Seronegative Spondylarthritis

Description

General Measures

Medicine Treatment

Referral

Arthritis, Reactive

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ICD-10 Code: M45.X0-X9/M47.9099

DESCRIPTION

• A group of diseases in which the rheumatoid factor is usually negative and the spine is often involved. 
• These disorders have certain similar clinical features and occur predominantly in individuals with HLA-B27 antigen. 
• The rheumatological manifestations in these disorders are variable, typically including asymmetrical lower-limb arthritis, sacro-iliitis, spinal inflammation (spondylitis), and enthesitis (e.g., Achilles tendonitis). 
• The spondyloarthritides include ankylosing spondylitis, reactive arthritis, psoriatic arthropathy, and the arthritides associated with inflammatory bowel disease. 
• Extra-articular manifestations may occur, especially uveitis, which occurs in about one third of patients.

GENERAL MEASURES

• Physiotherapy to prevent back deformity.

MEDICINE TREATMENT

Initiate treatment with NSAIDs.

• NSAID, e.g.:
  • Ibuprofen, oral, 400 mg 8 hourly with meals. 

LoE:I²⁵

In high-risk patients: i.e. patients >65 years of age, or with a history of peptic ulcer disease, or on concomitant warfarin, aspirin or corticosteroids:

ADD

• PPI, e.g.:
  • Lansoprazole, oral, 30 mg daily.

LoE:II²⁶

REFERRAL

• Uveitis, to an ophthalmologist.
• Psoriasis, to dermatologist and rheumatologist.
• Arthritis refractory to NSAIDs, to a rheumatologist.
• Deformity at diagnosis, to a rheumatologist.

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ARTHRITIS, REACTIVE

 

ICD-10 Code: M02.30-39

DESCRIPTION

• A spondylarthritis often preceded by enteric or urogenital infections 1–4 weeks before the arthritis and occurring predominantly in individuals with HLA-B27 antigen.
• It is a clinical diagnosis with no laboratory test or radiographic findings.
• It occurs more commonly in HIV infection.
• It is usually self-limiting. 

MEDICINE TREATMENT

• NSAIDs, e.g.:
  • Ibuprofen, oral, 400 mg 8 hourly with meals.

LoE:I²⁷

In high-risk patients: i.e. patients >65 years of age, or with a history of peptic ulcer disease, or on concomitant warfarin, aspirin or corticosteroids:

ADD

• PPI, e.g.:
  • Lansoprazole, oral, 30 mg daily. 

LoE:II²⁸

If urethritis is present, treatment may prevent further episodes of arthritis:

• Ceftriaxone, IM, 250 mg as a single dose.
  • For ceftriaxone IM injection: Dissolve ceftriaxone 250 mg in 0.9 mL lidocaine 1% without epinephrine (adrenaline).

AND

• Azithromycin, oral, 1 g, as a single dose.

LoE:III²⁹

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition