Spondyloarthritis: Classifications, indications, management, and further insights
Spondyloarthritis (SpA) is a group of inflammatory rheumatic diseases that primarily affect the spine and other joints. This condition is characterized by inflammation at entheses, where ligaments and tendons attach to bone. Major types of SpA include ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis, enteropathic arthritis (EPA), and undifferentiated spondyloarthritis (unSpA).
Causes
The exact causes of SpA are not fully understood, but they are believed to involve immune system dysfunction, often linked with genetic factors such as the HLA-B27 gene. Environmental triggers and infections can also contribute, particularly in reactive arthritis. SpA is seronegative (negative for rheumatoid factor), which distinguishes it from rheumatoid arthritis (RA).
Symptoms
Inflammatory back pain and stiffness, especially in the lower spine and pelvis, are common symptoms of SpA. Peripheral joint pain, often asymmetrical and oligoarticular (involving a few large joints), is also common. Enthesitis, or inflammation at tendon and ligament attachment points, is another symptom. Extra-articular manifestations such as anterior uveitis (eye inflammation), skin changes (psoriasis in PsA), and less commonly involvement of heart, kidneys, or lungs, may also occur. In advanced AS, there may be a gradual loss of spinal mobility and fusion of vertebrae, potentially leading to spinal deformity.
Treatment Options
Treatment for SpA focuses on controlling inflammation and managing symptoms. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are often used as a first-line treatment to reduce pain and inflammation. Physical therapy and exercise are essential for maintaining posture and mobility. Disease-Modifying Anti-Rheumatic Drugs (DMARDs) such as sulfasalazine or methotrexate may be used in peripheral joint disease. Biologic agents, especially Tumor Necrosis Factor (TNF) inhibitors and newer biologics, are effective for patients refractory to NSAIDs/DMARDs, particularly in AS and PsA. Lifestyle modifications such as stress management, nutrition support, and quitting smoking can also help manage the condition.
Comparison with Rheumatoid Arthritis (RA)
SpA differs from RA in several aspects. While RA is seropositive (positive for rheumatoid factor), SpA is seronegative. The primary joints affected by SpA are the spine, sacroiliac joints, and asymmetrical peripheral joints, whereas RA mainly affects small symmetrical joints (hands, wrists). Inflammation in SpA occurs at entheses, while in RA it occurs in the synovial membrane. Extra-articular features such as uveitis, psoriasis, and inflammatory bowel disease are common in SpA, while rheumatoid nodules and lung involvement are more common in RA. Genetically, there is a strong association with HLA-B27 in SpA, while HLA-DR4 is associated with RA. Imaging differences also exist, with bone fusion and spinal ankylosis possible in SpA, and joint erosions and cartilage loss in RA. Treatment options also differ, with NSAIDs, biologics (TNF inhibitors), and DMARDs used in SpA, and NSAIDs, DMARDs (methotrexate), and biologics (TNF, others) used in RA.
Living with Spondyloarthritis
Living with spondyloarthritis can make performing certain everyday tasks more difficult, but it is possible to manage the symptoms and prevent disease progression. Making certain behavioral changes, such as exercising, quitting smoking, eating an anti-inflammatory diet, and improving sleep hygiene, can make living with spondyloarthritis easier. A doctor may request an MRI scan if an X-ray does not show damage but a person has symptoms that suggest the presence of spondyloarthritis. Ankylosing spondylitis is the most common form of spondyloarthritis. Non-radiographic spondyloarthritis is a type that does not show up on X-rays but is visible on MRI scans. A person who has had chronic lower back pain since before the age of 40 years may have spondyloarthritis. People who are male, have a family history of spondyloarthritis, or are one or a descendant of certain northern populations may be more likely to develop spondyloarthritis. The early symptoms of spondyloarthritis usually start with back pain. Spondyloarthritis can cause fatigue, inflammation in various parts of the body, psoriatic rashes, and gastrointestinal symptoms. The doctor can perform ESR tests or CRP tests on the blood to determine if swelling is present in the body. There are spondyloarthritis support groups available for people who may need additional support.
- Spondyloarthritis (SpA) is a chronic disease that belongs to the group of health-and-wellness conditions, particularly chronic-diseases, as it primarily affects the axial skeleton, including the spine and other joints.
- Advancements in science have provided medical-conditions like SpA with treatment options, such as the use of nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Disease-Modifying Anti-Rheumatic Drugs (DMARDs), and biologic agents, to help manage the condition and alleviate symptoms.
- Spondyloarthritis, unlike rheumatoid arthritis (RA), is characterized by certain unique symptoms, such as inflammation at entheses, and extra-articular manifestations such as anterior uveitis, psoriasis, and inflammatory bowel disease, which set it apart as a distinct medical condition.
