Spondyloarthropathies

Spondyloarthropathies are a group of chronic inflammatory diseases of the spine and joints. The most common spondyloarthropathies include ankylosing spondylitis, reactive arthritis, psoriatic arthritis and arthritis secondary to inflammatory bowel diseases such as ulcerative colitis and crohn’s disease. Spondyloarthropathies can occur at any age, however, they occur more often in young males.  A positive family history increases the risk of spondyloarthropathies.

The exact cause of spondyloarthropathies is not yet known. Infections with Chlamydia and other bacteria that cause dysentery have been found to activate reactive arthritis, a type of spondyloarthropathy.

What are the symptoms of spondyloarthropathies?

Although the different spondyloarthropathies have their own specific symptoms, some of the common symptoms include fatigue, lower back pain which may spread to the buttocks, and early morning stiffness. Patients may also notice skin rashes, inflammatory eye diseases such as uveitis and intestinal disturbances. In severe cases, the spinal vertebrae fuse together resulting in pain and stiffness of the spine. A few of the symptoms of spondyloarthropathies are very similar to that of rheumatoid arthritis.

How are spondyloarthropathies diagnosed?

Diagnosis of Spondyloarthropathies includes a detailed medical history, a physical examination and laboratory investigations. Imaging tests such as X-ray of the sacroiliac joint and spine may be useful in detecting spondylitis (inflammation of the spine). Some patients may also be tested for the presence of HLA-B27 gene.

What are the treatment options?

Treatment of spondyloarthopathies is aimed at relieving pain and stiffness and prevention of any deformity. Regular physical exercise can retard the progression of the disease and also improve the functional ability of the joints. Medications such as non-steroidal anti-inflammatory drugs, disease modifying anti-rheumatic drugs and corticosteroids can provide symptomatic relief. For severe pain, corticosteroids can be directly injected into the joints or tendons. Antibiotics are prescribed for management of reactive arthritis. TNF alpha blocker injections have been found to be quite effective in managing the symptoms. Individuals prone to vertebral fracture are advised to wear a halo vest to stabilize the spine.

Surgical intervention is indicated in severe cases and may involve spinal fusion, osteotomy or total hip replacement.

What are the associated complications?

Complications such as osteoporosis, uveitis, inflammation of aortic valve in the heart, psoriasis and intestinal inflammation may occur in some patients and may require appropriate treatment by a physician, ophthalmologist, dermatologist or gastroenterologist.

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