Seronegative Spondyloarthropathies (SpA)

What Are They?

The 4 Classic Members (Mnemonic: PAIR)

1. 🦴 Ankylosing Spondylitis (AS)

• Who: Young men 20s–30s, M:F = 5:1
• Features:
  • Insidious low back pain + morning stiffness, relieved by activity ("inflammatory back pain")
  • Earliest changes in sacroiliac joints → bilateral sacroiliitis
  • Progressive ossification → "bamboo spine" (late finding)
  • Enthesitis of spine, pelvis
  • Extra-articular: acute anterior uveitis/iritis (most common), aortitis, restrictive lung disease (chest wall rigidity)
• Labs: ESR↑, CRP↑, HLA-B27 positive (70–90%), RF negative
• X-ray: Sacroiliitis → syndesmophytes → bamboo spine

2. 🦠 Reactive Arthritis (formerly Reiter Syndrome)

• Classic triad: Urethritis + Conjunctivitis + Arthritis → "Can't see, can't pee, can't climb a tree"
• Who: Young adult men, 2–6 weeks after GU or GI infection
• Triggers:
  • GU: Chlamydia trachomatis, Ureaplasma
  • GI: Shigella, Salmonella, Campylobacter, Yersinia, Klebsiella
• Features:
  • Asymmetric oligoarthritis (lower limbs: knees, ankles)
  • Conjunctivitis (classic ocular manifestation)
  • Uveitis, oral ulcers, keratoderma blennorrhagicum (papulosquamous rash, palms/soles), balanitis circinata
  • Enthesitis: Achilles tendon, plantar fascia → heel pain
• HLA-B27: Positive in 2/3 of patients
• Self-limiting: Usually resolves within 1 year

3. 🩹 Psoriatic Arthritis

• Who: ~20% of patients with psoriasis
• Patterns: Asymmetric oligoarthritis, DIP joint involvement (unlike RA which hits PIP/MCP), dactylitis (sausage digits), spondylitis, arthritis mutilans
• Skin clues: Nail pitting, onycholysis, psoriatic plaques
• X-ray: "Pencil-in-cup" sign (bone resorption at DIP)

4. 🫁 Enteropathic Arthritis (IBD-associated)

• Who: Up to 40% of patients with Crohn's disease or UC
• Pattern: Acute, asymmetric, migratory inflammatory polyarthritis, knees most common
• Joint flares often mirror IBD activity
• Can also cause ankylosing spondylitis (which does NOT follow IBD flares)

Your Vignette: Conjunctivitis + Sacroiliitis

• Conjunctivitis ← eye component
• Sacroiliitis / arthritis ← joint component
• Look for a history of preceding urethritis or GI infection (1–4 weeks prior)
• Young male patient, HLA-B27 positive

"Only one third of patients with reactive arthritis will present with the classic triad of urethritis, conjunctivitis, and arthritis." — Textbook of Family Medicine 9e

"Over half of patients presenting with HLA-B27–positive acute anterior uveitis have an underlying seronegative spondyloarthropathy." — Wills Eye Manual

Treatment Summary

Reactive Arthritis (your vignette)

Ankylosing Spondylitis

Psoriatic Arthritis

Enteropathic Arthritis

Quick Summary Table

Masturbation: Effects on Sexual Life & Fertility

Is Masturbation Normal?

"No other form of sexual activity is more discussed, more condemned, and more universally practiced."

• Nearly all men and ~75% of women masturbate at some point in their lives (Kinsey data)
• It begins as early as 15–19 months as normal genital self-exploration
• It continues throughout adult life, even in people in active sexual relationships
• When coitus is unavailable or unsatisfying, masturbation serves an adaptive purpose — tension release and sensual pleasure

Effects on Sexual Life

✅ Positive / Neutral Effects

⚠️ Potential Concerns (context-dependent)

Does Daily Masturbation Cause Infertility?

Short answer: No, daily masturbation does not cause infertility.

Sperm Production Is Continuous

• The testes produce ~1,500 sperm per second continuously via spermatogenesis
• There is no "finite supply" that gets depleted by frequent ejaculation
• The epididymis stores mature sperm and is constantly replenished

What Frequent Ejaculation Does Affect (Temporarily)

• Higher progressive motility (20.5% vs 13.3%)
• Lower DNA fragmentation (19.5% vs 27%)
• Better morphology

The Key Clinical Point

Summary