Spondyloarthritis is the name of a family of rheumatic diseases that are characterized by arthritis of the spine and peripheral joints, inflammation in the area where ligaments and tendons attach to bones, and inflammation of the skin, intestines and eyes. They are classified as seronegative spondyloarthritis to differentiate them from rheumatoid arthritis: symptoms between the two conditions often overlap, but blood tests in patients with the former are negative for the RhF marker (rheumatoid factor). The exact cause of spondyloarthritis is unknown, but hereditary factors are thought to play an important role, since these illnesses often run in families, and especially in individuals who express a genetic markers called HLA-B27.
Spondyloarthritis can be subdivided in:
1)Ankylosing spondylitis: it usually presents with pain and stiffness in the lower back, which over the years becomes rigid and curved as the vertebrae fuse together. About 40% of patients will also develop an eye inflammation called uveitis during the course of their disease. Ankylosing spondylitis is more common in males than females, usually strikes people in their twenties, and occurs predominantly in patients who express the HLA-B27 marker, which is found in 92-95% of all cases.
2)Reactive arthritis: it presents with redness and swelling of the large joints following a bacterial inflammation of the gastrointestinal tract, often caused by food poisoning, or genitourinary tract, usually caused by the micro-organisms responsible for chlamydia and gonorrhea. The genetic marker is found in 60-80% of patients.
3)Psoriatic arthritis and psoriatic spondylitis: it occurs in about 5% of people with psoriasis and is linked to the HLA-B27 marker, which is found in 60% of cases. The disease often manifests itself with tendinitis and swelling of the fingers, and tends to develop 10 years after the onset of psoriasis.
4)Enteropathic arthritis: it is associated with inflammatory bowel diseases, ulcerative colitis and Crohn's disease. In patients with enteropathic arthritis, inflammation of the peripheral joints is accompanied by gastrointestinal symptoms such as abdominal pain and diarrhea. About 60% of patients have the HLA-B27 marker.
5)Undifferentiated spondyloarthritis: patients have symptoms or signs of one of the illnesses above, but don't develop the full-blown disease. The HLA-B27 marker can be isolated in only 20-25% of patients, and there are indications that the majority of these will go on to develop one of the forms of spondyloarthritis described above, while for most patients without the marker there will be no disease progression.
There is a variety of treatment options for spondyloarthropathies. These can be divided in four categories:
Non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ibuprofen, diclofenac or indomethacin. No NSAID is considered superior to another and response is personal.
Disease modifying anti-rheumatic drugs (DMARDs), such as sulfasalazine and methotrexate, proved effective in treating arthritis in the arms or legs, but do not work for arthritis of the spine or sacroiliac joints.
Corticosteroids taken by mouth can be very effective, even though they have considerable side effects and thus should be used sparingly. Injections of steroid drugs into joints or tendon sheaths are especially useful in the symptomatic treatment of localized inflammation.
TNF alpha blockers (adalimumab, infliximab) have been shown to be excellent in treating both spinal and peripheral joint symptoms as well as other problems such as psoriasis and intestinal inflammation.
Additionally, patients with reactive arthritis respond to antibiotics and in particular ciprofloxacin, while ankylosing spondylitis and undifferentiated spondyloarthritis may benefit from physical therapy. Low impact activities such as stretching, yoga, and swimming can bring considerable improvement to quality of life by maintaining joint function and slowing down the stiffening of the spine.