Spondyloarthritis - Causes, Types, Symptoms, and Treatment

Introduction:

Lifestyle changes and food habits have made humans more susceptible to various diseases and infections. People with poor posture and lack of exercise are highly prone to joint pain. For example, spondyloarthritis is a condition that causes pain in the lower back. If left untreated, it may cause serious complications and affect vital organs like the heart and lungs. Hence, it is important to understand the causes and symptoms to prevent complications.

What Is Spondyloarthritis?

It is a type of arthritis that attacks mostly the spine and joints of the arms and legs; in more advanced cases, it may cause spine fusion. Spondyloarthritis is generally classified as axial or peripheral. The axial type affects the pelvic joints and spine, and the peripheral type affects the limbs. Spondyloarthritis involves both synovium and entheses (where ligament and tendon attach to the bone).

In recent years, there has been tremendous progress in understanding the natural history and pathogenetic mechanism underlying spondyloarthritis, leading to the development of treatment. In severe cases, this condition may lead to fibrosis and calcification, which results in the loss of flexibility and strength. The main clinical features are back pain and progressive spinal rigidity. Studies have revealed some factors that tend to cause the disease, including immune reactions, endocrine malfunctioning, genetic factors, and microbial infections. Young men are two to three times more affected by spondyloarthritis than women.

What Are the Causes of Spondyloarthritis?

The exact cause is not known, but genetic factors play a major role in this condition. The main gene involved in spondyloarthritis is HLA-B27; it might not be responsible for the condition but can increase the risk of developing the disease. Many patients with spondyloarthritis are positive for the gene HLA-B27; however, a single gene cannot determine whether the disease will affect a person.

What Are the Types of Spondyloarthritis?

• Ankylosing Spondylitis- This is the most common type of spondylitis and affects the joints and ligaments along the spine.

• Reactive Arthritis- This type causes joint pain and swelling in other parts of the body. This condition is mostly associated with an infection in the intestine or urinary tract. Also known as Reiter’s syndrome. An autoimmune reaction may cause conjunctivitis (pink eye).

• Psoriatic Arthritis- This type of arthritis occurs in people who have psoriasis disease- a skin condition. The body’s immune system attacks healthy cells and tissues of the skin, causing joint pain, swelling, and inflammation.

• Enteropathic Arthritis- This condition most commonly affects inflammatory bowel disease, affecting the spine and the other joints.

• Peripheral Spondyloarthritis (SpA): Patients with symptoms and findings that are primarily or completely peripheral rather than axial are referred to as having peripheral spondyloarthritis (SpA). These traits include dactylitis, enthesitis, and arthritis, which is typically asymmetric and primarily affects the lower limbs.

• Undifferentiated Arthritis- Often, the symptoms are similar to arthritis but are hard to diagnose; this includes lower back pain, buttocks, and heels.

What Are the Signs and Symptoms of Spondyloarthritis?

The following are the clinical manifestations of spondyloarthritis.

• Back pain and stiffness are worse at night.

• Long-standing low back pain.

• Painful swelling of joints.

• Tiredness.

• Digestive problems.

• Inflammation of the aortic heart valve.

• Psoriasis skin rashes and changes in nails.

• Swelling and pain in the tendons of the fingers and toes (sausage fingers).

• Irritation and redness in the eye region.

• Neck pain.

• Fatigue.

What Are the Complications of Spondyloarthritis?

Some people may tend to cause severe complications of the disease if not treated and in advanced stages show severe complications.

• Osteoporosis (bone weakness) and spinal fractures.

• Intestinal inflammation.

• Uveitis (inflammation in the middle layer of the eyes).

• Cardiovascular disease (heart problems).

• Reduced flexibility.

• Iritis (inflammation and irritation of the eyes).

• Joint damage.

• Amyloidosis (abnormal protein disorder).

• Edema (accumulation of fluid).

• Shortness of breath.

• Weight loss.

• Bone damage.

What Are the Diagnostic Tests Involved in Spondyloarthritis?

Based on the symptoms, physical examination, and medical history, the doctor also recommends the following diagnostic tests.

• Imaging Tests- X-rays detect the inflammation of the sacroiliac joints (sacroiliitis).

• Magnetic Resonance Tests (MRI)- Generally, non-invasive magnetic resonance imaging (MRI) uses a magnetic field, radio waves, and a computer to create detailed image slices of the various parts of the spine. This test detects any inflammatory and structural changes in patients with spondyloarthritis.

• Ultrasonography- A clear vision of joints and bones can be seen via ultrasonography, and abnormalities can be detected.

Laboratory Tests:

• Blood Tests- To check the HLA-B27 gene.

• C-reactive Protein (CRP)- A CRP test detects levels of CRP, which is a protein associated with inflammation in the body.

• Erythrocyte Sedimentation Rate (ESR) Test- It measures the inflammation in the body by calculating the RBC (red blood cell) settled at the bottom of the blood sample.

• Complete Blood Count (CBC)- A CBC checks the red blood cell count and white blood cell count. An increased or decreased blood count indicates inflammation associated with the disease.

What Are the Treatments for Spondyloarthritis?

The main objective of treatment is to minimize symptoms, reduce pain, improve mobility, and reduce risk factors that might cause the disease.

Lifestyle Changes:

1. Diet Modifications

• Some foods and ingredients might cause inflammation and should be reduced. These include sugars, fried food items, saturated fats, gluten-free foods, and prohibiting alcohol and smoking.

• Consuming diet-rich foods such as fruits and green leafy vegetables, lean protein, fibers, whole grains, legumes, and dried figs.

2. Physical Therapy

• Exercising helps strengthen muscles and joints and increases the joints' mobility and structure.

3. Medications:

1. Analgesics- Pain relievers such as Paracetamol and Ibuprofen.

2. NSAIDs (Non-steroidal Anti-inflammatory Drugs)- These help to reduce the pain and inflammation in the joints.

3. Corticosteroids- These can be given orally or are injectable. It helps in minimizing the symptoms and pain.

4. Depo Steroid Injection- Injection is given in the joints of the tendon sheath to relieve the symptoms of the local flares.

5. Tumor Necrosing Factor Alpha Blockers- Effective in both spinal and peripheral joints.

6. Other Drugs: Azathioprine and Methotrexate are also used in some cases as these are common man's biologics. However, the use of these drugs is fought with issues of high cost, latent tuberculosis recurrence, etc.

Conclusion

Some people might go into remission with proper management of spondyloarthritis, while others might have long-lasting symptoms. Advanced treatments and therapies are of huge benefit to the patient, which may help the patients to survive and can at least minimize their discomfort. But in some cases, the disease might worsen, and complications may arise. However, early diagnosis and proper treatment regimen can help lead a quality life.