This document discusses seronegative spondyloarthropathies, which are characterized by negative rheumatoid factors, involvement of the axial skeleton, and association with HLA-B27. Key features include inflammation of the sacroiliac joints, spine, and peripheral joints. Extra-articular manifestations can include uveitis, inflammatory bowel disease, and genital ulcers. Major types are ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis. Ankylosing spondylitis commonly causes back pain and stiffness and can result in fusion of the spine and loss of mobility over time. Management involves exercise, NSAIDs, TNF inhibitors, and sometimes surgery.

1. SERO NEGATIVE
SPONDYLOARTHROPATHY
Dr Kishore.v

2. COMMON FEATURES
• Negative rheumatoid factor( sero negative)
• No subcutaneous nodules( highly pathognomic in RA)
• Strong familial inheritance- HLA B27+ve (60-95 percent)
• Radiological sacroilitis

3. CLINICAL PICTURE
• Young and middle age men (<40 years)are commonly involved
• Skeleton: primarily axial skeleton involved
sacroiliac joints
Vertebral joints
• Peripheral joints : oligoarticular and assymetric
Erosive type of arthritis
lower limb commonly involved
• Enthesopathy; inflammation of tendon sheaths at insertion site to bone
are charecteristic

4. EXTRA SKELETAL DISTRIBUTION
• Eye : acute anterior uveitis
Glaucoma
Conjuncticitis
• Skin: psoriatic leisons
• GIT; inflammatory bowel disease
( crohns,UC, whipples)
• Genito urinary: genital ulcerations

5. IT’S A FAMILY OF RAPE RS
• REITERS SYNDROME (REACTIVE ARTHRITIS)
• ANKYLOSING SPONDYLITIS
• PSORIATIC ARTHRITIS
• ENTEROPAHY ASSOSIATED ARTHRITIS
• BEHCETS SYNDROME( recurrant oro genital ulcerations with arthritis)
• UNDIFFERENTIATES SPONDYLOSRTHROPATHY

6. ANKYLOSING SPONDYLITIS
• Generalised chronic inflammatory disease
• affects mainly spine and sacroiliac joints
• males, 15-25 years
• HLAB27 IN 60-95%

7. PATHOLOGICALLY
• SYNOVITIS;
• sacroiliac, facet joints
• Costovertebral joints- diminished respiratory excursion
• Peripheral joints- erosive type of arthritis
• Inflammation of fibro-osseous junctions
• Affects intervertebral discs,sacrospinal ligaments,pubic symphysis,manubrium sternei,
insertion of large tendons(plantar fasciitis)
• pathology progress to bony ankyloses of joints and ossification of periarticular ligaments
( syndesmophytes)

8. CLINICAL FEATURES
• Recurrant low back pain and stiffness, often long standing ,
often confusing between mechanical backache and disc
prolapse
• In early stages flat back , decreased lumbar spine
extension(early feature which loose movement), sacroiliac
tenderness can be seen.
• Gradually pain and stiffness become continuous, with morning
stiffness
• In advanced cases the entire spine may get involved leading to
typical posture –
• loss of normal lumbar lordosis
• Increased thoracic kyphosis
• Forward thrust of neck
• Upright posture is maintained by hip and knee flexion

9. CLINICAL FEATURES CONTINUED…
• Decreased chest expansion(normal >7cm in young men)
• Peripheral joints - usually shoulder, hip,knees involved in 1/3rd of patients with features of
inflammatory arthritis
• Multiple tender areas of bone tendon insertions can be seen over manubrium sternei, iliac crest,
pubic symphysis, greater tuberosity, costochondral junctions, plantar fasciitis
• Extraskeletal AS;
acute anterior uveitis( common- 25%)
Carditis, aortic valve diseases
Apical pulmonary fibrosis(rare)

11. DIAGNOSIS
• Sacroiliac joints;
• Earliest : erosion and haziness of joint
• Later : sclerosis on iliac side
• Very late: bony ankyloses
• Vertebral features:
• Early :Squaring of vertebra( flattening of anterior concavity)
• Bamboo spine( bridging syndesmophytes)
• Romanus (shiny corner ) sign
• Osteoporosis
• Thoracic hyperkyphosis and other deformities

12. • Peripheral joints: erosive arthritis or bony ankyloses
• MRI: helps in early diagnosis
• ESR, CRP are elevated in active phase– prognostic indicator
• RF is negative

13. MANAGEMENT
• The disease is not usually as damaging as rheumatoid arthritis and many patients
continue to lead an active life.
• General measures: encouraged to remain active and follow their normal activities.
Avoid rest and immobilization.
• Train them to maintain normal posture and spinal extension exercises every day
• Swimming, dancing, gymnastics are ideal forms of recreation

14. MANAGEMENT……
• NSAIDS
• TNF INHIBITORS
• SURGERIES: hip replacements provides moderate mobility
deformities of spine corrected by lumbar or cervical osteotomy. They are
difficult and hazardious.

15. COMPLICATIONS
• Spinal fractures: c5-c7 fractures are common
• Spinal cord compression
• Hyperkyphosis and postural difficulties
• Lumbosacral nerve root compressions are rare

16. REITERS DISEASE( REACTIVE ARTHRITIS)
• Triad of
• URETHRITIS ( cervicitis, cystitis)
• CONJUNCTIVITIS
• ARTHRITIS ( inflammatory arthritis assymetric, oligoarticular of ankle and foot
• Most gives history of bowel infection(shigella/salmonella dysentery) or urogenital infection few
weeks before arthritis features to appear
• Pustular dermatitis of feet a/k keratoderma blenorrhagicum classically seen in reiters disease.

17. PSORIATIC ARTHRITIS
• Arthritis of distal interphalyngeal joints(dactilitis)….ARTHRITIS MUTILANS a
severe form of psoriatic arthritis.
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18. THANK YOU