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Update on the spondyloarthropathies

Update on the spondyloarthropathies

ABSTRACT: The spondyloarthropathies (SpA) are strongly associated with the HLA-B27 gene. The diagnosis is based primarily on clinical findings. Ankylosing spondylitis (AS) often involves the sacroiliac joints and spine. Psoriatic arthritis (PsA) occurs in up to about one third of patients with psoriasis. Reactive arthritis must be distinguished from other arthropathies. Arthritis occurs in about 30% of patients with inflammatory bowel disease. Undifferentiated SpA includes several related disorders. Radiographic evidence of sacroiliitis is a characteristic feature of AS. SpA management should include patient education and regular exercise. NSAIDs are the first line of treatment. The tumor necrosis factor α inhibitors are highly effective in patients with active AS and in those with PsA that is unresponsive to conventional therapy. (J Musculoskel Med. 2008;25:31-40)


Together the spondyloarthropathies (SpA) form a group of overlapping chronic inflammatory rheumatologic diseases that show a predilection for involvement of the axial skeleton, entheses (bony insertions ofligaments and tendons), and peripheral joints. They also may involve extra skeletal structures, especially the eyes, lungs, skin, and GI tract. These diseases are strongly associated with the HLA-B27 gene but lack association with rheumatoid factor (RF) and antinuclear antibodies.1

The SpA include ankylosingspondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis of inflammatory bowel disease (IBD), and undifferentiated SpA. They are more common than previously recognized. Recent data from Europe and Asia suggest that as a group, the SpA might be as common as rheumatoid arthritis (RA); in Europe, the prevalence is 0.5% to 1%.2-4

Because there are no diagnostic criteria for the wider spectrum of the SpA, the diagnosis is based primarily on clinical findings.1,2,4-8 European Spondylarthropathy Study Group (ESSG) classification criteria are used frequently to help the clinical diagnosis (Table 1).9 Early diagnosis has become much more important in recent years as more effective therapeutic options have become available.

In this article, we describe the specific clinical entities in the SpA and their common laboratory and radiological features. Then we outline a variety of management strategies, including nonpharmacological modalities, pharmacological therapy, and ophthalmological or surgical referral.



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