Pp. 27-49 (23)
Spondyloarthropathies (SpA) are a group of chronic inflammatory
arthropathies affecting the spine, sacroiliac joints, entheses and extra-articular sites.
Clinical characteristics of spondyloarthritis are: peripheral arthritis, mainly in the lower
limbs, asymmetrical, tendency for radiographic sacroilitis, no rheumatoid factor and
presence of subcutaneous nodules. Significant familiar occurrence and association with
HLA-B27 are characteristics for SpA. Diseases belonging to the group of
spondyloarthritis are: ankylosing spondylitis, reactive arthritis (ReA), enteropathic
arthritis (Crohn’s disease, ulcerative colitis), psoriatic arthritis (PsA), undifferentiated
spondyloarthritis and juvenile chronic arthritis (juvenile onset ankylosing spondylitis).
SpA occurs due to genetic predisposition especially in patients with positive test for
major histocompatibility complex (MHC) class I molecule HLA-B27. Environmental
factors are also involved in the pathogenesis. Extra-articular features include skin
lesions in PsA, gut involvement in inflammatory bowel disease-related arthritis and the
oculo-urethrosynovial triangle in ReA.
NSAIDs and anti TNFα drugs are effective in the treatment of axial manifestations of
AS. Acute episodes of ReA are treated using NSAIDs and is used as the first line
treatment. In more severe cases including NSAIDs resistance, systemic or prolonged
disease, systemic GCS may be used. Management of peripheral arthritis in PsA:
NSAIDs, GCS, DMARDS: MTX, or Sulfasalazine or Ciclosporin or Leflunomide, anti
–TNFα, new options for treatment includes inhibitor IL-17 (ixekizumab or
secukinumab), ustekinumab – a fully human IgG 1k monoclonal antibody that binds to
the common p40 subunit shared by interleukins 12 and 23, and apremilast – a
Ankylosing spondylitis (AS), Anterior uveitis, antiTNFα drugs,
Apremilast, Asymmetrical, Crohn’s disease, Entheses, HLA-B27, Ixekizumab,
Lower limb, NSAIDs, Oculo-urethrosynovial triangle, Peripheral arthritis,
Psoriatic arthritis (PsA), Reactive arthritis (ReA), Sacroiliac joints, Secukinumab,
Spine, Spondyloarthropathies (SpA), Ulcerative colitis, Undifferentiated
Head of Rheumatology and Internal Diseases Department CSK MSWiA Warsaw Poland.