Spondylo Matters - Vol 5 No 2 - 2022

Introduction

Classification criteria and diagnosis of spondyloarthritis

Spondyloarthritis (SpA) is a chronic inflammatory disease that either involves the axial or the peripheral skeleton. It has been recognised as an overarching disease concept or family of diseases that is grouped together by common clinical features and an association with the human leucocyte antigen-B27 (HLA-B27). The prototypical disorder in this family is known as ankylosing spondylitis (AS), but others include are psoriatic arthritis, reactive arthritis and arthritis related to inflammatory bowel disease. Our understanding of SpA has been rapidly evolving in recent years. Because of the wide range of manifestations, it may present to different specialities such as general practitioners, dermatologists gastroenterologists and ophthalmologists. Appropriate referral to a rheumatologist would assist in determining if SpA is present and if treatment with advanced disease modifying treatment is indicated to achieve remission or low disease activity.

Treatment of spondyloarthritis

The spondyloarthritides (SpA) include Axial SpA (radiographic and non-radiographic) and peripheral spondyloarthritis (psoriatic arthritis, reactive arthritis, inflammatory bowel disease related arthritis). These conditions comprise a heterogenous group of disorders that differ amongst each individual in terms of their specific manifestations and associated conditions. Several domains of involvement have been described: Axial disease, peripheral arthritis, enthesitis, dactylitis, psoriasis, nail disease, uveitis and inflammatory bowel disease. In the treatment of SpA, all domains need to be assessed in every patient, so that the treatment approach can be individualised. Fortunately, the additions to SpA treatment options in the last few years have facilitated improved domain based treatment choices. This approach has been clarified in the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recent publication of their 2021 recommendations for treatment of PsA.

Imaging of spondyloarthtropathy: Specific findings on X-ray and MRI

The seronegative spondyloarthropathies (SpA) are a group of closely related inflammatory rheumatic diseases, all of which share a predilection for inflammatory involvement of the axial skeleton (predominantly the sacroiliac joints (SIJ) and spine) and/or the appendicular skeleton (predominantly the small joints of the hands and feet). Broadly speaking, patients can be divided into two large groups; axial SpA and peripheral SpA, with some overlap in clinical presentation.

Advances in the diagnosis and treatment of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune condition which, despite intense research over the last two decades, continues to present a diagnostic and therapeutic dilemma for practicing clinicians, research scientists and clinical trial investigators.