Spondyloarthritis is an inflammatory rheumatic disease affecting the spine, joints and entheses (which are sites of insertion of a ligament, tendon, or articular capsule into bone, for example, the Archilles tendonitis, plantar fasciitis). It is a collective group of several related diseases, including ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, reactive arthritis and undifferentiated spondyloarthritis.
Ankylosing spondylitis is a long-term disease that affects the joints in the spine, pelvis and, often, the peripheral joints such as hips, knees, ankles and feet as well. The main problem is chronic inflammation that may eventually cause the spine to fuse together.
The condition usually starts with low back pain that is worse at night, in the morning, or after prolonged inactivity, and tends to improve with exercise. Limited expansion in the chest may occur as a result of inflammation of the joints between the ribs. As the disease progresses, any portion of the spine may be affected.
The disease affects more males than females although females can also be affected. It tends to begin between the age of 20 and 40. Risk factors include having an affected family member and male gender.
Psoriasis is a scaly rash that can affect any part of the body, but most frequently the elbows, knees and scalp. In about 5 – 10% of patients with psoriasis, arthritis may also occur, giving rise to psoriatic arthritis. Apart from involvement of the spine, pelvis and joints, psoriatic arthritis is often accompanied by changes in the fingernails and toenails such as the appearance of small pits.
Enteropathic arthritis is a form of spondyloarthritis that is associated with inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, which typically causes inflammation of the intestines. About 1 in 6 people with inflammatory bowel disease will develop enteropathic arthritis affecting the spine and joints.
Reactive arthritis refers to a type of spondyloarthritis that may be triggered by certain germs which cause gastroenteritis or urinary tract infections. Reiter’s syndrome is a form of reactive arthritis which may also affect the eyes and the skin.
Not all patients have classic signs and symptoms that fit neatly into one of the categories outlined above, especially at the start of the illness. In such cases, the term, undifferentiated spondyloarthritis may be used.
In spondyloarthritis, there is inflammation of the spine, joints and entheses. If it involves fingers and toes, they may swell and take the appearance of ‘sausage digits’.
All of the diseases mentioned above display a variety of symptoms and signs, but they share many similarities, including:
Sacroiliitis (inflammation of the joint between the pelvis and the spine) and spondylitis (inflammation of the joints between the spine)
Presence of enthesitis (inflammation of an entheses)
Absence of positive blood test for rheumatoid factor ('seronegative')
A tendency to occur in more than one family member
Providing a detailed history of your symptoms to your doctor is crucial, as the diagnosis can often be made based on your symptoms.
This family of conditions are recognised as chronic autoimmune diseases with unknown cause, but genes may play a role and an infective trigger may sometimes be present.
In addition to taking a history and examination, your doctor may recommend certain blood tests such as a Full Blood Count, ESR, HLA-B27, and x-rays of the spine and pelvis to support the diagnosis.
HLA-B27 is a known genetic marker for ankylosing spondylitis. However, most HLA-B27 individuals do not have the disease, therefore it is not advisable to have the test if you do not have symptoms of ankylosing spondylitis, even if you have an affected relative.
As a first line treatment, your doctor may prescribe non-steroidal antiinflammatory drugs (NSAIDs) to reduce inflammation and pain. Occasionally corticosteroids may be prescribed for short-term use to suppress unwanted inflammation. Sometimes more potent drugs such as methotrexate or sulfasalazine may be prescribed if you do not respond well to NSAIDs or are dependent on high dose steroids.
Newer drugs called TNF blockers which block inflammatory proteins, have been shown to be highly effective in treating arthritis of the joints as well as spinal arthritis. This group of medication include Enbrel®, Remicade® and Humira®.
Surgery may very occasionally be needed if joint damage is severe and there are signifi cant secondary degenerative changes.
Exercise plays a very important role in helping to improve posture by reducing stiffness and pain. Most patients will benefit from a daily home exercise regime as recommended by a physiotherapist.
Excessive inactivity can certainly increase the risk for spinal fusion.
However, bear in mind that if you have ankylosing spondylitis, you should avoid high impact sports and heavy weight bearing exercises due to the increased risk of spinal fracture.
The symptoms of spondyloarthritis may either worsen, stabilise at any stage of the disease, or go into remission. The course of the disease is thus unpredictable.
Symptoms may come and go at any time. However, unless there is a major flare, most people are able to carry out activities of daily living normally if the disease remains under control.
In more extreme or long-term cases, damage of the joints and bones can lead to fusion of the joints in the spine or other areas, which can subsequently affect walking and function. As spondyloarthrits is a chronic disease, long-term follow up by a doctor is recommended.
Overview of spondyloarthritis what you need to know. Spondylitis Association of America - Ankylosing Spondylitis. (2024, June 21). https://spondylitis.org/about-spondylitis/overview-of-spondyloarthritis/
Patty Weasler, R. (2023, May 27). Peripheral spondyloarthritis: Symptoms and causes. Verywell Health. https://www.verywellhealth.com/peripheral-spondyloarthritis-6831335
Spondyloarthritis. Spondyloarthritis Symptoms and Treatment - Brigham & Women's Hospital. (n.d.). https://www.brighamandwomens.org/medicine/rheumatology-inflammation-immunity/services/spondyloarthritis
Spondyloarthritis. (n.d.). https://rheumatology.org/patients/spondyloarthritis
Khan, M. (2023). Axial spondyloarthritis. Ankylosing Spondylitis and Axial Spondyloarthritis, 16–21. https://doi.org/10.1093/oso/9780198864158.003.0002
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