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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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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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