Spondyloarthropathies / Related Chronic Seronegative Arthritides

Discussion

• conditions include:
  • AS
  • Reiter's Syndrome
  • Psoriatic Arthritis
  • Inflammatory Bowel Disease
• typically involves the axial skeleton;
• affected areas heal w/ fibroblastic proliferation followed by new bone formation;
• pathogenesis of these disorders is unknown except for Reiter's syndrome, which is generally believed to result from aberrant host response to a pathogenic microorganism;

Labs

• RF is negative;
• HLA-B27 phenotype:
  • typically possitive in seronegative arthritis;
  • typically negative in RA;

Clinical Manifestations

• Systemic manifestions:
  • low grade fever, malaise, wt loss, aortitis.
  • look for AR
• Iritis:
  • iritis assoc seronegative spondyloarthropathies is acute inflammatory process causing redness, pain, and photophobia. (in contrast to JRA it is self limiting and rarely leads to visual impairment.)
• Enthesopathy:
  • pain at ligament and tendon insertions;
  • seen frequently, may occur before back symptoms.
  • occurs in: metatarsal heads, plantar fascia, achilles tendon
  • less common: tibial tubercle, patella, greater trochanter, iliac crest, sacroiliac joints, and clavicle.

References

• Acne arthralgia.
• Alternatives to Total Knee Replacement:Autologous Hamstring Resurfacing Arthroplasty