Spondyloarthropathies
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Spondyloarthropathies (SpA)
Spondyloarthropathies are a group of related inflammatory rheumatic diseases primarily affecting the spine and the sacroiliac joints (where the spine meets the pelvis), but they can also involve peripheral joints, entheses (sites where tendons and ligaments attach to bone), and extra-articular organs.
Key Features
- Primary Symptoms:
- Chronic lower back pain and stiffness, often worse in the morning or after periods of inactivity, improving with exercise.
- Pain and swelling in peripheral joints such as hips, shoulders, knees, and fingers.
- Enthesitis: inflammation at tendon or ligament insertion sites, commonly the Achilles tendon or plantar fascia (heel pain).
- Extra-articular manifestations including eye inflammation (uveitis), skin psoriasis, and inflammatory bowel disease (IBD).
- Fatigue and systemic symptoms may occur.
- Affected Joints:
- Axial skeleton: sacroiliac joints and vertebrae.
- Peripheral joints: asymmetric arthritis in large joints, often lower limbs.
- Entheses: inflammation at tendon and ligament insertions.
- Genetics:
- Strong association with the HLA-B27 gene, especially in axial spondyloarthritis.
- Family history of SpA, psoriasis, IBD, or uveitis increases risk.
Types of Spondyloarthropathies
- Ankylosing Spondylitis (AS):
- The prototypical SpA characterized by progressive inflammation of the spine and sacroiliac joints, leading to fusion and reduced spinal mobility.
- Symptoms often begin in late adolescence or early adulthood, more common in males.
- Reactive Arthritis:
- Arthritis triggered by an infection elsewhere in the body, often genitourinary or gastrointestinal.
- Psoriatic Arthritis:
- Occurs in patients with psoriasis, characterized by joint inflammation and skin lesions.
- Enteropathic Arthritis:
- Associated with inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.
- Undifferentiated Spondyloarthritis:
- Patients with features of SpA who do not meet criteria for a specific subtype.
Diagnosis
- Based on clinical history, physical examination, imaging (X-rays, MRI showing sacroiliitis), and laboratory tests.
- Presence of HLA-B27 supports diagnosis but is not definitive.
- Classification criteria include the Amor, European Spondyloarthropathy Study Group (ESSG), and ASAS criteria.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Group of inflammatory arthritis affecting spine, sacroiliac joints, peripheral joints, and entheses |
| Common Symptoms | Lower back pain, stiffness, peripheral arthritis, enthesitis, uveitis, psoriasis, IBD |
| Key Joints Involved | Sacroiliac joints, spine, hips, shoulders, knees, fingers |
| Genetic Association | Strongly linked to HLA-B27 |
| Major Types | Ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis |
| Diagnosis | Clinical features, imaging (sacroiliitis), HLA-B27 testing, classification criteria |
| Treatment | NSAIDs, physical therapy, biologic agents (TNF inhibitors, IL-17 inhibitors), DMARDs |
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References
- Cleveland Clinic: Spondyloarthritis
https://my.clevelandclinic.org/health/diseases/spondyloarthritis-spondyloarthropathy - WebMD: Types of Spondyloarthropathies
https://www.webmd.com/arthritis/types-of-spondyloarthropies - Brigham and Women’s Hospital: Spondyloarthritis Symptoms and Treatment
https://www.brighamandwomens.org/medicine/rheumatology-inflammation-immunity/services/spondyloarthritis - Bangkok Hospital: Spondyloarthropathy
https://www.bangkokhospital.com/en/content/arthritis-and-spinal-arthritis - Mayo Clinic: Ankylosing Spondylitis Symptoms & Causes
https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808 - American College of Rheumatology: Spondyloarthritis
https://rheumatology.org/patients/spondyloarthritis - Physio-Pedia: Spondyloarthritis
https://www.physio-pedia.com/Spondyloarthritis - American Academy of Family Physicians: Spondyloarthropathies
https://www.aafp.org/pubs/afp/issues/2004/0615/p2853.html
Spondyloarthropathies are a group of inflammatory joint diseases primarily targeting the spine and sacroiliac joints, with systemic manifestations and a strong genetic component. Early diagnosis and treatment are essential to manage symptoms and prevent joint damage.
