Seronegative sponydloarthropathies – associated with HLA-B27

• Definition: group of interrelated multisystem inflammatory disorders that affect the spine, peripheral joints, and periarticular structures
• Characterized by:
• Sacroilitis – inflammation of the sacroiliac joint (the synovial joint between the sacrum and ilium)
• Peripheral inflammatory arthritis – inflammation of hands, wrists, etc.
• Spondylitis – inflammation of the spine
• Other common features include:
• Association with HLA-B27 – encodes class 1 Major histocompatability Complex
• Anterior ocular inflammation, variable mucocutaneous lesions, occasional aoritis, Ý family incidence
• NO association with rheumatoid factor or rheumatoid nodules
• Diseases include: Ankylosing Spondylitis (AS), Reiter’s syndrome, Spondyloarthritis
• Treatment: No specific definitive treatment or cure for these diseases. Management includes suppression of pain and stiffness with NSAID use. Other therapies include sulfasalazine –UC, Plaquenil – skin, methotrexate, etretinate, cyclosporin, corticosteroids, etc.

Ankylosing Spondylitis – "bent spine" – Hallmark: Sacroiliitis

• Definition: Chronic systemic inflammatory disorder of undetermined etiology
• Effects: Sacroiliac joint involvement is hallmark. Axial skeleton, Hip and shoulder joints, less commonly peripheral joints
• Pathogenesis: inflammation originates in sites of insertion of tendons and ligaments into bone or joint capsules (enthesopathy). Also and articular cartilage and juxta-articular subchondral bones and ligaments, as well as synovium. Inflammatory process results in Fibrous and bony ankylosis (fusion) of joints.
• Clinical Course: Bamboo spine – gradual and complete fusion of the spine (ossification of ligaments following inflammation). Results in "train track’s sign on A/P x-ray Þ spine can break easily (typically at C6-C7. Decreased Chest excursion (costal vertebral involvement). Also acute anterior uveitis (unilateral inflammation of the eye) seen in 30% of patient.
• Diagnosis:
• primary ankylosing spondylitis – association with HLA-B27 (97%), + Scholer’s test: Symptoms usually begin before age 40. Men> women. Pain at rest
• secondary ankylosing spondylitis – associated with ulcerative colitis, Crohn’s, Reiter’s – starts in early childhood

Reactive Arthritis (Reiter’s syndrome) – urethritis, asymmetric arthritis, uveitis.

• Definition: peripheral arthritis, often accompanied with extra-articular manifestations, appearing AFTER certain infections of the GI or genial tracts. Majority of patients have Human Leukocyte Antigen (HLA-B27) – 72%
• Pathogenesis: triggering organisms include: GI Þ Shigella, Salmonella, Yersinia, Clostridium difficile; Urogenital Þ Chlamydia, trachomatis, Neisseria gonorrheae, ureaplasma urealyticum.
• Clinical Course: Predominantly in young males. Syndrome classically seen as a triad of conditions but can occur in the absence of urethritis, conjunctivitis.

Psoriatic arthritis – arthritis with psoriasis

Enteropathic Arthritis – arthritis associated with Inflammatory Bowel Disease (UC, Crohn’s)