Seronegative Spondyloarthritis In Three Case Reports And Literature Review

Seronegative spondyloarthritis(SpA),also known as spondyloarthropathies,is a group of chronic inflammatory diseases with negative serum rheumatoid factor,including axial and peripheral inflammatory arthritis,enthesitis,and extra-articular manifestations.The diseases mainly included under this umbrella are ankylosing spondylitis(AS),Psoriatic arthritis(PsA),Reiter syndrome(RS),Inflammatory bowel disease-related arthritis(IBD-SpA),Reactive arthritis(ReA),undifferentiated spondyloarthropathy(uSpA)and SAPHO syndrome(synovitis,acne,pustules,bone hypertrophy and osteitis syndrome),and so on.Clinical features mainly included:negative tests for rheumatoid factors,no subcutaneous rheumatoid nodules,often asymmetrical peripheral inflammatory arthritis,such as tendon or ligament attachment inflammation,radiological sacroiliitis with or without spondylitis,evidence of clinical overlap between group members and tendency to familial aggregation.The development of spondyloarthropathies is a very long process,which have chronic progressive damage,high morbidity and affect the daily life and work seriously.Moreover,the period from its onset to diagnosis usually took 5 to 10 years,which might delay the treatment and aggravate the condition to a certain extent.In addition,there are no radical methods.Therefore,early specific examination,early definite diagnosis and early symptomatic treatment are essential to improve the prognosis of patients with SpAs.This study mainly involves three cases,the most typical case is ankylosing spondylitis,and two easily misdiagnosed cases are DISH and SAPHO syndrome.Most of patients might have characteristic extra-articular manifestations,such as skin and mucous membrane damage,anterior uveitis,pulmonary fibrosis,kidney damage and aortic root lesions.The study analysed the clinical data of three cases seronegative spondyloarthritis(AS,DISH and SAPHO syndrome)combined with literature review,thus we summarised the epidemiological data,clinical features,diagnostic criteria of seronegative spondyloarthritis,which was aimed at improving the identification and diagnosis levels of the clinicians on different types seronegative spondyloarthropathies.Objective:To analyze the clinical data of three cases seronegative spondyloarthropathies(AS,DISH and SAPHO syndrome)combined with literature review,summarize the common and individual clinical characteristics and diagnostic criteria of seronegative spondyloarthritis in different types,so as to enhance the awareness and diagnostic level of clinicians on seronegative spondyloarthropathy,and strive to provide guidance for clinical works.Methods:The etiology,clinical manifestations,laboratory findings and treatment strategies of the typical case--AS,rare cases--DISH and SAPHO syndrome were retrospectively analysed.Combined with review of literatures in the full text database of the Chinese Journal and the National Library of Medicine,some epidemiological data,clinical features,diagnostic criteria of seronegative spondyloarthritis were summarised.Results:1.Case summary:According to medical history,physical examination,laboratory tests and imaging studies,three cases seronegative spondyloarthritis has been clearly diagnosed.AS patient with cervical C7-T1 fracture and dislocation underwent posterior open reduction,internal fixation of C7-T1 fracture and anterior cervical plating with iliac crest autogenous bone grafting.The patient did well postoperatively,although the improvement of neurological symptoms was minor,his motivation increased,and pain from his neck disappeared.Large anterior osteophytes of DISH patient were removed with Kerrison rongeurs and high-speed air drill until the anterior spinal surface from C2 to C7 was at on palpation and on lateral scope control.The symptoms of dyspnea and dysphagia markedly improved after the surgical intervention.During the first postoperative month,the patient was able to continue his daily life.The patient with SAPHO syndrome receives anti-inflammatory,anti-osteoporosis and other conservative treatments,and pains from joints,chest wall and waist were improved effectively.2.Literature review:(1)The prevalence of seronegative spondylarthropathies is directly correlated with the prevalence of the HLA-B27 antigen in the population,and the expression of HLA-B27 might predict the tendency of SpA changing into AS.Although HLA-B27 has been established as one of the indexes in many diagnostic criteria,HLA-B27 positivity is not a requirement for the diagnosis of seronegative spondylarthropathies.(2)Seronegative spondylarthropathies in different types have some special clinical and radiologic manifestations:inflammatory spinal pain,sacroiliitis,chest wall pain,peripheral arthritis,peripheral enthesitis,dactylitis,lesions of the lung apices,conjunctivitis,uveitis and aortic incompetence together with conduction disturbances.In clinical practice,the attention to these non-specific extra-articular clinical manifestations could help clinicians avoid misdiagnosis of seronegative spondylarthropathies.(3)The Amor and ESSG criteria are the most commonly used criteria for the diagmosis of seronegative spondylarthropathies,while different diagnostic criteria should be applied to different types of seronegative spondylarthropathies respectively.Conclusions:1.The prevalence of seronegative spondyloarthritis is closely related to the positivity of HLA-B27,while HLA-B27 negativity cannot be used as an exclusive diagnostic criterion for seronegative spondyloarthritis.2.Clinicians should strengthen the understanding of seronegative spondyloarthritis.Familiarity and mastery of specific extra-articular manifestations and different diagnostic criteria can help improve the diagnosis level of seronegative spondyloarthritis and reduce the rate of misdisgnosis and the rate of missed diagnosis.