Spondyloarthropathy Causes, Types, Symptoms, Diagnosis, Treatment, Diet

Spondyloarthropathy Causes, Symptoms, Diagnosis, Treatment, Diet

What are spondyloarthropathies?

Spondyloarthropathies are a family of long-term (chronic) diseases of joints. These diseases occur in children (juvenile spondyloarthropathies) and adults. They include ankylosing spondylitis, Reiter's syndrome (reactive arthritis), psoriatic arthritis, and joint problems linked to inflammatory bowel disease (enteropathic arthritis). Spondyloarthropathies are sometimes called spondyloarthritis.

Although all spondyloarthropathies have different symptoms and outcomes, they are similar in that all of them:

  • Usually involve the attachments between your low back and the pelvis (sacroiliac joint).
  • Affect areas around the joint where your ligaments and tendons attach to bone (enthesitis), such as at the knee, foot, or hip.
  • It is important to recognize that the spondyloarthropathies are different from rheumatoid arthritis (RA) in adults and juvenile idiopathic arthritis (JIA) in children.

The spondyloarthritides include:

  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Reactive arthritis/Reiter's syndrome
  • Enteropathic arthritis
  • Undifferentiated: Patients with features of more than one disease who do not fit in the defined categories above

Spondyloarthropathy Types

The condition has been classified into various types, such as:

Ankylosing Spondylitis

It gives rise to pain and stiffness in the lower back region. The pain gradually spreads up and affects the upper back and the chest as well as other areas like the hips and the heels. In more acute cases, the spinal joints affected by the disorder may also fuse together. This can result in greater stiffness. Children affected by this disease may suffer from the symptoms in the heels, toes, hips or knees which may later graduate to the spine.

Enteropathic Arthritis

It affects the intestinal wall and the spine. This form of the disorder gives rise to symptoms that are inconstant in nature and tend to appear, go away and come back again. Arthritis in the spine often arises due to a flare-up of an inflammation in the wall of the intestine. Typically, the arthritic symptoms of this condition tend to impact the joints of various areas of the body such as the elbows, knees, hips and ankles.

Psoriatic Arthritis

This form of the disorder is most commonly related with Psoriasis; a skin condition that is quite common. The arthritic symptoms of this disease usually affect the elbows, hips and knees. These frequently arise long after the first appearance of psoriatic symptoms. The disorder commonly gives rise to inflammatory problems in the toes and fingers. The nails in the fingers and toes may also display signs of pitting or hardening.

Reiter’s Syndrome

It is one of the less common although one of the most serious types of Spondyloarthropathy. Also known as Reactive Arthritis, this condition leads to swelling of the joint between the lower back and pelvis. It is also a cause of inflammation in the joints in the fingers, toes and feet. In majority of patients, the disorder results in severe inflammation of the fingers and possible swelling of the toes. Inflammation of the toes is, however, less common than swelling of the fingers. Patients of this condition may also suffer from other problems like weight loss, skin rashes or fever.

Undifferentiated Spondyloarthropathy

It is a term used to refer to the signs of spondylitis in an individual who does not display enough symptoms of Ankylosing spondylitis (AS) or any associated disorder to be diagnosed for the same. Usually, patients of this disorder are found to have a good prognosis. However, some patients may develop AS or any other related ailment over a period of time. Presently, there is no definite treatment for this condition. However, medications and other curative options are available to manage and reduce pain and other discomforting symptoms.

What causes spondyloarthropathies?

Medical experts are still clueless about the exact cause of this condition. However, ankylosing spondylitis is mainly supposed to arise due to the presence of a specific gene known as HLA-B27. Patients who tend to suffer from any form of Spondyloarthropathy are typically found to carry this gene. Race is also associated with this condition as approximately 8 percent Caucasians are found to possess this particular gene.

The likeliness of appearance of the condition in families is higher than other types of rheumatic disease, such as rheumatoid arthritis or lupus.

Who gets spondyloarthropathy?

People who have other conditions such as psoriasis, Crohn's disease and inflammatory bowel disease are more likely to get spondyloarthropathy. 

Ankylosing spondylitis is a disease that affects more men than women from early teenage years up to approximately 35 years of age.

Reactive arthritis is a temporary form of arthritis that accompanies certain bacteria. People who have food poisoning, dysentery or gastroenteritis and come into contact with the bacteria associated with these may contract reactive arthritis. People with chlamydia are also susceptible to reactive arthritis, especially those with the genetic fingerprint HLA B-27.

Enteropathic arthritis affects people with bowel diseases such as Crohn's disease and ulcerative colitis. Again the HLA-B27 genetic fingerprint is a factor and people with this genotype that suffer from a chronic bowel condition are more likely to have enteropathic arthritis.

Psoriatic arthritis may accompany psoriasis.

What are the symptoms of Spondyloarthropathy?

Spondyloarthropathies often cause:

  • Low back pain that may spread into the buttock.
  • Morning stiffness that gets better during the day and after exercise.
  • Fatigue.
Although spondyloarthropathies all result in joint pain, each type also has specific symptoms.

  • Ankylosing spondylitis causes stiffness and low back pain. Over time, the pain usually moves from the lower back into the upper back. In severe cases, the affected joints in the spine fuse camera together, causing severe back stiffness. Other areas (such as the hips, chest wall, and heels) may also be affected. In children, symptoms usually begin in the hips, knees, heels, or big toes and later progress to the spine.
  • Reiter's syndrome causes pain, swelling, and inflammation of the joints, especially in the sacroiliac joint, the attachment between the lower back and pelvis, and in the fingers, toes, and feet. The fingers and toes may swell, causing a "sausage digit." Reiter's syndrome can also cause fever, weight loss, skin rash, and inflammation. In children, the joints of the lower legs are most commonly affected.
  • Psoriatic arthritis is a form of arthritis associated with a skin condition called psoriasis. The psoriasis symptoms (scaly red patches on the skin) often precede the arthritis symptoms, sometimes by many years. The severity of the rash does not mirror the severity of the arthritis. The fingernails and toenails may show pitting or thickening and yellowing. The joint problems involve large joints, such as the hips and sacroiliac joints. Swelling of entire toes or fingers, resulting in sausage digits, also occurs.
  • Enteropathic arthritis is spinal arthritis that also involves inflammation of the intestinal wall. Symptoms can come and go. And when the abdominal pain is flaring, this arthritis may also flare. The arthritis typically affects large joints, such as the knees, hips, ankles, and elbows. In children, the arthritis may begin before the intestinal inflammation.

A general difference between spondyloarthropathies and juvenile spondyloarthropathies is that in adults, the spine generally is affected, while in children the arms and legs are more frequently affected. Children may have 4 or fewer joints that are painful or swollen (typically the knees or ankles), inflammation of a part of the eye (iritis), and neck pain and stiffness.

Spondyloarthropathies may cause inflammatory eye disease, particularly uveitis. In some cases, spondyloarthropathies can cause disabilities, particularly if bones in the spine fuse together. People who have spondyloarthropathies for a long time may develop complications in organs, such as the heart and lungs.

How are spondyloarthropathies diagnosed?

Spondyloarthropathies are diagnosed through a medical history, lab tests, and by symptoms of joint and tissue inflammation, morning stiffness, and other symptoms unique to a specific spondyloarthropathy (such as scaly skin in psoriatic arthritis). Different types of tests may be done for the different spondyloarthropathies.

How are spondyloarthropathies treated?

This is typically a mild condition and may remain undetected for many years. Most individuals with this condition do not face problems while carrying out daily activities. Treatment is usually required in the later stages, characterized by acute pain and stiffness. Treatment aims to relieve the discomforting symptoms and involves use of:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) – These are commonly used to cure pain and swelling associated with the disorder. These are effective in reducing the progression of the disorder and preventing deformities.
  • Medications – These are used to cure specific symptoms like intestinal inflammation, as in Enteropathic Arthritis.
The use of treatment options basically depend on the form of Spondyloarthropathy that a patient suffers from. However, no treatment has been found to be completely effective in correcting the condition. Curative options usually aim at managing and controlling the symptoms of the disorder rather than removing them.

Apart from medical treatment, Stretching and Deep breathing exercises have also been found to be effective in reducing the progression of the symptoms of this discomforting disease. According to some medical studies, maintaining a correct posture has also been found to be the best way to prevent this spinal deformity. In very severe cases, supports and light weight braces are found to help patients in maintaining a better posture. In many cases, however, support of such equipments is not required.

Other than medications, pain management also often includes plenty of rest, regular exercise, and energy conservation techniques.

Diet to improve spondyloarthropathy

There has been significant success at relieving pain through a low carbohydrate diet. That means drastically reducing the intake of starch. This is found in: 
  • bread
  • potatoes
  • pasta
  • cakes

The science behind the theory is that as spondyloarthropathies are autoimmune diseases, the intake of starch can irritate this genre of disease from the gut. To compensate for the reduction of calories from starchy foods more fish, meat, fruit and vegetables (except potatoes) should be eaten. Many hospitals now prescribe this diet and have seen drastic results that have removed half of their patients from all drugs to simply diet controlled treatment. 

Psoriatic arthritis is also said to be improved by removing the following foods from the diet:
  • white flour
  • sugar
  • beef
  • milk

Spondyloarthropathy Prognosis

Although a non-threatening condition, Spondyloarthropathy does not have a good long term outcome. Once the condition arises, its progression cannot be actually controlled by any treatment. If the condition impacts the hip, a hip replacement surgery can be required. In case of an acute spinal involvement, a spinal wedge Osteotomy may become necessary. Better posture can help prevent worsening of the deformity.

When arising in children, Spondyloarthropathy tends to be a chronic problem that may persist even during the adult years. Most children affected with this disorder are able to lead an active lifestyle. However, episodic development of painful symptoms can be a cause for worry for both children and adults. If you find the symptoms of this disorder arising in any family member, consult a good doctor or therapist to find a way to manage the condition properly.