Spondyloarthropathy

Spondyloarthropathy
Classification and external resources
Specialty	rheumatology
ICD-10	M40–M54
ICD-9-CM	720, 721, 722, 723, 724

Spondyloarthropathy or spondyloarthrosis refers to any joint disease of the vertebral column.^[1] 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. However, many conditions involve both spondylopathy and spondyloarthropathy.

Spondyloarthropathy with inflammation is called ankylosing spondylitis^[2]. 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, the group often being termed specifically 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.

Nonvertebral symptoms 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. However, lower back pain is the most common clinical presentation of the disease; 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^[3] and having a negative serostatus.

"Seronegative" refers to the fact that these diseases are negative for rheumatoid factor,^[4] indicating a different pathophysiological mechanism of disease than what is commonly seen in rheumatoid arthritis.

Conditions

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

Condition	Percent of people with the condition who are HLA-B27 positive
Ankylosing spondylitis[5][6]	Caucasians: 92%[7] African-Americans:50%
Reactive arthritis[5][6] (formerly known as Reiter's syndrome)	60-80%
Enteropathic arthropathy or spondylitis associated with inflammatory bowel disease[5][6] (including Crohn's disease and ulcerative colitis)	60%
Psoriatic arthritis[5][6]	60%
Isolated acute anterior uveitis	50%
Juvenile idiopathic arthritis (subtype: late-onset oligoarticular JIA)
Undifferentiated spondyloarthropathy[5][6] (USpA)	20-25%

Some sources also include Behcet's disease and Whipple's disease.^[8]

Common characteristics

These diseases have the following conditions in common:

• Seronegative (i.e. rheumatoid factor is not present)^[6]
• They are in relation to HLA-B27^[9]
• Inflammatory axial arthritis, generally sacroiliitis and spondylitis^[6]
• Oligoarthritis, generally with asymmetrical presentation^[6]
• Enthesitis^[6] (inflammation of the entheses, the sites where tendons or ligaments insert into the bone.^[10][11]), e.g. Plantar fasciitis, Achillis tendonitis, costochondritis.
• familial aggregation occurs^[6]
• Extra-articular features, such as involvement of eyes (anterior uveitis), skin, genitourinary tract,^[6] 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 spondylarthritis (to be applied for patients with back pain greater than or equal to 3 months and age of onset less than 45 years).^[12] It is of two broad types:^[13][14]

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

Sacroiliitis on imaging:^[12]

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

SpA features:^[12]

• 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

Epidemiology

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

References

1. thefreedictionary.com/spondyloarthropathy citing:
   • Mosby's Medical Dictionary, 8th edition. © 2009
   • Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003
   • Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007
2. Mosby's Medical Dictionary, 8th edition. © 2009
3. 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.
4. "Seronegative Spondyloarthropathies: Joint Disorders: Merck Manual Professional". Retrieved 2008-12-15.
5. 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.
6. Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6.
7. Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Workup Author: Lawrence H Brent. Chief Editor: Herbert S Diamond. Updated: Apr 19, 2011
8. 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.
9. Shankarkumar U, Devraj JP, Ghosh K, Mohanty D (2002). "Seronegative spondarthritis and human leucocyte antigen association". Br. J. Biomed. Sci. 59 (1): 38–41. PMID 12000185.
10. Maria Antonietta D'Agostino, MD, Ignazio Olivieri, MD. (June 2006). "Enthesitis". Best Practice (Clinical Rheumatology) 20 (3): 473–486. doi:10.1016/j.berh.2006.03.007.
11. The Free Dictionary (2009). "Enthesitis". Retrieved 2010-11-27.
12. Lipton, Sarah; Deodhar, Atul. "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.
13. 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.
14. 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.
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: CD010208. doi:10.1002/14651858.CD010208.pub2. PMID 25375291.

External links

• http://www.gpnotebook.co.uk/simplepage.cfm?ID=-254803955[]
• Information from the American College of Rheumatology
• Spondyloarthropathies: Update on Diagnosis and Treatment from ConsultantLive