Until recently, spondyloarthritis (spon-di-low-ar-THRI-tis) didn’t receive much attention. It’s now generating more interest, in part because it’s diagnosed more often and there are better ways to treat it, says rheumatologist Philip Mease, MD, a professor at the University of Washington Medical Center in Seattle.
Spondyloarthritis, also known as spondyloarthropathy, is a family of inflammatory, rheumatic diseases that includes ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis (associated with inflammatory bowel disease, or IBD) as well as indeterminate arthritis (symptoms that don’t fit in other categories). These conditions have some key features in common. For example, they often attack the spine (axial spondyloarthritis) and can cause inflammation in joints in the arms and legs (peripheral spondyloarthritis), as well as in the eyes, intestines and skin. They’re also much more likely to occur in people who carry a gene called HLA-B27.
Dr. Mease says the introduction of anti-tumor necrosis factor (anti-TNF) drugs, a type of biologic, and their success in treating severe spondyloarthritis has spurred new research into the mechanisms of and treatments for the diseases. Here’s a brief look at the types of spondyloarthritis:
Ankylosing spondylitis (AS) mainly affects the spine, especially the sacroiliac joints in the pelvis, and is a frequent cause of low back pain and stiffness. Symptoms, which may be mild or severe, usually start before age 30, but changes to sacroiliac joints may not show up on X-rays for a decade or more. This has led to some controversy about how and when AS should be diagnosed.
Psoriatic arthritis (PsA) can strike joints in the spine, fingers and toes – even the tendons and ligaments at the ends of bones (entheses) – making it especially challenging to treat. Up to 30% of people with the skin disorder psoriasis develop PsA.
Reactive arthritis, which can cause inflammation in the joints, eyes and urinary tract, is usually triggered by an intestinal or genital tract infection. The infection may be treated with an antibiotic and the arthritis symptoms often go away on their own, though they may recur in some people. In the early stages, it can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs); other medications may be needed if it becomes chronic.
Enteropathic arthritis develops in 10% to 20% of people who have IBD (Crohn’s disease or ulcerative colitis). Like AS, it often affects the spine, but unlike AS, it rarely causes joint destruction or disability.
Treatment of spondyloarthritis depends on the type and how active it is. Although anti-TNFs and newer biologics are considered breakthroughs for these conditions, aggressive treatment sometimes isn’t needed. John Flynn, MD, a professor and medical director of the spondyloarthritis program at Johns Hopkins School of Medicine, in Baltimore, says many patients do well with NSAIDs and exercise. “I prescribe physical therapy for everyone,” he says, noting that exercise may even slow disease progression.
Author: Linda Rath
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