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Spondylitis – also called axial spondyloarthritis, or axSpA for short – is the name given to a family of closely related diseases that primarily affect the spine, neck, and hips (axial skeleton), but can affect other 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.
Read more about different types of spondylitis.
Spondylitis is usually diagnosed and treated by a rheumatologist – a specialist in autoimmune and musculoskeletal diseases.
What causes 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.
Read more about potential causes of spondylitis.
The history of spondylitis
In the fifth century BCE, 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 Rameses 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, 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 that 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 drugs (or anti-TNFs), 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.
How common is spondylitis?
Researchers estimate that 1 percent of the population, or 2.7 million, may suffer from axSpa in the United States. Most people begin experiencing symptoms of spondyloarthritis before age 45, most commonly in the 20s or 30s. Men are twice as likely as women to develop axSpa. Women with spondylitis tend to have a milder disease course than men.
Can you die from spondylitis?
Spondylitis is not a fatal condition. Some studies show that people with spondylitis have a higher risk for developing infections and heart disease than those without axSpA. For the most part, people with spondylitis have similar longevity as people without spondylitis. Most people with spondylitis die of the same conditions other people die of, such as cancer, stroke, and heart disease.
What are the different types of spondylitis?
Spondylitis, SpA, spondyloarthritis, axial spondyloarthritis, and axSpA are all different words for the same thing – an umbrella term for many types of inflammatory arthritis primarily affecting the spine. More specific subtypes of spondylitis include ankylosing spondylitis, enteropathic arthritis, psoriatic arthritis, reactive arthritis, undifferentiated spondyloarthritis, juvenile spondyloarthritis, and peripheral spondyloarthritis.
Read more about different types of spondylitis.
How is spondylitis diagnosed?
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.
Read more about the process of diagnosing spondylitis.
What are the symptoms of spondylitis?
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. People with severe spondylitis can experience fusion of the vertebrae in the spine leading to kyphosis – rounding of the upper back – along with motor symptoms such as range of motion limitations and difficulty walking or swallowing. General symptoms common in those with spondylitis include fatigue, depression, and anxiety.
Read more about spondylitis symptoms.
How is spondylitis treated?
Treatment for spondylitis depends on the severity of the symptoms. For mild axSpA, nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (Ibuprofen), Naprosyn (Naproxen), and Indocin (Indomethacin) are tried first. If NSAIDs do not adequately control inflammation, rheumatologists may prescribe biologic medications such as Humira (Adalimumab), Inflectra (Infliximab), or Simponi (Golimumab). Some people with spondylitis may benefit from older disease-modifying antirheumatic drugs (DMARDs) such as Methotrexate, Arava (Leflunomide), or Azulfidine (Sulfasalazine). 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.
Read more about treatments for spondylitis.
Is spondylosis the same thing as spondylitis?
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.
Read more about the similarities and differences between spondylitis and spondylosis.