Spondyloarthropathy

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
SpecialtyRheumatology 

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.

Non-vertebral signs and symptoms of degenerative or other not directly infected inflammation, in the manner of spondyloarthropathies, include asymmetric peripheral arthritis (which is distinct from rheumatoid arthritis), arthritis of the toe interphalangeal joints, sausage digits, Achilles tendinitis, plantar fasciitis, costochondritis, iritis, and mucocutaneous lesions. But lower back pain is the most common clinical presentation of the causes of spondyloarthropoathies; this back pain is unique because it decreases with activity.

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:

ConditionPercent 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 uveitis50%
Juvenile idiopathic arthritis (subtype: late-onset oligoarticular JIA)
Undifferentiated spondyloarthropathy[4][5] (USpA)20–25%

Some sources also include Behçet's disease 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 1 SpA feature, or
  2. HLA-B27 plus 2 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. Howe HS, Zhao L, Song YW, et al. (February 2007). "Seronegative spondyloarthropathy--studies from the Asia Pacific region" (PDF). Ann. Acad. Med. Singap. 36 (2): 135–41. PMID 17364081.
  3. "Seronegative Spondyloarthropathies: Joint Disorders: Merck Manual Professional". Retrieved 2008-12-15.
  4. Luong AA, Salonen DC (August 2000). "Imaging of the seronegative spondyloarthropathies". Curr Rheumatol Rep. 2 (4): 288–96. doi:10.1007/s11926-000-0065-z. PMID 11123073. S2CID 21358459.
  5. Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 978-0-7817-7153-5.
  6. Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Workup Author: Lawrence H Brent. Chief Editor: Herbert S Diamond. Updated: Apr 19, 2011
  7. Várvölgyi C, Bubán T, Szakáll S, et al. (April 2002). "Fever of unknown origin with seronegative spondyloarthropathy: an atypical manifestation of Whipple's disease". Ann. Rheum. Dis. 61 (4): 377–8. doi:10.1136/ard.61.4.377. PMC 1754069. PMID 11874851.
  8. Shankarkumar U, Devraj JP, Ghosh K, Mohanty D (2002). "Seronegative spondarthritis and human leucocyte antigen association". Br. J. Biomed. Sci. 59 (1): 38–41. doi:10.1080/09674845.2002.11783633. PMID 12000185. S2CID 32666163.
  9. Maria Antonietta D'Agostino, MD; Ignazio Olivieri, MD (June 2006). "Enthesitis". Best Practice. 20 (3): 473–486. doi:10.1016/j.berh.2006.03.007. PMID 16777577.
  10. The Free Dictionary (2009). "Enthesitis". Retrieved 2010-11-27.
  11. Lipton, Sarah; Deodhar, Atul (2012). "The new ASAS classification criteria for axial and peripheral spondyloarthritis: promises and pitfalls". International Journal of Clinical Rheumatology. 7 (6): 675–682. doi:10.2217/ijr.12.61.
  12. Rudwaleit, M; Landewe, R; van der Heijde, D; Listing, J; Brandt, J; Braun, J; Burgos-Vargas, R; Collantes-Estevez, E; Davis, J; Dijkmans, B; Dougados, M; Emery, P; van der Horst-Bruinsma, I E; Inman, R; Khan, M A; Leirisalo-Repo, M; van der Linden, S; Maksymowych, W P; Mielants, H; Olivieri, I; Sturrock, R; de Vlam, K; Sieper, J (17 March 2009). "The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal". Annals of the Rheumatic Diseases. 68 (6): 770–776. doi:10.1136/ard.2009.108217. PMID 19297345. S2CID 34185040.
  13. Rudwaleit, M; van der Heijde, D; Landewe, R; Listing, J; Akkoc, N; Brandt, J; Braun, J; Chou, C T; Collantes-Estevez, E; Dougados, M; Huang, F; Gu, J; Khan, M A; Kirazli, Y; Maksymowych, W P; Mielants, H; Sorensen, I J; Ozgocmen, S; Roussou, E; Valle-Onate, R; Weber, U; Wei, J; Sieper, J (17 March 2009). "The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection". Annals of the Rheumatic Diseases. 68 (6): 777–783. doi:10.1136/ard.2009.108233. PMID 19297344.
  14. Brüner, Mads; Dige, Anders; Loft, Anne Gitte; Laurberg, Trine Bay; Agnholt, Jørgen Steen; Clemmensen, Kåre; McInnes, Iain; Lories, Rik; Iversen, Lars; Hjuler, Kasper Fjellhaugen; Kragstrup, Tue Wenzel (2021). "Spondylitis-psoriasis-enthesitis-enterocolitis-dactylitis-uveitis-peripheral synovitis (SPEED-UP) treatment". Autoimmunity Reviews. 20 (2): 102731. doi:10.1016/j.autrev.2020.102731. PMID 33326852. S2CID 229300462.
  15. Hoving JL, Lacaille D, Urquhart DM, Hannu TJ, Sluiter JK, Frings-Dresen MH (2014). "Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis". The Cochrane Database of Systematic Reviews. 11 (11): CD010208. doi:10.1002/14651858.CD010208.pub2. PMID 25375291.
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