Spondyloarthropathies

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Spondyloarthropathies

What are spondyloarthropathies?

Spondyloarthropathies are a group of inflammatory rheumatic diseases that cause arthritis. Unlike other types of arthritis, spondyloarthropathies involve the areas where ligaments and tendons attach to bones and muscles. The chief symptoms are joint pain, swelling and redness. They develop in people in their teens to mid-40s, but a person of any age can be affected. These types of arthritis can damage joints and bones in your spine, shoulders and hips. The cause is unknown but researchers say genetics play a big role. Also called spondyloarthritis, almost two million Americans have some type of spondyloarthritis condition. 

What are the types of spondyloarthropathies?

  • Ankylosing spondylitis is the most common type and attacks the joints in your spine, and sometimes in your hips and shoulders. It can also cause fatigue, mild fever and loss of appetite. It most often affects White males between the ages of 15 and 40.
  • Psoriatic arthritis affects major joints in the body as well as fingers, toes, back and pelvis. It is more common in people who have psoriasis or a family history of psoriasis. About 20% of psoriasis patients develop it, most commonly between the ages of 35 and 45.
  • Reiter’s syndrome occurs as a reaction to an infection in another part of your body. It causes pain and swollen joints in knees, ankles and feet. It most commonly occurs in late teens to early adulthood.
  • Reactive arthritis can develop after an infection of the urinary tract, digestive system, or from a sexually transmitted infection. It most commonly attacks joints in legs, feet and toes, and is more likely to occur in late teens to early adulthood. This type usually lasts from three to 12 months, but arthritis returns in about half of patients. Up to 30% of patients develop chronic arthritis.
  • Enteropathic spondyloarthropathy occurs in about 20% of people who have digestive tract illnesses like ulcerative colitis or Crohn’s disease.
  • Undifferentiated spondyloarthropathy causes more general symptoms than the types listed above. It can develop into one of the more specific types.

Causes

What causes spondyloarthropathies?

While the cause is unknown, for some patients the cause may be related to their genetics. It tends to develop in families where one or more members have spondyloarthropathy. In other patients, the cause may be environmental, involve the immune system, or be triggered by an infection.

Men are three times more likely to get these diseases, compared to women. When women have the disease, they are more likely to have arthritis symptoms in arms, hands, legs and feet.  

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Symptoms

What are the symptoms of spondyloarthropathy?

The most common symptom is back pain. Symptoms vary according to the type, but the most common symptoms can include:

  • Painful, swollen joints in the hips, shoulders, knees and elbows
  • Pain can start in your heels that is caused by enthesitis (inflammation of a muscle) that progresses to where tendons and ligaments connect to bone
  • Dactylitis is inflammation in the whole finger or toe tendons that causes swelling
  • Uveitis causes eye redness and pain, usually affecting one eye
  • Skin rash (psoriasis)
  • Inflammatory bowel disease (IBD), Crohn’s disease and ulcerative colitis (Spondyloarthropathy occurs in about 20% of IBD patients.) 
  • Spinal deformities can result from limited mobility
  • Mouth ulcers
  • Kidney disease
  • Heart problems 
  • Ankylosing spondylitis can cause fatigue, mild fever, loss of appetite, prostatitis, lung fibrosis, eye pain, blurry vision, tearing and sensitivity to light

Reactive arthritis usually begins one to four weeks after an infection. The most likely germs to cause it are Salmonella, Shigella, Yersinia, Chlamydia, Ureaplasma, Yersinia, and Campylobacter. Both Reiter’s syndrome and reactive arthritis start quickly (the acute phase). Two to four joints become painful and swollen within a few days. The acute phase also includes weight loss, fever, conjunctivitis and diarrhea. 

Severe spondyloarthropathy can damage the vertebrae and make your spine stiffer. Two or more vertebrae may grow together, reducing the flexibility of your rib cage. This can make it hard to take a deep breath.

Diagnosis

How is spondyloarthropathy diagnosed?

Your doctor will do a physical examination and may order an X-ray or other imaging tests to check your pelvis joints and lower spine. This area can show early signs of the disease. A blood test will determine if you have a gene (HLA-B27) that makes you more susceptible to all types of spondyloarthropathies.

Treatment

What are the treatment options for spondyloarthropathy?

There is no cure but targeted treatment will ease symptoms and can slow progression of the disease. Treatment options include:

  • Non-steroidal anti-inflammatory drugs (NSAIDS -- aspirin, naproxen or ibuprofen) can relieve pain and reduce joint swelling. 
  • Antibiotics may be prescribed for infections that cause reactive arthritis. 
  • Corticosteroid shots into painful joints can provide quick pain relief, but it’s temporary.
  • Sulfasalazine, methotrexate, and tumor necrosis factor-α inhibitors may be prescribed if NSAIDS don’t relieve pain and stiffness. 
  • Disease-modifying antirheumatic drugs (DMARDs) can help with pain and inflammation in arms and legs. 
  • TNF inhibitors block a blood chemical that causes inflammation.
  • Joint-replacement surgery may be recommended for badly damaged joints. Artificial knee and hip replacements are the most common surgery sites.
  • If the spine vertebrae have grown together, forcing your back into a forward-curving position, surgery may be recommended to straighten your spine. However, this is a high-risk operation.
  • Non-drug therapy is important, and includes patient education about their disease, physical therapy, and a home exercise program that includes exercises to extend and strengthen the spine. Maintaining good posture is important. Severe cases may require inpatient rehabilitation.

Who treats spondyloarthropathy?

Your treatment team will likely include a rheumatologist (medical doctor who specializes in treating arthritis). Other team members may include a gastroenterologist (medical doctor who specializes in digestive system diseases), ophthalmologist (if the disease is affecting your eyes or vision), and a physical therapist, who can prescribe exercises and therapies to improve joint flexibility, and relieve pain and stiffness.

References

Kataria, R.J., DO; Brent, L.H., MD. (June 2004). Spondyloarthropathies. American Family Physician. Retrieved 8-17-21, {https://www.aafp.org/afp/2004/0615/p2853.html}
WebMD. (April 2021). What Are the Types of Spondyloarthropathies? Retrieved 8-17-21,  {https://www.webmd.com/arthritis/types-of-spondyloarthropies}
American College of Rheumatology. (March 2019). Spondyloarthritis. Retrieved 8-17-21, {https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Spondyloarthritis}
Arthritis Foundation. (n.d.). Spondyloarthritis. Retrieved 7-17-21, {https://www.arthritis.org/diseases/spondyloarthritis}

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Roy Kedem started his premedical studies at Harvard, and research in genetics and gene sequencing at Harvard, Beth Israel. He attended medical school in the UK at the Cambridge Overseas Medical Program in 1998. Dr Kedem then completed his residency in Internal Medicine at Columbia College of Physicians and Surgeons in Stamford, Connecticut and his fellowship in Hospital Medicine at the Cleveland Clinic in Cleveland, Ohio.

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