Seronegative Arthritis /HLA B27

(3rd Party Info.) illness is suggestive of spondyloarthropathy.

What Is Seronegative Spondyloarthropathy?
In the broadest sense, the term spondyloarthropathy includes joint involvement of vertebral column from any type of joint disease, including rheumatoid arthritis and osteoarthritis.  But the term seronegative  spondyloarthropathy is often used for a specific group of disorders with certain common features.  You can group yourself under this seronegative spondylarthropathies. 

Typically, patients of this group have an increased incidence of HLA-B27, as well as negative rheumatoid factor and anti-nuclear antibodies (ANA).

Seronegative spondyloarthropathy can further be of various types, such asankylosing spondylitis,  psoriatic arthritis with associated skin problems, spondylitis with associated inflammatory bowel or Crohn’s disease and reactive arthritis.

How to Diagnose Seronegative Spondyloarthropathy?
The presence of following characteristic features helps concluding a diagnosis:

Asymmetric peripheral arthritis(which serves as an important distinguishing factor with rheumatoid arthritis) is present. Any joint big or small can be affected.
Lower back pain is the most common clinical presentation. This back pain is unique because it decreases with activity.There is a relation to HLA-B27.
Inflammatory arthritis, generallysacroiliitis (hip girdle) and spondylitis (lumbar spine) is often there.Enthesitis (inflammation of the sites where tendons or ligaments insert into the bone) is there. For example,joints of the ribs. Patient feels pain on chest expansion.
The disease condition often runs in the family.
Rheumatoid factor is not present. Blood test for RF and ANA is negative.
Extra-articular features, such as involvement of eyes, skin and genitourinary tract may be found.
ESR and other acute-phase reactants (eg, C-reactive protein) are inconsistently elevated in patients in patients with active disease.

Diagnosis is confirmed by a rheumatologist after examination and blood work, showing negative RF and ANA. Increased ESR and other acute-phase reactants.

Presence of HLA B-27 may or may not be confirmed. Long standing ankylosing spondylitis may also lead to the fusion of vertebrae known as bamboo spine.

Treatment

Medications to reduce pain and suppress joint inflammation and muscle spasm are the first to be given. They increase the range of motion, which facilitates exercise and prevents contractures. Most NSAIDs do work and tolerance and toxicity towards them dictate the drug choice.The daily dose of NSAIDs should be as low as possible, but maximum doses may be needed with active disease. Drug withdrawal should be attempted only slowly, after systemic and joint signs of active disease have been suppressed for several months.Another drug called sulfasalazine may help reduce peripheral joint inflammation. Dosage should be started at 500 mg/day and increased by 500 mg/day at 1-wk intervals to 1 to 1.5 g bid maintenance.Methotrexate is another drug which has to be given judiciously, but is quite effective in this illness.Systemic corticosteroids are sometimes used. Intra-articular depot corticosteroids may be given, particularly when one or two peripheral joints are more severely inflamed than others; like injecting corticosteroids into the sacroiliac joints (hip girdle).

Treatment differs from case to case. All you need is an expert rheumatologist.

Physiotherapy
For proper posture and joint motion, daily exercise and other supportive measures (eg, postural training, therapeutic exercise) are vital to strengthen muscle groups that oppose the direction of potential deformities (ie, the extensor rather than flexor muscles).

Reading while lying prone and pushing up on the elbows or pillows and thus extending the back may help keep the back flexible.Because chest wall motion can be restricted, which impairs lung function, cigarette smoking, which also impairs lung function, is strongly discouraged.Heat may be used for stiffness, including hot baths and warm showers.Ice packs can be put over swellings.Some patients feel comfort with gentle massage therapy.Electrical stimulators are tried for pain (TENS or TNS units).Losing weight to lessen stress on joints usually help.