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Spondyloarthritis (Spondyloarthropathy)

Description

Spondyloarthritis (or spondyloarthropathy) is the name for a family of inflammatory rheumatic diseases that cause arthritis. The most common is ankylosing spondylitis, which affects mainly the spine. Others include:

axial spondyloarthritis, which affects mainly the spine and pelvic joints; peripheral spondyloarthritis, affecting mostly the arms and legs; reactive arthritis (formerly known as Reiter's syndrome); psoriatic arthritis; and enteropathic arthritis/spondylitis associated with inflammatory bowel diseases (ulcerative colitis and Crohn's disease).

Fast facts The main symptom (what you feel) in most patients is low back pain. This occurs most often in axial spondyloarthritis. In a minority of patients, the major symptom is pain and swelling in the arms and legs. This type is known as peripheral spondyloarthritis. Many people with axial spondyloarthritis progress to having some degree of spinal fusion, known as ankylosing spondylitis. This more often strikes young males. Nonsteroidal anti-inflammatory drugs (commonly called NSAIDs) offer symptom relief for most patients by reducing pain and swelling. Other medicines called anti-TNF drugs or TNF blockers are effective in patients who do not respond enough to NSAIDs. Frequent fitness activities and back exercises are helpful.

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What is spondyloarthritis?

Spondyloarthritis differs from other types of arthritis in that it involves the “entheses.” These sites are where ligaments and tendons attach to bones. Symptoms present in two main ways. The first is inflammation causing pain and stiffness, most often of the spine. Some forms can affect the hands and feet or arms and legs. The second type is bone destruction causing deformities of the spine and poor function of the shoulders and hips.

What causes spondyloarthritis?

Ankylosing spondylitis is hereditary. Many genes can cause it. Up to 30 of these genes have been found. The major gene that causes this disease is HLA-B27. Almost all white people with ankylosing spondylitis are carriers of HLA-B27.

The cause of enteropathic arthritis is unclear. It may be due to bacteria that enter the bowel when inflammation damages it. People with HLA-B27 are more likely to have this form of arthritis than those without the gene.

Discussions of the causes and risk factors for other members of the spondyloarthritis family appear in their own fact sheets.

Who gets spondyloarthritis? Ankylosing spondylitis tends to start in the teens and 20s and strikes males two to three times more often than females. Family members of affected people are at higher risk, depending partly on whether they inherited the HLA-B27 gene. There is an uneven ethnic distribution of ankylosing spondylitis. The highest frequency appears in the far north in cultures such as Alaskan and Siberian Eskimos and Scandinavian Lapps (also called Samis), who have a higher frequency of HLA-B27. It also occurs more often in certain Native American tribes in the western U.S. and Canada. African Americans are affected less often than other races. The frequency of ankylosing spondylitis in the U.S., based on data from the National Health and Nutrition Examination Survey (NHANES), is 0.5%. The frequency for axial spondyloarthritis is 1.4%.

How is spondyloarthritis diagnosed?

Correct diagnosis requires a physician to assess the patient’s medical history and do a physical exam. The doctor also may order imaging tests or blood tests. You may need an X-ray of the sacroiliac joints, a pair of joints in the pelvis. X-ray changes of the sacroiliac joints, known as sacroiliitis, are a key sign of spondyloarthritis. If X-rays do not show enough changes, but the symptoms are highly suspicious, your doctor might order magnetic resonance imaging, or MRI, which shows these joints better and can pick up early involvement before an X-ray can.

Over time, spondylitis results in pronounced curvature of the spine (left).

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Among the blood tests you may need is a test for the HLA-B27 gene. However, having this gene does not mean spondyloarthritis will always develop. Some people have the HLA-B27 gene but do not have arthritis and never develop arthritis. In the end, the diagnosis relies on the doctor’s judgment.

How is spondyloarthritis treated?

All patients should get physical therapy and do joint-directed exercises. Most recommended are exercises that promote spinal extension and mobility.

There are many drug treatment options. The first lines of treatment are the NSAIDs, such as naproxen, ibuprofen, meloxicam or indomethacin. No one NSAID is superior to another. Given in the correct dose and duration, these drugs give great relief for most

patients.

For joint swelling that is localized (not widespread), injections, or shots, of corticosteroid medications into joints or tendon sheaths (the membrane around a tendon) can be effective quickly.

For patients who do not respond to the above lines of treatment, disease modifying antirheumatic drugs (commonly called DMARDs) such as sulfasalazine (Azulfidine) might be effective. These drugs relieve

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