Peripheral Manifestations in Spondyloarthritis
Peripheral Manifestations in Spondyloarthritis
Purpose of review The field of spondyloarthritis (SpA) has evolved enormously over the last few years, starting with the advent of biological therapies at the end of the previous millenium. A lot of work has been done to construct valid outcome measures and treatment guidelines based upon the results of pivotal studies with Tumor necrosis factor (TNF)-blocking agents. Most of these trials were performed in well described populations, such as patients suffering from ankylosing spondylitis (AS) or psoriatic arthritis.
Recent findings Over recent years a reappraisal has been done with regard to considering again the full spectrum of diseases belonging to the SpA concept, especially in early disease stages. This effort culminated in the construction of new classification criteria for axial and peripheral SpA. Around the same time, a number of patient registries were set up, allowing the follow-up of patients in order to study the natural evolution of patients classified early. The first data from these cohorts provide interesting information on peripheral joint manifestations such as arthritis, enthesitis or dactylitis. Recognition and monitoring of these manifestations are essential for clinicians in order to provide comprehensive patient care.
Summary There is a growing interest in the field of SpA to move from rather restricted and longstanding diseases such as AS to a more comprehensive view, encompassing not only inflammatory back pain, but also peripheral arthritis and enthesitis, as well as extra-articular manifestations. The new classification criteria and guidelines for follow-up are applied now in a number of prospective patient registries, and provide us with valuable information on the early disease stages of SpA.
The spondyloarthritides (SpA) are a family of heterogeneous diseases which, however, share common clinical, radiological, genetic and even therapeutic characteristics. Originally, a disease such as ankylosing spondylitis (AS) was considered to be an axial variant of rheumatoid arthritis, and it wasn't until the 1960s that (especially European) rheumatologists started to realize that this disease was a distinct separate entity. In the 1970s Moll and Wright published seminal work formulating the unified concept of 'seronegative spondarthritis'; 'seronegative' referred to the abscence of rheumatoid factors (considered to be typical for rheumatoid arthritis), whereas the prefix 'spond-' was used to emphasize the close relationship between the different diseases and AS. In the original description, diseases such as AS, psoriatic arthritis (PsA), reactive arthritis, and arthritis/spondylitis associated with inflammatory bowel diseases (Crohn's disease, ulcerative colitis) were included. The concept was clinically characterized by peripheral arthritis and enthesitis, radiological sacroiliitis (with or without spondylitis), evidence of clinical overlap (including skin, gut and eye disease) and a tendency for familial aggregation. Shortly after the initial description of the SpA concept, the discovery of a strong association of these diseases with the genetic marker Human Leucocyte Antigen (HLA) B27 was simultaneously reported by two independent research groups, providing further support to this unifying theory.
Abstract and Introduction
Abstract
Purpose of review The field of spondyloarthritis (SpA) has evolved enormously over the last few years, starting with the advent of biological therapies at the end of the previous millenium. A lot of work has been done to construct valid outcome measures and treatment guidelines based upon the results of pivotal studies with Tumor necrosis factor (TNF)-blocking agents. Most of these trials were performed in well described populations, such as patients suffering from ankylosing spondylitis (AS) or psoriatic arthritis.
Recent findings Over recent years a reappraisal has been done with regard to considering again the full spectrum of diseases belonging to the SpA concept, especially in early disease stages. This effort culminated in the construction of new classification criteria for axial and peripheral SpA. Around the same time, a number of patient registries were set up, allowing the follow-up of patients in order to study the natural evolution of patients classified early. The first data from these cohorts provide interesting information on peripheral joint manifestations such as arthritis, enthesitis or dactylitis. Recognition and monitoring of these manifestations are essential for clinicians in order to provide comprehensive patient care.
Summary There is a growing interest in the field of SpA to move from rather restricted and longstanding diseases such as AS to a more comprehensive view, encompassing not only inflammatory back pain, but also peripheral arthritis and enthesitis, as well as extra-articular manifestations. The new classification criteria and guidelines for follow-up are applied now in a number of prospective patient registries, and provide us with valuable information on the early disease stages of SpA.
Introduction
The spondyloarthritides (SpA) are a family of heterogeneous diseases which, however, share common clinical, radiological, genetic and even therapeutic characteristics. Originally, a disease such as ankylosing spondylitis (AS) was considered to be an axial variant of rheumatoid arthritis, and it wasn't until the 1960s that (especially European) rheumatologists started to realize that this disease was a distinct separate entity. In the 1970s Moll and Wright published seminal work formulating the unified concept of 'seronegative spondarthritis'; 'seronegative' referred to the abscence of rheumatoid factors (considered to be typical for rheumatoid arthritis), whereas the prefix 'spond-' was used to emphasize the close relationship between the different diseases and AS. In the original description, diseases such as AS, psoriatic arthritis (PsA), reactive arthritis, and arthritis/spondylitis associated with inflammatory bowel diseases (Crohn's disease, ulcerative colitis) were included. The concept was clinically characterized by peripheral arthritis and enthesitis, radiological sacroiliitis (with or without spondylitis), evidence of clinical overlap (including skin, gut and eye disease) and a tendency for familial aggregation. Shortly after the initial description of the SpA concept, the discovery of a strong association of these diseases with the genetic marker Human Leucocyte Antigen (HLA) B27 was simultaneously reported by two independent research groups, providing further support to this unifying theory.
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