A progressive inflammatory disorder that causes lower back stiffness and pain is called Spondyloarthritis (SpA). However, people may also experience other symptoms, including swollen fingers, eye inflammation, and heel pain.
The name of this disorder means arthritis of the spine. It negatively affects the spine (the facet joints) between the vertebrae and the sacroiliac joints (located in the pelvic area). One of the most common symptoms of this disorder is lower back pain.
In general, spondyloarthritis is not only one disease, but is a group of disorders that begins in the spine. Check below some primary features of SpA:
- It is rheumatic – This disorder is a rheumatic disease, which means an inflammatory type of arthritis. Therefore, chronic (long-lasting) inflammation causes symptoms such as swelling and pain in the joints. Commonly, inflammatory arthritis is often a type of autoimmune disease.
- SpA is not a rheumatoid arthritis (RA) – While this condition is a type of rheumatoid arthritis, spondyloarthritis does not test positive for rheumatoid factor, which is an antibody often present in people with RA.
- Enthesitis – Physicians often look for inflammation in the entheses (enthesitis), which often indicates spondyloarthritis. The fibrous connective tissues that act similarly to joints are called entheses. The most common sites where spondyloarthritis causes enthesitis include the heels and knees.
- A gene known as HLA-B27 – Roughly 80% to 95% of people with SpA have this gene, especially people of northern European descent. However, this abnormal gene alone cannot cause spondyloarthritis.
It is not certain, but SpA occurs more frequently than rheumatoid arthritis. According to some research, approximately 0.5% to 2% of people suffer from spondyloarthritis in the entire world.
Types of Spondyloarthritis
Healthcare professionals have divided this disorder into two main categories. For example:
Axial Spondyloarthritis
This type of SpA negatively affects the joints located in the axial skeleton, including the neck, chest, and spine. When the condition advances, it may also affect other joints and organs.
One of the most severe types of axial spondyloarthritis is ankylosing spondylitis. Usually, those who develop it have noticeable changes to the spine bones (also known as ankylosis). Furthermore, this disorder is one of the most common SpA overall.
Peripheral Spondyloarthritis
This type of spondyloarthritis primarily affects peripheral joints and enthuses. When it progresses, you may also notice that the condition impacts the spine. Usually, peripheral spondyloarthritis also causes inflammation in other organs, including the eyes, skin, intestines, and others. Check below some types:
- Psoriatic arthritis – This type of disorder occurs along with psoriasis. It is an autoimmune disorder that negatively affects the skin, causing an inflammatory skin rash. In most cases, it happens in the small joints of the hand and feet. It may also cause painful swelling in the fingers and toes.
- Enteropathic arthritis – This condition often occurs along with inflammatory bowel disease (IBD).
- Reactive arthritis – This is a reaction of the immune system to an infection of the urinary tract or intestines. Usually, it negatively affects the following organs in the body. For example, the skin, bladder, genitals, eyes, or intestines. Commonly, it occurs temporarily, but in some people it may last up to 1 year.
Undifferentiated Spondyloarthritis
In people with this type of SpA, the symptoms fit the general profile of spondyloarthritis. However, they do not fit a specific subtype of the disease.
Juvenile Spondyloarthritis
This type of condition often occurs during childhood (before age 16). Furthermore, they may develop a specific subtype of the disease or symptoms that indicate multiple types.
Symptoms
People with spondyloarthritis often experience different symptoms. Moreover, they usually overlap. The following symptoms may occur with any type of spondyloarthritis. Examples include:
- Lower back pain that may spread to the buttocks (sacroiliitis)
- Stiffness that often worsens in the morning
- Back or neck pain
- Musculoskeletal chest pain
- Gradual curvature of the spine
- Stiffness and pain in the joints of the following parts of the body, including hips, shoulders, knees, elbows, wrists, or ankles
- Severely swollen toes and fingers
- Gastrointestinal symptoms (such as diarrhea)
- Inflammation in the urinary tract
- Psoriasis
- Nail pitting (also known as nail psoriasis)
- Appetite changes
- Fatigue (extreme tiredness)
- Mouth sores
- Uveitis (eye inflammation)
- Heel pain
- Bone spurs
Commonly, the symptoms listed above tend to occur earlier compared to other types of arthritis. It is also recommended to visit a doctor if you or your child experiences any of the previous symptoms.
Causes
The symptoms of spondyloarthritis are often caused by inflammation in the joints and other tissues. This inflammation is caused by an overreaction of the immune system to an infection. These disorders are called autoimmune disorders.
However, experts do not fully understand why this disorder occurs, but they think there are multiple factors involved. Like other autoimmune disorders, it seems to be partly genetic. For instance, genes in the HLA (human leukocyte antigen) family are usually involved in inflammatory arthritis. These genes produce some proteins that help the immune system distinguish its own cells from harmful germs. When these genes do not work properly, the immune system may mistakenly attack healthy cells, causing inflammation.
Triggers
While genes contribute to spondyloarthritis, they cannot cause it alone. Many people with this disorder carry the HLA-B27 gene, but there are a lot of people with this gene who do not develop this disease. Therefore, there is something else that triggers the inflammatory process. According to some research, triggers may include severe infections, environmental toxins, smoking, and misuse of alcoholic beverages.
Other theories suggest that this disorder is strongly linked to dysbiosis in the gut microbiome. It may weaken the immune system, making you more prone to infections that cause chronic inflammation in the intestines.
Diagnosis
Commonly, it is challenging to diagnose spondyloarthritis, especially if a person has combined symptoms. However, some people may have only joint pain and stiffness, which can be caused by multiple health conditions.
Usually, doctors begin the diagnosis with a physical examination and questions about the symptoms and medical history. They may also evaluate your family history. To get more clues about the disease, doctors often perform imaging tests. These include X-rays of the spine to examine the back and other joints. Another test that may confirm spondyloarthritis is a blood test to check for the HLA-B27 gene.
Treatment
Healthcare professionals often prescribe different treatments for people who develop spondyloarthritis. It depends on the severity and type of the condition, existing health problems, age, and preferences. However, the treatment may include exercise, over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), pain relievers, and others. If you do not notice improvements with these medicines, physicians may recommend the following treatments. For example:
- Regular Cortisone shots for localized pain relief
- Biologic or traditional DMARDs (disease-modifying anti-rheumatic drugs)
In addition, some types of spondyloarthritis may require other treatments for the underlying condition.
Frequently Asked Questions
How serious is spondyloarthritis?
If you develop a severe, chronic inflammatory arthritis, you may also experience some complications. These complications may negatively affect your quality of life rather than your overall lifespan. For instance, you may lose mobility in the joints and become more likely to bone fractures.
Can spondyloarthritis go away?
Unfortunately, there is no way to cure this disorder. That’s why the treatment focuses on relieving the symptoms and improving your quality of life. For more details, discuss it with your physician.
What are the spondyloarthritis symptoms?
These include:
- Pain and stiffness in the back, hips, neck, joints, tendons, and even eyes and intestines.
- Swelling
- Enthesitis
- Extreme tiredness
- Uveitis
- Gastrointestinal problems
It is advised to see a healthcare professional if any of the previous symptoms occur. Ask your healthcare provider if you have any other questions.
