SERONEGATIVE SPONDYLOARTHROPATHIES
 
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SERONEGATIVE SPONDYLOARTHROPATHIES

 

DEFINITION:

A group of rheumatic disorders involving entheses with joint (axial and peripheral) and systemic manifestations.

EPIDEMIOLOGY:

  • incidence: variable
  • age of onset:
    • variable
  • risk factors:
    • HLA-B27
    • others: infections (sexual, gastrointestinal), psoriasis, inflammatory bowel disease (IBD)
  • target joints:
    • major - usually the peripheral joints
    • minor - usually the axial joints

PATHOGENESIS:

1. Background

  • These disorders are a group of inflammatory arthropathies which affect the joints of the axial skeleton as well as the peripheral joints. The 4 disorders appear to be a part of the SEA Syndrome:
  • S - seronegative (RF & ANA)
  • E - enthesitis
  • A - arthritis
  • 1. axial - sacroiliitis, spondylitis
  • 2. peripheral - large & small joints
  • furthermore, each of the 4 disorders has in common the HLA-B27 antigen (also seen in anterior uveitis & yersinia arthropathies)

2. Types

  • 1. Enteropathic Arthritis
  • 2. Juvenile Ankylosing Spondylitis
  • 3. Psoriatic Spondyloarthritis
  • 4. Reiter's Disease

    • CLINICAL FEATURES:

    1. Arthritis

    1. Axial Joints

  • 1. Sacroiliitis (SI Joint)
    • pain with pressure, compression, or distraction (Patrick's Test) of the SI joint
  • 2. Spondylitis (Vertebrae)
    • asymmetry on lateral flexion or rotation
    • pain/stiffness in lumbar spine
    • loss of lumbar lordosis and kyphosis
    • flattening of lumbosacral spine on forward flexion
    • decreased back range of motion by the Schober Test (<6cm increase on forward flexion of the back)
  • 3. Others
    • pain over costosternal & costovertebral joints
    • limited chest expansion

    • 2. Peripheral Joints

    • tends to involve large and small joints of the lower extremities although the upper extremity joints may also be affected
    • tenosynovitis

    2. Entheses

    1. Enthesitis

    • inflammation at the site of attachment of ligaments, tendons, fascia, or capsules to bone results in localized pain/tenderness on palpation

    3. Systemic Manifestations

    • Ophthalmologic - iritis, conjunctivitis, uveitis
    • Cutaneous - psoriasis, dactylitis, erythema, tenosynovitis, balanitis, keratodermia blennorrhagia, etc.
    • Genitourinary - urethritis, urinary tract infection (UTI) symptoms
    • Gastrointest. - dysentery, IBD
    • Neurological - severe cervico-occipital pain
    • Cardiovascul. - severe aortic valve insufficiency
    • Respiratory - decreased chest expansion & vital capacity

    INVESTIGATIONS:

    1. Serum

    • seronegative - RF and ANA
    • HLA-B27 positive
    • indexes of inflammation
    • routine blood work

    2. Imaging Studies

    1. Skeletal X-Rays

    • spine, SI joint - sacroiliitis
    • peripheral joints
    • entheses

    3. Others

    • urinalysis
    • joint aspiration

    MANAGEMENT:

    1. Supportive

    • team approach with long-term follow-up
      • Paediatrics, Rheumatology, Ophthalmology, PT
    • treat the underlying condition - IBD, dysentery, psoriasis, UTI
    • physiotherapy to increase the range of motion of affected axial/ peripheral joints
    • treat enthesitis:
      • custom-made insoles
      • ultrasound or transcutaneous nerve stimulation

    2. Medications

    • anti-inflammatory drugs
      • ASA
      • NSAID

     

     

     

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