Spondyloarthritis is an umbrella term for inflammatory diseases that involve both the joints and the entheses (the sites where the ligaments and tendons attach to the bones). The most common of these diseases is ankylosing spondylitis. Others include reactive arthritis, psoriatic arthritis and enteropathic arthritis, which is associated with the inflammatory bowel disease.
Spondyloarthritis, in most cases, primarily affects the spine. Some forms can affect the peripheral joints -- those in the hands, feet, arms and legs.
There is a strong genetic component to the development of spondyloarthritis. Scientists have identified as many as 30 genes that cause ankylosing spondylitis. The major one is called HLA-B27. Almost all white people with ankylosing spondylitis carry this gene. People with HLA-B27 are also more likely to have enteropathic arthritis; however, other causes are unclear. Scientists believe it may be related to bacteria that enter the damaged bowel.
Spondyloarthritis has two main symptom patterns. For most people, the first and predominant symptom is low back pain. If not controlled, spinal involvement can progress, resulting in fusion of the vertebrae and limiting the spine’s mobility.
Less commonly, the main symptom is swelling in the arms and legs. This is referred to as peripheral spondyloarthritis.
Joint inflammation often comes and goes and is accompanied by fatigue. Other problems can occur along with spondyloarthritis, including osteoporosis, pain and redness of the eye, inflammation of the aortic heart valve, intestinal inflammation and the skin disease psoriasis.
Diagnosis of spondyloarthritis is based mainly on the results of a medical history and physical exam, but doctors may order imaging and blood tests to confirm the diagnosis. X-rays of the sacroiliac joints, a pair of joints in the pelvis, often show changes called sacroilitis in people with spondyloarthritis. If these changes do not show up on X-ray but symptoms suggest spondyloarthritis, the doctor may take a magnetic resonance image (MRI) that can show these changes before an X-ray can.
A blood test for the HLA-B27 gene can also help confirm a suspected diagnosis of spondyloarthropathy. However, not everyone with the gene have or develop arthritis. Therefore, a positive finding by itself doesn’t mean spondyloarthritis.
Several medications, including various nonsteroidal anti-inflammatory drugs (NSAIDs), are effective for relieving pain and inflammation in spondyloarthritis. When joint swelling is not widespread, injections of a corticosteroid medication directly into the joint or membrane surrounding the affected area can provide quick relief.
When these drugs alone do not provide relief, doctors may prescribe disease-modifying antirheumatic drugs (DMARDs) to relieve symptoms and prevent joint damage. DMARDs are most effective for arthritis that affects the joints of the arms and legs.
Another class of drugs called tumor necrosis alpha (TNF-alpha) blockers are effective for arthritis of the both the spine and joints of the arms and legs. However, they are expensive and can increase the risk of serious infections.
Antibiotics may be helpful for reactive arthritis.
When inflammation destroys the cartilage in the hips, surgery to replace the hip with a prosthesis, called total hip replacement, can relieve pain and restore the joint’s function.
Spondyloarthritis Self Care
Self care for spondyloarthritis should address both the physical and emotional effects of the disease through healthy lifestyle choices such as exercising regularly and not smoking. Counseling or taking part in a support group offered by the Arthritis Foundation may also be helpful.