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Spondyloarthritis

What is spondyloarthritis?

Spondyloarthritis refers to a group of arthritic diseases that cause inflammation of the spine and vertebra. The inflammation can also occur in joints and possibly eyes, bowel, genital tract, or skin. With these diseases, chronic pain and stiffness in the lower back is what brings most patients to the doctor.

There are two common forms of spondyloarthritis: ankylosing spondylitis and psoriatic arthritis.

Ankylosing Spondylitis (AS) is a systemic, chronic inflammatory disease that causes arthritis of the spine and large joints, such as hips, knees, or ankles. Inflammation in the spine can lead to persistent pain and stiffness in the lower back, sometimes spreading to the buttocks. If inflammation occurs in the ribs, breathing problems can result. In some cases, over time, the bones in the spine may fuse together, resulting in a rigid spine with limited flexibility and a stooped posture. You may experience fever, fatigue, loss of appetite, and eye or bowel inflammation. The condition is twice as likely to occur among men compared to women. Symptoms of AS typically start in late adolescence to early adulthood (before 30 years old); it is rare for AS to begin after the age of 45.

Psoriatic arthritis (PsA) occurs in up to 40 percent of people who already have psoriasis, an inflammatory skin condition that is characterized by red patches of skin topped with silvery scales. In PsA, your body's immune system attacks healthy cells and tissue, causing inflammation in the skin, as well as in the spine and joints. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis; however, they can occur at the same time and sometimes the joint problems can begin before skin lesions appear. PsA affects both men and women equally with symptoms usually starting between the ages of 30 and 55 years old.

What causes spondyloarthritis?

There is no known cause of PsA or AS, though there is a strong genetic component in the disease development. Many people with PsA or AS have a family history of either sponyloarthritis or related conditions. Environmental factors, such as physical trauma or certain injections, may trigger spondyoarthritis in people who have an inherited tendency to the disease.

What are the symptoms of spondyloarthritis?

It is important to recognize the symptoms of AS and PsA — especially if you already have psoriasis — and to seek treatment from your rheumatologist if you experience the following:

  • Chronic pain and stiffness in the lower back and/or buttocks, particularly in the morning, which gets better as the day passes
  • Pain and stiffness in the back after a prolonged period of inactivity, which improves with exercise
  • Pain and stiffness gradually spreading to upper back, neck, and chest
  • Pain, swelling, stiffness, or reduced flexibility in one or more joints
  • Swelling and redness of fingers or toes
  • Pain in the bottom of the foot or swelling in the heel
  • Red patches of skin with silvery scales
  • Nail changes, such as separating from nail bed or becoming pitted
  • Red, painful eyes
  • Bowel inflammation
  • Fatigue

How is spondyloarthritis diagnosed?

The symptoms of PsA and AS are similar to other inflammatory arthritis diseases, so it can take a long time to get an accurate diagnosis. Sometimes, diagnosis does not occur until the joints have fused or become damaged.

To accurately diagnose your symptoms, your doctor will ask you questions about your family's medical history and any history of autoimmune diseases. It is very helpful to recall when you first started experiencing symptoms, whether there is anything you have done to make the symptoms feel better (or worse), and whether you have noticed any pattern in how symptoms are experienced.

No single test can confirm a diagnosis of PsA or AS, so your doctor will do a thorough physical exam as well as conduct some blood tests to rule out gout and other forms of arthritis. These include:

  • X-rays can show spine and joint changes indicative of PsA or AS.
  • Magnetic resonance images (MRI) will show active inflammation in the spine or joints. MRIs are more expensive than x-rays and only likely to be used if other test results are inconclusive.
  • Blood tests can help rule out other inflammatory conditions, such as rheumatoid arthritis. Your blood may also be tested for the HLA-B27 gene. Receiving a positive test result for this gene does not mean you have the disease, but it is a useful piece of information for your rheumatologist to have in diagnosing your illness.
  • Joint fluid test can help rule out gout.

How is spondyloarthritis treated?

There is no cure for PsA or AS. The goal is to relieve symptoms, restore and preserve physical functions, and maintain a high quality of life. As with most diseases, treatment is most effective if started at the onset of symptoms, before AS or PsA causes irreversible damage to your joints.

Treatment involves a combination of physical therapy, medications, and lifestyle modifications. Occasionally, surgery may be needed if the joints are severely damaged. Be sure to contact your physician if your symptoms change, you have a negative reaction to your medication, or another physician prescribes a drug that could interact with the treatment prescribed by your rheumatologist.

Complications of spondyloarthritis

  • 30-50% of people with AS have eye inflammation. If you experience rapid-onset eye pain, redness, sensitivity to light, and blurred vision, you should seek medical care immediately.
  • During the early stages of AS, some people develop osteoporosis, which increases risk of spine fracture or injury to the spinal cord.
  • In severe AS, the spine may become fused, causing limited flexibility and increased risk of having spine fracture and even injury to the spinal cord.
  • People who experience fusion in their rib cage may experience limited lung capacity and function.