Seronegative spondyloarthritis

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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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