Seronegative spondylitis is spine inflammation that occurs with a blood test that is negative for possible causes.

Back pain happens for a variety of reasons, such as mechanical issues, structural problems, or inflammatory conditions. Other medical issues such as kidney stones or infection may also contribute to spine discomfort.

Seronegative spondylitis is an inflammatory cause of back pain.

This article will provide an overview of seronegative spondylitis and discuss symptoms, causes, diagnosis, and treatment.

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Seronegative spondylitis is a type of inflammatory spine disease.

“Seronegative” refers to a lab test result that shows very small or no amounts of a substance such as an antibody.

Some types of joint inflammation, such as rheumatoid arthritis, are seropositive and occur with autoantibodies such as rheumatoid factor. However, a seronegative result means that no or minimal antibodies were present in the lab test.

Spondylitis is inflammation in the joints of the spine. If enough inflammation and growth occur, the joints can get stiff or fuse together, and the condition becomes ankylosing spondylitis.

Seronegative spondylitis is a type of spondyloarthritis, which is a group of diseases featuring inflammation in the spine and joints, such as:

Spondyloarthritis conditions fall into one of three categories:

  • axial, affecting the spine and hips
  • peripheral, affecting tendons and joints in areas other than the spine
  • juvenile onset

Seronegative spondylitis is in the axial category, and doctors sometimes refer to it as axial spondyloarthritis.

People may also call it nonradiographic axial spondyloarthritis. “Nonradiographic” refers to X-ray results that do not show the spine changes seen in ankylosing spondylitis.

However, nonradiographic axial spondyloarthritis may cause spine damage that is visible on a magnetic resonance imaging (MRI) scan.

Seronegative spondylitis symptoms may include:

  • persistent back, buttock, and hip pain
  • fatigue
  • tenderness from inflammation
  • appetite loss
  • range of motion limitations
  • back pain and stiffness that is worse at night, in the morning, or with lack of movement
  • reduction in back pain and stiffness with physical activity
  • restriction in chest expansion

Symptoms may also include pain, redness, swelling, and warmth in the following areas:

  • neck
  • shoulders
  • upper spine
  • rib cage
  • knees
  • ankles
  • heels
  • toes

If seronegative spondylitis progresses to become ankylosing spondylitis, symptoms such as reduced range of motion and chest expansion restriction may be more noticeable.

Seronegative spondylitis often occurs with the gene HLA-B27.

An estimated 9 in 10 people with ankylosing spondylitis also have the HLA-B27 gene, which usually occurs in only about 7% of the United States population.

One theory is that the HLA-B27 gene may change a person’s gut microbiome, which controls the immune system. Microbiome disruption from the gene may affect the immune system enough to trigger seronegative spondylitis.

Most people with the HLA-B27 gene never develop seronegative spondylitis. However, for some people with the gene, exposure to a trigger such as bacteria or a virus can cause the onset of inflammation and symptoms.

There are several areas doctors assess when diagnosing seronegative spondylitis.

A review of the person’s symptoms may offer relevant information, and a physical examination can reveal:

  • pain locations
  • lumbar flexion
  • upper thoracic mobility
  • cervical spine mobility

Doctors also use imaging to look for bone changes characteristic of ankylosing spondylitis, such as calcification and squaring of vertebral bodies.

They may also look for certain accompanying conditions or risk factors, including:

Blood tests can rule out the autoantibodies characteristic of seropositive disease. A doctor may also order genetic testing to look for the HLA-B27 gene.

The presence of enthesitis can also help doctors tell whether a person’s symptoms are from seronegative spondylitis instead of a seropositive condition such as rheumatoid arthritis. Enthesitis is inflammation in the locations where ligaments and tendons insert into bone.

The goal of treatment for seronegative spondylitis is to:

  • ease symptoms
  • reduce functional interference
  • lower the chance of complications

Exercise

Exercise for seronegative spondylitis may help to preserve a person’s spine strength and range of motion. A physical therapist can provide instructions on how to safely perform beneficial exercises.

Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first type of medication doctors suggest.

However, sometimes NSAIDs are not effective for symptom management, cause unwanted side effects, or a person cannot use them because of another medical condition.

When NSAIDs do not work, other options include biologics — such as infliximab, adalimumab, etanercept, certolizumab, and golimumab — and the monoclonal antibody secukinumab.

Nonbiologic disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and sulfasalazine may also help people experiencing peripheral artery disease, but they are not effective for treating spinal pain and inflammation.

Self-care

There are self-care strategies a person can use that may help to ease their symptoms of seronegative spondylitis:

Stress management activities may also help, such as meditation and deep breathing exercises.

Seronegative spondylitis is a spine disease featuring inflammation. Blood tests reveal only small amounts or the absence of autoantibodies.

Symptoms include persistent back pain, fatigue, and tenderness.

Doctors diagnose seronegative spondylitis using tools such as a symptom assessment, physical exam, and imaging and blood tests.

Exercise and medication may provide symptom relief and reduce or prevent disease progression.