SERONEGATIVE SPONDYLOARTHRITIS: PATHOGENESIS, CLINICAL COURSE, DIAGNOSTIC AND TREATMENT APPROACHES

Аннотация

Seronegative spondyloarthritides (SpA) represent a heterogeneous group of chronic, immune-mediated inflammatory disorders that primarily affect the axial skeleton, peripheral joints, and entheses. They are termed "seronegative" due to the absence of rheumatoid factor (RF) in the patient's serum. This article reviews the etiology, pathogenesis, clinical progression, diagnostic modalities, and modern treatment strategies of seronegative spondyloarthritis, with references to local medical sources and clinical experiences relevant toUzbekistan. Introduction Seronegative spondyloarthritides include several diseases such as ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis (associated with inflammatory bowel disease), and undifferentiated spondyloarthritis. Despite their differences, these diseases share several features: familial aggregation, HLA-B27 positivity, axial involvement,and enthesitis. In Uzbekistan, rheumatologic diseases are being diagnosed and treated more frequently due to increasing awareness and access to imaging modalities such as MRI. This article aims to provide a detailed overview of these conditions with attention to their relevance inlocal clinical practice. EtiologyandPathogenesis 1.Genetic Predisposition HLA-B27 is the most important genetic marker associated with SpA, found in up to 90–95% of patients with ankylosing spondylitis. Other genes such as ERAP1, IL-23R also contribute to diseasesusceptibility. page2242 INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE ISSN:2692-5206,ImpactFactor:12,23 AmericanAcademicpublishers,volume05,issue05,2025 Journal: https://www.academicpublishers.org/journals/index.php/ijai 2. Environmental and Microbial Triggers Infections caused by Yersinia, Salmonella, Shigella, and Chlamydia trachomatis can trigger reactive arthritis, particularly in genetically predisposed individuals. 3. Immunopathogenesis .The immune response involves activation of innate immunity and Th17 lymphocytes.Cytokines like TNF-α, IL-17, and IL-23 play key roles in the inflammatory process. Enthesitis(inflammation at tendon and ligament insertions)isa hallmark feature. 4. Gut-Joint Axis.Dysbiosis in intestinal microbiota contributes to systemic inflammation via mucosal immunesystem interaction. Clinical ManifestationsandCourse Common Clinical Features:Inflammatory back pain: Often starts before age 45, insidious onset, morning stiffness, improves with exercise.Peripheral arthritis: Mostly asymmetric and oligoarticular.Enthesitis: Painat siteslikeAchilles tendon and plantar fascia. Dactylitis:"Sausage" swellingof fingers ortoes. Extra-articular manifestations: Uveitis, psoriasis, and bowel inflammation.Disease Progression in Patients:In early stages, symptoms may be nonspecific or mild.Over time, if untreated, patients may develop: Fusion ofspinal vertebrae (bamboo spine inAS).Disability dueto jointankylosis, Systemiccomplications (e.g., amyloidosis, cardiovascular disease). Modern DiagnosticApproaches. Clinical Evaluation:ASAS criteria for axial and peripheral spondyloarthritis are commonly used.Thorough history and physical examination focusing on inflammatory pain, family history, andextra-articular symptoms. Laboratory Tests: Negative RFand anti-CCPhelp differentiate from rheumatoid arthritis. HLA-B27 testing isuseful, especially in axial forms. Elevated ESR and CRPmay indicate activeinflammation. Imaging: X-ray ofsacroiliac jointsis essential for structural changes. MRIis more sensitive, revealing early sacroiliitis and enthesitis. Ultrasound can help detect peripheral enthesitis and synovitis. page2243 INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE ISSN:2692-5206,ImpactFactor:12,23 AmericanAcademicpublishers,volume05,issue05,2025 Journal: https://www.academicpublishers.org/journals/index.php/ijai TreatmentApproaches 1. Non-pharmacologic Measures:Patient education: Self-management and awareness.Physical therapy: Regular spinal mobilityexercises.Smoking cessation: Smoking worsens axial SpA. 2.PharmacologicTreatment:NSAIDs: First-line agents for pain and stiffness. Conventional DMARDs: Such as sulfasalazine and methotrexate, useful for peripheral arthritis.Biologic DMARDs:TNF inhibitors: (Etanercept, Adalimumab, Infliximab) – highly effectivefor axialand peripheral forms. IL-17 inhibitors:(Secukinumab) –emerging evidence supports theiruse. JAKinhibitors:Under investigation forSpAtreatment. 3. Surgical Intervention:Indicated in advanced cases with joint destruction,especially hip replacement in severe ankylosis. Prognosis With early detection and proper management, many patients can lead functional lives. However, delayed diagnosis, poor treatment compliance, and lack of access to biologics can lead to disability and reduced quality of life.Challenges in Uzbekistan.Limited access to MRI and biologics in rural regions.Insufficient early diagnosis, especially in young patients with back pain.Need forcontinuing medical education onrheumatic diseases