Seronegative spondyloarthritides, also known as spondyloarthropathies, 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.
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.
- 1. Jacobson JA, Girish G, Jiang Y et-al. Radiographic evaluation of arthritis: inflammatory conditions. Radiology. 2008;248 (2): 378-89. doi:10.1148/radiol.2482062110 - Pubmed citation
- 2. Saraux A, Guillemin F, Guggenbuhl P et-al. Prevalence of spondyloarthropathies in France: 2001. Ann. Rheum. Dis. 2005;64 (10): 1431-5. doi:10.1136/ard.2004.029207 - Free text at pubmed - Pubmed citation
- 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
- 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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