Spondyloarthritis (SpA) is a group of conditions that cause inflammatory arthritis affecting primarily the spine. Other joints in the body can be affected as well as other areas of the body.
Conditions within the group include:
The management of spinal disease is similar in all conditions, therefore the focus is on the most common condition, Ankylosing Spondylitis.
Ankylosing Spondylitis (AS) is a spondyloarthritis that causes inflammation in the spine. This results in stiffness in the neck, back and pelvis. The inflammation results in the body laying down extra calcium around the back bones which can result in the bones fusing together (Ankylosis). If this is left untreated it can result in permanent spine curvature and loss of movement. The most common areas to be involved are the joints between the back bones and between the backbones and pelvis (sacroiliac joints).
Inflammation is usually caused by the body to help deal with infection and trauma, however in certain conditions, the immune system triggers inflammation inappropriately resulting in damage to healthy bones and joints.
The exact cause of AS is still unknown, but there are some well known genetic markers that are associated with developing the condition. This is related to the genetic inheritance of a gene called HLA-B27. Therefore if a first-degree relative suffers from AS, the risk of developing it is around 15-20%. There is also involvement of environmental factors and the gut microbiome.
AS is more common in males and those from North European ancestry.
If left untreated over a long period of time, the bones in the back can fuse together (Ankylosis) which leads to permanent restriction in movement. This can result in thinning of the bones (osteoporosis) and increased risk of spinal fractures.
Ankylosing Spondylitis is diagnosed based on history, examination and imaging of the spine. Investigations that are carried out are listed below:
Initial treatment of the spinal disease is with exercise and stretching and NSAIDs to reduce the inflammation.
Should NSAIDs not improve symptoms in the spine then biological therapies are used. The most common first line treatment is with adalimumab an Anti-TNF medication.
If other joints outside of the spine are involved, these can be treated with DMARD therapy and steroids.
Rarely if other joints such as the hips or neck become very damaged, surgery might be required to replace or support the joint.
Assessment of disease activity
To ensure that the treatments are working, we usually monitor your joints in our clinics to assess activity.
This is done by assessing the range of movement in the areas of the spine, examination of any other joints that might be tender or swollen and assessment of symptoms using a BASDAI score.
Versus Arthritis: http://www.versusarthritis.org
National Axial Spondyloarthritis Society (NASS): https://nass.co.uk