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Spondyloarthritis: Causes, Symptoms & Treatment

Spondyloarthritis is a group of inflammatory rheumatic diseases primarily affecting the spine and sacroiliac joints. It includes conditions such as ankylosing spondylitis and psoriatic arthritis.

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Things worth knowing about "Spondyloarthritis"

Spondyloarthritis is a group of inflammatory rheumatic diseases primarily affecting the spine and sacroiliac joints. It includes conditions such as ankylosing spondylitis and psoriatic arthritis.

What Is Spondyloarthritis?

Spondyloarthritis (also referred to as spondyloarthropathy) is a group of chronic inflammatory rheumatic diseases that primarily affect the spine and the sacroiliac joints, but can also involve peripheral joints and other organs. The main subtypes include ankylosing spondylitis (also known as axial spondyloarthritis with radiographic changes), psoriatic arthritis, reactive arthritis, and arthritis associated with inflammatory bowel disease. The condition is broadly classified into axial spondyloarthritis (affecting the spine and pelvis) and peripheral spondyloarthritis (affecting the limb joints).

Causes

The exact cause of spondyloarthritis is not fully understood. A combination of genetic predisposition and immune system dysregulation plays a central role:

Genetic factors: The presence of the HLA-B27 gene marker is found in the majority of patients and is a significant risk factor.
Immune dysregulation: The immune system mistakenly attacks the body's own tissues, triggering chronic inflammation at the joints and entheses (tendon insertion sites).
Environmental triggers: Bacterial infections of the gut or urinary tract can precipitate reactive spondyloarthritis.
Gut microbiome: Alterations in intestinal flora are increasingly discussed as contributing factors.

Symptoms

Symptoms vary depending on the subtype but commonly include:

Chronic back pain, particularly in the lower back and buttocks, typically worse in the morning and improving with movement
Morning stiffness lasting more than 30 minutes
Pain and swelling in peripheral joints such as the knees, ankles, and hips
Enthesitis: inflammation at tendon attachment sites, commonly affecting the heel (Achilles tendon) or the sole of the foot
Dactylitis: sausage-like swelling of an entire finger or toe
Eye inflammation (uveitis)
Skin manifestations such as psoriasis
Bowel symptoms related to Crohn's disease or ulcerative colitis
General symptoms: fatigue, malaise, and occasionally low-grade fever

Diagnosis

Diagnosis is based on a combination of clinical evaluation, laboratory testing, and imaging:

Medical history and physical examination: Assessment of pain patterns, morning stiffness, and range of motion
Laboratory tests: Testing for HLA-B27, inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
Imaging: X-rays and MRI of the spine and pelvis to detect early inflammatory changes and structural damage
Classification criteria from the ASAS (Assessment of SpondyloArthritis international Society) are widely used to support diagnosis

Treatment

There is currently no cure for spondyloarthritis. Treatment focuses on reducing inflammation, relieving pain, and maintaining mobility and quality of life.

Pharmacological Treatment

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are the first-line treatment for pain and inflammation.
Biologics, including TNF-alpha inhibitors (e.g., adalimumab, etanercept) and IL-17 inhibitors (e.g., secukinumab), are used in patients with moderate to severe disease.
JAK inhibitors (e.g., tofacitinib, upadacitinib) represent a newer oral treatment option.
Corticosteroids may be used locally or systemically during acute flares.

Non-Pharmacological Treatment

Physiotherapy and regular exercise are essential to maintain joint mobility and posture.
Occupational therapy to adapt daily activities
Patient education and self-management strategies

Prognosis

The course of spondyloarthritis varies widely between individuals. With early diagnosis and consistent treatment, quality of life can be significantly improved. Without adequate therapy, progressive structural damage such as spinal fusion (ankylosis) may occur, leading to reduced mobility and disability.

References

Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73-84. doi:10.1016/S0140-6736(16)31591-4
van der Heijde D et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2017;76(6):978-991.
Ward MM et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2019;71(10):1599-1613.

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