Spondyloarthritis is a family of inflammatory diseases characterized by pain and stiffness in the spine (especially the low back).
Subtypes include axial spondyloarthritis (axSpA), which affects the spine and sacroiliac joints, and peripheral spondyloarthritis (pSpA), which affects joints of parts of the body other than the spine, such as the arms and legs.
Spondyloarthritis often starts in the late teens to mid-20s, but it can take years to get an accurate diagnosis.
Lifestyle changes including smoking cessation, good posture, exercise and diet are important.
There is a genetic component to spondyloarthritis, and physicians may use genetic tests to help diagnose it.
Spondyloarthritis is a family of inflammatory rheumatic diseases that causes arthritis.1 The main symptoms are pain and stiffness in the spine (especially the low back). It is relatively common, affecting more people than multiple sclerosis, rheumatoid arthritis or amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease), yet it remains relatively unknown to many patients and physicians.2 One in 100 people have spondyloarthritis, including 2.7 million people in the United States.2
Spondyloarthritis is a progressive disease, and some people may experience new bone formation in the spine or spinal fusion which can lead to problems with mobility. There is no cure for spondyloarthritis, but symptoms such as pain, stiffness, and fatigue can be managed.
Axial spondyloarthritis (axSpA) is a type of spondyloarthritis that mostly affects the spine and sacroiliac joints (a pair of joints in the pelvis).1 There are two progressive stages of the disease:
- Non-radiographic axial spondyloarthritis, where damage to the spine or sacroiliac joints is not visible on X-ray but can be visible as inflammation on magnetic resonance imaging (MRI).
- Ankylosing spondylitis (AS, or radiographic axial spondyloarthritis), where there is visible damage of the spine or sacroiliac joints on X-ray.3
Not all people living with non-radiographic axSpA will progress to radiographic AS; however, people affected by either stage may have similar levels of pain, stiffness, and fatigue.
Peripheral spondyloarthritis (pSpA) is a type of spondyloarthritis that affects the joints of parts of the body other than the spine, such as the arms and legs.1 There are a number of subtypes,6 including:
- Reactive arthritis (formerly known as Reiter's syndrome), which arises following an infection7
- Psoriatic arthritis, which is associated with the skin condition psoriasis
- Enteropathic arthritis/spondylitis, which is associated with inflammatory bowel diseases (ulcerative colitis and Crohn's disease)
- Undifferentiated spondyloarthritis, which does not meet established definitions for other forms of spondyloarthritis
What Are Symptoms of Spondyloarthritis?
Common symptoms of spondyloarthritis include:
- Lower back pain and/or buttock pain
- Morning stiffness which improves with exercise but not with rest
- Pain that causes sleep disturbances
- Reduced mobility
Half of people with spondyloarthritis have other health issues that can manifest with spondyloarthritis8 including:
- Uveitis (inflammation of the eye), which occurs in up to 40% of people with spondyloarthritis
- Inflammatory bowel disease
- Cardiovascular problems
- Osteoporosis, which occurs in up to half of people with ankylosing spondylitis1
Spondyloarthritis is Often Genetic
Spondyloarthritis has a genetic component. Family members of those with spondyloarthritis are at higher risk, depending partly on whether they inherited the HLA-B27 gene.1 Having the HLA-B27 gene does not always mean someone will develop spondyloarthritis. In the end, the diagnosis relies on a rheumatologist’s judgment based on several factors considered together.
How is Spondyloarthritis Diagnosed?
Spondyloarthritis often starts in the late teens to mid-20s. It can take between 8 to 11 years to get a correct diagnosis.4 Lower back pain is a symptom for most people with spondyloarthritis, but is also extremely common in the general population. Often, back pain is initially managed by non-specialists until it becomes severe or a doctor determines you have inflammatory back pain. Inflammatory back pain is different than mechanical back pain, which is caused by structural changes in the joints, vertebrae, or tissue, or may be caused by an injury. For diagnosis, a rheumatologist may order imaging, including X-ray or MRI of the spine or sacroiliac joints to look for signs of inflammation or spinal fusion.1 (Take our Quiz: Could I Have Spondyloarthritis?)
How is Spondyloarthritis Managed?
Living with the chronic back pain of axial spondyloarthritis requires care from a specialist called a rheumatologist. A rheumatologist can help create a treatment plan that may include nonsteroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs) if peripheral arthritis is present, or biologic treatments in the case of ankylosing spondylitis when treatment with NSAIDs has failed.5
In addition, lifestyle changes, such as good posture, exercise and a nutritious diet may help some people with spondyloarthritis. Smoking in particular has been shown to increase spinal disease progression as well as reduce response to treatment.9 Exercise is particularly important for people with axial spondyloarthritis, including physical therapy and joint-directed exercises.1 Many recommended exercises promote spinal extension and mobility. (Read: Spondyloarthritis Exercises for Better Posture)
About Peripheral Spondyloarthritis10
Common symptoms of pSpA include:
- Peripheral arthritis, or arthritis in joints other than the back or pelvis
- Enthesitis, which is inflammation of the areas where ligaments and tendons connect to bones. This often presents as swelling at the heels, and can cause pain and tenderness
- Dactylitis, also known sausage toe or sausage finger, which is severe inflammation of tissues in the fingers or toes. While it is uncommon, it is a characteristic feature of pSpA and often associated with psoriasis
- Inflammatory back pain, such as that experienced with axSpA, is also possible in people with pSpA, but it is generally not the key symptom
Additionally, people with pSpA may have one or more of the following:
- Inflammatory bowel disease (IBD)
- Anterior uveitis
- Damage on sacroiliac joints (in the pelvis) visible on X-ray
- Past history of back pain
- Family history of spondyloarthritis or having the HLA-B27 gene, which is associated with spondyloarthritis
- Spondyloarthritis. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Spondyloarthritis. Updated November 2013. Accessed January 2018.
- Spondyloarthritis: A Family of Related Diseases. Spondylitis Association of America. http://www.spondylitis.org/Overview. Accessed January 2018.
- Sieper J, van der Heijde D. Nonradiographic Axial Spondyloarthritis: New Definition of an Old Disease? Arthritis & Rheumatism. 2013;65:543-551.
- Lipton S, Deodhar A. The new ASAS classification criteria for axial and peripheral spondyloarthritis: promises and pitfalls. International Journal of Clinical Rheumatology. 2012;7(6):675-682. doi:10.2217/ijr.12.61.
- Spondyloarthritis. Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/spondyloarthritis/. Accessed January 2018.
- Overview of Types of Spondylitis. Spondylitis Association of America. https://www.spondylitis.org/Types-of-Spondylitis. Accessed March 2018.
- Reactive Arthritis. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Reactive-Arthritis. Updated March 2017. Accessed January 2018.
- Gupta N, Agarwal A. Management of uveitis in spondyloarthropathy: Current trends. Perm J 2018;22:17-041. DOI: https://doi.org/10.7812/TPP/17-041.
Taurog J, Chhabra A, Colbert R. Ankylosing Spondylitis and Axial Spondyloarthritis. The New England Journal of Medicine. 2016;374:2563-2574. doi:10.1056/NEJMra1406182
- Rudwaleit, M. New approaches to diagnosis and classification of axial and peripheral spondyloarthritis. Current Opinion in Rheumatology. 2010;22:375-80. doi: 10.1097/BOR.0b013e32833ac5cc