What Is Spondyloarthritis?
Spondyloarthritis is a group of inflammatory diseases that cause arthritis. You also may hear it called spondyloarthropathy or, for short, SpA. It’s different from other kinds of arthritis because it also causes inflammation in areas called entheses where ligaments and tendons attach to bones. Ligaments are tissues that connect your bones to one another, and tendons are tissues that connect your bones to your muscles.
Spondyloarthritis is a major cause of lower back pain, arthritis in the peripheral joints such as those in arms and legs, eye problems, and even inflammatory bowel disease (IBD).
It tends to affect people in their teens and 20s, especially young men. If you have a relative with any form of spondyloarthritis, you may be at a higher risk of developing it.
Types of Spondyloarthritis
There are a number of conditions in the spondyloarthritis family. They include:
- Ankylosing spondylitis (also called “spondylitis"). This is the most common form. It affects the joints and ligaments along your spine and causes pain and stiffness that start in your lower back and may spread into your upper spine, chest, and neck. Eventually, the joints and bones there can fuse and make your spine stiffen into a C-shape. That leads to a hunched posture.
- Reactive arthritis. This starts with an infection of your intestine or urinary tract. An immune reaction may follow that can cause pinkeye (conjunctivitis) and can cause rash oral ulcers and urinary tract inflammation as well as arthritis. This condition used to be known as Reiter’s syndrome.
- Psoriatic arthritis. Some people who have the skin disease psoriasis also get this type of arthritis. With it, your body’s immune system attacks healthy joints and skin by mistake. That can cause joint pain, stiffness, and swelling in your hands and feet as well as the spine.
- Enteropathic arthritis. This inflammatory arthritis affects some part of your digestive tract. It can be associated with a number of inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis.
There’s no cure for spondyloarthritis. But with treatment, exercise, and some changes to your lifestyle, you can have an active and productive life.
Symptoms of Spondyloarthritis
The different types of spondyloarthritis may have:
- Back pain
- Digestive issues
- Inflammation of the aortic heart valve
- Pain or swelling in other joints, including your hips, knees, ankles, feet, hands, wrists, elbows, and shoulders
- Psoriasis skin rash
- Swelling along the tendons of your fingers or toes (“sausage fingers")
- Swelling, pain, or redness in part of an eye
Causes of Spondyloarthritis
Spondyloarthritis tends to be inherited. Scientists have linked about 30 genes to the condition. The biggest culprit is one called HLA-B27. It’s found in 90% of people who have the most common form of spondyloarthritis (ankylosing spondylitis). But not everyone who has the gene gets it.
To find out if you have spondyloarthritis, your doctor will do a complete physical exam and look at your medical history.
They may want to take X-rays of your spine and a pair of joints in your pelvis called the sacroiliac joints to look for changes. You also may need an MRI (magnetic resonance imaging), which uses powerful magnets and radio waves to get a clearer look at your joints.
Your doctor may want to do a blood test to see if you carry the HLA-B27 gene. The test can help confirm diagnosis.
Doctors can’t cure spondyloarthritis, but some things can help:
- Nonsteroidal anti-inflammatory drugs. NSAIDs like ibuprofen, indomethacin (Tivorbex), meloxicam (Mobic), and naproxen (Aleve, Anaprox, Naprosin) can help with your symptoms.
- Corticosteroid medication. Shots in your joints or in the membrane around your tendon can work quickly. This option works best if your joint swelling is in one specific area.
- Antibiotics. If you have reactive arthritis, which begins with a bacterial infection, antibiotics can help, at least at first.
- Disease-modifying antirheumatic drugs. DMARDs such as methotrexate and sulfasalazine (Azulfidine) work best if you have arthritis that affects the joints in your arms and legs. Your doctor may prescribe these to help your symptoms and prevent joint damage.
- Immunotherapy. Mononuclear antibodies are used to stimulate the body’s own immune system to help fight the disease. Ixekizumab (Taltz) has recently been approved to help prevent the inflammation.
- Tumor necrosis alpha (TNF-alpha) blockers. This newer class of drugs, known as biologics, can treat arthritis in both the spine and joints. The ones the FDA has approved for ankylosing spondylitis include adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, certolizumab pegol (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi), infliximab (Remicade), infliximab-dyyb (Inflectra), a biosimilar to Remicade, and secukinimab (Cosentyx). However, these treatments are expensive and can cause serious infections. Talk with your doctor to make sure it’s right for you.
- Surgery. Over time, inflammation can damage the cartilage in your hips, causing pain and problems with movement. In that case, you may need a hip replacement. In rare cases, you might need spinal surgery.
To ease some of the pain and other bad effects without medication or surgery, take these steps:
- Get frequent exercise. Physical therapy and home exercise can help your joint and heart health. If you have ankylosing spondylitis, stretching can help keep your spine from stiffening into an awkward position.
- Stop smoking. In addition to its other bad health effects, smoking can make the bones in your spine grow together faster.
- Practice good posture. When you have pain in your spine, you tend to bend over, causing more strain on your backbone. Good posture can help keep your spine from growing in a slumped-over position.
- American College of Rheumatology: “Spondyloarthritis."
- Arthritis Foundation: “Ankylosing Spondylitis," “Inflammatory Bowel Disease," “Psoriatic Arthritis," “Reactive Arthritis," “Spondyloarthritis."
- Cleveland Clinic: “Spondylitis."
- FDA: FDA approves Amjevita, a biosimilar to Humira.”
- Spondylitis Association of America: “Overview of Spondyloarthritis: A Family of Related Diseases."
- University of Maryland Medical Center: “A Patient’s Guide to Cervical Kyphosis."