Special RepoRt

Spondyloarthritis Spondyloarthritis comprises a group of inflammatory rheumatic diseases that share a common genetic predisposition but distinctive clinical features that primarily affect the spine, sacroiliac joints and ligaments. Extra-articular manifestations in organs such as the intestines, urinary tract, heart, eyes and skin are also frequently observed. The conditions grouped within the spondyloarthritis family include ankylosing spondylitis, psoriatic arthritis, arthritis/spondylitis associated with inflammatory bowel disease, reactive arthritis, undifferentiated spondyloarthritis, uveitis associated with the B-27 antigen, atrio-ventricular block, aortic insufficiency and j uvenile chronic arthritis [1]. The onset of the disease occurs between the third and fourth decades of life but can also occur during childhood and adolescence in a form called juvenile spondyloarthritis; however, the time of onset and clinical characteristics are different from those observed in adults. The prevalence of spondyloarthritis is approximately 0.5–1.9%, and this condition may occur in both sexes but is most often diagnosed in men because women have fewer symptoms [2]. The Assessment in Ankylosing Spondylitis (ASAS) International Society has recently established criteria for the classification of spondyloarthritis as summarized in Table 1 [3]. This classification includes joint, axial and peripheral manifestations and considers systemic and joint manifestations, demographic characteristics and other clinical parameters such as the age of onset and the presence of uveitis, psoriasis or ulcerative colitis/Crohn’s disease; a history of preceding infection (urethritis/cervicitis or diarrhea 1 month before the onset of arthritis/enthesitis/dactylitis); HLA-B27 positivity; sacroiliitis demonstrated by x-ray or MRI; and a family history of spondyloarthritis among firstor second-degree relatives [4]. Notably, extra-articular manifestations are observed in 20–60% of cases at some time during the disease course and are associated with axial or joint inflammation, including anterior uveitis in 51%, psoriasis in 20%, inflammatory bowel disease in 19% and combined symptoms in 10% of patients [5].