A wider spectrum of spondyloarthropathies

https://doi.org/10.1016/0049-0172(90)90023-9Get rights and content

Abstract

As in other diseases of undetermined etiology, the diagnosis of ankylosing spondylitis (AS) and related Spondyloarthropathies (SpA) is based on clinical and roentgenographic features. The current criteria for diagnosis of some of these diseases are too restricted, and do not recognize the existence of a much wider disease spectrum. For example, radiographically detected sacroiliitis is extremely frequent in AS, but may not be an obligate manifestation, especially in early or atypical forms of the disease. Arthritis involving the axial skeleton, including the sacroiliac joints, can be present in some patients without evidence of erosive disease roentgenographically. The disease spectrum of Reiter's syndrome has also been broadened considerably, and “incomplete” forms of Reiter's syndrome are observed much more commonly than the classical triad of arthritis, conjunctivitis, and urethritis. The term “B27-associated reactive arthritis” has been used in recent years to refer to SpA following enteric or urogenital infections, and the disease spectrum includes the clinical picture of typical Reiter's syndrome. The clinical spectrum of psoriatic SpA has been better clarified. Some of the less well defined B27-associated clinical syndromes include seronegative oligoarthritis, polyarthritis, or dactylitis (“sausagelike” toes) of the lower extremities, and heel pain caused by calcaneal (and tarsal) periostitis. These and other undifferentiated SpA have been ignored in previous epidemiological studies because of the inadequacy of the existing classification criteria. The European Spondylarthropathy Study Group (ESSG) has completed a study aimed at developing preliminary classification criteria for the whole group of SpA patients, with the specific intention of encompassing patients with undifferentiated SpA.

References (63)

  • MA Khan

    Newer clinical and radiographic features of seronegative spondyloarthropathies

    Curr Op Rheumatol

    (1989)
  • BL Kidd et al.

    Delay in diagnosis of spondarthritis

    Br J Rheumatol

    (1988)
  • K Kaarela et al.

    Hidden psoriatic arthritis in seronegative oligoarthritis: A 14-year follow-up study

    Clin Rheumatol

    (1989)
  • MA Khan et al.

    Diagnosis of ankylosing spondylitis

  • JMH Moll et al.

    New York clinical criteria for ankylosing spondylitis. A statistical evaluation

    Ann Rheum Dis

    (1973)
  • SM van der Linden et al.

    The risk of developing ankylosing spondylitis in HLA-B27 positive individuals: A comparison of relatives of spondylitis patients with the general population

    Arthritis Rheum

    (1984)
  • SM van der Linden et al.

    Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria

    Arthritis Rheum

    (1984)
  • SM van der Linden et al.

    Chest pain without radiographic sacrioliitis in relatives of patients with ankylosing spondylitis

    J Rheumatol

    (1988)
  • DD Gladman et al.

    Discordance between HLA-B27 and ankylosing spondylitis: A family investigation

    J Rheumatol

    (1986)
  • W Mau et al.

    Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup

    J Rheumatol

    (1988)
  • Spondylitis: Time for a new name and a new approach to diagnosis

    Lancet

    (1985)
  • L Bergfeldt et al.

    An important genetic risk factor for lone aortic regurgitation and severe conduction system abnormalities

    Am J Med

    (1988)
  • S Qaiyumi et al.

    Seronegative spondylarthropathies in lone aortic insufficiency

    Arch Intern Med

    (1985)
  • K Granfors et al.

    Yersinia antigens in synovial-fluid cells from patients with reactive arthritis

    N Engl J Med

    (1989)
  • HR Schumacher et al.

    Light and electron microscopic studies on the synovial membrane in Reiter's syndrome: Immunocytochemical identification of Chlamydial antigen in patients with early disease

    Arthritis Rheum

    (1988)
  • FC Arnett

    The Lyme spirochaete: Another cause of Reiter's syndrome?

    Arthritis Rheum

    (1989)
  • CM Weyand et al.

    Immune responses to Borrelia burgdorferi in patients with reactive arthritis

    Arthritis Rheum

    (1989)
  • IF Rowe et al.

    Human immunodeficiency virus infection and the rheumatologist

    Ann Rheum Dis

    (1989)
  • LR Espinoza et al.

    Rheumatic manifestations associated with human immunodeficiency virus infection

    Arthritis Rheum

    (1989)
  • Cited by (0)

    1

    From the Department of Medicine, Case Western Reserve University, Division of Rheumatology, MetroHealth Medical Center Cleveland, OH.

    2

    From the Department of Medicine, Division of Rheumatology, University of Limburg, Maastricht, The Netherlands.

    View full text