Spondyloarthropathy and Ankylosing Spondylitis: What should you know about it?

What is Spondyloarthropathy?

Spondyloarthropathy (or spondyloarthritis), is a group of inflammatory joint diseases (arthritis) with predominant spine and nearby large joint pain and inflammation. It is also known as SpA in short. In this group of diseases, one of the severe types is known as Ankylosing Spondylitis. These diseases have some common diagnostic criteria and treatments are also similar.

Sometimes, Spondyloarthropathy also causes inflammation in the eyes, gastrointestinal tracts, skin, and areas where ligaments attach to the bones. It is classified as either axial (affecting pelvic joints and spine) or peripheral (affecting the limbs) Spondyloarthropathy. Axial SpA causes mostly back pain and peripheral SpA causes knee pain, ankle pain, etc.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis is a specific type of spondyloarthropathy where there is ankylosis or fusion of the spine joints.

As the disease progresses all the spine joints are fixed with calcifications of ligaments around the spine and gradually the patient is unable to move the spine, unable to turn the head, unable to touch the chest with the chin.

It is a severe and debilitating form of SPA.

What are the different types of Spondyloarthropathies?  What are their signs and symptoms?

Spondyloarthritis has the following types, which can fall under either axial or peripheral classification.

  • Ankylosing Spondylitis: In this disease, chronic inflammation causes pain and stiffness in the joints and spine. In severe cases, spinal vertebrae may fuse (hence the name ankylosis), giving rise to rigid spine and abnormal posture. The disease can also cause fever, fatigue, and inflammation of the eyes or bowel. In rare cases, it can involve the heart and lungs as well.
  • Reactive Arthritis: Formerly known as Reiter’s syndrome, it develops 2 to 4 weeks after an infection of the urinary tract or digestive system. It tends to cause inflammation of the lower joints, eyes, and urinary tract but may also lead to the inflammation of the spinal joints.
  • Psoriatic Arthritis: It develops in the 30s or 40s, and affects men and women equally. It is seen in associated with the skin condition psoriasis and develops after its symptoms have appeared already. The disease affects the pelvis and the back, major joints of the body, and fingers and toes. It may cause neck pain as well.
  • Enteropathic Arthritis: It is associated with inflammatory bowel diseases, i.e., ulcerative colitis and Crohn’s disease. It causes pain in the spine and peripheral joints and may also cause bloody diarrhea and abdominal pain.
  • Juvenile Spondyloarthropathy: It is not a specific disease but a group of conditions that develop in children at or before the age of 16 but may last throughout adulthood. It affects the lower extremities such as the pelvis, hips, ankles, and knees and causes pain.
  • Undifferentiated Spondyloarthropathy: Its symptoms are not as specific as other diseases of this group. It causes pain in the lower back and heels. Sometimes, it develops into a more identifiable disease such as ankylosing spondylitis.

What causes Spondyloarthropathy?

The exact cause of Spondyloarthropathy is not known, although several genes have been linked to it.

The main gene involved in all these diseases is HLA B27. It does not cause the condition, though, but increases the risk of developing it.

Some research also suggests it may be due to an imbalance of the intestinal microbiome.

Psoriatic arthritis may be an autoimmune disease, while the cause of reactive arthritis is Chlamydia infection or food-borne infection.

How to make a diagnosis of Spondyloarthropathy?

The doctor may suspect Spondyloarthropathy based on signs and symptoms, medical history, and physical evaluation. For a formal diagnosis, the testing may include

  • X-rays: It is performed to see changes in the sacroiliac joints. These changes are a
  • Magnetic resonance imaging/ MRI: If the x-ray results are unclear. This is more sensitive than X-ray to make a diagnosis of sacroilitis and therefore spondyloarthritis.
  • Blood test: Its purpose is to check for the presence of the HLA-B27 gene.

What is the prognosis of Spondyloarthropathy

In most reactive arthritis patients, the prognosis is usually good as they recover within 2 to 3 months. But in 15 to 20 percent of them, it progresses to Spondyloarthropathy and ankylosing in the next 10 to 20 years.

There is no cure for Spondyloarthropathy, but as compared to rheumatoid arthritis, the long-term anti-inflammatory therapy shows better outcomes.

What are the treatments of Spondyloarthropathy?

Since there is no cure, treatment focuses on managing pain, improving mobility, and reducing complications. The available options are

  • Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving pain and inflammation temporarily. Examples include aspirin, ibuprofen, naproxen, etc.
  • Corticosteroids such as methylprednisone are also effective in relieving pain temporarily when the swelling is not widespread.
  • Disease-modifying anti-rheumatic drugs (DMARDs) are used when NSAIDs and corticosteroids are no more effective. Methotrexate is a commonly used DMARD.
  • Tumor necrosis factor (TNF) alpha-blockers are used to block an inflammation-causing chemical called tumor necrosis factor-alpha.
  • Antibiotics might be given to treat reactive arthritis if the bacterial infection is still active.
  • Surgery is performed in severe cases of Spondyloarthropathy to treat bone destruction or cartilage damage.

What are the exercises for Spondyloarthropathy

Four main types of exercises recommended for Spondyloarthropathy are as follows

  • Range of motion or stretching exercises such as yoga.
  • Aerobic or cardiovascular exercises, e,g., running, climbing, or cycling
  • Strengthening exercises, such as climbing stairs, weight lifting, or gardening.
  • Balance exercises such as standing on one leg.