Spondyloarthritis (SpA)- Definition, Symptoms, Types and Treatment

Definition

Spondyloarthritis (also known as spondyloarthropathy) is the term which describes the connective tissue diseases. It is the group of inflammatory diseases, including arthritis of the peripheral joints and spine (sacroiliitis or spondylitis); including the area where ligaments and tendons attach to bones (enthesitis or enthesopathy). These diseases cause pain or stiffness in the leg or arm joints, spine, ligaments and tendons become inflamed. Skin rashes, eye, and intestinal problems may also be able to occur.

Epidemiology

  • Spondyloarthritis is a pathology that specifically strikes young people. The symptoms most frequently start before the age of 45. It affects more males than females.
  • Predisposition to spondyloarthritis, especially SpA, is determined largely by genetic factors.
  • The incidence rate is higher in populations with a higher prevalence of HLA-B27.
  • Psoriatic skin lesions and colitis due to inflammatory bowel disease (IBD) have been considered as both basic, subtype-defining entities with their own genetic background (distinct from HLA-B27 genotype), and as manifestations of spondyloarthritis.
  • There is a strong need to diagnose patients with SpA in an earlier stage; currently, there is a delay of 5–10 years between onset of the first symptoms and diagnosis.

Types

There are five types of spondyloarthritis

Ankylosing spondylitis or Bechterew disease: It is the type of arthritis that affects the spine. Symptoms include pain and stiffness in the lower back and in the neck. Spine bones fuse together and it will become rigid spine and it leads to stoope over posture.

Psoriatic arthritis: Psoriatic arthritis is the form of arthritis that affects the people who have psoriasis. Most people diagnosed with psoriasis and later diagnosed with psoriatic arthritis. It may affect any part of the body such as fingertips and spine. The main symptoms are joint pain, stiffness, and swelling.

Psoriatic arthritis

Reactive arthritis:  It occurs due to the infection by certain bacteria. Often the bacteria’s from genitals (Chlamydia trachomatis) or bowel (Campylobacter, Salmonella, Shigella, and Yersinia). It usually targets your knees and joints of ankles or feet.

Reactive arthritis

Undifferentiated arthritis: Undifferentiated inflammatory arthritis does not conform to any of the recognized inflammatory arthritis types. It may include monoarthritis of a single joint; oligoarthritis, which is usually when four or fewer joints are involved; or polyarthritis, which usually involves many small joints.

Risk factors

Risk factors may be higher due to following reasons

  • Family member having the gene which causes spondyloarthritis
  • Positive results for the HLA-B27 gene
  • Recurring bacterial infection in your gut
  • Have other inflammatory conditions such as psoriasis or inflammatory bowel disease

Causes

  • The main cause is not known, but researchers pointed out that the hereditary genetics playing an important role in this disease. Since this disease occurs often in family members of patients who have spondyloarthritis.
  • Many genes cause it. Up to 30 genes have been found. But the major gene that causes spondyloarthritis is HLA-B27.
  • Bacterial infections can also cause reactive spondyloarthritis known to be triggered by a bacteria chlamydia or food borne infections.

Symptoms and complications of Spondyloarthritis

The first and major symptoms of all types of spondyloarthritis are severe low back pain, swelling of arms, stiffness, and fatigue. The different types of spondyloarthritis can be manifested by the following signs and symptoms.

  • Alternative or unilateral buttock pain
  • Arthritis in small joints
  • Arthritis in large joints such as knee joint, ankle joint and elbow joint (peripheral arthritis)
  • Numbness and tingling sensation in arms and legs
  • Spinal fusion may occur in ankylosing spondylitis
  • Inflammation at the interfaces between bone and tendon or ligament of limbs (Enthesitis)
  • Inflammation of intestine, urinary tract and aortic heart valves. These can lead to spinal joints inflammation.
  • Inflammation of joints in pelvis and spine (sacroiliitis)
  • Enteropathic arthritis shows symptoms such as diarrhea and abdominal pain
  • Digestive problems
  • Skin disease like psoriasis
  • Osteoporosis
  • Redness of eye (Iritis)
  • Swollen fingers and
  • Pain in the heels cause difficult to walk, stand even for small duration

Diagnosis and Testing

First a doctor may ask for patient’s medical history, physical exam and may suspects for symptoms of spondyloarthritis. To confirm doctor may perform the following diagnosis and tests.

  • X-rays: X-Ray images shows the change of the sacroiliac joints in the pelvis and fusion of spine. If these changes not observed, but symptoms shows spondyloarthritis doctor will suggest MRI scan. MRI shows these changes more promptly than the X-Ray.
  • MRI scans: It can show a very clear image of enthesitis and also the changes of sacroiliac joints.
  • CT scans: CT also used for the imaging of bone joints.
  • HLA-B27: Most patients with spondyloarthritis have HLA-B27 gene, but some people don’t have this gene. So it is necessary to go for a HLA-B27 test if the symptoms suspects spondyloarthritis.
  • Complete blood count (CBC): CBC can be useful to find the inflammation.
  • Musculoskeletal ultrasound scanning: Ultrasound imaging uses sound waves to produce the images of inflammatory conditions of muscles, ligaments, and tendons.
  • Dual-energy X-ray absorptiometry (DEXA) scans: Used for measuring the bone mineral density usually the bones of the lower spine and hips. Bone loss is measured through this technique.

Treatment of Spondyloarthritis.

There is no way to cure this disease condition, but there are treatments to counterparts the symptoms.

  • Nonsteroidal anti-inflammatory drugs: Certain NSAID’S like naproxen, ibuprofen, meloxicam, or indomethacin are prescribed by doctors to relief from the pain due to symptoms.
  • Corticosteroid medication: Inflammation around the tendons and in the joints can be overcome by taking some corticosteroid drugs. This helps to reduce the swelling in the joints.
  • Antibiotics: Antibiotics can be used in the case of reactive spondyloarthritis in which bacteria cause the major problems.
  • Disease-modifying antirheumatic drugs (DMARD’s): Sulfasalazine (Azulfidine) and methotrexate are the best DMARD’s to be used for the joint damages in limbs affected by arthritis.
  • Tumor necrosis alpha (TNF-alpha) blockers: FDA approved TNAB are Adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, certolizumab pegol (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi), infliximab (Remicade), infliximab-dyyb (Inflectra), a biosimilar to Remicade, and secukinimab (Cosentyx). These are biosimilars used to treat arthritis in spine joints.
  • Surgery: Patients with over inflammation of pelvis joints needs hip replacement. In the case of heavy damage in the cartilage of joints needs surgery to repair. In some rare cases, spinal surgery also needed.

Prevention and control measures

Prevention from spondyloarthritis needed some lifestyle changes as follows.

  • Quit smoking: smoking speeds up the spinal fusion in addition to other bad health effects.
  • Follow good posture: practicing a proper sitting and posture makes your spine to escape from growing into slumped-over position and strain.
  • Daily physical exercise: Frequent home exercise and physiotherapy is essential to reduce the stiffening of spine and other joint problems. It also helps to have your heart healthy.
  • Good diet: Follow the diets that are rich in calcium. Dairy products are preferred foe calcium rich foods.

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44 comments

  1. i try to take various pain meds for relief but ends up feeling like i get a nervous breakdown after taking them i also suffer anxiety and panic attack because of the tearing pain in .my hip and tightness in my shoulders that triggers the uncomfortable and chronic feeling in my body.

  2. I have experience such pain for five years and am still facing the same problem, please I want to ask whether it can be cured with natural medicine

  3. was told to do some exercises but not working what can take and do to relieve the pain?

  4. Desmond.f.johannes

    I have spondithriarthritis what can I use, because I have also tried many options but nothing helps.
    what can I do?, in my lower spine and down to my legs and feet..

  5. what should be done if someone is not treated fast

    • If not treated fast, spinal involvement can progress, resulting in fusion of the vertebrae and limiting the spine’s mobility.

  6. In the case of Reactive SPA which appropriate antibiotics can be taken and for how long?

  7. What specific test can be done to confirm Reactive Spondyloarthritis ?

  8. L5s1 mild bulz pls sher ur opinion oke

  9. hi, I always gets pain in the lower part of my back alot, what can I do for that, I went to the doctors office to the hospital and all they give me is pain killers

  10. anytime I wake from bed in the morning I feel pain below my spanner to my waist joint. and a help.

  11. hi doc, my back sometimes if feel so hot inside. but I don’t know my problem and how to finish it. please help me

  12. Hi Doc..
    My Father firstly about 3 years earlier…feels back pain only when he wake up in morning.
    later it comes ofenly by same method.
    now i am surprised.
    he instantly have a very bad pain in his right arm and shoulder muscel and back pain is Gone.
    why this happen..
    what should be the treetment..??
    type and which stage is this..??

    • It may be a usual problem which arises after age 50 but consult a doctor once to know the causes and to get reduce the pain.

  13. i will like to know actual drugs some one can use for this type of disease bcs am one of the patient according to what i read here

  14. I am have warm and pepperish sensation on the right hand of my body from the shoulder down through elbow, armpit, ribs, thigh, leg and foot. sometimes, it is so hot like hot pepper. treat as urgent please.

  15. Doctor, please I was diagnosed of cervical osteophytes or spondylosis. I feel pain in my neck and numbness in my arms. What can I used

  16. I have pains on my back and any time I exercise it become worst. the cause of this pain was intensive labour about five years back. please help what can I do. I have taken calcium and tramol to no avail

    • Please consult a gynecologist and physiotherapist in order to rectify the problem that occurs due to the labor or heavy workout.

  17. hlo mam /sir
    please add one more disease psoriasis…

  18. it took me 30 years to be diagnosed when all they needed was laying right there in front of them. they diagnosed me with fibromyalgia, but mainly all that hurt was my back and debilitating sciatica. I had a rheumatologist diagnose me with spinal arthritis. And another doctor called my sciatica pseudo sciatica, whatever that means. I infused from my T12 vertebrae to C1 and I am pretty hyperkyphotic! I kept researching. I found my dx and was on a waitlist 2 yrs to get it confirmed!

  19. I see many of you asking if it can be cured and what you can do naturally comma Etc. it really depends on what you have, but if you have something like ankylosing spondylitis it is an incurable and Progressive disease. I am not sure about the others. one thing I wish others had told me was stay as limber as you can. Do yoga and most of all watch your posture! Bend and stretch your spine all the time all the time even when it hurts! when it fuses up, it’s too late! massage is good too!

  20. Adebiyi Abiodun

    I’m 60, I’ve pain at my waist and in my right limb,from the waist to the leg. I used to administer ‘Diclofenac forte’ as advised by a health worker,but still persists.This pain occurs, especially in the early hours of the day. Please, what’s the remedy.

  21. I normally have swollen feet after sitting for long, the bone between my back and hand sometimes inch and pain me.

  22. I have a chronic back pain for 10 years n how can i helf my shelf,please Doctor consalt me.

  23. I have this problem and I have been seeing a doctor from time to time but still suffers from pain at heels and can’t even walk properly sometime. pls what can I do?

  24. I have undergone so many tests and xray but still suffer the pàin. pls I need more advises.

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