Spondyloarthritis is also known as Spondyloarthropathy. This is a name which is applied to a family of inflammatory rheumatic diseases which cause arthritis. Spondyloarthritis differs from other types of arthritis since it involves sites where tendons & ligaments attach to bones known as ‘entheses’. Signs & symptoms of spondyloarthritis present themselves in two main ways. The first is inflammation which is causing stiffness & pain, most often of the spine, while the second type is destruction of bone causing deformities of spine & poor function of hips & shoulders.
Types of Spondyloarthritis
The most common type of spondyloarthritis is ankylosing spondylitis which is mainly found to affect the spine. The other types of spondyloarthritis include the following.
- Peripheral Spondyloarthritis – mainly affecting arms & legs.
- Axial Spondyloarthritis – mainly affecting spine & pelvic joints.
- Reactive Arthritis – earlier known as Reiter’s syndrome.
- Psoriatic Arthritis
- Enteropathic Arthritis Spondylitis – generally associated with inflammatory bowel diseases like Crohn’s desease & ulcerative colitis.
Spondyloarthritis generally has two main patterns of signs & symptoms. First predominant symptom among most people is lower back pain. In case this is not controlled, spinal involvement may eventually progress & result in fusion of vertebrae & to limit mobility in spine. The other less common main symptom is swelling in arms & legs. This condition is referred to as peripheral spondyloarthritis. Symptoms of joint inflammation may often come & go & are usually accompanied by fatigue. Other problems which occur with spondyloarthritis include osteoporosis, inflammation of aortic heart valve, intestinal inflammation, pain & redness in eye & also a skin disease called psoriasis.
Ankylosing spondylitis is typically hereditary. There are many genes which can cause this condition. Up to 30 of these genes have been identified so far. Major gene which is found to cause ankylosing spondylitis is HLA-B27. Almost the entire population of white people with ankylosing spondylitis is found to be carrying HLA-B27. Enteropathic arthritis is another form of chronic inflammatory arthritis. Two most common types of this form of arthritis are Crohn’s disease & ulcerative colitis. However, cause of enteropathic arthritis is yet unclear. This may be caused due to bacteria which enter the bowel when it is damaged by inflammation. Generally, people with HLA-B27 gene are most likely to have this form of arthritis than people without the gene.
Ankylosing spondylitis generally tends to start in teens & in the 20s & is found to strike males 2 – 3 times more often than it does to females. Moreover, family members of people affected with this condition are at higher risk, but partly depending upon whether they have inherited the HLA-B27 gene. There is also an uneven ethnic distribution of ankylosing spondylitis among the general population. Highest frequency of this condition appears in far north cultures like Siberian Eskimos, Alaskans & Scandinavian Lapps (also known as Samis) who are found to have higher frequency of HLA-B27 genes. Ankylosing spondylitis is also found to occur more often among native-American tribes of Canada & United States. African Americans population is less often affected than other races. Based upon the data, frequency of ankylosing spondylitis within the United States is 0.5 percent, while frequency of axial spndyloarthritis is about 1.4 percent.
Correct diagnosis of spondyloarthritis requires the doctor to properly assess the patient’s medical history along with a physical examination. Doctors may also order the patient to undergo imaging tests or blood tests. Patients may require x-rays of sacroiliac joints called as sacroiliitis & which is a key sign & symptom of spondyloarthritis. In case x-rays do not reveal enough changes & symptoms are still suspicious, rheumatologists may order patients to undergo MRI – magnetic resonance imaging so as to see these joints better & from where they can pick up early involvement of spondyloarthritis. Among the blood tests which are performed for spondyloarthritis, patients may need to undergo a test for HLA-B27 gene as well. But having this gene alone does not anyway confirm development of spondyloarthritis, since some people are found to have HLA-B27 yet do not have or ever develop arthritis. Nevertheless, confirming diagnosis of spondyloarthritis eventually depends upon the doctor’s judgment.
All spondyloarthritis patients should undergo physical therapy & perform joint-directed exercises. Most exercises which are recommended for this condition generally promote mobility & spinal extension. There are several options for drug treatments as well. First line of drug treatment includes NSAIDs like indomethacin, meloxicam, ibuprofen or naproxen. No single NSAID is however superior than another. All these drugs provide great relief for most patients when given in correct dosage & duration. When joint swelling is localized & not widespread, shots or injections of corticosteroid medications into tendon sheaths (membrane surrounding tendon) or inside affected bone-joints can be quickly effective. Disease modifying antirheumatic drugs called DMARDs like sulfasalazine (Azulfidine) is found to be effective for spondyloarthritis patients who do not positively respond to NSAIDs. DMARDs usually relieve signs & symptoms & may even be able to prevent further damage to joints. However, this class of drugs is mainly helpful for patients with arthritis which also have this condition affecting the joints of arms & legs. Although corticosteroids are effective, oral consumption through pills are generally discouraged. This is normally due to the reason that high oral doses may eventually lead to many side effects. Antibiotics are also an option, particularly for patients with reactive arthritis. TNF alpha blockers are a new class of drugs called biologics. They are very effective in treatment of both peripheral & spinal joint symptoms of spondyloarthritis. TNF alpha blockers which are commonly used for patients with ankylosing spondylitis include the following.
- Infliximab (Remicade) – This is administered intravenously (IV infusion) every 6 – 8 weeks in a dose of 5 mg/kg.
- Etanercept (Enbrel) – Normally given as an injection of 50 mg, once a week under the skin.
- Adalimumab (Humira) – This is administered through injections of 40 mg, every other week subcutaneously.
- Golimumab (Simponi) – Administered as injections in a dose of 50 mg, once every month under the skin (subcutaneously).
Anti-TNF treatments however are expensive & not without side effects which include increased risk of serious infections. Biologics are often found to cause latent tuberculosis without any symptoms, so as to develop an active infection. Doctors & patients should therefore weigh benefits & risks while considering spondyloarthritis treatments with biologics. Patients with spondyloarthritis in ankles, feet, elbows, hands & wrists should undergo DMARD therapy before moving on to anti-TNF treatment.
Surgical treatments are also very helpful for some patients with spondyloarthritis. Total hip replacement surgery is extremely useful for patients with hip disability due to joint destruction from loss of cartilage. However, spine surgery is rarely required, except for patients with traumatic fractures (bones broken due to injury) or for patients looking to correct excessive flexion deformities of neck, where they are unable to straighten neck.
Other problems are also found to occur among patients with spondyloarthrits. Patients should therefore discuss possible complications with their doctors. Some common complications include the following.
- Osteoporosis – This generally occurs among 50 percent of patients with ankylosing spondylitis, especially among those patients whose spine has fused. Moreover, osteoporosis can also raise the risk of developing spinal fractures.
- Inflammation of Eye – Part of the eye usually gets inflamed on this condition & which is called uvelitis. Generally found to occur in about 40 percent of spondyloarthritis cases, signs & symptoms of uvelitis include pain & redness of the eye. While severe cases of uvelitis may require treatments from an ophthalmologist, steroid eye drops are most often found to be effective in normal cases of eye inflammation.
- Inflammation of Aortic Valve – Inflammation of aortic valve in heart is sometimes found to occur over time in patients with spondyloarthritis. Doctors should therefore check the patient’s heart in order to make sure that they are not having this problem.
- Psoriasis – This involves a patchy skin disease which in case if severe will require treatment by skin doctors (dermatologists).
- Intestinal Inflammation – Sometimes this may be so severe among spondyloarthritis patients that it requires to be treated by doctors specializing in digestive diseases, called gastroenterologists.
Stiffness, pain & fatigue can often be occasional or continuous among spondyloarthritis patients. Despite these signs & symptoms, most patients with spondyloarthritis can lead productive lives & a normal span of life, especially with the quality of newer treatments which are available. However, there are some things which patients can do so as to improve their health. These include frequent exercises which are essential to maintain heart & joint health. Spondyloarthritis patients who smoke must try to quit smoking, since smoking aggravates this condition & can even speed up rate of spinal fusion. Moreover, patients should also look for & join support groups which can provide helpful information alongside emotional support.
- Spondyloarthritis is basically a type of arthritis which attacks the spine & in some cases, even the joints of arms & legs. This disease in some cases also involves eyes, skin & intestines. Main symptom in most spondyloarthritis patients is lower back pain. Low back pain is most often found to occur in axial spondyloarthritis patients.
- Major symptom in a minority of spondyloarthritis patients is swelling & pain in arms & legs. This type of spondyloarthritis is generally known as peripheral spondyloarthritis.
- Particularly males who are in their teens & 20s are most often affected with spondyloarthritis. Moreover, family members of spondyloarthritis patients are at higher risk of developing this condition.
- Many patients with axial spondyloarthritis are found to progress to having some degree of spinal fusing & which is medically known as ankylosing spondylitis. This is most often found to develop among young males.
- NSAIDs or non-steroidal anti-inflammatory drugs provide relief from spondyloarthritis symptoms for most patients by reducing swelling & pain. Other anti-TNF drugs or TNF blockers are effective among patients who do not positively respond to NSAIDs.
- Newer treatments have immensely helped spondyloarthritis patients in dealing & controlling symptoms alongside back exercises & regular fitness activities.
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