Seronegative Spondyloarthritis

Abstract

The term spondyloarthritis encompasses a family of clinically, epidemiologically, and genetically related inflammatory diseases that primarily affect spinal and peripheral joints. The prototypic disease known as ankylosing spondylitis is characterized by progressive ankylosis in the joints of the axial skeleton that is readily evident on radiography and culminates in a permanently stooped spinal posture. Disease may not progress to ankylosis and may initially affect the peripheral joints and entheses, so the term spondyloarthritis is now considered the more appropriate term for this group of arthritides. This review provides a comprehensive overview of the classification, epidemiology, pathogenesis (including genetic factors, effector cytokines, bacteria and intestinal inflammation, and the link between inflammation and spinal ankylosis), pathology, diagnosis, management (including patient education, physical modalities, symptom-modifying antirheumatic drugs, second-line agents, biologic therapies, antibiotics, and surgery), and prognosis of spondyloarthritis. Graphs, algorithms, illustrations, and radiographic images are provided. Tables outline the modified New York criteria for ankylosing spondylitis, disease associations with genes outside the HLA locus in ankylosing spondylitis and overlap with Crohn disease and psoriasis, Assessments in SpondyloArthritis international Society (ASAS)/European League against Rheumatism (EULAR) recommendations for the management of ankylosing spondylitis, 2010 recommendations for the use of anti–tumor necrosis factor agents in patients with axial spondyloarthritis, and the ASAS core set for clinical record keeping. This review contains 15 highly rendered figures, 5 tables, and 176 references.