“Spondylitis” means inflammation of the spine. It occurs as part of a group of related conditions called spondyloarthritis. Some people first develop spinal inflammation without another clear diagnosis, while others have it as part of another condition, such as inflammatory bowel disease or psoriatic arthritis.

Spondyloarthritis usually affects the back, but it can affect joints in other places, too. If your symptoms are only (or mostly) in your back, it’s called axial spondyloarthritis. About 1 percent of people in the United States have some form of spondyloarthritis. One of the most common types is ankylosing spondylitis (AS). “Ankylosing” means the vertebrae (spinal bones) fuse or bond together. Peripheral spondyloarthritis is when joint inflammation affects areas beyond the spine (like the elbows or knees).

If you’ve been recently diagnosed with a type of spondyloarthritis, it can be helpful to learn more about the condition so you can better understand your symptoms and treatment options.

The History of Spondylitis

In the fifth century B.C., famed Greek physician Hippocrates described spinal deformities using the terms “kyphosis” and “scoliosis.” Hippocrates recommended correcting abnormal curves in the spine by tying the person on a ladder or a board and shaking them. This was sometimes done upside down, depending on what areas were affected.

Historians studying ancient Egypt believe several pharaohs may have had spondylitis. The mummy of Ramses II was examined in recent years and found to have severe spinal fusion.

Irish-born anatomist Bernard Connor reported the first detailed case of a fused spine, which at the time was believed to be from rheumatoid arthritis. In the 1890s, Vladimir Bekhterev, a Russian neurologist, described spondylitis as a separate inflammatory disease. However, it wasn’t called ankylosing spondylitis until Adolph Strümpell and Pierre Marie used the term a few years later.

By the 1930s, spondylitis was treated with unsafe and ineffective treatments. Doctors tried using arsenic, gold, the radioactive elements thorium and radium, and X-rays. These toxic treatments caused some people with spondylitis to develop serious health problems like leukemia. However, the physical therapy and breathing exercises developed during this time are still recommended for spondylitis.

Spondylitis has long been thought to run in families. By the 1980s, the genetic factor, HLA-B27, was linked to a 16 times higher rate of AS. Finding certain genetic links has made it easier for doctors to diagnose spondylitis. New treatments that modify the immune system help reduce symptoms and slow disease progression.

What Is the Main Cause of Spondylitis?

Different types of spondylitis have different causes. Often, the underlying cause is an autoimmune disease. In autoimmune diseases, the immune system mistakenly attacks healthy tissues. Having an autoimmune disease raises inflammation levels throughout the body, often in the joints.

Cause of Ankylosing Spondylitis

AS is caused by inflammation, but it’s not always clear what triggers it. The HLA-B27 gene is common in people with AS. However, most people with this gene don’t develop AS. As a result, doctors don’t recommend testing for the gene unless you’re having symptoms.

Scientists are studying several other genes that may raise the risk of AS. Some also think that AS is triggered by an immune response in the digestive tract. Researchers believe that frequent gut infections may raise the risk of AS in people who have other risk factors.

Cause of Peripheral Spondylitis

There are many different types of peripheral spondylitis. They’re usually caused by autoimmune disorders. For example, psoriatic arthritis is related to the skin condition, psoriasis. During psoriatic arthritis, small joints in the hands and feet become painful and swollen. Enteropathic arthritis is caused by the digestive condition, inflammatory bowel disease. When possible, treating the original cause of spondylitis can help improve your symptoms.

People are more likely to get an autoimmune disease if they have the following risk factors:

• Being female (although spondylitis is more common in males)
• Having a family history of autoimmune disease
• Being exposed to certain chemicals in your environment (including cigarette smoke)
• Having a history of certain viral infections

If you’ve been diagnosed with an autoimmune disease, you’re at greater risk of developing another one.

Reactive arthritis is a form of peripheral spondylitis that isn’t caused by an autoimmune disease. It’s thought to be caused by a gastrointestinal or urinary infection.

What Are the Symptoms of Spondylitis?

Spondylitis symptoms usually start in early adulthood before age 45. The main symptom is lower back and hip pain. Rather than staying in one spot, this pain may radiate and move from one side to the other. Back stiffness is also common. It tends to be worse with inactivity.

Spondylitis can also cause fever and a poor appetite, especially in the early stages. Over time, curving of the spine can lead to restricted breathing. Breathing issues may get worse if spondylitis inflammation affects the joints between the ribs. Some people also develop scar tissue in the lungs.

Symptoms may start in the neck or back. If left untreated, inflammation can spread to other places. For instance, people with spondylitis may develop digestive problems, eye inflammation, or skin symptoms.

In peripheral spondyloarthritis, other parts of the body are affected more than the spine. Joints in other areas have pain and inflammation. Because any type of spondylitis can affect how you move and feel day to day, it’s important to get diagnosed and start treatment as soon as possible.

How Is Spondylitis Diagnosed?

Doctors use a physical exam and testing to diagnose spondylitis. They’ll ask about your medical history and any current symptoms. They’ll also take a look at your back and posture. If they suspect spondylitis, the next step is ordering an X-ray of your back. The X-ray images can show any bone deformities, including the telltale sign of AS, fused bones.

Doctors often use an MRI to look for inflammation in the spine and the joints that connect the spine to the pelvis, called the sacroiliac joints. For types of spondyloarthritis that affect other joints, an ultrasound can help find swelling or irritation in those areas.

A blood test called erythrocyte sedimentation rate (ESR) also measures the amount of inflammation in the body. Although this test alone can’t confirm spondylitis, it helps paint a bigger picture of what’s going on in the body.

Genetic testing is also very helpful for diagnosing spondylitis. Since 95 percent of people with spondylitis have the HLA-B27 gene, it’s a strong sign of spondylitis risk.

What Is the Best Treatment for Spondylitis?

Treatment for spondylitis helps to reduce pain, maintain flexibility, and avoid deformities. Medications that can help with pain and swelling, as needed, include:

• Corticosteroids (steroids)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Other pain relievers and muscle relaxants

Doctors may also prescribe long-term treatments to help reduce inflammation and prevent your joints from more damage. These might include disease-modifying antirheumatic drugs (DMARDs), which help slow the disease in people with peripheral spondyloarthritis. You might also take JAK inhibitors, which block immune system signals that cause inflammation. Another option is biologic treatments such as TNF blockers or interleukin-17 inhibitors, which target specific parts of the immune system to control symptoms.

Physical activity is also helpful for many people with spondylitis. A physical therapist can recommend exercises to strengthen the back muscles, improve flexibility, and maintain good posture.

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