The spondyloarthropathies (SpA) are a group of inflammatory rheumatic diseases affecting the spine, peripheral joints and nonarticular structures. Often referred to as "seronegative" due to the absence of rheumatoid factor, SpA include ankylosing spondylitis (AS), reactive arthritis (ReA), enteropathic (IBD) associated arthritis, psoriatic arthritis (PsA), as well as undifferentiated, and juvenile SpA. A broad and overlapping spectrum of disease presentations creates difficulties in determining an initial diagnosis. In the last 10 years treatment options have expanded.