Seronegative spondyloarthritis: Difference between revisions

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"Seronegative" refers to the fact that these diseases are negative for [[Rheumatoid factor]] and CCP in the serum.
"Seronegative" refers to the fact that these diseases are negative for [[Rheumatoid factor]] and CCP in the serum.


==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>
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{{Family tree/start}}

Revision as of 17:28, 10 April 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

"Seronegative" refers to the fact that these diseases are negative for Rheumatoid factor and CCP in the serum.

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:
  • 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
  • Enthesotos (heel)
  • Uveitis
  • Dactylitis
  • Psoriasis
  • Crohn's disease or ulcerative colitis
  • Good response to NSAIDs
  • Family history for SpA
  • HLA-B27
  • Elevated CRP

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
  • Entheistis
  • Dactylitis
  • Inflammatory back pain in the past
  • Positive family history of SpA

Differential

Arthritis Type Clinical Features Body Distribution Key Signs Laboratory Abnormalities
History 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 + ++ + + + +++ (DIP/PIP) +++ ++ (Unilateral) ++ - ++ (Widening) ++ +++ (Fluffy) ++ + - 30-75%
Rheumatoid arthritis ++ + - - - +++

(MCP/wrist)

+++ + (Unilateral) ++(Cervical) +++ +++ (Narrowing) + + (Linear) +++ +++ +++ 6-8%
Ankylosing spondylitis +++ - + - - + + +++ (Bilateral) +++ +++ ++ (Narrowing) +++ +++ (Fluffy) + +++ - 90%
Reactive arthritis (Reiter's syndrome) +++ - + + - ++ +++ ++ (Unilateral) + + + (Narrowing) - +++ (Fluffy) ++ ++ - 75%

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

  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.


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