These are a group of conditions that share similar symptoms and signs. The most distinguishing feature is inflammation of the Axial joints (joints of the trunk of the body; the neck, spine, and pelvic bone joints).
The conditions also present with swellings of the large joints, especially of the legs (for example the knees). There may also be small joint involvement (such as of the small joints of the fingers) and inflammation at the sites where the ligaments attach to the bone (for example at the point the Achilles, tendon attaches to the heel).
The specific syndromes that are fall under this family include:
- Reactive arthritis (formerly Reiters' syndrome)
- Ankylosis spondylitis
- Spondyloarthritis associated with inflammatory bowel diseases (Crohns and Ulcerative colitis)
- Juvenile onset spondyloarthritis
- Spondyloarthritis associated with psoriasis
- Undifferentiated spondyloarthritis
- Non-radiological axial spondyloarthritis
There tends to be a family history of theses conditions and there is a strong association with a certain marker on the white blood cells of the sufferers of this condition - HLA-B27(>90% will have this marker). There are approximately 30 other genes that have been associated with these conditions.
This condition has a predilection for males, who will have a two to three times higher risk of haveing the condition compared to females. It has a peak occurrence in the early twenties.
The general clinical presentations of the conditions include skeletal (joint involvement), eye involvement, skin and genital ulcerations and inflammation of the bowel.
The Skeletal Features
These include back pain that tends to occur mostly at night and at rest and is relieved by movement and exercise. This is termed inflammatory back pain is found in over 70 percent of patients with these conditions.
Usually occurs acutely and involves the knees (swelling may be considerable) and ankles but any joint can be involved. it tends to affect one to three joints only.
There tends to be inflammation where the ligaments attach to the bone. The most common site of inflammation is the Achilles' tendon.
Other features include sternum pain and buttock pain that may alternate.
There are two main conditions that may occur.
- Anterior Uveitis (inflammation of the front position of the eyeball
Inflammation Of The Bowel
Sixty-six percent of patients with these conditions may have inflammation of the bowel, but they are usually no symptoms of this inflammation.
For reactive arthritis, testing for bacterial infections is important for a diagnosis, but this is not valid for the other forms.
If your doctor suspects one of these conditions he/she may order a number of test such as:
- X-rays of the affected joint e.g hip bones and spine
- MRI of the spine or other joints
- Check for your HLA-B27 status
Treatment will depend on a number of criteria and the disease severity and activity
Complications of these conditions include:
- Osteopetrosis, which may predispose the suffers to fractures. This is a significant problem in Ankylosing Spondylitis.
- Eye problems due to recurrent inflammation in the eyes
- Inflammation of one of the main valves of the heart leading to heart problems later on in life
- Lung problems; if the spine is affected.
There is no cure (exception for reactive arthritis if the offending infection is treated, but this may not be the case all the time) but these conditions are manageable. Unfortunately many people go for many years without a diagnosis, thus is your suspect you may have one of these conditions discuss it with your doctor or visit your local rheumatologist.
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