Seronegative spondyloarthritides, also known as spondyloarthropathies or spondyloarthritis, are a group of musculoskeletal syndromes linked by common clinical features and common immunopathologic mechanisms. The subtypes of spondyloarthritis are usually distinguished on the basis of the patient’s history and clinical findings.
The diagnostic criteria for spondyloarthritides have evolved in step with the changing understanding of the disease process. In particular, there is growing recognition that early forms of disease precede the typical changes on plain radiography.
In 2009, the Assessment of SpondyloArthritis International Society (ASIS) proposed a new classification system in order to recognize early disease 4,5. They propose using the term spondyloarthritis (SpA) to refer to all spondyloarthropathies, with the following distinctions:
axial SpA - predominantly axial symptoms (i.e. chronic back pain)
- preradiographic / non-radiographic - no changes by imaging (radiograph or MRI)
- radiographic SpA - sacroiliitis by imaging
- peripheral SpA - only peripheral manifestations (e.g. peripheral arthritis, dactylitis)
Extra-axial involvement such as uveitis, calcaneal enthesitis or peripheral arthritis occurs in all five subtypes, albeit with different frequencies.
As such these arthritides are negative to rheumatoid factor and involve the axial skeleton. Most patients test positive to the HLAB27 gene.
Five subgroups of spondyloarthritis are distinguished:
- ankylosing spondylitis: ~ 90% HLAB27 positive
- psoriatic arthritis: ~ 60% HLAB27 positive 1
- reactive arthritis (Reiter syndrome): ~ 85% HLAB27 positive
- enteropathic arthritis (i.e. extra-intestinal manifestation of IBD)
- undifferentiated spondyloarthritis
Imaging does not play a major role in differentiating between the subtypes as imaging features are comparable, especially in early disease. Exceptions to this rule are:
- Undifferentiated spondyloarthritis, diagnosed in cases with no definite radiologic signs of sacroiliitis.
- Psoriatic arthritis, known to produce parasyndesmophytes, a form of bony outgrowth distinct from syndesmophytes.
Also, spondylitis with bone marrow edema of the entire vertebra occurs more frequently in psoriatic arthritis.
Treatment and prognosis
All forms of spondyloarthritis may ultimately develop into ankylosing spondylitis in patients with longstanding disease 3.
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- 3. Hermann KG, Althoff CE, Schneider U et-al. Spinal changes in patients with spondyloarthritis: comparison of MR imaging and radiographic appearances. Radiographics. 2005;25 (3): 559-69. doi:10.1148/rg.253045117 - Pubmed citation
- 4. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sørensen IJ, Ozgocmen S, Roussou E, Valle-Oñate R, Weber U, Wei J, Sieper J. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. (2009) Annals of the rheumatic diseases. 68 (6): 777-83. doi:10.1136/ard.2009.108233 - Pubmed
- 5. Rudwaleit M, van der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y, Van den Bosch F, Olivieri I, Roussou E, Scarpato S, Sørensen IJ, Valle-Oñate R, Weber U, Wei J, Sieper J. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. (2011) Annals of the rheumatic diseases. 70 (1): 25-31. doi:10.1136/ard.2010.133645 - Pubmed
- seronegative spondyloarthritides
- Jaccoud arthropathy
- juvenile idiopathic arthritis
- lyme arthritis
- rheumatoid arthritis
- systemic lupus erythematosus
- erosive osteoarthritis
- osteoarthritis (mnemonic)
- primary cystic arthrosis of the hip
- rapidly destructive osteoarthritis of the hip
- secondary synovial osteochondromatosis
- miscellaneous disorders
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