• Clinical science

Seronegative spondyloarthropathies

Abstract

Seronegative spondyloarthropathies include several chronic inflammatory arthritic diseases that affect the vertebral column. The most important diseases in this group are ankylosing spondylitis, reactive arthritis, and psoriatic arthritis. Common features include the absence of rheumatoid factor (RF) and a strong genetic association with HLA-B27. Spondyloarthropathies disproportionately affect men, with symptom onset generally occurring before the age of 45. The cardinal sign is slowly progressive pain in the lower back and sacroiliac joints (especially at night). Asymmetrical oligoarthritis and enthesopathy are also common. The diseases differ in the involvement of other organs, such as the eyes, the genitourinary tract (particularly in reactive arthritis) or the skin (particularly in psoriatic arthritis). Seronegative spondyloarthropathies usually respond well to NSAID therapy.

Types of seronegative spondyloarthropathies

The different types of seronegative spondyloarthropathy do not necessarily represent distinct diseases, but may overlap significantly in etiology, pathology, clinical features, and treatment. The terminology and classification of these diseases are constantly evolving.

Common features of seronegative spondyloarthropathies

  • Negative for rheumatoid factor
  • Genetic association with HLA-B27
  • Generally more commonly affects men
  • Age of onset: typically between 20–40 years of age
  • Non-specific symptoms (fever, fatigue, weight loss)
  • Arthritis
  • Extra-articular manifestatitons vary according to type, but involvement of the eye is common (e.g., iritis, iridocyclitis, uveitis)

HLA-B27 associations

Conditions commonly associated with HLA-B27 are A-PAIR:

HLA-B27 positive

Increase of relative risk

Ankylosing spondylitis
  • 88% (overall)
    • 50% (African Americans)
    • 92% (whites)
∼ 90 times higher

Reactive arthritis

30–80%

∼ 15–35 times higher

Psoriatic arthritis affecting the vertebral column

60% ∼ 2–4 times higher

References:[1][2]

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last updated 01/30/2018
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