Whether or not there is any conscious awareness with a patients vegetative state is a prominent issue. Three completely different aspects of this should be distinguished. First, some patients can be conscious simply because they are misdiagnosed (see above). In fact, they are not in vegetative states. Second, sometimes a patient was correctly diagnosed but is then examined during the early stages of recovery. Third, perhaps some day the notion itself of vegetative states will change so to include elements of conscious awareness. Inability to disentangle these three example cases causes confusion. An example of such confusion is the response to an experiment using functional magnetic resonance imaging which revealed that a woman diagnosed with PVS was able to activate predictable portions of her brain in response to the testers requests that she imagine herself playing tennis or moving from room to room in her house. The brain activity in response to these instructions was indistinguishable from those of healthy patients.In 2010, Martin Monti and fellow researchers, working at the MRC Cognition and Brain Sciences Unit at the University of Cambridge, reported in an article in the New England Journal of Medicine that some patients in persistent vegetative states responded to verbal instructions by displaying different patterns of brain activity on fMRI scans. Five out of a total of 54 diagnosed patients were apparently able to respond when instructed to think about one of two different physical activities.
Conditions
The following conditions are typically included in the group of seronegative spondylarthropathies:

Some sources also include Behçets disease and Whipples disease. Common characteristics
These diseases have the following conditions in common:

Seronegative (i.e. rheumatoid factor is not present)
They are in relation to HLA-B27
Inflammatory axial arthritis, generally sacroiliitis and spondylitis
Oligoarthritis, generally with asymmetrical presentation
Enthesitis (inflammation of the entheses, the sites where tendons or ligaments insert into the bone. ), e.g. Plantar fasciitis, Achilles tendinitis, costochondritis. Familial aggregation occurs
Extra-articular features, such as involvement of eyes (anterior uveitis), skin, genitourinary tract, and aortic regurgitation
Overlap is likely between several of the causative conditions

Classification
Assessment of Spondylarthritis International Society (ASAS criteria) is used for classification of axial spondyloarthritis (to be applied for patients with back pain greater than or equal to 3 months and age of onset less than 45 years). It is of two broad types:
Sacroiliitis on imaging plus 1 SpA feature, or
HLA-B27 plus 2 other SpA featuresSacroiliitis on imaging:
Active (acute) inflammation on MRI highly suggestive of SpA-associated sacroiliitis and/or
Definite radiographic sacroiliitisSpA features:
Inflammatory back pain
Arthritis
Enthesitis
Anterior uveitis
Dactylitis
Psoriasis
Crohns disease or ulcerative colitis
Good response to NSAIDs
Family history of SpA
HLA-B27
Elevated CRP

Treatment
Many patients have more than one of the spondyloarthritis disease manifestations. Some immunosuppressive drugs have shown efficacy in more than one of the diseases, e.g. tumor necrosis factor (TNF) inhibitors. But some of the immunosuppressive drugs are particularly effective for a specific inflamed tissue and approved in only one or two of the disease entities, so an interdisciplinary approach is required. Epidemiology
Worldwide prevalence of spondyloarthropathy is approximately 1.9%. References


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