Ankylosing spondylitis is a variant of spondyloarthritis that affects young adults. In ankylosing spondylitis, inflammation in the spine and sacroiliac joints causes chronic pain and stiffness in the back. Spondyloarthritis patients predominantly have disease in peripheral joints and frequently have inflammation at the attachment sites of tendons and ligaments to bones. Inflammation of whole fingers and toes is common, giving rise to a characteristic sausage-like appearance.
Psoriatic arthritis is another variant of spondyloarthritis. In psoriatic arthritis, psoriasis of the skin is paired with musculoskeletal features of spondyloarthritis, typically affecting peripheral joints. Eye inflammation (uveitis) is common in patients with ankylosing spondylitis or psoriatic arthritis.
Causes and Risk Factors
It is thought that spondyloarthritis develops through to the interaction of genetic and environmental factors. Many patients with spondyloarthritis are positive for HLA-B27, a gene variant that controls immune responses. However, no single gene determines whether a person will develop spondyloarthritis. Many other genetic variants have been identified that increase disease risk. Reactive arthritis is a type of spondyloarthritis that develops after a urinary tract infection or an episode of infectious diarrhea caused by certain types of bacteria. It has been hypothesized that bacteria also play a role in ankylosing spondylitis and other variants of spondyloarthritis, typically without causing overt infection. Patients with inflammatory bowel (Crohn’s disease or ulcerative colitis) disease may develop spondyloarthritis suggesting that certain disease mechanisms are shared. Currently, we do not understand enough about the causes of spondyloarthritis to be able to prevent the disease.
Symptoms of spondyloarthritis vary between patients but may include:
Longstanding low back pain
Back pain and stiffness are typically worse at night and improve with exercise
Painful swelling of joints
Sausage-like appearance of fingers or toes
Skin and nail changes of psoriasis
Episodes of eye inflammation (uveitis)
Many patients with spondyloarthritis have a first degree relative with spondyloarthritis or spondyloarthritis-related disease (ankylosing spondylitis, psoriatic arthritis, psoriasis, Crohn’s disease, ulcerative colitis, uveitis).
Your doctor typically will begin by going through your medical history and conducting a thorough physical exam. Tests and procedures that may be used for diagnosing spondyloarthritis include:
Blood tests, to determine your HLA-B27 status and measure markers of inflammation.
Imaging studies, to look for evidence of inflammation and rule out other potential causes of the patient’s symptoms. The specific type of imaging study (X-ray, ultrasound, MRI) will vary depending on the patient’s symptoms.
The treatment for spondyloarthritis depends on the type of spondyloarthritis and severity of the illness. Treatment options include the following medications:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate or sulfasalazine may be used in patients with peripheral arthritis. These medications are not effective for the treatment of spinal inflammation.
Biologics are second-line drugs used for patients with inflammation in the spine (ankylosing spondylitis). TNF inhibitors, IL-17A inhibitors and other biologics are also used to treat peripheral spondyloarthritis. Drug development efforts in this field are ongoing.
Physical therapy - is an important part of long-term management of spinal disease.
To learn more about our services or to make an appointment with a Brigham and Women’s Hospital rheumatologist, contact one of our trained coordinators at 1-800-294-9999 to get connected with the best doctor for your needs.