PROGNOSIS, COURSE OF DISEASE, AND TREATMENT OF THE SPONDYLOARTHROPATHIES
Section snippets
SPECTRUM OF SPONDYLOARTHROPATHIES
Spondyloarthropathy is a cover diagnosis for a group of joint diseases with several features in common.14 Patients have seronegative mono- or oligoarthritis with or without inflammatory back symptoms. Extra-articular inflammatory symptoms also characterize the diseases. The diagnostic subgroups in the spondyloarthropathy family include reactive arthritis, Reiter's disease, undifferentiated arthritis, and ankylosing spondylitis.
INFECTION AND SPONDYLOARTHROPATHY
Infection plays either a definite role in the cause of spondyloarthropathies, such as in acute reactive arthritis, or in some other forms, infection is suggested to contribute to the clinical activity or to the exacerbation of the disease. In addition to infections, genetic factors, especially human leukocyte antigen (HLA) B27 are usually required for the development of acute reactive arthritis. The arthritis is usually followed by gastrointestinal (enteroarthritis) or urogenital (uroarthritis)
Course of Reactive Arthritis
The duration of acute reactive arthritis varies between reports. In Finnish studies, the average duration of arthritis was 3 to 5 months, and about 15% of patients developed chronic sequels or proceeded into chronic spondyloarthropathy.47 In some other studies, chronicity has been reported in the vast majority of patients with Reiter's disease, 20 a form of severe arthritis most frequently triggered by C. trachomatis infection. A prolonged (>1 year) extension of acute arthritis has been
PROGNOSTIC FACTORS
There are several predictors of severity in patients with spondyloarthropathies, including:
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Family history of spondyloarthropathy
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Family history of Crohn's disease
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Male gender
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Chronic gut lesions
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HLA-B27
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Uroarthritis
TREATMENT
The treatment can be discussed with respect to (1) treatment of acute joint inflammation, (2) treatment of the triggering infection, and (3) treatment of chronic spondyloarthropathy.
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Infectious mimics of rheumatoid arthritis
2022, Best Practice and Research: Clinical RheumatologyCitation Excerpt :Sulfasalazine has been used in both acute and chronic reactive arthritis especially when NSAIDs are ineffective. Other DMARDs like methotrexate, leflunomide and azathioprine are useful in peripheral arthritis [64,65]. Refractory cases have successfully been treated with biologics like anti-TNF agents [66].
Spondyloarthritides
2019, The Autoimmune DiseasesOsteo-articular manifestations of gastro-intestinal infections
2016, Revue du Rhumatisme MonographiesThe overlap between spondyloarthritis and inflammatory bowel disease: Clinical aspects
2016, Revue du Rhumatisme MonographiesReactive arthritis in relation to internal derangements of the temporomandibular joint: a case control study
2015, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :In patients with general reactive arthritis induced by a distant bacterial infection, the genotype HLA B27 has often been found.14 The presence of a HLA B27 genotype also seems to predispose the patient to a more severe form of reactive arthritis.15 No particular HLA has been found to be dominant in patients with chronic closed lock of the TMJ.
Address reprint requests to Marjatta Leirisalo-Repo, MD, Department of Medicine, Helsinki University Central Hospital, PO Box 342, FIN-00029 HYKS, Finland
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From the Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Helsinki, Finland