undifferentiated spondyloarthropathy
Introduction
Introduction to undifferentiated spondyloarthropathy Undifferentiated spondyloarthropathy refers to a group of diseases with certain clinical and/or radiological features of spondyloarthropathy that are atypical but have not yet reached any established diagnostic criteria for spondyloarthropathy. It is not an independent disease, nor a syndrome. It is simply a set of symptom spectrum and clinical phase. It is a temporary diagnosis, which is used to classify rheumatoid arthritis, diffuse connective tissue disease, and other rheumatic diseases. . Undifferentiated spondyloarthropathy can manifest as one or more symptoms, which can occur intermittently, with different weights and different durations. Undifferentiated spondyloarthropathy is not uncommon in clinical practice, and the majority of outpatients with seronegative spondyloarthropathy can be diagnosed as this disease. The prevalence of undifferentiated spondyloarthropathy is 3 to 10 times that of patients with ankylosing spondylitis in the same population. In the study of the family of ankylosing spondylitis, only 1/4 to 1/2 of patients with first-degree relatives have axonal sinusitis diagnosed as positive ankylosing spondylitis, and others are not. The extent of differentiated spondyloarthropathy. Therefore, patients with undifferentiated spondyloarthropathy are more common with severe spondylitis, which deserves our attention. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: tenosynovitis arthritis
Cause
Causes of undifferentiated spondyloarthropathy
(1) An early manifestation of certain axonal arthropathy, which will progress and differentiate into a certain axonal joint disease in the future;
(2) An incomplete type of a definite spinal joint disease, or "abortion type" or a frustration type, will not develop into a typical manifestation of the spondyloarthropathy in the future;
(3) belongs to a certain overlapping syndrome and does not develop into a certain axonal joint disease;
(4) Something that cannot be defined now is an unknown subtype that needs to be classified later.
Undifferentiated spondyloarthropathy is not uncommon in clinical practice, and the majority of outpatients with seronegative spondyloarthropathy can be diagnosed as this disease. The prevalence of undifferentiated spondyloarthropathy is 3 to 10 times that of patients with ankylosing spondylitis in the same population. In the study of the family of ankylosing spondylitis, only 1/4 to 1/2 of patients with first-degree relatives have axonal sinusitis diagnosed as positive ankylosing spondylitis, and others are not. The extent of differentiated spondyloarthropathy. Therefore, patients with undifferentiated spondyloarthropathy are more common with severe spondylitis, which deserves our attention.
Prevention
Undifferentiated spondyloarthropathy prevention
About 30% of patients with this disease will eventually develop into affirmative ankylosing spondylitis after a certain number of years, and the proportion of patients with HLA-B27 positive is relatively high. 5% to 10% can develop into other spondyloarthropathy, about 26% have recurrent oligoarthritis, and the remaining patients no longer progress. X-ray abnormalities appear after many years, such as ankle joint changes take 9 to 14 years, spinal lesions need 11 to 16 years. After 10 years of follow-up diagnosis of patients with ankylosing spondylitis, most of the spine function well, so the overall prognosis is good.
Complication
Undifferentiated spinal joint disease complications Complications Tenosynovitis
(1) Some manifestations of spondyloarthropathy, such as inflammatory low back pain, HLA-B27 positive attachment point disease (tendonitis, tenosynovitis, Achilles tendinitis, calcaneus or humeral periostitis), lower extremity oligoarthritis, finger (toe) inflammation, ophthalmia, skin and mucous membrane damage, increased erythrocyte sedimentation rate, etc., may be combined alone or in part. However, there is no clear radiological ankle arthritis, and there is no history of psoriasis or inflammatory bowel disease or intestinal or genitourinary infection.
(2) There is radiographic ankle arthritis without back pain or other spondyloarthropathy, or only unilateral ankle arthritis.
(3) Patients with early ankylosing spondylitis or possible ankylosing spondylitis who failed to meet the diagnostic criteria for ankylosing spondylitis (AS).
(4) Some scholars believe that children with ankylosing spondylitis or other spondyloarthropathy can be called children's undifferentiated spondyloarthropathy (JuSpA) before they can be clearly diagnosed and other diseases are excluded. Late onset ankylosing spondylitis can also be attributed to undifferentiated spondyloarthropathy before diagnosis.
Symptom
Undifferentiated spondyloarthropathy symptoms Common symptoms Joint pain Joints hard toe Heel pain Joint swelling Stomach ulcer Low back pain
More onset of concealment, both men and women can be affected, but more men, accounting for 62% to 88%. The age of onset is between 16 and 23 years old. Because women have milder lesions and fewer affected joints, the average age of onset is higher than that of men. In addition, late-onset undifferentiated spondyloarthropathy is widespread in middle-aged people. The main clinical manifestations are:
(1) inflammatory low back pain, accounting for 52% to 80%;
(2) Lower extremity-based peripheral arthritis (60% to 100%), common in the knee, hip, ankle joint. May involve one or more joints, the latter often asymmetrical polyarthritis (40%);
(3) tendon end disease, such as attachment point inflammation (56%), heel pain (20% to 28%);
(4) Ankle arthritis (16% to 30%) and spondylitis (29%). Other central axis arthritis, such as intervertebral arthritis, head and neck arthritis, and rib arthritis;
(5) Characteristic systemic manifestations such as conjunctivitis or iritis (33%), skin mucosal lesions (16%). Common skin mucosal lesions include empyema keratosis, balanitis, oral ulcers, and occasionally gangrenous pyoderma;
(6) Other clinical manifestations: There may also be multiple manifestations such as genitourinary system disease (26%), inflammatory bowel disease (4%), and heart damage (8%). A small number of HLA-B27-positive patients who develop after 50 years of age may have concave edema in the lower extremities. Dry mouth, dry eyes, may be secondary dry syndrome caused by non-specific inflammation involving the salivary glands.
Examine
Examination of undifferentiated spondyloarthropathy
(1) Rheumatoid factor and autoantibodies are mostly negative. If the rheumatoid factor is positive, the positive rate is the same as that of the same age group;
(2) HLA-B27 positive (80%84%), HLA-B27 is closely related to extra-articular symptoms, and HLA-B27-positive patients are prone to cause inflammation to develop more severely;
(3) ESR can increase (19% to 30%).
(4) IgG levels can be significantly increased.
(5) A few cases of fiberoptic colonoscopy can be found in asymptomatic inflammatory bowel disease, the pathological manifestations of chronic non-specific inflammation, direct immunofluorescence showed IgG, IgA, IgM, C3, C4, fibrinogen.
(6) X-ray, CT and MRI examinations can show ankle arthritis (16% to 30%) and spondylitis (about 20%).
Diagnosis
Diagnosis and differentiation of undifferentiated spondyloarthropathy
The diagnosis of this disease should be based on the overall classification of spondyloarthropathy, so the first step is to determine whether it is spondyloarthropathy, specifically according to the European Spine Joint Disease Study Group (ESSG) classification criteria or Amor spinal joint disease diagnosis Standard diagnosis, the latter has higher sensitivity and specificity. Then, if possible, further classified into different types of spondyloarthropathy, which are not diagnosed as a certain type of spondyloarthropathy, of course, undifferentiated spondyloarthropathy.
As far as undifferentiated spondyloarthropathy itself is concerned, there is currently no uniform standard. The authors believe that the early diagnostic criteria for undifferentiated spondyloarthropathy, which is better done and longer follow-up, are recommended as follows:
(1) Genetics
HLA-B27 was positive for 1.5 points.
(2) clinical manifestations
1 score for inflammatory spinal pain;
Spontaneous or compression of the back pain caused by the ankle, involved in the hip or the back of the thigh 1 point;
Chest pain, spontaneous or pressure-induced, or chest expansion limited ( 2.5cm) 1 point;
1 point of pain in the surrounding joint or heel;
Anterior uveitis 1 point;
The cervical or lumbar spine is limited to 1 point in all directions.
(3) Laboratory inspection
ESR increased by 1 point.
Age <50 years old: male>15mm/h, female>25mm/h
Age 50 years old: male > 20mm / h, female > 30mm / h
(4) Radiology
Spinal signs: ligament callus, vertebral body square, barrel vertebral body, Romanus or Andersson lesion, involving the bone joint or rib vertebrae joint 1 point.
A total of 3.5 points will reach the diagnostic criteria.
Because of the variety of symptoms of undifferentiated spondyloarthropathy, the performance is not typical, so the rate of misdiagnosis is high, and it is often misdiagnosed as disc herniation, rheumatoid arthritis, sciatica, lumbar muscle strain, etc., so it should be more vigilant against the disease. Pay attention to pain in the buttocks, pain in the inner thigh, pain in the hip area, as well as heel pain, foot pain and swelling of the knee joint. Check carefully for signs of attachment inflammation.
Although the low back pain is not significant or even absent in patients with undifferentiated spondyloarthropathy, it is still important to check the signs of ankle arthritis when the disease is suspected. Ankle imaging and HLA-B27 should also be performed.
In addition, many patients with undifferentiated spondyloarthropathy eventually develop ankylosing spondylitis, but the early characteristics of patients with ankylosing spondylitis have the following characteristics:
(1) The symptoms are mild and not typical;
(2) Limited spinal activity;
(3) Not necessarily arthritis;
(4) HLA-B27 is not necessarily positive, and the positive rate is higher in the group of straight spondylitis;
(5) The proportion of women with strong proportion of straight spondylitis is significantly higher, indicating that women are milder, and even if the course is longer, they are mostly undifferentiated.
