Spondylitis — also called spondyloarthritis (SpA) — is the name given to a family of closely related diseases that primarily affect the spine, neck, and hips (axial skeleton). When spondylitis involves the axial skeleton, it is called axial spondyloarthritis (axSpA). Spondylitis can affect other, peripheral joints and cause additional symptoms as well.
The words doctors use to talk about spondylitis have been changing since the late 2000s, when specialists agreed on a new set of criteria to use for the diagnosis of spondylitis. If you have heard doctors use multiple terms to talk about your condition, that’s because there is still discussion in the medical field about the best way to classify types of spondylitis.
Spondylitis is an autoimmune disease, meaning that pain and inflammation are a result of the body’s immune system attacking its own tissues. No one knows yet exactly what causes spondylitis to develop in some people, but it is now believed that genetics play a significant role.
In the fifth century B.C., famed Greek physician Hippocrates described five types of spinal diseases, using the terms “kyphosis” and “scoliosis” to indicate spinal deformities. Hippocrates recommended that abnormal spinal curvatures be corrected by stretching the patient on a ladder or a board, applying traction, and shaking the person. A number of ancient Egyptian pharaohs may have had spondylitis. The mummy of Ramses II was examined in recent years and found to have severe spinal fusion.
Several skeletons with ankylosing spondylitis dating from the Middle Ages have been unearthed in Europe. In 17th century writings, German surgeon Johannes Schultheiss described complex devices designed to straighten the spines of those with kyphosis. In the late 1600s, Irish-born anatomist Bernard Connor reported an unmistakable case of ankylosing spondylitis he discovered in a skeleton: the sacrum (triangular bone at the base of the spine), lower 15 vertebrae, and connecting ribs had fused into one mass of bone.
In the early 1900s, French neurologists Pierre Marie and André Léri coined the term ”spondylarthrite ankylosante” (ankylosing spondylitis) to describe six of their patients with the disease. Their case studies established the young age of onset, stiff spine, spinal and hip fusion, rounded spinal deformity, and progressive nature characteristic of spondylitis.
In the 1930s, doctors offered spondylitis treatments such as arsenic, gold, the radioactive elements thorium and radium, and X-rays. These treatments were administered to spondylitis patients long before their safety or effectiveness was studied. Some toxic treatments caused many people with spondylitis to develop leukemia and aplastic anemia years later.
Spondylitis has long been thought to run in families. In 1973, scientists proved spondylitis has a strong genetic predisposition. A specific inherited genetic marker known as HLA-B27 is present in about 90 percent of people who have ankylosing spondylitis. This marker is associated with other autoimmune conditions, including psoriasis, inflammatory bowel disease (IBD), and reactive arthritis.
Anti-tumor necrosis factor (or anti-TNF) drugs, also known as biologics, first became available in the 1990s. Anti-TNF drugs are a common treatment for spondylitis today. Biologics have allowed people living with spondylitis to maintain mobility later in life.
Researchers estimate that 1 percent of the U.S. population, or 2.7 million, may be living with spondylitis. Most people begin experiencing symptoms of spondyloarthritis before age 45, most commonly in their 20s or 30s. Men are more likely to be diagnosed with spondylitis, though some researchers have found that women living with the condition may underdiagnosed. Men tend to present more radiographic symptoms (visible on X-rays) than women.
Spondylitis, SpA, and spondyloarthritis are all different words for the same thing — the many types of inflammatory arthritis primarily affecting the spine. Spondylitis involving the spine is called axial spondyloarthritis. More specific subtypes of spondylitis include:
There is no one conclusive test for diagnosing spondylitis. Spondylitis is typically diagnosed by a rheumatologist with a combination of a thorough physical exam, personal and family medical history, scans such as X-rays or magnetic resonance imaging (MRI), and blood tests for certain inflammatory markers and genetic factors.
The most common symptoms of spondylitis include joint pain and stiffness — especially in the spine, hips, and neck. Inflammation can also cause uveitis (eye pain), bowel or bladder problems, and skin rash.
Additionally, people with severe spondylitis can experience fusion of the vertebrae in the spine leading to kyphosis — rounding of the upper back — along with range-of-motion limitations and difficulty walking or swallowing. General symptoms common in those with spondylitis include fatigue, depression, and anxiety.
Treatment for spondylitis depends on the severity of the symptoms. For mild symptoms, nonsteroidal anti-inflammatory drugs (NSAIDs) — ibuprofen (Advil), naproxen (Naprosyn), and indomethacin (Indocin) — are tried first. If NSAIDs do not adequately control inflammation, rheumatologists may prescribe biologic medications, such as adalimumab (Humira), infliximab-dyyb (Inflectra), or golimumab (Simponi).
Some people with spondylitis may benefit from older disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, leflunomide (Arava), or sulfasalazine (Azulfidine). Uncontrolled pain may be treated with opioids. Antidepressants and muscle relaxants may ease other symptoms.
Ankylosing spondylitis sometimes necessitates hip replacement or spinal surgery. Radiofrequency nerve ablation or nerve block injections are procedures that may help control pain. Some people with spondylitis try clinical trials, medical marijuana, or complementary or alternative treatments such as acupuncture.
Spondylitis and spondylosis are separate and unrelated conditions with some similarities and some important differences. It is easy to confuse the conditions since they sound similar and share many symptoms.
Spondylitis is not a fatal condition. Some studies show that people with spondylitis have a higher risk for developing infections and heart disease. For the most part, people with spondylitis have similar longevity as people without spondylitis.