Close
Close

Spondylarthritis

Spondylitis, Spondyloarhtropathy

Overview

Spondylitis (also called spondyloarthropathy, or Spondyloarthritis) 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;

Within axial SpA there are 2 groups:

- Ankylosing Spondylitis (AS): Where the x-ray changes are clearly present.

- Non-radiographic axial spondyloarthritis (nr-axSpA): Where x-ray changes are not present but you have symptoms.

Up to 70% of people in this group have visible inflammation in the sacroiliac joints and/or the spine when an MRI of the back is done.

30% of people in this group may not have any change visible on the MRI despite symptoms of back pain. In fact some of these patients may never show any inflammation on an MRI even if this is repeated later on in life. The reasons for this are still not well understood but may be due to how sensitive our methods to image the joints are.

- peripheral spondyloarthritis, affecting mostly the arms and legs;

- reactive arthritis (formerly known as Reiter's syndrome);

- psoriatic arthritis;

- enteropathic arthritis/spondylitis associated with inflammatory bowel diseases (ulcerative colitis and Crohn's disease).

 

Symptoms - Spondylarthritis

This group of diseases primarily affect the spine (spondylo) and other joints. The group includes: ankylosing spondylitis, reactive arthritis (formerly Reiter's syndrome), psoriatic arthritis, Juvenile SpA, enteropathic arthritis (spondylitis/arthritis associated with inflammatory bowel disease), and undifferentiated SpA. All display a variety of symptoms and signs, but they also share many features in common, including:

  • Pain
  • Morning stiffness
  • Fatigue
  • Extraarticular symptoms
  • Fever and weight loss

Causes - Spondylarthritis

Evidence strongly suggests a familial tendency in ankylosing spondylitis. The presence of human leukocyte antigen (HLA)-B27 (positive in more than 90% of patients with this disease) and circulating immune complexes suggests immunologic activity. One out of 10,000 people has ankylosing spondylitis. It affects more males than females and usually emerges between ages 20 and 40, although it may develop in children younger than age 10. Recent evidence strongly suggests a familial tendency in ankylosing spondylitis. The presence of histocompatibility antigen HLA-B27 (positive in over 90% of patients with this disease) and circulating immune complexes suggests immunologic activity. A possible link to underlying infection is being investigated.

Prevention - Spondylarthritis

Not supplied.

Diagnosis - Spondylarthritis

Not supplied.

Prognosis - Spondylarthritis

Not supplied.

Treatment - Spondylarthritis

A common treatment regimen for all the spondyloarthropathies (ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis, and undifferentiated spondyloarthropathy) involves medication, exercise and possibly physical therapy, good posture practices, and other treatment options such as applying heat/cold to help relax muscles and reduce joint pain. In severe cases of ankylosing spondylitis, surgery may also be an option.

Depending on the type of spondyloarthritis, there may be some variation in treatment. For example, in psoriatic arthritis, both the skin component and joint component must be treated. In enteropathic arthritis (spondylitis/arthritis associated with inflammatory bowel disease such as Crohn's or ulcerative colitis), medications may need to be adjusted so the gastrointestinal component of the disease is not exacerbated.

Very often, a rheumatologist will be the one to outline a treatment plan, but other professionals may also be able involved in your care.

No treatment reliably stops progression of this disease, so management aims to delay further deformity through good posture, stretching and deep-breathing exercises and, in some patients, braces and lightweight supports.

Medication

NSAIDs (nonsteroidal anti-inflammatory drugs) are still the cornerstone of treatment and the first stage of medication in treating the pain and stiffness associated with spondylitis. However, NSAIDs can cause significant side effects, in particular, damage to the gastrointestinal tract.

When NSAIDs are not enough, the next stage of medications, (also known as second line medications), are sometimes called disease modifying anti-rheumatic drugs (DMARDS). This group of medications include: Sulfasalazine, Methotrexate and Corticosteroids.

The most recent and most promising medications for treating ankylosing spondylitis are the biologics, or TNF Blockers. These drugs have been shown to be highly effective in treating not only the arthritis of the joints, but also the spinal arthritis. Included in this group are Enbrel, Remicade, Humira and Simponi.

Exercise

Exercise in an integral part of any spondylitis management program. Regular daily exercises can help create better posture and flexibility as well as help lessen pain.

A properly trained physical therapist with experience in helping those with ankylosing spondylitis can be a valuable guide in regard to exercise. Click here to learn more about exercise.

Posture

Practicing good posture techniques will also help avoid some of the complications of spondylitis including stiffness and flexion deformities / kyphosis (downward curvature) of the spine. Click here to learn more about posture.

Heat/Cold

Applying heat to stiff joints and tight muscles can help reduce pain and soreness. Applying cold to inflamed areas can help reduce swelling. Hot baths and showers can also help provide relief.

Surgery

In severe cases of ankylosing spondylitis, surgery can be an option in the form of joint replacements, particularly in the knees and hips. Surgical correction is also possible for those with severe flexion deformities (severe downward curvature) of the spine, particularly in the neck, although this procedure is considered risky. Click here to learn more about surgery.

Other Symptom Management Tools

Alternative treatments such as massage and using a TENS unit (electrical stimulators for pain) can also aide in pain relief. Maintaining a healthy body weight and balanced diet can also aide in treatment. Click here for more information on alternative treatments.

 

 

 

Resources - Spondylarthritis

Not supplied.
Videos
Currently no videos.
To submit one, CLICK HERE