Spondyloarthritis(Spondyloarthropathies)

Spondyloarthritis(orspondyloarthropathy)istheoverallnameforafamilyofinflammatoryrheumatic
diseasesthatcanaffectthespineandjoints,ligamentsandtendons.Thesediseasescancausefatigue
andpainorstiffnessintheback,neck,hands,knees,andanklesaswellasinflammationoftheeyes,
skin,lungs,andheartvalves.Whilethereisnocourseofpreventionatthistime,treatmentcanreduce
discomfortanddelaythedevelopmentofspinaldeformities.

Fastfacts
Spondyloarthritisusuallystrikesyoungmales,particularlyfamilymembersofthosewiththese
diseases.
NonsteroidalAntiinflammatoryDrugs(NSAIDS)offerconsiderablesymptomrelief.
Aregularregimenofrecreationalactivitiesandbackexerciseswillimprovecomfortlevels.

Whatisspondyloarthritis?
Thetermspondyloarthritis(alsoknownasspondyloarthropathy)coversagroupofcloselyrelated
inflammatorydiseasesincludingarthritisofthespine(sacroiliitisorspondylitis)andperipheraljoints;as
wellasinflammationintheareawhereligamentsandtendonsattachtobones(enthesitisor
enthesopathy).Thesediseasescancausepaininthespine,legsandarmsasjoints,ligaments,and
tendonsbecomeinflamedand/orpredisposepatientstospinalvertebralfractures.Skinrashes,eye,and
intestinalproblemscanalsooccur.

Diseasesthatfallunderspondyloarthritisumbrellacaninclude:1)ankylosingspondylitis;2)reactive
arthritis(knownpreviouslyasReiter'ssyndrome)3)psoriaticarthritisandpsoriaticspondylitis,and4)
thearthritisorspondylitisassociatedwiththeinflammatoryboweldiseases,ulcerativecolitisand
Crohn'sdisease.Stillotherpatientsmaydevelopundifferentiatedspondyloarthritis.Thismeansthey
havesymptomsorsignsofoneoftheillnessesabove,butdon'tdevelopthefullblowndisease.

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Whatcausesspondyloarthritis?
Theexactcauseofspondyloarthritisisunknown.
However,researcherspointtohereditaryfactorsas
playinganimportantrolesincetheseillnessestendto
occurmoreofteninfamilymembersofpatientswho
havespondyloarthritis.Thesepatientsusuallyshare
commongeneticmarkerscalledHLAB27,whichoccurs
inaboutsevenpercentofthepopulation.

Otherinfections,suchaschlamydia(whichcancause
urethritisorburningonurination)andbacteriathat
causeintestinaldysentery(suchastypesofsalmonella,
shigella,etc.),cantriggeracertaintypeofreactive
arthritisthatisaformofspondyloarthritis.Beyond
these,nospecificinfectionhasbeenlinkedtoother
typesofthedisease.
Overtime,spondylitisresultsin
Whogetsspondyloarthritis? pronouncedcurvatureofthespine(left).
Spondyloarthritistendstoimpactthoseintheirteens
and20s,andyoungmentwotothreetimesmore
frequentlythanyoungwomen.(Psoriaticarthritisdoesaffectyoungmenandwomenequally).Family
membersofpatientswithspondyloarthritisrunthehighestriskofcontractingthesediseases,
particularlythosewithHLAgenes.

ThehighestfrequencyappearsinthefarnorthinculturessuchasAlaskanandSiberianEskimosand
ScandinaviansLapps(Samis),aswellasincertainNativeAmericatribesinthewesternU.S.andCanada.
AfricanAmericansareleastfrequentlyaffected.Aboutonein200Caucasianshavespondyloarthritis.

Howisspondyloarthritisdiagnosed?
Diagnosisismadefollowingacarefulhistoryandphysicalexaminationofinflammatorybackpainor
arthritisofthelegasitdiffersfromothertypesofarthritissuchasrheumatoidarthritis.

AdditionaltestssuchasXraysofthesacroiliacjointsandspinecanconfirmthepresenceofspondylitis.
(ResearchersarecurrentlydevelopingMRIscansthatwillalsodiagnosethedisease).Ifsymptomsand
signsindicate,thephysicianwillalsocheckforthepresenceoftheHLAB27gene.

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Howisspondyloarthritistreated?
Likemanyformsofarthritis,physicaltherapy
andrecreationalexerciseatleast30minutes
perdaycansignificantlyimprovepainand
stiffness.Additionalbackexercisesatleastfive
daysperweekwillalsoimprovepainand
functioninpatientswithankylosing
spondylitis.

Redareasshowlocationofinflammationinthe
Thereisalsoavastarrayofdrugtreatment
sacroiliacjoints.
optionsforspondyloarthropathy,startingwith
nonsteroidalantiinflammatorydrugs
(NSAIDs),suchasnaproxen,ibuprofen,diclofenacorindomethacingivenattheoutsetofthedisease
symptoms.NoonespecificNSAIDisconsideredsuperiortoanotherforspondyloarthritispatients.These
inandofthemselveswillgenerateconsiderablereliefforpatients.

Diseasemodifyingantirheumaticdrugs(DMARDs)suchassulfasalazineandmethotrexatehaveproven
effectiveintreatingaccompanyingarthritisinthearmsorlegs,butnotforarthritisofthespineor
sacroiliacjoints.

Corticosteroidstakenbymouthalsocanbeeffective.However,giventheirsideeffects,particularly
osteoporosisandinfections,andnewagentsnowavailable(seebelow),thesemedicationsarenot
recommendedunlessthemoreeffectivetreatmentscannotbeused.Injectionsofdeposteroid
medicationsintojointsortendonsheathsarefrequentlyusedbycliniciansforsymptomaticreliefof
localflares.

Antibioticssuchasciprofloxacin,givenoverathreemonthcoursesoonafterdiseaseonset,mayhavea
beneficialeffectontheprognosisofreactivearthritis,especiallywhentriggeredbyChlamydia
trachomatis,butnotinothertypesofspondyloarthritis.

TNFalphablockers(alsoknownasbiologics)havebeenshowntobequiteeffectiveintreatingboththe
spinalandperipheraljointsymptomsofspondyloarthritis,aswellasotherproblemssuchaspsoriasis
andintestinalinflammation.Therearethreetypescurrentlyavailable:

infliximab(Remicade),whichisusedatadoseof5mg/kggivenintravenouslyeverysixtoeight
weeks;
etanercept(Enbrel),given25mgundertheskintwiceweekly;and
adalimumab(Humira),injectedatadoneof40mg.everyotherweekundertheskin.

However,antiTNFtreatmentisexpensiveandnotwithoutcomplications,includinganincreasedriskfor
infections,especiallytuberculosis.Therefore,NSAIDandDMARDtherapyaretriedfirst.

Somepatientsrequiresurgicaltreatment.Forthosewithankylosingspondylitis,atotalhipreplacement
isthemostcommon.However,becausepatientswithspondylitisareatincreasedriskforvertebral

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fracture,theymayexperienceoftenspinalcorddamage.Typically,thesepatientsmustwearakindof
bracecalledahalovest.Surgicalspinalfusionmaybenecessarywhenspinalcordornervefunctionis
compromised.

Somepatientsseeksurgicalcorrectionofthespinaldeformitiesthatcanoccurwithankylosing
spondylitis,calledosteotomy.Giventheextensivecomplicationrates,patientsconsideringthis
procedureshouldconsultsurgeonsexperiencedwiththistypeofoperation.

Broaderhealthimpacts
Patientswithspondyloarthritiscandevelopadditionalcomplicationswhichshouldbediscussedwith
theirphysician.Thesecaninclude:
Osteoporosiswhichoccursinuptohalfofpatientswithankylosingspondylitis,especiallyin
thosewhosespineshavefused,andcanpredisposetospinalfracture.Treatmentsinclude
calciumsupplements,bisphosphonatesandotherstandardtreatmentsforosteoporosis.
Eyeinflammation,calleduveitis,whichoccursinabout40percentofthosewith
spondyloarthritis.Usuallysteroideyedropsareeffective,thoughmoreseverecasesmayrequire
strongertreatmentsbyanophthalmologist.
Inflammationoftheaorticvalveintheheartwhichcanoccurovertimesinpatientswith
spondylitis.Thisshouldbemonitoredwiththephysician.
Psoriasisandintestinalinflammationwhichmaybesosevereastorequiremorespecialized
treatmentbyadermatologistorgastroenterologist.

Livingwithspondyloarthritis
Despitethepain,fatigueandstiffnessthatcharacterizethesediseases,mostpatientswith
spondyloarthritiscanhavelongandproductivelives,particularlywiththenewertreatmentsavailable.
Regularphysicalexerciseisessentialtoreducespinalfusionanddeformitiesandtomaintainjointand
cardiovascularhealth.

PatientsupportgroupsarealsoavailablethroughtheSpondylitisAssociationofAmerica,thePsoriasis
FoundationortheArthritisFoundation.(seelinksbelow).Theseindividualsandmedicalpractitioners
canbeprovidevaluableinformationandsupport.

Pointstoremember
Spondyloarthritisisatypeofarthritisthatoccursinthespineandperipheraljoints(hands,
knees,ankles,etc.)thatcanalsoinvolvetheskin,intestines,andeyes.
Thoseintheirteensand20s,particularlymales,areaffectedmostoften.Familymembersof
spondyloarthritispatientsareatthehighestrisk.
Newertreatmentshavehelpedagreatdealincontrollingthesymptomsandsigns.

Tofindarheumatologist
Foralistingofrheumatologistsinyourarea,clickhere.Learnmoreaboutrheumatologistsand
rheumatologyhealthprofessionals.

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Formoreinformation
TheAmericanCollegeofRheumatologyhascompiledthislisttogiveyouastartingpointforyourown
additionalresearch.TheACRdoesnotendorseormaintaintheseWebsites,andisnotresponsiblefor
anyinformationorclaimsprovidedonthem.Itisalwaysbesttotalkwithyourrheumatologistformore
informationandbeforemakinganydecisionsaboutyourcare.

SpondylitisAssociationofAmerica
www.spondylitis.org

ThePsoriasisFoundation
www.psoriasis.org

TheArthritisFoundation
www.arthritis.org

UpdatedJune2005
WrittenbyJohnD.Reveille,MD,andreviewedbytheAmericanCollegeofRheumatology

Thispatientfactsheetisprovidedforgeneraleducationonly.Individualsshouldconsultaqualifiedhealthcare
providerforprofessionalmedicaladvice,diagnosesandtreatmentofamedicalorhealthcondition.

2010AmericanCollegeofRheumatology

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