[Seronegative spondylarthropathy: variable manifestations, common characteristics].
A 38-year-old man and a 35-year-old woman had a 5 and 15 year history, respectively, of oligoarthritis, enthesitis, tendinitis, bursitis, and uveitis, all of varying severity. The diagnosis of these various features and symptoms, which were initially hard to classify, was undifferentiated spondylarthropathy, a member of the family of HLA-B27-associated seronegative spondylarthropathies. The arthritis of peripheral joints of the woman responded to a conventional disease-modifying antirheumatic drug (methotrexaat), but she eventually developed typical ankylosing spondylitis. The spondylarthropathy of the male patient remained undifferentiated and was refractory to conventional disease-modifying antirheumatic drugs, but it responded very well to the TNFalpha-blocking agent adalimumab. Spondylarthropathy includes several chronic, slowly progressive, inflammatory diseases. The treatment of spondylarthropathy comprises life-style advice, physical therapy, non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and local glucocorticoid injections. Conventional disease-modifying antirheumatic drugs fail to inhibit axial inflammation in spondylarthropathy, in contrast to TNFalpha-blocking agents. Early treatment of patients with severe spondylarthropathy with TNFalpha-blocking agents may prevent structural damage and functional disability.
Universitair Medisch Centrum Utrecht, afd. Reumatologie en Klinische Immunologie, F02.127, Postbus 85.500, 3508 GA Utrecht. a.vanrijthoven@umcutrecht.nl
A W A M
AW
van Rijthoven
J W G
JW
Jacobs
D000068879:Adalimumab; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D015796:HLA-B27 Antigen / Q000276:immunology; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D012720:Severity of Illness Index; D025242:Spondylarthropathies / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D015796:HLA-B27 Antigen; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D008727:Methotrexate