Arthritis / Rheumatology Crohn's / IBD

Spondyloarthritis: Symptoms, treatments, and causes

Spondyloarthritis is the term for several inflammatory diseases that cause different types of arthritis. Also known as spondyloarthropathy, it is a condition that affects the joints and the entheses, the areas where ligaments and tendons attach to bone.

Spondyloarthritis (SpA) mainly occurs in the spine and pelvic area, where it is classified as axial spondyloarthritis. When it affects the limbs or other areas, such as the eyes and digestive tract, it is known as peripheral spondyloarthritis.




Fast facts on SpA:

  • There are several types of SpA

  • The exact cause of SpA is not known. It is thought that there is a genetic component.

  • Treatments include medications and surgery.

  • Risk factors include smoking and other lifestyle factors, such as diet.



Types of SpA


The different types of SpA are highlighted here:


Ankylosing spondylitis (AS)


Senior woman with lower back pain.
Spondyloarthritis is the name for a group of inflammatory conditions that may cause various forms of arthritis. It mainly affects the pelvis and lower spine.


AS is the most common form of SpA. It is estimated that AS affects between two and five adults in every 1,000 people in certain European populations.


However, in some groups, up to 1 percent or 10 people in 1,000 may be affected.


Symptoms include pain and stiffness in the spine and the area between the spine and the pelvis. AS is more common in men than women, and symptoms usually begin in early adulthood.


Reactive arthritis (ReA)


Previously called Reiter’s syndrome, ReA begins when an intestinal or urinary tract infection leads to an immune reaction.


ReA affects the joints, eyes, urethra, and skin with signs and symptoms including mouth ulcers, eye inflammation, patches of scaly skin, and pain at the entheses. Unlike AS, ReA does not usually affect the spine.


Enteropathic arthritis (EnA)


Affecting certain areas of the digestive tract, this form of inflammatory arthritis is linked to inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis.


EnA mainly affects the peripheral joints of the limbs, but it can also impact on the entire spine. Stomach pain and bloody diarrhea are other common symptoms. 


Psoriatic arthritis (PsA)


This type of SpA affects those who have psoriasis, an inflammatory skin disease that causes patches of red, flaky, and scaly skin.


PsA may affect up to 30 percent of people with psoriasis. Symptoms include joint pain, stiffness, and swelling in the spine, hands, and feet.


Juvenile spondyloarthritis (JSpA)


Also known as juvenile spondyloarthropathy, JSpA is a form of childhood arthritis that first presents in those under 16 years of age. Symptoms usually affect the lower body, including the hips, knees, and feet, but can occur in other places. 


Forms of JSpA can include juvenile AS, PS, ReA, and EnA, along with undifferentiated spondyloarthritis.


Undifferentiated spondyloarthritis (USpA)


The term ‘undifferentiated spondyloarthritis’ or USpA is used if someone displays certain spondylitis signs and symptoms but does not meet the full criteria for a diagnosis of one of the above conditions.


Some people who are initially diagnosed with USpA may eventually develop more symptoms to enable them to receive a diagnosis of AS or another related condition.




Symptoms


Signs and symptoms of SpA depend on the form the disease takes. However, symptoms usually present in two distinct ways:


Inflammation and pain


Inflammation is a defining characteristic of SpA. It usually begins in the spine, but it may also affect the pelvis, hands, feet, arms, and legs. The inflammation causes pain and stiffness.


Bone damage


Destruction of the bone may occur. This damage can eventually lead to spinal deformities, which can impact mobility. Along with inflammation, pain, and bone damage, people with SpA may experience:


  • fatigue

  • eye pain and inflammation

  • gastrointestinal symptoms

  • urinary symptoms

  • psoriasis

  • osteoporosis

What are the causes and risk factors?


Psoriasis on the hand.
Having certain pre-existing conditions, such as psoriasis or inflammatory bowel disease (IBD), may increase the risk of developing SpA.


Approximately 30 genes have been identified that may cause AS, the most common form of SpA. The most studied gene is one called HLA-B27.


People who carry HLA-B27 are at greater risk of developing AS than those without it, although not everyone with the gene develops the condition.


Similarly, not everyone with AS carries the HLA-B27 gene.


According to the Canadian Spondylitis Association, approximately 10 percent of people with SpA do not have the HLA-B27 gene.


Those who have the gene are also more likely to develop EnA.


Some research suggests that SpA is linked to an imbalance in the bacteria in the gut. Bacterial infections, such as chlamydia or food poisoning, can trigger ReA.


Risk factors


While the reasons for getting SpA are often unclear, certain factors increase the risk of disease development, including:


  • carrying the HLA-B27 gene

  • bacterial infections

  • having IBD or psoriasis

  • having a family member with SpA

  • being of Siberian Eskimo, Alaskan, or Scandinavian Lapps descent


What are the treatment options?


As no cure exists for SpA, treatment involves managing the symptoms, limiting the spread of the disease, and reducing the risk of complications.


The treatment regimen employed will depend on the individual and the form of SpA they have. Treatment options include:


Medications


NSAIDs.
NSAIDs may be prescribed to help treat SpA, as well as corticosteroid injections or TNF-alpha blockers.


Several medications are used to treat the symptoms of SpA, such as:


  • nonsteroidal anti-inflammatory drugs (NSAIDs)

  • corticosteroid injections

  • disease-modifying antirheumatic drugs (DMARDs)

  • tumor necrosis alpha (TNF-alpha) blockers

  • antibiotics

Surgery


Some people with SpA may benefit from surgical interventions. For example, if significant pain or disability results from cartilage destruction in the hip, replacing the hip with a prosthesis may be beneficial.


Surgery on the spine is usually unnecessary. However, it may be carried out on those with broken bones or deformities of the neck that leave the person unable to straighten their neck.


Physical therapy


Regular physical activity helps to improve or maintain mobility. A qualified physical therapist can devise a suitable program of exercises and stretches for those with SpA.


Emotional support


SpA can have an emotional impact and a physical one. People with the condition may find it useful to attend counseling or to take part in a support group for those with chronic conditions.



Prevention


As the cause of SpA is not clear and is likely to have a genetic component, preventing its onset is difficult. However, early diagnosis and intervention can limit disease progression and help manage symptoms. Listed below are some factors to consider:


Lifestyle choices


Leading a healthy lifestyle can go a long way to easing the symptoms of SpA. Important lifestyle factors include:


Diet


Eating a healthful, balanced diet is important for overall health and maintaining a healthy body weight. Being overweight puts additional stress on the joints.


An anti-inflammatory diet may help reduce inflammation in the body. This type of diet is similar to the Mediterranean diet and is recommended by the Arthritis Foundation and the Cancer Treatment Centers of America. Foods to eat include:


  • fruits

  • vegetables

  • whole grains

  • nuts and seeds

  • lean protein, such as beans, lentils, and lean meats

  • fatty fish

Exercise


Regular physical activity is extremely important in the management of SpA. It helps to relieve pain and stiffness and can maintain mobility.


Low-impact exercises are best, as they put less pressure on the joints than high-impact activities. Examples of low-impact exercises include walking, swimming, and using an elliptical trainer.


Quitting smoking


Smoking causes inflammation and can make symptoms of SpA worse. Smoking also increases the risk of cancer and other diseases.




Outlook


SpA is a serious and progressive disease with no known cure. Nonetheless, once steps are taken to manage the condition and limit its progression, the outlook for the majority of people with SpA is good. They can go on to live full lives with a low risk of further complications. 

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