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Rheumatoid arthritis (RA) and spondylitis are both chronic inflammatory disorders that may cause joint pain. They have many similarities — and thus may be misdiagnosed as one over the other.
Although RA and spondylitis are both common rheumatological conditions, they have distinct differences. If you are experiencing joint pain and other symptoms, it’s important to consult your primary physician or a recommended specialist to establish an accurate diagnosis and course of treatment.
RA and spondylitis may have some overlapping symptoms, including joint pain and stiffness, but they can usually be differentiated by where in the body the joint pain or other symptoms begin.
RA is first characterized by joint pain in smaller joints, like those in the hands, feet, or knees. This pain is due to swelling of the synovium, the soft tissue lining the joints. Morning stiffness (stiffness in the joints when you wake up) is a common symptom. As RA progresses, affected joints may erode, deform, or shift out of place. Joint pain and swelling may worsen at times, producing flares. People living with the condition also can have stretches of time when symptoms calm down, called remission.
As RA progresses, it may spread to other joints and affect other areas of the body, including the skin, lungs, heart, and eyes. RA may produce inflammation in these or other areas of the body, including in the gums, blood vessels, and muscles around the heart. It can also cause inflammation of the lungs, which could lead to lung disease.
Ankylosing spondylitis (AS), the most common type of spondylitis, is typically differentiated from RA by its first major symptom: chronic pain in the lower back. Pain in AS is due to inflammation of the spine and usually originates from the sacroiliac joint, which is between the base of the spine and the pelvis. Other early AS symptoms include hip, neck, and shoulder pain — as well as morning stiffness.
“The stiffness is terrible. Sometimes I think it's worse than the pain,” wrote one MySpondylitisTeam member.
Spondylitis, like RA, may affect other areas of the body. For example, some people with the condition experience swelling of the cartilage between the breastbone and ribs. This can lead to breathing difficulties and chest pain. Other complications include conditions like inflammation of the eyes, heart disease, or jaw pain.
“I have been experiencing terrible swollen eyes in the morning and bloodshot eyes all day. I had no idea that it could be from spondylitis,” wrote one MySpondylitisTeam member.
There are other types of spondylitis, including:
Although inflammation is common in all of them, symptoms vary by type. Psoriatic arthritis, for example, is usually accompanied by a psoriasis skin rash.
Like RA, spondylitis is a chronic condition. It may improve or stay the same over time. In severe cases, the vertebrae may fuse together. Inflammation and compression of the spine may produce other symptoms like:
RA and spondylitis are both considered autoimmune conditions, characterized by the immune system attacking healthy tissue of the joints. However, they have no clear or specific causes, though genetic and environmental factors play roles in both diseases.
In RA, the genes HLA-DR4 and HLA-DR1 are important to the development of disease. Having a genetic predisposition to RA and exposure to environmental factors like stress or infections may also contribute to the development of RA.
Spondylitis is also thought to have a genetic component, with many genes associated with the risk of developing the condition. In ankylosing spondylitis, the gene HLA-B27 has been found to have the strongest association with the disease. Not all people who have the gene develop spondylitis, but about 95 percent of the people with AS have some form of it. HLA-B27 is not associated with RA.
One MySpondylitisTeam member wrote about the genetic influence of their AS. “I am a fellow AS patient with genetic origin. My dear grandfather was a sufferer, unable to turn his head or rotate his trunk,” they said.
It’s possible for a person to have both the HLA-DR1 gene and HLA-B27 gene, and a person can indeed have RA and ankylosing spondylitis at the same time. Cases of coexisting RA and AS have been reported since 1976, but they are rare.
RA and spondylitis have different risk factors. RA is more common among women and most commonly occurs in middle age. Other factors, including smoking and being overweight, increase a person’s risk of developing RA.
Ankylosing spondylitis, on the other hand, is more common among men, and the onset of the disease occurs earlier, usually by early adulthood.
Doctors will use similar types of diagnostic tests to determine if a person has RA or spondylitis. An examination of physical symptoms alone likely won’t establish a diagnosis, so a doctor may conduct blood tests to determine whether your symptoms are due to RA, spondylitis, or another condition.
The early stages of RA may be difficult to diagnose. A positive rheumatoid factor test result (through a blood test) can help to confirm a diagnosis. The presence of inflammatory arthritis or joint swelling in three or more joints for more than six weeks is also an indicator of RA.
Blood tests can also measure different markers of inflammation, including the erythrocyte sedimentation rate and C-reactive protein levels. People with RA often have elevated levels of these indicators. Blood tests may also be able to determine the presence of anti-cyclic citrullinated peptide antibodies, another potential indicator of RA.
Additionally, a doctor may order X-rays, MRI scans, or ultrasound if they suspect RA. These tests can provide a clear picture of swelling and damage to the joints, helpful for evaluating the disease’s progression over time.
Chronic lower back pain is typically the initial indicator of spondylitis. Thus, a doctor will likely first conduct a physical exam to evaluate your range of motion and the flexibility in your spine.
X-rays are often used to evaluate inflammation of the affected joints. X-rays may detect inflammation of the sacroiliac joints (sacroiliitis), which may help establish a spondylitis diagnosis. However, some types of spondylitis will not show evidence on an X-ray. MRI scans, however, may provide a better image of joint inflammation, especially earlier in the disease’s progression.
There are no definitive blood tests or other types of tests for confirming spondylitis or ankylosing spondylitis. As with RA, blood tests can measure general levels of AS-related inflammation in the body. Genetic tests can check for the presence of the HLA-B27 gene in people with suspected spondylitis.
For both RA and spondylitis, treatment options depend on factors including age, overall health, symptoms, and the amount of joint damage. There is no cure for either condition, so treatment is aimed at managing symptoms and slowing the progression of joint damage or fusion. Both RA and spondylitis may be treated with medications, physical therapy, and in severe cases, surgery.
Medications used to treat RA or spondylitis will depend on the amount of joint damage, the person’s medical history, and other factors. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help with relieving pain and reducing inflammation. They include ibuprofen (like Motrin or Advil) and naproxen (like Aleve or Naprosyn). NSAIDs can be purchased over-the-counter or by prescription. Corticosteroids, such as prednisone, may also help reduce inflammation and pain. They have a number of side effects, however, which make them poor options for long-term treatment.
If NSAIDs are not effective in relieving pain, your doctor may prescribe drugs called biologics, such as tumor necrosis factor (TNF) blockers or interleukin-17 (IL-17) inhibitors. These drugs aim to address inflammation and reduce symptoms like stiffness, pain, and joint swelling.
Common TNF blockers include:
Other medications used to treat RA include drugs called disease-modifying antirheumatic drugs (DMARDs). These medications aim to slow the progression of joint and tissue damage. Some common DMARDs used to treat RA include:
Physical therapy can be helpful in treating symptoms of both RA and spondylitis. Physical therapists work with you to create individualized exercise plans to help reduce pain and stiffness and improve joint flexibility and strength. Physical therapy can be an important tool in maintaining your quality of life and the use of your affected joints. It should be considered in addition to other treatments.
“I had physical therapy this morning at the pool. Always makes me feel better,” wrote one MySpondylitisTeam member.
For spondylitis, surgery is reserved for severe cases. When joints have completely eroded, they may need to be replaced with a prosthesis, a synthetic joint made of metal and plastic. Surgery aims to improve the use of joints and reduce pain.
For RA, surgery may be an option when medications don’t work to address joint damage or to improve joint function. Surgery may be used to repair tendons, fuse or replace joints, or remove the joint lining (called a synovectomy) if it is inflamed.
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