Spondylitis and spondylosis are easy conditions to confuse. Both begin with “spondy-” — a prefix that refers to the spinal column or vertebrae (bones of the spine) — indicating that both conditions affect the spine. Despite sounding similar and sharing many symptoms, spondylitis and spondylosis are two distinct conditions.
Spondylitis, which is also called spondyloarthritis or SpA, is an umbrella term that covers a group of related types of inflammatory arthritis. These include:
Spondylitis is an inflammatory arthritis. In fact, the suffix “-itis” means “inflammation.” As an autoimmune disease, spondylitis occurs when the immune system mistakenly attacks the joints and other tissues, leading to an inflammatory response. Spondylitis often develops before age 45, and most people experience their first symptoms in their 20s or 30s. Spondylitis is a fairly rare disease, occurring in only about 1 percent of the population.
Spondylitis can be further categorized by disease progression as either nonradiographic axial spondylitis (nr-axSpA) or radiographic spondylitis (ankylosing spondylitis). Ankylosing spondylitis is detectable by damage that’s visible on X-rays, while nr-axSpA is diagnosed in the early stages of disease activity, before changes are detectable by X-ray.
The suffix “-osis” refers to an abnormal state. Like spondylitis, spondylosis (or spinal osteoarthritis) is also a type of arthritis. Unlike spondylitis, however, spondylosis is not an inflammatory condition. It is a spinal arthritis that develops due to normal wear and tear to the intervertebral discs as part of the aging process.
Spondylosis is very common and becomes more prevalent with age. More than 85 percent of people aged 60 and older experience cervical spondylosis, or arthritis in the neck. Spondylosis can affect the cervical spine (neck), thoracic spine (upper back), and lumbar spine (lower back).
Both spondylitis and spondylosis can cause chronic, degenerative back and hip pain and stiffness that can diminish range of motion and cause trouble walking. Spondylitis and spondylosis may share other symptoms, including bowel or bladder problems (urgency or incontinence) and neuropathy (numbness and tingling sensation) in the extremities.
Axial spondylitis causes pain and damage in the spine, neck, ribs, and hips — known as the axial skeleton. Spondylitis symptoms often begin in the sacroiliac joints and lumbar spine (lower back). Inflammatory arthritis, such as ankylosing spondylitis, can also cause the bones to become weaker and lead to osteoporosis.
Peripheral spondylitis affects the joints further from the spine, like those in the hands and feet, and causes further joint pain and stiffness. The inflammation from spondylitis can also sometimes attack the eyes (uveitis), the digestive system (inflammatory bowel disease), and the skin (psoriasis).
As discs in the spine shrink, cervical spondylosis causes bone spurs (or bony growths) to develop along the bones of the neck. These growths indicate osteoarthritis. However, it is sometimes possible for spondylosis to progress without any symptoms.
Spondylosis can also result in neuropathy due to the narrowing of space in the spinal cord. This narrowing causes compression (pinching) of the nerve root that passes through the spine to other parts of the body. Neuropathy in spondylosis can lead to numbness, weakness, and tingling in the legs, feet, hands, or arms. Neuropathy may also cause difficulty walking, poor coordination, and loss of bowel or bladder function.
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Spondylitis is caused by inflammation related to an overactive immune system. The specific cause of spondylitis is unknown, although it likely involves both hereditary and environmental factors.
Spondylosis, on the other hand, is caused by normal wear and tear on the joints over time. This degeneration may also be exacerbated by previous injuries.
Doctors are more likely to suspect spondylosis in older people, whereas chronic lower back pain before age 45 could be caused by spondylitis. Tests for both spondylosis and spondylitis are likely to involve imaging scans and physical exams for pain and range of motion.
Blood tests are often ordered for those suspected of having spondylitis. These tests are used to detect inflammatory markers as well as a genetic marker (the HLA-B27 antigen) that is a risk factor for developing spondylitis.
Because spondylitis is an inflammatory condition, people strongly suspected to be living with spondylitis will be referred to a rheumatologist — a doctor who deals with inflammatory or infectious musculoskeletal conditions. A rheumatologist will confirm a diagnosis of spondylitis based on a physical examination, blood tests, medical history, and imaging scans.
Early diagnosis is important for treating spondylitis promptly. Early intervention can slow disease progression. Spondylitis can sometimes be diagnosed before becoming radiographic (visible on X-ray), thanks to the use of imaging techniques such as MRI and CT scans. These tests are more sensitive than X-rays and can pick up early spondylitis disease activity in the soft tissues of the spine and joints.
There is not yet a cure for spondylitis or spondylosis, but intervention under the medical advice of a doctor can help alleviate many symptoms and slow disease progression. Many lifestyle practices, including diet, exercise, and meditation, may also improve the quality of life for people living with either condition.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), naproxen (Naprosyn), and indomethacin (Indocin), can be used to manage mild to moderate pain and inflammation in spondylitis and spondylosis. Likewise, antidepressants, antiseizure medications, and muscle relaxants may be prescribed for pain relief in either spondylitis or spondylosis.
Corticosteroids, such as epidural steroid injections directly into the affected joint, can greatly reduce pain and inflammation and improve range of motion for people with either spondylitis or spondylosis. Meanwhile, short-term use of oral steroids, such as prednisone, can tame a severe inflammatory flare in someone living with spondylitis.
Complementary therapies, including occupational and physical therapy, hot and cold therapies, and transcutaneous electrical nerve stimulation (TENS), can also help manage the pain and stiffness of both spondylitis and spondylosis.
The goal when treating spondylitis goes beyond just pain relief — it aims to slow disease progression. Spondylitis medications that are focused on modifying the immune system help to stop the inflammatory process and slow down spondylitis progression. These medications would not help people living with spondylosis.
Disease-modifying antirheumatic drugs, such as methotrexate, adalimumab (Humira), infliximab (Inflectra), and golimumab (Simponi), can help delay fusing of the vertebral bodies of the spine. These treatments may prevent or delay the progression of axial spondyloarthritis from evolving to radiographic axial spondyloarthritis.
Support is crucial when you’re living with a chronic condition. MySpondylitisTeam, the social network for people with spondylitis, has your back. More than 84,000 members come together to ask questions, give advice, and share their experiences with others who understand life with spondylitis.
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