Spondyloarthropathy or spondyloarthrosis refers to any

joint disease An arthropathy is a disease of a joint. Types Arthritis is a form of arthropathy that involves inflammation of one or more joints, while the term arthropathy may be used regardless of whether there is inflammation or not. Joint diseases can be cla ...

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 chordata, ...

. 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 spond ...

, which is a disease of the vertebra itself, but many conditions involve both spondylopathy and spondyloarthropathy. Spondyloarthropathy with inflammation is called

axial spondyloarthritis Axial spondyloarthritis (also often referred to as axSpA) is a chronic, autoinflammatory disease predominantly affecting the axial skeleton (sacroiliac joints and spine). The best-known member of the axial spondyloarthritis disease family is ankyl ...

. 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 joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involv ...

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 w ...

, 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 Human leukocyte antigen (HLA) B27 (subtypes B*2701-2759) is a class I surface antigen encoded by the B locus in the major histocompatibility complex (MHC) on chromosome 6 and presents antigenic peptides (derived from self and non-self antigens) to ...

, as well as negative rheumatoid factor and ANA.

Enthesopathy An enthesopathy refers to a disorder involving the attachment of a tendon or ligament to a bone. This site of attachment is known as the enthesis (pl. entheses). If the condition is known to be inflammatory, it can more precisely be called an ...

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 A peripheral or peripheral device is an auxiliary device used to put information into and get information out of a computer. The term ''peripheral device'' refers to all hardware components that are attached to a computer and are controlled by th ...

(which is distinct from rheumatoid arthritis), arthritis of the toe interphalangeal joints,

sausage digits Dactylitis or sausage digit is inflammation of an entire digit (a finger or toe), and can be painful. The word dactyl comes from the Greek word "daktylos" meaning "finger". In its medical term, it refers to both the fingers and the toes. Associa ...

Achilles tendinitis Achilles tendinitis, also known as achilles tendinopathy, occurs when the Achilles tendon, found at the back of the ankle, becomes sore. Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties. The ...

plantar fasciitis Plantar fasciitis or plantar heel pain (PHP) is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the f ...

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 A mucocutaneous junction, or mucocutaneous boundary, is a region of the body in which mucosa transitions to skin. Mucocutaneous zones occur in animals, at the body orifices. In humans, mucocutaneous junctions are found at the lips, nostrils, conjun ...

lesions. But

lower back pain Low back pain (LBP) or lumbago is a common 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 vary from a dull constant ache to a sudden sharp feeli ...

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 (anatomy), trunk of a vertebrate. In the human skeleton, it consists of 80 bones and is composed of six parts; the human skull, skull (22 bones), als ...

and having a negative

serostatus Serostatus refers to the presence or absence of a serological marker in the blood. The presence of detectable levels of a specific marker within the serum is considered seropositivity, while the absence of such levels is considered seronegativity. ...

. "Seronegative" refers to the fact that these diseases are negative for rheumatoid factor, 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 Behçet's disease (BD) is a type of inflammatory disorder which affects multiple parts of the body. The most common symptoms include painful sores on the mucous membranes of the mouth and other parts of the body, inflammation of parts of the e ...

and

Whipple's disease Whipple's disease is a rare systemic infectious disease caused by the bacterium '' Tropheryma whipplei''. First described by George Hoyt Whipple in 1907 and commonly considered as a gastrointestinal disorder, Whipple's disease primarily causes m ...

Common characteristics

These diseases have the following conditions in common: * Seronegative (i.e. rheumatoid factor is not present) * They are in relation to

* 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 bo ...

and

spondylitis Spondylitis is an inflammation of the vertebrae. It is a form of spondylopathy. In many cases, spondylitis involves one or more vertebral joints, as well, which itself is called spondylarthritis. __TOC__ Types Pott disease is a tuberculous di ...

Oligoarthritis Oligoarthritis (from Greek ''oligos'' - 'few') is defined as arthritis Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth ...

, generally with asymmetrical presentation *

Enthesitis Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone. It is an enthesopathy, a pathologic condition of the entheses. Early clinical manifestations are an aching sensation akin to "working out too ...

(

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 sites where tendons or ligaments insert into the bone.), e.g.

Plantar fasciitis Plantar fasciitis or plantar heel pain (PHP) is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the f ...

. *

Familial aggregation Family aggregation, also known as familial aggregation, is the clustering of certain traits, behaviours, or disorders within a given family. Family aggregation may arise because of genetic or environmental similarities.Butcher, J., S. Mineka, and ...

occurs * Extra-articular features, such as involvement of eyes (anterior uveitis), skin,

genitourinary tract The genitourinary system, or urogenital system, are the organs of the reproductive system and the urinary system. These are grouped together because of their proximity to each other, their common embryological origin and the use of common pathw ...

, 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

(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