Skip to main content

Advertisement

Log in

Undifferentiated spondyloarthritis: A global perspective

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

This paper reviews the concept and outcome of undifferentiated spondyloarthritis (SpA) as reported in retrospective and prospective studies from different parts of the world. Although the designs and definitions vary across different studies, clearly a significant proportion of patients with undifferentiated SpA will fulfill ankylosing spondylitis within 10 years in association with certain prognostic factors. The paper also examines the concept of axial SpA and its importance as an early indicator of ankylosing spondylitis. Ultimately, the recognition of undifferentiated SpA and axial SpA may lead to early treatment with highly efficacious drugs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Khan MA: Update on spondyloarthropathies. Ann Intern Med 2002, 136:896–907.

    PubMed  Google Scholar 

  2. Amor B, Dougados M, Mijiyawa M: [Criteria of the classification of spondylarthropathies]. Rev Rhum Mal Osteoartic 1990, 57:85–89.

    PubMed  CAS  Google Scholar 

  3. Dougados M, van der Linden S, Juhlin R, et al.: The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991, 34:1218–1227.

    Article  PubMed  CAS  Google Scholar 

  4. Khan MA, van der Linden S, Kushner I: Symptomatic ankylosing spondylitis without radiographic sacroiliitis in B27 positive relatives. Clin Res 1983, 31:804A.

    Google Scholar 

  5. Prakash S, Bansal R, Rajgopalan P, Malaviya AN: Immunological studies in seronegative spondyloarthropathies. Br J Rheumatol 1983, 22:146–150.

    Article  PubMed  CAS  Google Scholar 

  6. Burns TM, Calin A: Undifferentiated spondyloarthropathy. In Spondyloarthropathies. Edited by Calin A. Orlando, FL: Grune & Stratton; 1984:253–264.

    Google Scholar 

  7. Khan MA: Newer clinical and radiographic manifestations of the seronegative spondyloarthropathies. Curr Opin Rheumatol 1989, 1:139–143.

    Article  PubMed  CAS  Google Scholar 

  8. Khan MA, van der Linden SM: Undifferentiated spondyloarthropathies. Spine: State of the Art Reviews 1990, 4:657–664.

    Google Scholar 

  9. Khan MA, van der Linden SM: A wider spectrum of spondyloarthropathies. Semin Arthritis Rheum 1990, 20:107–113.

    Article  PubMed  CAS  Google Scholar 

  10. Zeidler H, Brandt J, Schnarr S: Undifferentiated spondyloarthritis. In Ankylosing Spondylitis and the Spondyloarthropathies. Edited by Weisman MH, Reveille JD, van der Heijde D. Philadelphia: Mosby Elsevier; 2006:75–93.

    Google Scholar 

  11. Rudwaleit M, van der Heijde D, Khan MA, et al.: How to diagnose axial spondyloarthritis early. Ann Rheum Dis 2004, 63:535–543.

    Article  PubMed  CAS  Google Scholar 

  12. Zeidler H, Mau W, Khan MA: Undifferentiated spondyloarthropathies. Rheum Dis Clin North Am 1992, 18:187–202.

    PubMed  CAS  Google Scholar 

  13. van der Linden S, Valkenburg HA, Cats A: Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984, 27:361–368.

    Article  PubMed  Google Scholar 

  14. Feldtkeller E, Khan MA, van der Heijde D, et al.: Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 2003, 23:61–66.

    PubMed  Google Scholar 

  15. Rudwaleit M, Listing J, Brandt J, et al.: Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Ann Rheum Dis 2004, 63:665–670.

    Article  PubMed  CAS  Google Scholar 

  16. Sieper J, Rudwaleit M: How early should ankylosing spondylitis be treated with tumour necrosis factor blockers? Ann Rheum Dis 2005, 64(Suppl 4):iv61–64.

    Article  PubMed  CAS  Google Scholar 

  17. Boyer GS, Templin DW, Bowler A, et al.: Spondyloarthropathy in the community: clinical syndromes and disease manifestations in Alaskan Eskimo populations. J Rheumatol 1999, 26:1537–1544.

    PubMed  CAS  Google Scholar 

  18. Roux CH, Saraux A, Le Bihan E, et al.: Rheumatoid arthritis and spondyloarthropathies: geographical variations in prevalence in France. J Rheumatol 2007, 34:117–122.

    PubMed  Google Scholar 

  19. Chou CT, Lin KC, Wei JC, et al.: Study of undifferentiated spondyloarthropathy among first-degree relatives of ankylosing spondylitis probands. Rheumatology (Oxford) 2005, 44:662–665.

    Article  CAS  Google Scholar 

  20. Porcher R, Said-Nahal R, D’Agostino MA, et al.: Two major spondylarthropathy phenotypes are distinguished by pattern analysis in multiplex families. Arthritis Rheum 2005, 53:263–271.

    Article  PubMed  Google Scholar 

  21. Baddoura R, Awada H, Okais J, et al.: Validation of the European Spondylarthropathy Study Group and B. Amor criteria for spondylarthropathies in Lebanon. Rev Rhum Engl Ed 1997, 64:459–464.

    PubMed  CAS  Google Scholar 

  22. Howe HS, Zhao L, Song YW, et al.: Seronegative spondyloarthropathy—studies from the Asia Pacific region. Ann Acad Med Singapore 2007, 36:135–141.

    PubMed  Google Scholar 

  23. Collantes E, Zarco P, Muñoz E, et al.: Disease pattern of spondyloarthropathies in Spain: description of the first national registry (REGISPONSER)—extended report. Rheumatology (Oxford) 2007, Epub ahead of print.

  24. Sany J, Rosenberg F, Panis G, Serre H: Unclassified HLA-B27 inflammatory rheumatic diseases: followup of 23 patients. Arthritis Rheum 1980, 23:258–259.

    Article  PubMed  CAS  Google Scholar 

  25. Schattenkirchner M, Krüger K: Natural course and prognosis of HLA-B27-positive oligoarthritis. Clin Rheumatol 1987, 6(Suppl 2):83–86.

    Article  PubMed  Google Scholar 

  26. Mau W, Zeidler H, Mau R, et al.: Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol 1988, 15:1109–1114.

    PubMed  CAS  Google Scholar 

  27. Collantes E, Veroz R, Escudero A, et al.: Can some cases of ‘possible’ spondyloarthropathy be classified as ‘definite’ or ‘undifferentiated’ spondyloarthropathy? Value of criteria for spondyloarthropathies. Spanish Spondyloarthropathy Study Group. Joint Bone Spine 2000, 67:516–520.

    Article  PubMed  CAS  Google Scholar 

  28. Sampaio-Barros PD, Bertolo MB, Kraemer MH, et al.: Undifferentiated spondyloarthropathies: a 2-year follow-up study. Clin Rheumatol 2001, 20:201–206.

    Article  PubMed  CAS  Google Scholar 

  29. Huerta-Sil G, Casasola-Vargas JC, Londoño JD, et al.: Low grade radiographic sacroiliitis as prognostic factor in patients with undifferentiated spondyloarthritis fulfilling diagnostic criteria for ankylosing spondylitis throughout follow up. Ann Rheum Dis 2006, 65:642–646.

    Article  PubMed  CAS  Google Scholar 

  30. Kumar A, Bansal M, Srivastava DN, et al.: Long-term outcome of undifferentiated spondylarthropathy. Rheumatol Int 2001, 20:221–224.

    Article  PubMed  CAS  Google Scholar 

  31. Lau CS, Burgos-Vargas R, Louthrenoo W, et al.: Features of spondyloarthritis around the world [review]. Rheum Dis Clin North Am 1998, 24:753–770.

    Article  PubMed  CAS  Google Scholar 

  32. Petty RE, Southwood TR, Manners P, et al.: International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004 31:390–392.

    PubMed  Google Scholar 

  33. Burgos-Vargas R, Vazquez-Mellado J: The early clinical recognition of juvenile-onset ankylosing spondylitis and its differentiation from juvenile rheumatoid arthritis. Arthritis Rheum 1995, 38:835–844.

    Article  PubMed  CAS  Google Scholar 

  34. Rudwaleit M, Metter A, Listing J, et al.: Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 2006, 54:569–578.

    Article  PubMed  Google Scholar 

  35. Calin A, Porta J, Fries JF, Schurman DJ: Clinical history as a screening test for ankylosing spondylitis. JAMA 1977, 237:2613–2614.

    Article  PubMed  CAS  Google Scholar 

  36. Gran JT: An epidemiological survey of the signs and symptoms of ankylosing spondylitis. Clin Rheumatol 1985, 4:161–169.

    Article  PubMed  CAS  Google Scholar 

  37. van der Linden SM, Fahrer H: Occurrence of spinal pain syndromes in a group of apparently healthy and physically fit sportsmen (orienteers). Scand J Rheumatol 1988, 17:475–481.

    PubMed  Google Scholar 

  38. Braun J, van der Heijde D: Imaging and scoring in ankylosing spondylitis. Best Pract Res Clin Rheumatol 2002, 16:573–604.

    PubMed  CAS  Google Scholar 

  39. Bollow M, Fischer T, Reisshauer H, et al.: Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis-cellularity correlates with the degree of enhancement detected by magnetic resonance imaging. Ann Rheum Dis 2000, 59:135–140.

    Article  PubMed  CAS  Google Scholar 

  40. Appel H, Loddenkemper C, Grozdanovic Z, et al.: Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis. Arthritis Res Ther 2006, 8:R143.

    Article  PubMed  CAS  Google Scholar 

  41. Heuft-Dorenbosch L, Landewé R, Weijers R, et al.: Combining information obtained from magnetic resonance imaging and conventional radiographs to detect sacroiliitis in patients with recent onset inflammatory back pain. Ann Rheum Dis 2006, 65:804–808.

    Article  PubMed  CAS  Google Scholar 

  42. Heuft-Dorenbosch L, Landewé R, Weijers R, et al.: Performance of various criteria sets in patients with inflammatory back pain of short duration; the Maastricht early spondyloarthritis clinic. Ann Rheum Dis 2007, 66:92–98.

    Article  PubMed  CAS  Google Scholar 

  43. Brandt HC, Spiller I, Song IH, et al.: Performance of referral recommendations in patients with chronic back pain and suspected axial spondyloarthritis. Ann Rheum Dis 2007, Epub ahead of print.

  44. Oostveen J, Prevo R, den Boer J, van de Laar M: Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol 1999, 26:1953–1958.

    PubMed  CAS  Google Scholar 

  45. Palazzi C, Padula A, Montaruli M, et al.: Pharmacological management of undifferentiated spondyloarthropathies. Expert Opin Investig Drugs 2006, 15:39–46.

    Article  PubMed  CAS  Google Scholar 

  46. Carter JD, Valeriano J, Vasey FB: Doxycycline versus doxycycline and rifampin in undifferentiated spondyloarthropathy, with special reference to chlamydia-induced arthritis. A prospective, randomized 9-month comparison. J Rheumatol 2004, 31:1973–1980.

    PubMed  CAS  Google Scholar 

  47. Sieper J, Fendler C, Laitko S, et al.: No benefit of long-term ciprofloxacin treatment in patients with reactive arthritis and undifferentiated oligoarthritis: a three-month, multicenter, double-blind, randomized, placebo-controlled study. Arthritis Rheum 1999, 42:1386–1396.

    Article  PubMed  CAS  Google Scholar 

  48. Sinha R, Aggarwal A, Prasad K, Misra R: Sporadic enteric reactive arthritis and undifferentiated spondyloarthropathy: evidence for involvement of Salmonella typhimurium. J Rheumatol 2003, 30:105–113.

    PubMed  Google Scholar 

  49. Martínez A, Pacheco-Tena C, Vázquez-Mellado J, Burgos-Vargas R: Relationship between disease activity and infection in patients with spondyloarthropathies. Ann Rheum Dis 2004, 63:1338–1340.

    Article  PubMed  Google Scholar 

  50. Braun J, Zochling J, Baraliakos X, et al.: Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicentre randomised controlled trial. Ann Rheum Dis 2006, 65:1147–1153.

    Article  PubMed  CAS  Google Scholar 

  51. van den Bosch F, Kruithof E, Baeten D, et al.: Effects of a loading dose regimen of three infusions of chimeric monoclonal antibody to tumour necrosis factor alpha (infliximab) in spondyloarthropathy: an open pilot study. Ann Rheum Dis 2000, 59:428–433.

    Article  PubMed  Google Scholar 

  52. Kruithof E, Van den Bosch F, Baeten D, et al.: Repeated infusions of infliximab, a chimeric anti-TNFalpha monoclonal antibody, in patients with active spondyloarthropathy: one year follow up. Ann Rheum Dis 2002, 61:207–212.

    Article  PubMed  CAS  Google Scholar 

  53. Schnarr S, Kuipers JG, Zeidler H: Anti-tumour necrosis factor (TNF)-alpha therapy in undifferentiated spondyloarthropathy. Clin Exp Rheumatol 2002, 20(6 Suppl 28):S126–129.

    PubMed  CAS  Google Scholar 

  54. Brandt J, Khariouzov A, Listing J, et al.: Successful short term treatment of patients with severe undifferentiated spondyloarthritis with the anti-tumor necrosis factor-alpha fusion receptor protein etanercept. J Rheumatol 2004, 31:531–538.

    PubMed  CAS  Google Scholar 

  55. Van Den Bosch F, Kruithof E, Baeten D, et al.: Randomized double-blind comparison of chimeric monoclonal antibody to tumor necrosis factor alpha (infliximab) versus placebo in active spondylarthropathy. Arthritis Rheum 2002, 46:755–765.

    Article  CAS  Google Scholar 

  56. Marzo-Ortega H, McGonagle D, O’Connor P, Emery P: Efficacy of etanercept in the treatment of the entheseal pathology in resistant spondylarthropathy: a clinical and magnetic resonance imaging study. Arthritis Rheum 2001, 44:2112–2117.

    Article  PubMed  CAS  Google Scholar 

  57. Rudwaleit M, Baraliakos X, Listing J, et al.: Magnetic resonance imaging of the spine and the sacroiliac joints in ankylosing spondylitis and undifferentiated spondyloarthritis during treatment with etanercept. Ann Rheum Dis 2005, 64:1305–1310.

    Article  PubMed  CAS  Google Scholar 

  58. Baeten D, Van Damme N, Van den Bosch F, et al.: Impaired Th1 cytokine production in spondyloarthropathy is restored by anti-TNFalpha. Ann Rheum Dis 2001, 60:750–755.

    Article  PubMed  CAS  Google Scholar 

  59. Baeten D, Kruithof E, Van den Bosch F, et al.: Immunomodulatory effects of anti-tumor necrosis factor alpha therapy on synovium in spondylarthropathy: histologic findings in eight patients from an open-label pilot study. Arthritis Rheum 2001, 44:186–195.

    Article  PubMed  CAS  Google Scholar 

  60. Vandooren B, Kruithof E, Yu DT, et al.: Involvement of matrix metalloproteinases and their inhibitors in peripheral synovitis and down-regulation by tumor necrosis factor alpha blockade in spondylarthropathy. Arthritis Rheum 2004, 50:2942–2953.

    Article  PubMed  CAS  Google Scholar 

  61. Kruithof E, Baeten D, Van den Bosch F, et al.: Histological evidence that infliximab treatment leads to downregulation of inflammation and tissue remodelling of the synovial membrane in spondyloarthropathy. Ann Rheum Dis 2005, 64:529–536.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rubén Burgos-Vargas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Burgos-Vargas, R. Undifferentiated spondyloarthritis: A global perspective. Curr Rheumatol Rep 9, 361–366 (2007). https://doi.org/10.1007/s11926-007-0058-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-007-0058-2

Keywords

Navigation