Spondyloarthropathy

"SpA" redirects here. For the Italian type of company, see Società per azioni.

Spondyloarthropathy
Classification and external resources
Specialty
ICD-10	M40–M54
ICD-9-CM	720, 721, 722, 723, 724
Patient UK	Spondyloarthropathy

Spondyloarthropathy or spondyloarthrosis refers to any joint disease of the vertebral column. As such, it is a class or category of diseases rather than a single, specific entity. It differs from spondylopathy, which is a disease of the vertebra itself. However, many conditions involve both spondylopathy and spondyloarthropathy.

Spondyloarthropathy with inflammation is called ankylosing spondylitis. In the broadest sense, the term spondyloarthropathy includes joint involvement of vertebral column from any type of joint disease, including rheumatoid arthritis and osteoarthritis, but the term is often used for a specific group of disorders with certain common features, the group often being termed specifically seronegative spondylarthropathies. They have an increased incidence of HLA-B27, as well as negative rheumatoid factor and ANA. Enthesopathy is also sometimes present in association with seronegative spondarthritides.

Nonvertebral symptoms of spondyloarthropathies include asymmetric peripheral arthritis (which is distinct from rheumatoid arthritis), arthritis of the toe interphalangeal joints, sausage digits, Achilles tendinitis, plantar fasciitis, costochondritis, iritis, and mucocutaneous lesions. However, lower back pain is the most common clinical presentation of the disease; this back pain is unique because it decreases with activity.

Seronegative spondyloarthropathy

Seronegative spondyloarthropathy (or seronegative spondyloarthritis) is a group of diseases involving the axial skeleton and having a negative serostatus.

"Seronegative" refers to the fact that these diseases are negative for rheumatoid factor, indicating a different pathophysiological mechanism of disease than what is commonly seen in rheumatoid arthritis.

Conditions

The following conditions are typically included within the group of seronegative spondylarthropathies:

Condition	Percent of people with the condition who are HLA-B27 positive
Ankylosing spondylitis	Caucasians: 92% African-Americans:50%
Reactive arthritis (formerly known as Reiter's syndrome)	60-80%
Enteropathic arthropathy or spondylitis associated with inflammatory bowel disease (including Crohn's disease and ulcerative colitis)	60%
Psoriatic arthritis	60%
Isolated acute anterior uveitis	50%
Juvenile idiopathic arthritis
Undifferentiated spondyloarthropathy (USpA)	20-25%

Some sources also include Behcet's disease and Whipple's disease.

Common characteristics

These diseases have the following conditions in common:

• Seronegative (i.e. rheumatoid factor is not present)
• They are in relation to HLA-B27
• Inflammatory axial arthritis, generally sacroiliitis and spondylitis
• Oligoarthritis, generally with asymmetrical presentation
• Enthesitis (inflammation of the entheses, the sites where tendons or ligaments insert into the bone.), e.g. Plantar fasciitis, Achillis tendonitis, costochondritis.
• familial aggregation occurs
• Extra-articular features, such as involvement of eyes (anterior uveitis), skin, genitourinary tract, and aortic regurgitation
• Overlap is likely between several of the causative conditions

Classification

Assessment of Spondylarthritis International Society (ASAS criteria) is used for classification of axial spondylarthritis (to be applied for patients with back pain greater than or equal to 3 months and age of onset less than 45 years). It is of two broad types:

1. Sacroiliitis on imaging plus 1 SpA feature, or
2. HLA-B27 plus 2 other SpA features

Sacroiliitis on imaging:

• Active (acute) inflammation on MRI highly suggestive of SpA-associated sacroiliitis and/or
• Definite radiographic sacroiliitis

SpA features:

• Inflammatory back pain
• Arthritis
• Enthesitis
• Anterior uveitis
• Dactylitis
• Psoriasis
• Crohn's disease or ulcerative colitis
• Good response to NSAIDs
• Family history of SpA
• HLA-B27
• Elevated CRP

Epidemiology

Worldwide prevalence of spondyloarthropathy is approximately 1.9%.

External links

• http://www.gpnotebook.co.uk/simplepage.cfm?ID=-254803955
• Information from the American College of Rheumatology
• Spondyloarthropathies: Update on Diagnosis and Treatment from ConsultantLive