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Abstract
Seronegative SpA are HLA-B27 arthritis characterized by sacroiliitis, peripheral inflammatory arthritis and absence of RF.
SpA include ankylosing spondylitis, acute and chronic ReA, PsA, spondylitis associated with chronic inflammatory bowel disease and undifferentiated SpA. All of these disorders show clinical manifestations. The prevalence of sacroiliitis is high and extraarticular manifestations of disease, including uveitis and occasionally oral ulcers, tend to be similar and frequent among these illnesses.
Traditionally, NSAIDs have been the cornerstone of treatment for patients with seronegative spondyloarthropathy. However, the realization that these medications do not alter disease course, combined with evidence from RA trials demonstrating that second line agents may improve long-term outcome, has led some clinicians to take a more aggressive treatment approach. In the use of second line agents in treatment of SpA, several observations deserve comments. First, SSZ is effective in treatment of peripheral but not axial joints in patients with AS, PsA, and ReA. Second, MTX can retard radiographic progression in PsA, but it is not effective in treatment of AS and ReA. Third, antibiotics may be of benefit in acute ReA but do not alter course of established disease.