What Is Spondylitis?
Spondylitis—also known as spondyloarthritis or spondyloarthropathy—is not a condition per se. Rather, it is an umbrella term that describes a group of conditions that affect the spinal column. Many of these conditions are inflammatory forms of arthritis.
Spondylitis can be either axial—affecting the spine or the pelvis—or peripheral, meaning locations other than the spine or pelvis, such as the hands, fingers, knees, etc. Conditions grouped under the heading of spondylitis include:
- Ankylosing spondylitis—Inflammation of the spine that may eventually cause some vertebrae to fuse together
- Enteropathic arthritis—Arthritis affecting the spine that is associated with inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis
- Juvenile spondyloarthritis—Any of the other forms of spondylitis in which symptoms begin in childhood
- Psoriatic arthritis—Arthritis, usually found in the small joints of the fingers and toes, that is caused by the skin disease psoriasis
- Reactive arthritis—Arthritis that develops due to an infection that precedes joint inflammation
- Undifferentiated spondyloarthritis—Spondylitis that does not fit neatly into any of the other categories
Many forms of spondylitis are genetic. While a number of genes interact to cause spondylitis, most forms are associated with a gene variation known as HLA-B27, which governs the making of an immune system protein.
Most people with a form of spondylitis have developed it before the age of 45. Some forms of spondylitis, such as ankylosing spondylitis, affect more men than women, while in other forms the distribution between men and women is similar.
Symptoms of spondylitis mostly affect the back, but some can affect the arms, legs, shoulders, eyes and even the skin and stomach. The most common symptoms of spondylitis are pain—especially in the lower back—stiffness and limited mobility of the spine. The pain is usually worse after rest but improves with activity.
Other symptoms can include:
- Anxiety and depression
- Pain, stiffness and swelling in the shoulders, elbows, wrists, fingers, hips, knees, ankles or toes
Diagnosing spondylitis can be difficult, as evidenced by the fact that the time between symptom onset and diagnosis can be up to eight years or longer for some forms. Most diagnoses will start with a physical exam and medical history, paying special attention to any evidence of a family history of spondylitis.
Blood tests, especially those to detect HLA-B27, are often used to help in a diagnosis. X-rays can detect joint abnormalities, such as fusion in the case of ankylosing spondylitis.
Treatment will depend somewhat on the form of spondylitis present, but some methods of treatment are useful for most spondyloarthropathies. Because back pain is generally eased by activity, physical therapy and exercise can be immensely helpful for people who have spondylitis.
Medication is the standard treatment for spondylitis. Most patients start with over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs). However, there are many other options for those who do not respond well to NSAIDs.
Anti-tumor necrosis factor (anti-TNF) drugs—also known as TNF inhibitors—can be helpful for those who have tried NSAIDs without success. TNF causes inflammation, and anti-TNF drugs block the production of TNF, leading to a reduction in symptoms.
In certain cases, steroid injections into a swollen or painful joint can provide relief, but this is typically used only when one or two joints are causing the most pain.
Surgery is not usually used to treat spondylitis. Sometimes a wedge osteotomy, where surgeons remove a wedge-shaped piece of vertebra, may be helpful. In some cases, where a person has extreme hip pain or severely limited hip mobility due to inflammation, a total hip replacement may be warranted.
For more information about the various forms of spondylitis, or to discuss treatment options, contact Nova Pain & Spine Centers today.