SPONDYLOARTHRITIS

        Spondyloarthritis

Definition

Spondyloarthritis (also known as spondyloarthropathy) is the term which describes the connective tissue diseases. It is the group of inflammatory diseases, including arthritis of the peripheral joints and spine (sacroiliitis or spondylitis); including the area where ligaments and tendons attach to bones (enthesitis or enthesopathy). These diseases cause pain or stiffness in the leg or arm joints, spine, ligaments and tendons become inflamed. Skin rashes, eye, and intestinal problems may also be able to occur.

Epidemiology

• Spondyloarthritis is a pathology that specifically strikes young people. The symptoms most frequently start before the age of 45. It affects more males than females.
• Predisposition to spondyloarthritis, especially SpA, is determined largely by genetic factors.
• The incidence rate is higher in populations with a higher prevalence of HLA-B27.
• Psoriatic skin lesions and colitis due to inflammatory bowel disease (IBD) have been considered as both basic, subtype-defining entities with their own genetic background (distinct from HLA-B27 genotype), and as manifestations of spondyloarthritis.
• There is a strong need to diagnose patients with SpA in an earlier stage; currently, there is a delay of 5–10 years between onset of the first symptoms and diagnosis.

Types

There are five types of spondyloarthritis

Ankylosing spondylitis or Bechterew disease: It is the type of arthritis that affects the spine. Symptoms include pain and stiffness in the lower back and in the neck. Spine bones fuse together and it will become rigid spine and it leads to stoope over posture.

Psoriatic arthritis: Psoriatic arthritis is the form of arthritis that affects the people who have psoriasis. Most people diagnosed with psoriasis and later diagnosed with psoriatic arthritis. It may affect any part of the body such as fingertips and spine. The main symptoms are joint pain, stiffness, and swelling.

Psoriatic arthritis

Reactive arthritis:  It occurs due to the infection by certain bacteria. Often the bacteria’s from genitals (Chlamydia trachomatis) or bowel (Campylobacter, Salmonella, Shigella, and Yersinia). It usually targets your knees and joints of ankles or feet.

Reactive arthritis

Undifferentiated arthritis: Undifferentiated inflammatory arthritis does not conform to any of the recognized inflammatory arthritis types. It may include monoarthritis of a single joint; oligoarthritis, which is usually when four or fewer joints are involved; or polyarthritis, which usually involves many small joints.

Risk factors

Risk factors may be higher due to following reasons

• Family member having the gene which causes spondyloarthritis
• Positive results for the HLA-B27 gene
• Recurring bacterial infection in your gut
• Have other inflammatory conditions such as psoriasis or inflammatory bowel disease

Causes

• The main cause is not known, but researchers pointed out that the hereditary genetics playing an important role in this disease. Since this disease occurs often in family members of patients who have spondyloarthritis.
• Many genes cause it. Up to 30 genes have been found. But the major gene that causes spondyloarthritis is HLA-B27.
• Bacterial infections can also cause reactive spondyloarthritis known to be triggered by a bacteria chlamydia or food borne infections.

Symptoms and complications of Spondyloarthritis

The first and major symptoms of all types of spondyloarthritis are severe low back pain, swelling of arms, stiffness, and fatigue. The different types of spondyloarthritis can be manifested by the following signs and symptoms.

• Alternative or unilateral buttock pain
• Arthritis in small joints
• Arthritis in large joints such as knee joint, ankle joint and elbow joint (peripheral arthritis)
• Numbness and tingling sensation in arms and legs
• Spinal fusion may occur in ankylosing spondylitis
• Inflammation at the interfaces between bone and tendon or ligament of limbs (Enthesitis)
• Inflammation of intestine, urinary tract and aortic heart valves. These can lead to spinal joints inflammation.
• Inflammation of joints in pelvis and spine (sacroiliitis)
• Enteropathic arthritis shows symptoms such as diarrhea and abdominal pain
• Digestive problems
• Skin disease like psoriasis
• Osteoporosis
• Redness of eye (Iritis)
• Swollen fingers and
• Pain in the heels cause difficult to walk, stand even for small duration

Diagnosis and Testing

First a doctor may ask for patient’s medical history, physical exam and may suspects for symptoms of spondyloarthritis. To confirm doctor may perform the following diagnosis and tests.

• X-rays: X-Ray images shows the change of the sacroiliac joints in the pelvis and fusion of spine. If these changes not observed, but symptoms shows spondyloarthritis doctor will suggest MRI scan. MRI shows these changes more promptly than the X-Ray.
• MRI scans: It can show a very clear image of enthesitis and also the changes of sacroiliac joints.
• CT scans: CT also used for the imaging of bone joints.
• HLA-B27: Most patients with spondyloarthritis have HLA-B27 gene, but some people don’t have this gene. So it is necessary to go for a HLA-B27 test if the symptoms suspects spondyloarthritis.
• Complete blood count (CBC): CBC can be useful to find the inflammation.
• Musculoskeletal ultrasound scanning: Ultrasound imaging uses sound waves to produce the images of inflammatory conditions of muscles, ligaments, and tendons.
• Dual-energy X-ray absorptiometry (DEXA) scans: Used for measuring the bone mineral density usually the bones of the lower spine and hips. Bone loss is measured through this technique.

Treatment of Spondyloarthritis.

There is no way to cure this disease condition, but there are treatments to counterparts the symptoms.

• Nonsteroidal anti-inflammatory drugs: Certain NSAID’S like naproxen, ibuprofen, meloxicam, or indomethacin are prescribed by doctors to relief from the pain due to symptoms.
• Corticosteroid medication: Inflammation around the tendons and in the joints can be overcome by taking some corticosteroid drugs. This helps to reduce the swelling in the joints.
• Antibiotics: Antibiotics can be used in the case of reactive spondyloarthritis in which bacteria cause the major problems.
• Disease-modifying antirheumatic drugs (DMARD’s): Sulfasalazine (Azulfidine) and methotrexate are the best DMARD’s to be used for the joint damages in limbs affected by arthritis.
• Tumor necrosis alpha (TNF-alpha) blockers: FDA approved TNAB are Adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, certolizumab pegol (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi), infliximab (Remicade), infliximab-dyyb (Inflectra), a biosimilar to Remicade, and secukinimab (Cosentyx). These are biosimilars used to treat arthritis in spine joints.
• Surgery: Patients with over inflammation of pelvis joints needs hip replacement. In the case of heavy damage in the cartilage of joints needs surgery to repair. In some rare cases, spinal surgery also needed.

Prevention and control measures

Prevention from spondyloarthritis needed some lifestyle changes as follows.

• Quit smoking: smoking speeds up the spinal fusion in addition to other bad health effects.
• Follow good posture: practicing a proper sitting and posture makes your spine to escape from growing into slumped-over position and strain.
• Daily physical exercise: Frequent home exercise and physiotherapy is essential to reduce the stiffening of spine and other joint problems. It also helps to have your heart healthy.
• Good diet: Follow the diets that are rich in calcium. Dairy products are preferred foe calcium rich foods.