Spondyloarthritis

Spondyloarthritis, or spondyloarthropathy, is an inflammatory arthritis affecting the spine. The main symptom (what you feel) in most patients is low back pain. This occurs most often in axial spondyloarthritis. Many people with axial spondyloarthritis progress to having some degree of spinal fusion, known as ankylosing spondylitis. In a minority of patients, the major symptoms are pain and swelling in large joints of the arms and legs. This type is known as peripheral spondyloarthritis.

Spondyloarthritis often inflames the entheses, the sites where ligaments and tendons enter bone. Spondyloarthritis more often affects males in their teens or 20s. Ankylosing spondylitis (AS) is associated with the HLA-B27 gene. Psoriatic arthritis, reactive arthritis and enteropathic arthritis associated with inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis, are types of spondyloarthritis.

What Are the Signs/Symptoms?

Low back pain is the most common symptom. Some spondyloarthropathies may affect the hands, feet, arms, or legs. Patients may have pain, fatigue or stiffness that is continuous or comes and goes.

Correct diagnosis requires a physician to assess the patient’s medical history and do a physical exam. The doctor also may order imaging tests or blood tests. X-ray changes of the sacroiliac joints, known as sacroiliitis, are a key sign of spondyloarthritis.

Among the blood tests you may need is a test for the HLA-B27 gene. However, having this gene does not mean spondyloarthritis will always develop.

What Are Common Treatments?

Spondyloarthritis patients should get physical therapy and do joint-directed exercises to promote spinal extension and mobility. First-line medications for symptom relief are nonsteroidal anti-inflammatory drugs (NSAIDs). For localized joint swelling, corticosteroid injections into the joint or tendon sheath are quickly effective. If patients do not respond, disease-modifying antirheumatic drugs (DMARDs) may be used to relieve symptoms and prevent joint damage. Some members of a newer class of drugs, known as biologics, are very effective in treating both the spinal and peripheral joint symptoms of spondyloarthritis. Oral corticosteroids are not recommended. Antibiotics are used to treat reactive arthritis only. Surgery, such as total hip replacement, may be helpful for some patients. Spinal surgery is rarely needed.

Living with Spondyloarthritis

With newer treatment options, most people with spondyloarthritis lead normal, productive lives and have a normal lifespan. People with spondyloarthritis should exercise frequently to maintain joint and heart health. People with spondyloarthritis who smoke should quit or get help to do so. Patient support groups for people with spondyloarthritis may be helpful and informative.

Updated February 2023 by Cheryl Crow, MOT, OTR/L, and reviewed by the American College of Rheumatology.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.