Spondyloarthropathy or spondyloarthrosis refers to any joint disease of the

vertebral column The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordate ...

. As such, it is a class or category of diseases rather than a single, specific entity. It differs from

spondylopathy Spondylopathies are disorders of the vertebrae. When involving inflammation, it can be called spondylitis. In contrast, a spondyloarthropathy is a condition involving the vertebral joints, but many conditions involve both spondylopathy and spon ...

, which is a disease of the vertebra itself, but many conditions involve both spondylopathy and spondyloarthropathy. Spondyloarthropathy with inflammation is called axial spondyloarthritis. In the broadest sense, the term spondyloarthropathy includes joint involvement of vertebral column from any type of joint disease, including

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and ...

and

osteoarthritis Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the ...

, but the term is often used for a specific group of disorders with certain common features, which are often specifically termed seronegative spondylarthropathies. They have an increased incidence of HLA-B27, as well as negative

rheumatoid factor Rheumatoid factor (RF) is the autoantibody that was first found in rheumatoid arthritis. It is defined as an antibody against the Fc portion of IgG and different RFs can recognize different parts of the IgG-Fc. RF and IgG join to form immune com ...

and ANA. Enthesopathy is also sometimes present in association with seronegative . Non-vertebral signs and symptoms of degenerative or other not directly infected inflammation, in the manner 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 Costochondritis, also known as chest wall pain syndrome or costosternal syndrome, is a benign inflammation of the upper costochondral (rib to cartilage) and sternocostal (cartilage to sternum) joints. 90% of patients are affected in multiple ri ...

iritis Uveitis () is inflammation of the uvea, the pigmented layer of the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and ...

, and mucocutaneous lesions. But

lower back pain Low back pain (LBP) or wiktionary:lumbago#Etymology, lumbago is a common musculoskeletal disorders, disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can ...

is the most common clinical presentation of the causes of spondyloarthropoathies; 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 The axial skeleton is the part of the skeleton that consists of the bones of the head and trunk of a vertebrate. In the human skeleton, it consists of 80 bones and is composed of six parts; the skull (22 bones), also the ossicles of the middl ...

and having a negative serostatus. "Seronegative" refers to the fact that these diseases are negative for

, indicating a different pathophysiological mechanism of disease than is commonly seen in

Conditions

The following conditions are typically included in the group of ''seronegative spondylarthropathies'': Some sources also include Behçet's disease and Whipple's disease.

Common characteristics

These diseases have the following conditions in common: * Seronegative (i.e.

is not present) * They are in relation to HLA-B27 * Inflammatory axial arthritis, generally

sacroiliitis Sacroiliitis is inflammation within the sacroiliac joint. It is a feature of spondyloarthropathies, such as axial spondyloarthritis (including ankylosing spondylitis), psoriatic arthritis, reactive arthritis or arthritis related to inflammatory ...

and spondylitis * Oligoarthritis, generally with asymmetrical presentation * Enthesitis (

inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

of the

entheses The enthesis (plural entheses) is the connective tissue between tendon or ligament and bone. There are two types of entheses: ''Fibrous entheses'' and ''fibrocartilaginous entheses''. In a fibrous enthesis, the collagenous tendon or ligament dire ...

, the sites where tendons or ligaments insert into the bone.), e.g. Plantar fasciitis, Achilles tendinitis,

. * 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 spondyloarthritis (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: # Sacroiliitis on imaging plus 1 SpA feature, or # 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

Treatment

Many patients have more than one of the spondyloarthritis disease manifestations. Some immunosuppressive drugs have shown efficacy in more than one of the diseases, e.g. tumor necrosis factor (TNF) inhibitors. But some of the immunosuppressive drugs are particularly effective for a specific inflamed tissue and approved in only one or two of the disease entities, so an interdisciplinary approach is required.

Epidemiology

Worldwide

prevalence In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...

of spondyloarthropathy is approximately 1.9%.

References

External links

{{DEFAULTSORT:Spondyloarthropathy Arthritis Musculoskeletal disorders