MANUAL MINORS
Seronegative spondyloarthritis is a group of inflammatory diseases primarily affecting the spine and sacroiliac joints but can also involve other peripheral joints and extra-articular tissues. It is termed “seronegative” because patients do not have the typical antibodies found in diseases such as rheumatoid arthritis (rheumatoid factor or anti-CCP).
This group includes ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated spondyloarthritis. A common genetic marker in these patients is HLA-B27.
Diagnosis
Diagnosis is based on the presence of inflammatory lower back pain (which improves with exercise and not with rest), prolonged morning stiffness, and in some cases, peripheral arthritis, enthesitis (inflammation where tendons insert into bones), or dactylitis (sausage fingers).
Imaging studies, such as MRI, are useful for identifying inflammation in the sacroiliac joints and spine. Blood tests may show elevated acute-phase reactants like C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), but rheumatoid serology is negative.
Differential Diagnosis
Condition | Distinctive Features |
Rheumatoid arthritis | Symmetrical polyarthritis, positive serological tests (RF, anti-CCP), primarily affects small joints. |
Osteoarthritis | Mechanical joint pain, non-inflammatory, associated with degenerative changes on X-rays. |
Fibromyalgia | Generalised musculoskeletal pain, no inflammatory signs or imaging abnormalities. |
Paget’s disease | Bone pain, skeletal deformities, elevated alkaline phosphatase levels. |
Systemic lupus erythematosus | Multisystem involvement, positive serological tests (ANA, anti-DNA). |
Emergency Management
Management of spondyloarthritis in emergencies focuses on controlling acute inflammatory flares. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment to reduce pain and inflammation.
For severe pain, corticosteroid injections into the affected joints or systemic corticosteroids may be considered during severe flares. In more complex cases, if there is suspicion of extra-articular involvement, such as uveitis (ocular inflammation), urgent referral to a specialist may be necessary.
Definitive Treatment
Definitive treatment includes long-term use of NSAIDs, and in more advanced or refractory cases, disease-modifying drugs such as TNF inhibitors (etanercept, infliximab) or interleukin inhibitors (secukinumab).
Physiotherapy and regular exercise are essential to maintain spinal mobility and prevent stiffness. Patients may also require specialist care for complications or systemic involvement, such as uveitis, inflammatory bowel disease, or dermatological conditions.
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