Seronegative spondyloarthritis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 2: Line 2:


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


==Overview==
==Overview==
Line 18: Line 18:
==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


Line 62: Line 62:
{| class="wikitable"
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! 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
Line 68: Line 68:
|-
|-
|
|
|'''History'''
|'''Symmetric [[joint]] involvement'''
|'''Symmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
Line 88: Line 87:
|-
|-
|'''[[Psoriatic arthritis]]'''
|'''[[Psoriatic arthritis]]'''
|
| +
| +
| ++
| ++
Line 108: Line 106:
|-
|-
|'''[[Rheumatoid arthritis]]'''
|'''[[Rheumatoid arthritis]]'''
|
| ++
| ++
| +
| +
Line 129: Line 126:
|-
|-
|'''[[Ankylosing spondylitis]]'''
|'''[[Ankylosing spondylitis]]'''
|
| +++
| +++
| -
| -
Line 149: Line 145:
|-
|-
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
|
| +++
| +++
| -
| -
Line 168: Line 163:
|75%
|75%
|-
|-
|[[Enteropathic arthropathy|Inflammatory bowel disease-related arthritis]]
|[[Enteropathic arthropathy|'''Inflammatory bowel disease-related arthritis''']]
|
|
|
|<nowiki>++</nowiki>
|<nowiki>++</nowiki>
Line 185: Line 179:
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
|
++
++
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|50-75%
|50-75%
|-
|-
|Juvenile ankylosing spondyloarthritis
|'''Juvenile ankylosing spondyloarthritis'''
|
| -
| -
| ++
| ++
Line 212: Line 204:


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==

Revision as of 16:50, 16 April 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" 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:
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 + ++ + + + +++ (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%
Inflammatory bowel disease-related arthritis ++ + + - ++ ++ +++ (Bilateral) + + ++ (Widening) + + +

++

- 50-75%
Juvenile ankylosing spondyloarthritis - ++ ++ + + + +++ +++ ++ - - +++ - ++ + - 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.


Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Seronegative_spondyloarthritis&oldid=1463055"