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Rheumatology 2000; 39: 360-368
© 2000 British Society for Rheumatology

Reviews

Managing seronegative spondarthritides

L. Koehler, J. G. Kuipers and H. Zeidler

Division of Rheumatology, Department of Internal Medicine, Medical School Hannover, Carl-Neuberg Strasse 1, D 30625 Hannover, Germany


   Introduction
 
Over the last several decades the classification of rheumatoid factor-negative arthritis has changed substantially. For some time it was common practice to consider psoriatic arthritis, Reiter's syndrome, and ankylosing spondylitis as ‘atypical’ or ‘special forms of rheumatoid arthritis’, as reflected in the proposed classification of rheumatic diseases by the International League Against Rheumatism in 1957 [1]. As described by Moll et al. [2] the school of ‘lumpers’, who preferred to group the so-called ‘variants of rheumatoid arthritis’ with rheumatoid arthritis itself, were overcome by the school of ‘splitters’, prompted by the idea that these seronegative arthritides were, in fact, entirely separate entities. This change was mirrored by the Nomenclature and Classification of the Rheumatic Diseases proposed by the American Rheumatism Association in 1963 [1]. Rheumatoid arthritis, juvenile Still's disease, ankylosing spondylitis, psoriatic arthritis, and Reiter's syndrome were then classified under separate headings with . . . [Full Text of this Article]


   How can we overcome the outdated classification of ‘seronegative arthritis’ by a rational, cost-effective diagnostic strategy?
 

   Which follow-up measurements are really needed for routine management?
 

   Symptom- and problem-orientated therapeutic management
 
Spinal disease
Enthesiopathy
Peripheral arthritis
Underlying chronic or persistent infections
Management of refractory spondarthritides

   Future perspectives
 

   Conclusions
 

   Acknowledgments
 

   Notes
 

   References
 

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