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What is Spondyloarthropathy?

Spondyloarthropathy (or spondyloarthritis), is a group of inflammatory joint diseases arthritis with predominant spine and nearby large joint pain and inflammation. It is also known as SpA in short. In this group of diseases, one of the severe types is known as Ankylosing Spondylitis. These diseases have some common diagnostic criteria and treatments are also similar.

Sometimes, Spondyloarthropathy also causes inflammation in the eyes, gastrointestinal tracts, skin, and areas where ligaments attach to the bones. It is classified as either axial (affecting pelvic joints and spine) or peripheral (affecting the limbs) Spondyloarthropathy. Axial SpA causes mostly back pain and peripheral SpA causes knee pain, ankle pain etc.

What are the different types of Spondyloarthropathies?  

What are their signs and symptoms?Spondyloarthritis has the following types, which can fall under either axial or peripheral classification.

Ankylosing Spondylitis
In this disease, chronic inflammation causes pain and stiffness in the joints and spine. Enquire about axial skeleton involvement (lower lumbar back pain, with early morning stiffness, that improves with exercise).


In severe cases, spinal vertebrae may fuse (hence the name ankylosis), giving rise to rigid spine and abnormal posture. Peripheral joint involvement, uveitis, and anaemia of chronic disease may be found. The disease can also cause fever, fatigue, and inflammation of the eyes or bowel. In rare cases, it can involve the heart and lungs as well.

Psoriatic arthropathy
Clinical features :

It develops in the 30s or 40s, and affects men and women equally. May present as an asymmetrical large- or small- joint oligoarthritis, symmetrical polyarthritis, or a clinical picture similar to RA or ankylosing spondylitis. Joint destruction may be extensive (arthritis mutilans). Look for rash (knees, elbows, scalp, behind the ears, umbilicus, natal cleft) and nail changes (pitting, onycholysis, ridging).

Reactive arthritis
Clinical features:

Formerly known as Reiter’s syndrome, it develops 2 to 4 weeks after an infection of the urinary tract or digestive system.
• Typically young, sexually active individual with oro- genital ulcers (painless), conjunctivitis (which may progress to iritis), and rash (soles of feet— keratoderma blenorrhagica).
• May occur following non- specific urethritis or gastrointestinal infection,
e.g. with Shigella, Salmonella, Yersinia, or Campylobacter.
Enteropathic Arthritis:
It is associated with inflammatory bowel diseases, i.e., ulcerative colitis and Crohn’s disease. It causes pain in the spine and peripheral joints and may also cause bloody diarrhea and abdominal pain.

Juvenile Spondyloarthropathy:
It is not a specific disease but a group of conditions that develop in children at or before the age of 16 but may last throughout adulthood. It affects the lower extremities such as the pelvis, hips, ankles, and knees and causes pain.

Undifferentiated Spondyloarthropathy:
Its symptoms are not as specific as other diseases of this group. It causes pain in the lower back and heels. Sometimes, it develops into a more identifiable disease such as ankylosing spondylitis.

What causes Spondyloarthropathy?
The exact cause of Spondyloarthropathy is not known, although several genes have been linked to it. The main gene involved in all these diseases is HLA B27. It does not cause the condition, though, but increases the risk of developing it. Some research also suggests it may be due to an imbalance of the intestinal microbiome.
Psoriatic arthritis may be an autoimmune disease, while the cause of reactive arthritis is Chlamydia infection or food-borne infection.

How to make a diagnosis of Spondyloarthropathy?
The doctor may suspect Spondyloarthropathy based on signs and symptoms, medical history, and physical evaluation. For a formal diagnosis, the testing may include

X-rays: It is performed to see changes in the sacroiliac joints. These changes are a
Magnetic resonance imaging/ MRI: If the x-ray results are unclear. This is more sensitive than X-ray to make a diagnosis of sacroilitis and therefore spondyloarthritis.

Blood test: Its purpose is to check for the presence of the HLA-B27 gene.


Prognosis of Spondyloarthropathy
In most reactive arthritis patients, the prognosis is usually good as they recover within 2 to 3 months. But in 15 to 20 percent of them, it progresses to Spondyloarthropathy and ankylosing in the next 10 to 20 years.
There is no cure for Spondyloarthropathy, but as compared to rheumatoid arthritis, the long-term anti-inflammatory therapy shows better outcomes.

Treatments of Spondyloarthropathy?

Since there is no cure, treatment focuses on managing pain, improving mobility, and reducing complications. The available options are

  • Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving pain and inflammation temporarily. Examples include aspirin, ibuprofen, naproxen, etc.
  • Corticosteroids such as methylprednisone are also effective in relieving pain temporarily when the swelling is not widespread.
  • Disease-modifying anti-rheumatic drugs (DMARDs) are used when NSAIDs and corticosteroids are no more effective. Methotrexate is a commonly used DMARD.
  • Tumor necrosis factor (TNF) alpha-blockers are used to block an inflammation-causing chemical called tumor necrosis factor-alpha.
  • Antibiotics might be given to treat reactive arthritis if the bacterial infection is still active.
  • Surgery is performed in severe cases of Spondyloarthropathy to treat bone destruction or cartilage damage.

What are the exercises for Spondyloarthropathy

Four main types of exercises recommended for Spondyloarthropathy are as follows
Range of motion or stretching exercises such as yoga.
Aerobic or cardiovascular exercises, e,g., running, climbing, or cycling
Strengthening exercises, such as climbing stairs, weight lifting, or gardening.
Balance exercises such as standing on one leg.