What is Spondylitis?
Spondyloarthritis (pronounced spon-dyl-oh-arthritis) is the name given to a group of closely related rheumatic diseases that primarily affect the spine (spondylo) and other joints.
Spondyloarthritis can sometimes be referred to as spondyloarthropathy, and informally, spondylitis. The term seronegative can at times precede any of these terms, and simply means that certain antibodies commonly associated with rheumatoid arthritis and other rheumatic diseases did not present in the person’s bloodwork.
(Thus, spondyloarthritis = spondyloarthropathy = spondylitis.)
Common features of spondyloarthritis include inflammatory back pain, as well as pain and inflammation in the pelvis, neck, intestine, eyes, heels, and various larger joints.
Spondyloarthritis, or SpA, is a form of inflammatory arthritis, which usually begins between the ages of 17 and 45. Systemic inflammation is a key feature that helps distinguish spondyloarthritis from other types of arthritis, including wear-and-tear arthritis such as osteoarthritis.
Reducing systemic inflammation and keeping active is key to minimizing the risk of fusion in the spine, as well as in various other joints and entheses (the connective tissues between tendon/ligament and bone), which is a complication of spondyloarthritis.
This family of diseases is divided into individual categories according to the predominant disease feature(s).
The main similarities that can occur with any type of spondyloarthritis are:
- Inflammation in the pelvis and spine that usually causes inflammatory back pain
- Pain and/or swelling of any other joint in the body (hips, knees, ankles, feet, hands, wrists, elbows, shoulders, etc.)
- Uveitis/iritis, the rapid onset of marked pain and redness in one eye at a time
- Psoriasis skin rash
- Inflammation in the intestine (Crohn’s, ulcerative colitis, undifferentiated colitis)
- Dactylitis, or “sausage digits”, the inflammation along the tendons of the finger or toes
- Enthesitis, inflammation where tendons and ligaments meet the bone; this commonly occurs at the back or bottom of the heel.
Ankylosing Spondylitis (AS)
Inflammation in the spine and/or pelvis causes inflammatory back pain. Inflammatory back pain usually starts gradually before the age of 45, tends to improve with activity but not rest, and occurs with stiffness in the morning that lasts at least 30 minutes.
Over time, this inflammation can lead to ankylosis new bone formation in the spine causing sections of the spine to fuse in a fixed, immobile position. AS can also cause inflammation, pain and stiffness in other areas of the body such as the shoulders, hips, ribs, heels, and other joints.
Enteropathic Arthritis (EnA)
Arthritis Associated With Inflammatory Bowel Disease
In addition to inflammatory back and/or joint pain, inflammation of the intestine, which includes the bowel, is a predominant feature of EnA. Symptoms may include chronic diarrhea, abdominal pain, weight loss, and/or blood in the stool. The most common types of inflammatory bowel diseases are Crohn’s, ulcerative colitis, and undifferentiated colitis.
Psoriatic Arthritis (PsA)
PsA frequently causes pain and swelling in the small joints of the hands and feet. Most people with PsA have a psoriasis skin rash. Some people have a “sausage digit” with a toe or finger that swells between the joints and around the joints. A portion of people with PsA also has pain and stiffness in the spine.
Reactive Arthritis (ReA)
An infection in the intestine or urinary tract usually occurs before inflammation in the joints. ReA can cause inflammation and pain in the joints, skin, eyes, bladder, genitals, and mucous membranes. ReA frequently follows a limited course, with symptoms typically subsiding in three to 12 months. The condition does have a tendency to recur, however, and some people with ReA will develop a chronic form of arthritis.
Undifferentiated Spondyloarthritis (USpA)
People with USpA have symptoms and disease features consistent with spondyloarthritis, but their disease doesn’t fit into another category of SpA. For example, an adult may have iritis, heel pain (enthesitis), and knee swelling, without back pain, psoriasis, a recent infection, or intestinal symptoms. This person’s combination of disease features suggests spondyloarthritis, but she doesn’t neatly fit into the categories of ankylosing spondylitis, psoriatic arthritis, reactive arthritis, juvenile spondyloarthritis, or enteropathic arthritis.
Juvenile Spondyloarthritis (JSpA)
Symptoms begin in childhood. JSpA can look like any other type of spondyloarthritis. Enthesitis, inflammation where tendons or ligaments meet bone, is often a dominant disease feature. Children and adolescents with JSpA tend to have more peripheral arthritis than adults with SpA. Arthritis typically involves joints in the lower extremities in an asymmetric fashion.
Axial Spondyloarthritis (AxSpA)
Axial SpA causes inflammation in the spine and/or pelvis that typically brings on inflammatory back pain. AxSpA is a broad category that includes people with and without characteristic inflammatory changes of the sacroiliac joints (joints linking the lowest part of the spine to the pelvis) seen on X-ray.
Doctors classify people as having a certain type of axial spondyloarthritis:
- Radiographic AxSpA with characteristic changes seen on X-ray.
- Nonradiographic AxSpA without characteristic changes seen on X-ray.
Peripheral Spondyloarthritis (pSpA)
Peripheral SpA commonly causes inflammation in joints and/or tendons outside the spine or sacroiliac joints. Commonly involved sites include joints in the hands, wrists, elbows, shoulders, knees, ankles, and feet. Inflammation of the tendons can occur in the fingers or toes (dactylitis) or where tendons and ligaments meet with the bone (enthesitis). Almost all people with PsA fit into the pSpA category at some point in their disease. People with reactive arthritis, enteropathic arthritis, and undifferentiated arthritis may also fit into this category.
Many people with SpA have or will develop both axial SpA and peripheral SpA. Others will have only axial SpA or only peripheral SpA.
What are the symptoms of spondylitis?
The symptoms of ankylosing spondylitis vary. It’s often characterized by mild to moderate flare-ups of inflammation that alternate with periods of almost no symptoms.
The most common symptom is back pain in the morning and at night. You may also experience pain in the large joints, such as the hips and shoulders. Other symptoms may include:
- early morning stiffness
- poor posture or stooped shoulders
- loss of appetite
- low-grade fever
- weight loss
- anemia or low iron
- reduced lung function
Because ankylosing spondylitis involves inflammation, other parts of your body can be affected as well. People with ankylosing spondylitis may also experience:
- inflammation of the bowels
- mild eye inflammation
- heart valve inflammation
- Achilles tendonitis
While ankylosing spondylitis is primarily a condition of the spine, it can impact other parts of the body, too.
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How to diagnose spondylitis?
The diagnosis of ankylosing spondylitis is based on several factors, including:
- Findings of a physical exam
- X-rays of the back and pelvis
- Measurements of the chest when breathing
- Lab tests
There are no specific lab tests to identify ankylosing spondylitis. Certain blood tests can check for markers of inflammation, but inflammation can be caused by many different health problems.
Your blood can be tested for the HLA-B27 gene, but most people who have that gene don’t have ankylosing spondylitis, and fewer black people with the disease have the gene than do white people.
RA Factor Test – Your doctor may order a blood test to check for the presence of RF if they suspect you have an autoimmune condition, such as rheumatoid arthritis
What Is Spondylosis?
Spondylosis is arthritis that affects that spine. That’s the simplest definition possible. Actually, looking at the Latin roots might give the simplest definition possible. Spondy means spine; losis means the problem. Spondylosis, then, is a problem with your spine, but doctors today use it to specifically mean arthritis in the spine.
Spondylosis is a degenerative spinal disorder, meaning that it’s part of ageing. As we get older, our bodies tend to wear out—no surprise there. Years of use and overuse can cause parts of the spine, especially the joints, ligaments, and intervertebral discs, to change and not work as well.
However, ageing is an individual process. Just as some people go grey earlier, some people will feel the effects (mostly pain) of their ageing spine earlier. In fact, some people may not have much pain ever. It all depends on how the parts of your spine are changing and if those changes are affecting the spinal cord or spinal nerves.
Spondylosis can affect all regions of the spine, another factor determining what symptoms you have. You can have spondylosis in your neck (cervical spine), mid-back (thoracic spine), or low back (lumbar spine).
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