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Spondyloarthritis: Symptoms, Causes, Treatments, and More

Spondyloarthritis is the name for a group of conditions that cause arthritis in the spine. In some cases, other joints in the body are involved. Symptoms may also occur at the entheses (attachment points of tendons and ligaments to bone). People in their teens and 20s are most often affected and males have a higher risk of developing spondyloarthritis than females. The most common symptoms of spondyloarthritis are pain and stiffness in the affected joints, most often the spine.

Types of Spondyloarthritis

Spondyloarthritis refers to a family of diseases that cause arthritis. Some of the most common forms of spondyloarthritis include:

  • Ankylosing Spondylitis: affects mainly the spine and pelvic joints
  • Psoriatic Arthritis: affects mainly the joints in the arms and legs as well as the skin
  • Peripheral Spondyloarthritis: affects mainly the joints in the arms and legs
  • Reactive Arthritis (Reiter’s Syndrome): affects mainly joints in the legs and occurs after an infection
  • Enteropathic Arthritis: affects mainly the joints in the arms and legs, associated with inflammatory bowel diseases

Symptoms

Symptoms vary depending on what form of spondyloarthritis you have, but symptoms most commonly start with hip or low back pain. Pain is usually the most severe in the morning and may worsen with vigorous activity.

  • Lower back pain which decreases with exercise
  • Pain and swelling in joints of legs including hips, knees, and ankles
  • Joint stiffness, especially in the morning
  • Pain at the back of the heel (Achilles tendon)
  • Impaired range of motion and mobility
  • Limited ability to expand the ribcage
  • Buttock pain which alternates from side to side
  • Fatigue

Summary: The most common symptoms of spondyloarthritis is joint pain and stiffness in the lower back. Though symptoms may also involve other joints in the body and include fatigue and impaired mobility.

Risk Factors

Spondyloarthritis typically develops in males between the ages of 10-30, though females may be underdiagnosed. Other risk factors include:

  • Having a family history of spondyloarthritis
  • Belonging to one of the following northern populations (1)
    • Alaskans
    • Siberian Eskimos
    • Scandinavian Lapps
  • Genetics: being a carrier of the HLA-B27 gene (2)
  • Smoking: smoking increases the symptoms of spondyloarthritis and may speed up the rate of spinal fusion

Diagnosing

A correct diagnosis requires a rheumatologist, which is a doctor that specializes in arthritis, to perform a medical history review and a physical examination.  During the physical examination, the doctor will assess your joints for swelling, tenderness, and range of motion. The doctor may recommend imaging tests which may include an x-rya or MRI. Blood tests are also routinely administered and may consist of a test for the HLA-B27 gene which is commonly carried by those diagnosed with spondyloarthritis.

Treatment for Spondyloarthritis

There are several different treatment options for spondyloarthritis. Treatment is based on the severity of symptoms and the form of spondyloarthritis being treated.

Medication

Medication is usually the first line of treatment in spondyloarthritis. There are many classes of drugs that are used to treat the symptoms of spondyloarthritis which include:

  • Analgesics: this class of drugs is used to reduce pain
  • Non-steroidal Anti-inflammatory Drugs (NSAIDs): these drugs are used to reduce pain and inflammation and may be prescribed or given over the counter. NSAIDs include Ibuprofen, Naproxen, and Meloxicam.
  • Disease Modifying Anti-rheumatic Drugs (DMARDs): DMARDs are used to slow disease progression and reduce symptoms. They are effective for those that have arthritis in the joints of the arms and legs.
  • Corticosteroids: this class of drug is a powerful anti-inflammatory and is used to treat joint swelling. Corticosteroids may be administered by pill or injection.
  • Antibiotics: used to treat infection in those with reactive arthritis.

Biologics

Biologics are a newer class of medications that are effective in treating symptoms not only in the joints of the arms and legs but also in the spine. They target the immune system and work to reduce disease activity. Biologic treatment is usually expensive and carries the risk of side effects such as an increased risk of infection. Biologic medication is given either by IV or injection. There are two classes of biologic drugs used to treat spondyloarthritis: TNF-alpha blockers (including Ebrel, Remicade, and Humira) and IL-17 inhibitors (including Cosentyx).

Physical Therapy and Exercise

Physical therapy and exercise are usually recommended for people diagnosed with spondyloarthritis in combination with medication. Physical therapy can help people with spondyloarthritis improve their mobility, range of motion, strength, overall function, and quality of life. Physical therapists can recommend safe ways to stretch and strengthen the affected areas of the body to maintain functional mobility and reduce symptoms.

Surgery

Surgery is sometimes recommended if symptoms are not controlled with medication and physical exercise. Joint replacements at the hip and knee are among the most common surgeries performed for spondyloarthritis. Another common surgery that is performed for spondyloarthritis is a spinal fusion which is usually recommended if the spinal cord or nerve function is compromised due to the effects of spondyloarthritis on the spine.

 

Summary: Treatment options for spondyloarthritis vary depending on the severity and type of arthritis you have, but include medication, exercise, and surgery.

Complications

Having a diagnosis of spondyloarthritis can put you at risk for developing other conditions and symptoms. These may include:

  • Osteoporosis: causes weakening of the bones increasing the risk for fracture. Osteoporosis occurs in up to half of those diagnosed with ankylosing spondylitis.
  • Eye irritation: uveitis (or inflammation of the eye) occurs in 40% of those with spondyloarthritis. Symptoms include redness and eye pain.
  • Aortitis: aortitis refers to inflammation of the aortic valve in your heart which is a risk factor in those with spondyloarthritis (3).
  • Psoriasis: this disease affects the skin and causes dry, scaly patches. It commonly occurs in those with psoriatic arthritis.
  • Intestinal inflammation: common in those with enteropathic arthritis and causes abdominal pain, cramping, and diarrhea.

Conclusion

Spondyloarthritis refers to a group of conditions that cause arthritis in the spine and may involve other joints and areas where the tendons and ligaments attach to bones. The symptoms of spondyloarthritis include joint pain and stiffness, especially in the morning or after periods of inactivity. The causes of spondyloarthritis include genetics and family history. Treatment options depend on the severity of symptoms and type of spondyloarthritis, but will typically involve medication and exercise. In some cases, surgery is needed. If you have symptoms of spondyloarthritis contact your doctor today to start treatment.