The seronegative arthritis family of joint pain is characterized by the combination of joint pains as well as non-joint manifestations. The four syndromes are ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome/reactive arthritis, and arthritis related to inflammatory bowel disease. These conditions share many common characteristics, but each has specific symptoms that help with diagnosis. Overall treatments are aimed at decreasing inflammation. Arthritis symptoms can be chronic or transient, depending upon the individual and the specific disease.
Similar Characteristics
Seronegative arthritis has a strong association with an immunologic marker known as HLA --B27. Physicians can order this as a blood test, however the presence or non-presence of HLA-B27 does not exclude or confirm any diagnosis.
These arthritis conditions are negative for the rheumatoid factor (RF). The rheumatoid factor is commonly present in patients with rheumatoid arthritis. The term "seronegative" actually refers to the lack of the rheumatoid factor in these arthritic patients.
Common manifestations of seronegative arthritis include eye inflammation, rash, oral ulcers, enthesitis or tendon/ligament insertion pain, and inflammation of the sacroiliac joint and spine. It is important to note that patients may not have all of these symptoms. According to the 2004 "American Family Physician" article by Dr Rajesh Kataria of Albert Einstein Medical Center in Philadelphia, Pennsylvania, the common sites of enthesitis are on the Achilles tendon near the heel, the plantar fascia, patellar tendon, around the patella, metatarsal heads, base of the fifth metatarsal or lateral ankle, and spinal ligaments.
Treatments are aimed at decreasing joint destruction, treating the underlying condition as in ulcerative colitis, and preserving joint range of motion. Non-steroidal anti-inflammatories, corticosteroids, anti-malarials, and biologic agents aimed at decreasing inflammation all can help with symptoms. Physical therapy is a very important part of treatment.
Ankylosing Spondylitis
Ankylosing spondylitis usually presents as chronic low back pain in young adults. The spine and the sacroiliac joints are commonly involved. There is advancing stiffness of the spine with time. The spine stiffness is informally known as "bamboo spine."
Psoriatic Arthritis
Psoriatic arthritis refers to the presence of joint arthritis in combination with a history of psoriasis. The patient can have active skin psoriasis or nail pitting. Nail pitting is a manifestation at of previous psoriasis. Psoriatic arthritis is very similar in presentation to rheumatoid arthritis in that many joints can be involved. A unique characteristic of psoriatic arthritis is the development of "sausage finger," which refers to lack to normal taper in the finger due to arthritis at the finger joint closest to the fingernail.
Reiter's Syndrome/ Reactive Arthritis
Reactive arthritis involves urethrtis, conjunctivitis or uveitis, mucocutaneous lesions and aseptic arthritis. Urethritis is inflammation of the urethra. Conjunctivitis and uveitis are inflammation of different parts of the eye. Mucocutaneous lesions refer to skin findings located on skin and on the mucous membranes of the body including the mouth. Aseptic arthritis refers to lack of known bacteria or pathogen in the joint fluid leading to arthritis. Genetic parts of the bacteria have been found isolated in the joint fluid, however, which may prove this syndrome to be an immunologic reaction to the bacteria that occurs some time after infection.
Most cases of reactive arthritis occur after a previous bout with a gastrointestinal pathogen. The implicated gastrointestinal bacteria can be Shigella, Salmonella, Yersinia, and Campylobacter. Sexually transmitted diseases such as Chlamydia trachomatis and Ureaplasam urealyticum can also occur prior to the arthritic symptoms.
Inflammatory Bowel Disease Related Arthritis
Crohn's disease, ulcerative colitis, and Whipple's disease are disorders of the gastrointestinal system that can also present with arthritis. In Crohn's and ulcerative colitis, controlling the gastrointestinal disease often helps with the arthritis. Whipple's disease is different in that the arthritis may present prior to the gastrointestinal symptoms, and these joint symptoms may resolve once the gastrointestinal disease begins.
References
- "AAOS Comprehensive Orthopaedic Review"; Dr. Jay Lieberman (editor); 2008.
- "Current Medical Diagnosis and Treatment"; Dr Steven McPhee, Dr Maxine Papadakis; 2007.
- "American Family Physician": Spondyloarthropathies
