This is a group of arthritis affecting predominantly spine of the body. Spondylo means vertebra and arthritis mean joint pain. Along with vertebrae bones, they can also affect other joints like hips, knees.
Following diseases are included in this group:
• Ankylosing Spondylitis (AS)
• Psoriatic Arthritis
• Reactive Arthritis (ReA)
• Inflammatory Bowel Disease (IBD) related arthritis
• Undifferentiated Arthritis.
Ankylosing Spondylitis (AS):
It is a chronic inflammatory disease occurring predominantly in males < 45 years of age. Patient experiences lower back pain (for at least 3 months) which is very critical to diagnose or else they may be treated as simple lower back pain leading to deformities.
Symptoms
• Back pain occurs predominantly on rest, relieves with activities,.
• Stiffness of lower back lasting more than ½ hour
• Disturbed sleep especially 2nd half of sleep and alternating buttock pain.
If the untreated disease progresses to spine and mobility is reduced which affects posture and daily life. Enthesitis is one of the characteristic features of AS. Enthesitis is inflammation of enthesis which is the insertion of a tendon, ligament, capsule, and fascia. They can have extra-skeletal manifestations like uveitis (painful redness of eyes), amyloidosis, aortic insufficiency, etc.
In AS patients, along with environmental factors, there is also a genetic component. HLA B27 gene contributes 30-40% of heritability. Only 2% (1 out of 50) of HLA-B27-positive individuals develop AS during their lifetime. However, among those HLA-B27-positive individuals
with an affected first-degree relative, the rate increases to 15% to 20%. In short, being HLA- B27 positive doesn’t mean that the patient has AS.
Blood tests: There can be anemia, elevated ESR, CRP which reflects increased disease activity. It’s very important that liver and kidney function tests to be normal before starting therapy for any type of spondyloarthropathies. HLA-B27 is done in cases where Xray/MRI are not helpful
X rays, MRI: spine, pelvis to look for sacroiliitis, syndesmophytes i.e. evidence for disease and damage due to fusion of vertebrae,
Treatment: First and best therapy is an exercise that reduces pain, improves muscle strength, flexibility and posture.
NSAIDs – these are drugs that reduce pain, stiffness, and inflammation in joints, which can dramatically provide relief if taken under supervision.
DMARDs (Disease Modifying Anti- Rheumatic Drugs): Useful in peripheral joint involvement (elbow, wrist, knee, hip)
Biologics: These are medicines that attack cytokine (protein) eg: TNF Alpha, IL-17 thereby significantly reducing inflammation and increasing mobility. One of the important drawbacks is that it can reactivate tuberculosis and may increase the chances of infection.
Intra-articular steroids: In peripheral joint involvement, a steroid injection is given in the joint itself.
Patients can lead a normal life with regular exercise, medications and lifestyle changes.
• To Conclude:
• Spondyloarthritis affects the spine and peripheral joints
• They have negative Rheumatoid factor
• They can present with additional skin, nail, eye, bowel symptoms.
• Exercise, NSAIDs are the frontline therapy
• If no relief, intra-articular steroids, DMARD’s, Biologicals can be tried.
Reference:
1. Sacroiliac joints Radiographic anatomy, Wiki Radiography
2. www. Radiopedia. Org
For any further information, you may contact the Author: Dr. Pravin Jain, Consultant Immunologist & Rheumatologist, KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi.
(M) 7821057906 E-mail: pravdip@rediffmail.com
(Part-II Will be published shortly.)
