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Monday, November 26, 2012

Seronegative Spondyloarthritis:

Ø  Ankylosing spondylitis
Ø  Reactive arthritis (Reiter’s syndrome)
Ø  Psoriatic arthritis
Ø  Enteropathic arthritis (associated with inflammatory Bowel disease such as Ulcerative Colitis and Crohn’s disease)

Clinical features common to Seronegative Spondyloarthropathy:

Ø  Asymmetrical inflammatory oligoarthritis (lower > upper limb)
Ø  Enthesitis
Ø  Sacroiliitis and spondylitis
Ø  Familial
Ø  Extra – articular features:

o   Conjunctivitis
o   Buccal ulceration
o   Urethritis
o   Prostatitis
o   Bowel ulcers
o   Pustular skin lesions
o   Anrerior uveitis
o   Aortic root fibrosis (causing aortic regurgidation, heart blocks)

Ankylosing spondylitis

It is chronic inflammatory seronegative arthritis especially affecting sacroiliac joints and spine and characterized by stiffening and fusion of the axial skeleton.


o   Age: 25 – 35 years
o   Male to female ratio 3:1
o   More than 90 % of affected persons carry the histocompatibility antigen HLA – B27

Clinical features:

o   Chronic low back pain
o   Morning stiffness < 1 hour
o   Relieves with exercise
o   Other are same as for Seronegative Spondyloarthropathy


o   ESR and CRP often raised
o   RA factor absent
o   HLA – B27 in 90 % cases
o   X – ray:
§  Sacroiliitis
§  Syndesmophytes
§  Fusion of vertebrae (Bamboo spine)


o    Methotrexate
o    Sulfasalazine
Biological Response Mediator (BRM):
Anti – TNF therapy:
o    Inflixemab
o    Etanercept


Joint replacement


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