume= 68 | issue= 6 | pages= 777-83 | pmid=19297344 | doi=10.1136/ard.2009.108233 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19297344  }}</ref>
|
| +++
| +++
| -
| -
Line 147: Line 144:
|90%
|90%
|-
|-
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''<ref name="pmid6358890">{{cite journal| author=Keat A| title=Reiter's syndrome and reactive arthritis in perspective. | journal=N Engl J Med | year= 1983 | volume= 309 | issue= 26 | pages= 1606-15 | pmid=6358890 | doi=10.1056/NEJM198312293092604 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6358890  }}</ref>
|
| +++
| +++
| -
| -
Line 166: Line 162:
| -
| -
|75%
|75%
|-
|[[Enteropathic arthropathy|'''Inflammatory bowel disease-related arthritis''']]
| -
|<nowiki>++</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>++</nowiki>
|<nowiki>++</nowiki>
|<nowiki>+++ (Bilateral)</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>++ (Widening)</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
++
|<nowiki>-</nowiki>
|50-75%
|-
|'''Juvenile ankylosing spondyloarthritis'''<ref name="pmid21684384">{{cite journal| author=Prakken B, Albani S, Martini A| title=Juvenile idiopathic arthritis. | journal=Lancet | year= 2011 | volume= 377 | issue= 9783 | pages= 2138-49 | pmid=21684384 | doi=10.1016/S0140-6736(11)60244-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21684384  }}</ref>
| -
| ++
| ++
| +
| +
| +
| +++
| +++
| ++
| -
| -
| +++
| -
| ++
| +
| -
|90%
|}
|}


Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
==Diagnosis==
===History and Symptoms===
*Onset of symptoms typically occurs in early adulthood.
*Presenting symptom is typically dull pain over the buttock and lower lumbar area associated with morning stiffness, which is relieved by exercise and aggravates with inactivity.
*Other symptoms include:
**Frank arthritis (involve large joints, asymmetrical fashion)
**Enthesopathy
**Dactylitis
**Recurrent acute anterior uveitis
**Cardiovascular manifestations
***Aortic insufficiency
***Congestive heart failure
***Aortitis
***Angina
***Pericarditis
***Cardiac conduction abnormalities
**Pulmonary manifestations (due to pulmonary fibrosis)
***Dyspnoea
***Cough
***Hemoptysis
**Genitourinary manifestations (Present in reactive arthritis)
***Urethritis
***Cervicitis
***Vulvovaginitis
***Salpingitis
***Prostatitis
*Specific manifestations:
**Psoriasis
**Inflammatory bowel disease
**Oral ulcers
**Erythema nodosum
**Conjunctivitis


==References==
==References==

Latest revision as of 14:04, 14 May 2018


Seronegative spondyloarthritis Main Page

Home

Patient Information

Overview

Classification

Axial Spondyloarthritis
Peripheral Spondyloarthritis
Psoriatic arthritis
Reactive arthritis
Inflammatory bowel disease-related arthritis
Juvenile ankylosing spondyloarthritis

Classification Criteria

Differential Diagnosis

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

Algorithm showing classification of seronegative spondyloarthritis[1]
 
 
 
 
 
 
 
 
 
 
 
 
 
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:
    1. Sacroiliitis on imaging* plus ≥ 1 feature of SpA**
    2. HLA-B27 plus ≥ 2 feature of SpA**
*Sacroiliitis on imaging:
OR
  • Definite radiographic sacroillitis accorging to modified New York criteria
**SpA features:

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:
PLUS ≥ 2 of:

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] ++ + - - - +++

(MCP/wrist)

+++ + (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

  1. ↑ Dougados M, Baeten D (2011). "Spondyloarthritis". Lancet. 377 (9783): 2127–37. doi:10.1016/S0140-6736(11)60071-8. PMID 21684383.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ Brockbank J, Gladman D (2002). "Diagnosis and management of psoriatic arthritis". Drugs. 62 (17): 2447–57. PMID 12421102.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.


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