Seronegative Spondyloarthritis (SpA): Causes, Symptoms & Treatment Guide

Seronegative Spondyloarthritis (SpA) is a group of inflammatory joint diseases that are negative for rheumatoid factor (RF) and share genetic association with HLA-B27, along with similar articular and extra-articular manifestations.

 Mnemonic: "S.E.R.O. = Spondyloarthritis Excludes Rheumatoid factor & Overlaps in Features"

---

TYPES OF SERONEGATIVE SPONDYLOARTHRITIS

1. Ankylosing Spondylitis (AS) → Chronic spine & sacroiliac joint inflammation → Bamboo Spine.
2. Reactive Arthritis (Reiter’s Syndrome) → Post-infectious arthritis → Conjunctivitis, Urethritis, Arthritis.
3. Psoriatic Arthritis (PsA) → Associated with psoriasis → Nail Changes, Dactylitis.
4. Enteropathic Arthritis (EA) → Associated with Inflammatory Bowel Disease (IBD) → Crohn’s, Ulcerative Colitis.

Mnemonic: "A.R.P.E. = Ankylosing, Reactive, Psoriatic, Enteropathic Arthritis"

---

CAUSES & RISK FACTORS

• HLA-B27 Gene (Strongest Risk Factor – Present in >90% of AS Cases).
• Genetic Predisposition (Family History Common).
• Post-Infection Triggers (Chlamydia, Dysentery in Reactive Arthritis).
• Inflammatory Bowel Disease (In Enteropathic Arthritis).
• Psoriasis (In Psoriatic Arthritis).

 Mnemonic: "H.G.P.I.P. = HLA-B27, Genetics, Post-Infection, IBD, Psoriasis"

---

PATHOLOGY OF SERONEGATIVE SPONDYLOARTHRITIS

• Non-Specific Synovitis (Inflammation of Joint Lining).
• Enthesitis (Inflammation of Ligament & Tendon Insertions – Key Feature!).
• Cartilage & Subchondral Bone Involvement (Leads to Fusion & Deformities).
• Syndesmophytes (Bony Growths Bridging Vertebrae – Seen in AS).
• Fibrosis & Calcification of Joints (Leads to Joint Stiffness).

 Mnemonic: "S.E.C.S.F. = Synovitis, Enthesitis, Cartilage Damage, Syndesmophytes, Fibrosis"

---

SYMPTOMS OF SERONEGATIVE SPONDYLOARTHRITIS

• Inflammatory Back Pain (Worse in Morning, Improves with Activity).
• Sacroiliitis (Pain in Buttocks, Lower Back Stiffness).
• Peripheral Arthritis (Knees, Ankles, Wrists in PsA & EA).
• Enthesitis (Heel Pain, Achilles Tendinitis).
• Dactylitis ("Sausage Fingers" in Psoriatic & Reactive Arthritis).
• Extra-Articular Symptoms: Uveitis (Eye Inflammation), Skin Lesions (PsA), Bowel Symptoms (EA).

 Mnemonic: "B.S.P.E.D.E. = Back Pain, Sacroiliitis, Peripheral Arthritis, Enthesitis, Dactylitis, Extra-Articular Features"

---

DIAGNOSIS OF SERONEGATIVE SPONDYLOARTHRITIS

 Clinical Examination (Inflammatory Back Pain, Enthesitis, Peripheral Joint Swelling).
 Blood Tests:

• HLA-B27 Positive (Seen in Most Cases).
• CRP & ESR Elevated (Indicates Inflammation).
• Rheumatoid Factor (RF) & Anti-CCP Negative (Differentiates from RA).
   X-ray (Best for Late Disease) → Sacroiliitis, Syndesmophytes.
   MRI (Best for Early Disease) → Detects Early Sacroiliitis, Bone Marrow Edema.

 Mnemonic: "C.B.X.M. = Clinical, Blood, X-ray, MRI"

---

TREATMENT OF SERONEGATIVE SPONDYLOARTHRITIS

1. LIFESTYLE & SUPPORTIVE CARE

• Exercise & Physiotherapy (Prevents Spinal Deformities, Improves Mobility).
• Posture Training (Keeps Spine Straight in AS).
• Weight Loss (Reduces Joint Load).

 Mnemonic: "E.P.W. = Exercise, Posture, Weight Loss"

---

2. MEDICAL MANAGEMENT

• NSAIDs (First-Line for Pain & Inflammation – Indomethacin, Naproxen).
• DMARDs (For Peripheral Arthritis – Sulfasalazine, Methotrexate).
• Biologics (TNF-α Inhibitors – Etanercept, Infliximab for Severe Cases).
• Steroids (For Severe Flares or Extra-Articular Involvement).

 Mnemonic: "N.D.B.S. = NSAIDs, DMARDs, Biologics, Steroids"

---

3. SURGICAL MANAGEMENT (For Severe Cases)

• Hip Replacement (For Severe Hip Arthritis in AS).
• Spinal Surgery (For Severe Spinal Fusion & Deformity).

 Mnemonic: "H.S. = Hip Replacement, Spinal Surgery"

---

HOMOEOPATHIC MANAGEMENT OF SERONEGATIVE SPONDYLOARTHRITIS

• For Chronic Back Pain & Stiffness:
• Rhus Tox, Bryonia, Calcarea Fluor, Ruta.

• For Enthesitis & Joint Inflammation:
• Kali Carb, Causticum, Hypericum, Ledum Pal.

• For Extra-Articular Symptoms (Uveitis, Skin, Bowel Issues):
• Natrum Mur, Sulphur, Thuja, Medorrhinum.

Mnemonic: "R.B.C.R. = Rhus Tox, Bryonia, Calc Fluor, Ruta for Back Pain"

---

FINAL REVISION WITH MNEMONICS

• Definition = "S.E.R.O. = Spondyloarthritis Excludes Rheumatoid factor & Overlaps in Features"
• Types = "A.R.P.E." (Ankylosing, Reactive, Psoriatic, Enteropathic Arthritis)
• Causes = "H.G.P.I.P." (HLA-B27, Genetics, Post-Infection, IBD, Psoriasis)
• Pathology = "S.E.C.S.F." (Synovitis, Enthesitis, Cartilage Damage, Syndesmophytes, Fibrosis)
• Symptoms = "B.S.P.E.D.E." (Back Pain, Sacroiliitis, Peripheral Arthritis, Enthesitis, Dactylitis, Extra-Articular Features)
• Diagnosis = "C.B.X.M." (Clinical, Blood, X-ray, MRI)
• Lifestyle = "E.P.W." (Exercise, Posture, Weight Loss)
• Medical = "N.D.B.S." (NSAIDs, DMARDs, Biologics, Steroids)
• Surgical = "H.S." (Hip Replacement, Spinal Surgery)
• Homeopathy = "R.B.C.R." (Rhus Tox, Bryonia, Calc Fluor, Ruta for Back Pain)