Clinical manifestations and diagnosis of peripheral spondyloarthritis in adults
- David T Yu, MD
David T Yu, MD
- Emeritus Professor
- University of California Los Angeles
- Astrid van Tubergen, MD, PhD
Astrid van Tubergen, MD, PhD
- Maastricht University Medical Center
Peripheral spondyloarthritis (SpA) is the term used to describe patients with features of SpA whose symptoms and findings are predominantly or entirely peripheral rather than axial; these features include arthritis, which is predominantly of the lower limbs and/or asymmetric; enthesitis; and dactylitis. Patients included in this category, who have these findings in common, include those with psoriatic arthritis (PsA), reactive arthritis, SpA related to inflammatory bowel disease (IBD), and the subset of patients with such manifestations who do not meet established definitions for these forms of SpA. Patients with ankylosing spondylitis and non-radiographic axial SpA are not included within the peripheral SpA category, even if peripheral manifestations of musculoskeletal involvement are also present [1,2].
A clear distinction between the clinically defined subsets of patients with peripheral SpA is often lacking, other than for those with PsA. As examples, in a considerable number of patients skin manifestations of psoriasis do not occur until after the manifestation of rheumatic symptoms; preceding infections may be clinically asymptomatic, as an example, with Chlamydia; and IBD can also be asymptomatic when patients present with musculoskeletal symptoms [3,4].
An overview of the clinical manifestations, diagnosis, and differential diagnosis of peripheral SpA in adults will be presented here. The treatment of peripheral SpA; the classification of SpA; and the clinical manifestations, diagnosis, and treatment of ankylosing spondylitis, non-radiographic axial SpA, PsA, reactive arthritis, arthritis associated with IBD, and SpA in children are discussed in more detail separately. (See "Treatment of peripheral spondyloarthritis" and "Overview of the clinical manifestations and classification of spondyloarthritis" and "Clinical manifestations of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults" and "Clinical manifestations and diagnosis of psoriatic arthritis" and "Diagnosis and differential diagnosis of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults" and "Spondyloarthritis in children" and "Reactive arthritis" and "Assessment and treatment of ankylosing spondylitis in adults" and "Clinical manifestations and diagnosis of arthritis associated with inflammatory bowel disease and other gastrointestinal diseases".)
EPIDEMIOLOGY AND NATURAL HISTORY
The global prevalence of spondyloarthritis (SpA), including axial and peripheral SpA, has been estimated at about 1 percent [5,6]; about one-quarter of SpA patients overall may exhibit predominantly peripheral SpA, although the incidence and prevalence of peripheral SpA alone has not been well-studied. Study results vary widely between different populations and ethnic groups, which can at least partly be explained by differences in the prevalence of human leukocyte antigen (HLA)B27. Other important contributors to these differences are heterogeneity in the populations analyzed, variation in the criteria used for case definition, and the number of participants approached and included in each study.
The prevalence of SpA was estimated to be 0.43 percent in a large population-based cohort representative of the French population, consisting of 20,625 employees of the French national electricity and gas company ; the proportion with peripheral SpA was 25 percent, consistent with a prevalence estimate within the French population of 0.11 percent.
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- EPIDEMIOLOGY AND NATURAL HISTORY
- CLINICAL MANIFESTATIONS
- Musculoskeletal features
- Inflammatory eye disease
- Inflammation of the bowel mucosa
- LABORATORY FINDINGS
- DIAGNOSIS AND CLASSIFICATION
- Diagnostic strategy
- Use of classification criteria
- Peripheral SpA subgroups
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS