By Ratan-NM, M. Pharm.

Reviewed by Jennifer Logan, MD, MPH

Spondyloarthritis is a group of inflammatory joint diseases that affect the spine and, in some cases, the peripheral joints of the arms and legs. Some forms of spondyloarthritis may also involve the skin, intestines and eyes.

Ankylosing spondylitis is the most common form of spondyloarthritis. Reactive arthritis, psoriatic arthritis and enteropathic arthritis are other types. The major difference between spondyloarthritis and other forms of arthritis is the involvement of entheses, which are the connective region between tendon or ligament and bone.

What are the symptoms of Spondyloarthritis?

Pain and stiffness are two main symptoms associated with spondyloarthritis. Inflammation and bone damage may be seen on imaging studies.

Bone deterioration or damage can lead to eventual spine distortions and this severely impairs the function of the region around the shoulder and hips.

What are the different forms of Spondyloarthritis?

Spondyloarthritis is an umbrella term used for inflammatory joint diseases. Spondyloarthritis may be classified on the basis of two classification system:

1. The Traditional System recognizes six separate diseases – Ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis, undifferentiated spondyloarthritis and juvenile spondyloarthritis.
2. The Newer System recognizes only two categories which broadly classifies the various diseases. This includes axial spondyloarthritis – which involves mainly the spine and pelvic joint, and peripheral spondyloarthritis – which involves the arms and legs.

What causes spondyloarthritis?

Genetics plays a key role in the development of spondyloarthritis. The gene HLA-B27 is one of the most important factors held responsible for the development of the disease. However, emerging research suggests that around 30 genes have been identified for the development of ankylosing spondylitis. In addition to genetics, bacterial infections have also been associated with the initiation of enteropathic arthritis.

What are the of symptoms spondyloarthritis?

Lower back pain is the most debilitating symptom of spondyloarthritis. This can progress to spinal involvement, which may ultimately lead to spinal immobility.

In the peripheral form of spondyloarthritis, inflammation of the arms and legs is a common occurrence.

Joint swelling, osteoporosis, fatigue, heart problems, skin problems, eye redness and inflammation of the intestine are some other complications.

How is spondyloarthritis diagnosed?

Diagnosis is mainly on the basis of a clinical examination. The doctor may also recommend certain laboratory tests and imaging techniques to confirm the diagnosis.

X-rays of the pelvic joint is usually taken to assess the presence of inflammation in the pelvic joints or the sacroiliac joints. A magnetic resonance image (MRI) is recommended in cases with persistent symptoms but normal findings in an X-ray.

Laboratory tests to detect the presence of the HLA-B27 gene may also aid diagnosis.

What are the treatment options for spondyloarthritis?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the drug of choice to treat the pain and swelling associated with spondyloarthritis. Corticosteroid injections can be a good therapy option for cases with local inflammation.

Cases resistant to the above therapies can be prescribed disease-modifying antirheumatic drugs (DMARDs). DMARDs can help to provide relief from symptoms and help maintain joint function, especially of the arms and legs.

Biologics such as tumor necrosis alpha (TNF-alpha) blockers can also be used in spondyloarthritis; however, their cost and associated adverse effects make them a less popular choice.

Antibiotics can be used to treat infections in patients with reactive arthritis.

Total hip replacement is a surgical procedure which can be used to replace a damaged hip joint with a prosthetic implant. The procedure is useful in patients whose cartilage tissues have been extensively damaged due to inflammation.

Self-care also forms an integral part of spondyloarthritis management. Adopting a healthy lifestyle and regular exercise should be encouraged in patients. Smoking is said to aggravate symptoms, hence patients should be counselled to quit smoking.

Sources

• https://www.ncbi.nlm.nih.gov/pubmed/29461959
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857562/
• https://www.arthritis.org/about-arthritis/types/spondyloarthritis/
• www.rheumatology.org/…/Spondyloarthritis
• www.nice.org.uk/guidance/NG65/ifp/chapter/What-is-spondyloarthritis

Last Updated: Apr 8, 2019