Types Of Spondylitis: Spondyloarthritis Vs Ankylosing Spondylitis

Spondyloarthritis, a type of inflammatory arthritis, is characterized by inflammation of the joints as well as the entheses, which is the area where the ligaments attach to bones. There are six different types of spondyloarthritis:

1. Ankylosing spondylitis. This is the most common type of spondyloarthritis and is characterized by inflammation in the spine and/or pelvis. It gradually starts before the age of 45 and improves with increased physical activity. Joint stiffness in the morning lasts at least 30 minutes in these patients. Over time, sections of the spine can become fused, leading to severe mobility restrictions.
2. Psoriatic arthritis. Patients with psoriatic arthritis have pain and swelling in the small joints of the hands and feet.
3. Enteropathic arthritis. This is a form of spondyloarthritis that is associated with the development of an autoimmune disease called inflammatory bowel disease. Symptoms of enteropathic arthritis include chronic diarrhea, abdominal pain, weight loss, and blood in feces.
4. Reactive arthritis. This type of arthritis is caused by an infection in the intestine or urinary tract, which occurs before the inflammation of the joints sets in. Reactive arthritis causes inflammation and pain in the joints, as well other organs such as skin, eyes, bladder, genitals, and mucus membranes.
5. Undifferentiated spondyloarthritis. This type of arthritis can be diagnosed in those people that have symptoms and features that are consistent with spondyloarthritis, but don’t fit into other categories.
6. Juvenile spondyloarthritis. This type of arthritis has features consistent with spondyloarthritis and develops in children and adolescents.

While all diseases that fall into the broader category of spondyloarthritis are unique in their disease characteristics, the commonality across these diseases is that they all involve inflammation of the axial skeleton (spine and sacroiliac joints that join the pelvis to the lower spine) which is different from patients with rheumatoid arthritis.

Patients with spondyloarthritis demonstrate disease involvement primarily of the spine. However, some forms of spondyloarthritis can also affect the peripheral joints, such as those in the hands, feet, arms and legs.

Spondyloarthritis usually begins in people that are between the ages of 17 and 45. Systemic inflammation is a primary feature of spondyloarthritis and this is what helps distinguish spondyloarthritis from other types of arthritis, such as osteoarthritis. Patients with spondyloarthritis are seronegative, which basically means that certain antibodies that are commonly associated with rheumatoid arthritis and other rheumatic diseases are not present in the person’s blood stream.

Causes of spondyloarthritis

Most cases of spondyloarthritis can be attributed to genetic causes. In fact, researchers have identified up to 30 different genes that can cause the development of ankylosing spondylitis, the major one being a gene called HLA-B27. Interestingly, almost all people of Caucasian decent that have ankylosing spondylitis tend to carry this gene. Furthermore, people with HLA-B27 are also more likely to have enteropathic arthritis. Other than genetics, other further that contribute to the development of this disease are unknown to date.

What are the symptoms of spondyloarthritis?

The most common symptom of spondyloarthritis is inflammatory back pain, pain limited to the lower back that is not caused by mechanical factors such as injury, excessive activity, or improper posture. Additionally, patients who live with spondyloarthritis can develop pain and inflammation in the pelvis, neck, intestine, eyes, heels, and other large joints.

There are two different patterns of symptoms that characterize patients with spondyloathritis:

1. For the majority of patients with spondyloarthritis, the disease manifests predominantly as low back pain. If left untreated, the disease progresses to involve the spine. Eventually, patients will experience a fusion of the vertebrae, which limits the spine’s mobility severely.
2. For a minority of patients, the disease manifests as swelling of the arms and legs. This type of spondyloathritis is known as peripheral spondyloarthritis.

Other symptoms and related conditions that can occur across all patients with spondyloathritis include:

• Joint inflammation that comes and goes
• Fatigue
• Osteoporosis
• Pain and redness of the eye
• Inflammation of heart valve
• Inflammation of the intestine
• Psoriasis

Diagnosis: How do doctors diagnose spondyloarthritis?

Physicians begin the process of diagnosing patients with spondyloarthritis based on the results of their medical history and physical exam. Other tests can then be ordered to confirm a diagnosis of spondyloarthritis once the doctor strongly suspects it:

1. Imaging tests can be used to confirm a diagnosis of spondyloarthritis if physicians suspect that a patient has spondyloarthritis. For example, physicians can order the patient to undergo X-rays of the sacroiliac joints, which are a pair of joints in the pelvis that undergo changes called sacroiliitis in cases of spondyloarthritis. Often, these changes may not show up on an X-ray, in which case an MRI scan can be ordered.
2. Genetic tests to look for one of up to 30 different genetic contributors to the development of spondyloarthritis. Most often, a test for presence of the HLA-B27 gene is ordered. However, just because you have the gene doesn’t mean you have or will develop spondyloarthritis.

Treatment for spondyloarthritis

These are the medical treatments that are commonly prescribed to patients with spondyloarthritis:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, are effective at relieving pain and inflammation.
2. Corticosteroids. Injections of corticosteroids directly into the joint or membrane into the area of the joint affected can help provide fast but long-lasting relief.
3. Disease-modifying antirheumatic drugs (DMARDs). These medications are prescribed when neither NSAIDs nor corticosteroids provide enough relief. DMARDs are used to relieve symptoms and prevent joint damage. In particular, DMARDs are effective for patients who have arthritis that affects the joints within the arms and legs.
4. Tumor necrosis alpha (TNF-alpha) blockers. These are a class of drugs that are effective at treating arthritis of both the spine and joints in the arms and legs. However, patients who take these drugs are at a higher risk for serious infections, and hence they are prescribed with caution.
5. Antibiotics can be useful for the treatment of reactive arthritis.
6. Surgery can be used as a treatment option for spondyloarthritis patients when inflammation destroys the cartilage in the hips. Surgeries for this type of problem can include a replacing a hip with a prosthesis, which is called a total hip replacement.