Seronegative Arthritis

INTRODUCTION

Seronegative arthritis refers to a diverse group of musculoskeletal syndromes linked by common clinical features and  common immunopathologic mechanisms.  Included within the group are the entities psoriatic arthritis, Reiter’s syndrome, enteropathic arthritis, reactive arthritis, ankylosing spondylitis, undifferentiated seronegative arthritis, Whipple’s disease, arthritis associated with pustular acne, post-intestinal bypass arthritis, and several forms of HIV associated arthritis.

NOSOLOGY

Many names have been proposed for this group of conditions including:

  • spondylarthropathy
  • seronegative spondylarthropathy
  • seronegative arthritis
  • BASE syndrome (B27,arthritis, spondylitis, enthesopathy)

The disease is often incorrectly referred to as seronegative rheumatoid arthritis.  This is incorrect because the demographics and clinical presentations of the diseases within this group differ markedly from rheumatoid arthritis.

KEY CLINICAL FEATURES

In contrast to rheumatoid arthritis, seronegative arthritis is male predominant (with exception of psoriatic arthritis where M=F).  The ago of onset is variable and disease may start in the teens or early twenties.  The arthritis tends to run a waxing and waning course with spontaneous exacerbations and remissions.  Inflammation occurs not only in the joints, but in the spine and at tendon attachment points (entheses).  The arthritis is often asymmetric and has a tendency to involve the large joints of the lower extremities and the feet and ankles.  Sometimes an entire digit is swollen, producing what is known as sausage digit or dactylitis.  Uncontrolled inflammation tends to result in stiffening and loss of motion as well as in damage to cartilage.

What distinguishes this group of diseases from one another and from rheumatoid arthritis are a wide range of non-articular features which include psoriasis and nail changes, inflammatory eye disease, inflammatory bowel disease, canker sores, and urethritis.  The disease frequently runs in families where it is linked to HLA genes including but not limited to HLA B27.

TREATMENT

Treatment for these conditions includes non-steroidal anti-inflammatory agents (NSAIDS), non-biologic DMARDS (methotrexate, leflunomide, azulfidine) and biologic agents (Enbrel, Humira, Remicade).  Ancillary treatment includes topical treatments for skin and eye disease, antibiotics for inciting infections, and physical therapy to maintain range of motion in joints, tendons and the spine.

For more information call:
NYU Langone Medical Center, Center for Musculoskeletal Care 646-501-7400.