|Classification and external resources|
|ICD-10||M40 through M54|
|ICD-9||720, 721, 722, 723, 724|
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 spondylarthritis. 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 IP Joints, sausage digits, Achilles tenosynovitis, 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" 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.
The following conditions are typically included within the group of seronegative spondylarthropathies:
|Condition||Percent of people with the
condition who are HLA-B27 positive
|Reactive arthritis (Reiter's syndrome)||60-80%|
|enteropathic spondylitis or spondylitis associated with
|Isolated acute anterior uveitis||50%|
|Juvenile rheumatoid arthritis|
|Undifferentiated spondyloarthropathy (USpA)||20-25%|
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.), eg. 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
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:
- 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
- Inflammatory back pain
- Anterior uveitis
- Crohn's disease or ulcerative colitis
- Good response to NSAIDs
- Family history of SpA
- Elevated CRP
- thefreedictionary.com/spondyloarthropathy citing:
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- Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003
- Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007
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- "Seronegative Spondyloarthropathies: Joint Disorders: Merck Manual Professional". Retrieved 2008-12-15.
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- Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Workup Author: Lawrence H Brent. Chief Editor: Herbert S Diamond. Updated: Apr 19, 2011
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- Maria Antonietta D'Agostino, MD, Ignazio Olivieri, MD. (June 2006). Enthesitis 20 (3). Clinical Rheumatology. pp. 473–486. doi:10.1016/j.berh.2006.03.007.
- The Free Dictionary (2009). "Enthesitis". Retrieved 2010-11-27.
- Lipton, Sarah; Deodhar, Atul. "The new ASAS classification criteria for axial and peripheral spondyloarthritis: promises and pitfalls". International Journal of Clinical Rheumatology 7 (6): 675–682. doi:10.2217/ijr.12.61.
- Rudwaleit, M; Landewe, R; van der Heijde, D; Listing, J; Brandt, J; Braun, J; Burgos-Vargas, R; Collantes-Estevez, E; Davis, J; Dijkmans, B; Dougados, M; Emery, P; van der Horst-Bruinsma, I E; Inman, R; Khan, M A; Leirisalo-Repo, M; van der Linden, S; Maksymowych, W P; Mielants, H; Olivieri, I; Sturrock, R; de Vlam, K; Sieper, J (17 March 2009). "The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal". Annals of the Rheumatic Diseases 68 (6): 770–776. doi:10.1136/ard.2009.108217.
- Rudwaleit, M; van der Heijde, D; Landewe, R; Listing, J; Akkoc, N; Brandt, J; Braun, J; Chou, C T; Collantes-Estevez, E; Dougados, M; Huang, F; Gu, J; Khan, M A; Kirazli, Y; Maksymowych, W P; Mielants, H; Sorensen, I J; Ozgocmen, S; Roussou, E; Valle-Onate, R; Weber, U; Wei, J; Sieper, J (17 March 2009). "The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection". Annals of the Rheumatic Diseases 68 (6): 777–783. doi:10.1136/ard.2009.108233.
- Information from the American College of Rheumatology
- Spondyloarthropathies: Update on Diagnosis and Treatment from ConsultantLive.