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Seronegative Spondyloarthropathies

Seronegative Spondyloarthropathies. DefinitionA group of related inflammatory arthritic conditions that are characterized by axial skeletal arthritis, peripheral joint arthritis and varied organ involvement The term Spondyloarthropathies includes Ankylosing Spondylitis, Reiter's Syndrome(Reactive

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Seronegative Spondyloarthropathies

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    1. Seronegative Spondyloarthropathies Peter Rumore, MD Assistant Professor SUNY Stony Brook

    2. Seronegative Spondyloarthropathies Definition A group of related inflammatory arthritic conditions that are characterized by axial skeletal arthritis, peripheral joint arthritis and varied organ involvement The term Spondyloarthropathies includes Ankylosing Spondylitis, Reiters Syndrome(Reactive arthritis), Psoriatic Arthritis, and Enteropathic Arthropathy (Arthritis of Colitis)

    3. SPA common clinical manifestations Back pain Diffuse morning stiffness Insidious onset Young adult onset Sacroiliitis Male predominance Migratory peripheral joint arthritis Dactylitis (inflammation of synovium and surrounding ligaments/tendons

    4. SPA common clinical manifestations Oligoarticular Asymmetric Large joints Lower extremity predominance costochondritis Rheumatoid factor negative Enthesitis (point of insertion of ligamant or tendon to bone) Tendonitis, esp. Achilles Plantar fasciitis/heel spur

    5. SPA - Immunogenetics The genetic link is HLA B 27 (and similar alleles B7, B22, B 40, and B 44) The HLA B gene codes for a cell surface molecule which is necessary for cell-cell interactions/signaling It is especially important in T cell activation

    6. SPA Immunogenetics presence of HLA B27 Ankylosing Spondylitis - >90% Reiters Syndrome _ ~ 80% Psoriatic Spondylitis ~ 50% Healthy Caucasians ~ 14% Blacks ~ 4%

    7. SPA - Pathogenesis HLA B 27 alone is not sufficient ? another gene A triggering event such as an infection eg, post chlamydial and post shigella arthritis suggest an infectious trigger An imbalance of pro- and anti- inflammatory cytokines ?

    8. SPA Pathogenesis unanswered questions Infectious agents specific arhritogenic strains? Abnormal processing of garden variety infectious organisms or antigens? Persistent antigens, or persistent live organisms? Molecular mimicry

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