Spondyloarthritis

Spondyloarthritis

What is Spondyloarthritis?

Spondyloarthritis is a group of inflammatory joint diseases. It's divided into two main categories: axial spondyloarthritis, primarily affecting the spine, and peripheral spondyloarthritis, mainly involving other joints. Conditions within this group include ankylosing spondylitis (visible by X-ray), non-radiographic axial spondyloarthritis, psoriatic arthritis, reactive arthritis, and arthritis associated with inflammatory bowel diseases.

Axial Spondyloarthritis

This group mainly involves back pain or buttock pain. It's divided into non-radiographic (not visible on X-ray) and ankylosing spondylitis (visible on X-ray), differentiated by X-ray visible inflammation of the sacroiliac joints. Non-radiographic cases can be detected through MRI. Some non-radiographic cases may progress to ankylosing spondylitis over time. Indicators of axial spondyloarthritis include back pain starting before 45 years of age, gradual onset, lasting at least three months, night pain, morning stiffness lasting over 30 minutes, improvement with movement or NSAIDs, and no relief with rest. Other associated symptoms include a history of eye inflammation, psoriasis, chronic inflammatory bowel disease, peripheral arthritis, sausage-like finger or toe swelling, tendon inflammation, or a family history of similar conditions. If these symptoms are present, consult a rheumatologist. If back pain doesn't suggest inflammation, consult an orthopedic surgeon.

Peripheral Spondyloarthritis

Patients may experience inflamed joints, inflamed tendon attachment points, or sausage-like swollen fingers or toes. Affected joints might include the knees, ankles, elbows, wrists, or fingers/toes, usually asymmetrically inflamed (e.g., one wrist but not the other). Enthesitis, the inflammation at tendon attachment points, is common in areas like the heel or elbow.

Extra-Spinal and Extra-Articular Symptoms

Patients might also have eye inflammation, psoriasis, and chronic inflammatory bowel disease. They are at higher risk of depression, fibromyalgia, and cardiovascular diseases. Eye inflammation can cause pain, blurred vision, redness, and light sensitivity. Psoriasis presents as thick, scaly silver or white patches on red skin, possibly with nail changes. Chronic inflammatory bowel disease causes abdominal pain, diarrhea, and sometimes blood in the stool.

Diagnosis

Spondyloarthritis is usually diagnosed by a rheumatologist using patient history, physical examination, blood tests, and imaging (X-rays or MRIs). Diagnosis isn't just about meeting criteria but interpreting symptoms, blood tests (like HLA-B27, CRP, ESR), and imaging results. Blood tests might include rheumatoid factor, anti-CCP, or ANA to differentiate from other diseases. Imaging can show abnormalities in sacroiliac joints, but interpretation can be challenging and needs to consider clinical context.

Treatment

Treatment approaches for different types of spondyloarthritis are similar but vary in specifics according to symptoms and severity.

Exercise

Exercise is crucial in managing spondyloarthritis, focusing on strengthening core muscles, aerobic exercises for lung and heart health, exercises to expand the chest for better breathing, and exercises to improve spinal and joint mobility. Stretching exercises are also recommended. Posture in daily routines and suitable sleeping positions (like using a flat pillow for ankylosing spondylitis patients) are important. Avoid high-impact sports like boxing, football, or rugby, and certain massage or chiropractic techniques that can harm the spine.

Medication

- NSAIDs are often the first-line treatment for reducing inflammation and pain.

- Targeted steroid injections can reduce inflammation in specific areas.

- Sulfasalazine and methotrexate can help control peripheral joint inflammation.

- Biologic and targeted synthetic DMARDs like infliximab, etanercept, adalimumab, golimumab, secukinumab, ixekizumab, and tofacitinib may be considered if initial treatments are ineffective.