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Seronegative Arthropathy .pdf



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Seronegative
Spondyloarthropathy

Dr. Jamal Uddin Ahmed
Assistant Professor, Internal Medicine
BIRDEM & IMC

Dx ?






30 yrs male
Low back pain
Morning stiffness
CRP – 48
Xray SI joint – B/L sacroilitis

What are these?
• A group of related inflammatory joint diseases
• Considerable overlap in their clinical features
• Shared immunogenetic association with the
HLA-B27 antigen

These are






Ankylosing spondylitis
Axial spondyloarthritis
Reactive arthritis, including Reiter’s syndrome
Psoriatic arthritis
Arthropathy associated with inflammatory
bowel disease.

Etiology
• Aberrant response to infection
• In genetically predisposed individuals.
In some situations, a triggering organism can
be identified, as in reactive arthritis following
bacterial dysentery or chlamydial urethritis,

Clinical features common to seronegative
spondyloarthritis
• Asymmetrical inflammatory oligoarthritis (lower > upper
limb)
• Sacroiliitis and inflammatory spondylitis
• Inflammatory enthesitis
• Tendency for familial aggregation
• RF and ACPA negative
• Absence of nodules and other extra-articular features of
RA
• Typical overlapping extra-articular features:

Typical overlapping extra-articular features:
 Mucosal inflammation: conjunctivitis, buccal
ulceration,
 Urethritis, prostatitis, bowel ulceration
 Pustular skin lesions and nail dystrophy
 Anterior uveitis
 Aortic root fibrosis (aortic incompetence, conduction
defects)
 Erythema nodosum

Ankylosing Spondylitis

• The prototype of the spondyloarthropathies.
• Marie-Strumpell disease or Bechterew's
disease.


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