Do your back joints hurt too? Let's learn about spondyloarthritis!

Do you also start your day with a stiff back and pain when you wake up in the morning? Or do you sometimes feel like your back pain spreads to your buttocks? You may be a little uncomfortable with symptoms like these. This condition may not be a simple backache. Today we are going to talk about a slightly complicated, but understandable disease called Spondyloarthritis .

What is spondyloarthritis? Simply put...

Simply put, spondyloarthritis is an arthritis condition that occurs in the joints of your spine . "Spondyl-" means related to the spine. "Arthritis" means pain and stiffness in the joints. This condition mainly affects the joints that connect your spine. That is, the small joints (facet joints) between the vertebrae and the sacroiliac joints that connect your spine to your hip bones. This is why lower back pain is often the main symptom . However, it is not limited to the spine. It can affect other joints and cause other symptoms.

Remember, this is not a single disease, but a group of diseases with similar symptoms. Doctors also call this condition spondyloarthropathy . It means a disease (`-pathy`) of the joints of the spine (`arthro-`). You may have heard of osteoarthritis (caused by joint wear) and rheumatoid arthritis (RA) (caused by a problem with the immune system). Spondyloarthritis is a different condition from both of those, but it can also affect the joints of the spine.

What are the main characteristics of this condition? Let's take a closer look!

There are several specific symptoms related to spondyloarthritis:

• This is a rheumatic disease: Spondyloarthritis is a type of arthritis that falls under the category of rheumatic diseases , which is an inflammatory type of arthritis . Chronic inflammation causes pain and swelling in the joints. It is not a condition that causes joint damage like osteoarthritis. Inflammatory arthritis is usually an autoimmune disease . This means that your body's immune system mistakenly attacks your own joints, causing ongoing inflammation. This inflammation can affect not only the joints, but also other parts of the body.

• This is not rheumatoid arthritis (RA): Although it is a type of arthritis, this is not the rheumatoid arthritis (RA) we all know. We know this because blood tests for people with spondyloarthritis do not show the rheumatoid factor , an antibody specific to RA. This is why doctors sometimes call this condition "seronegative spondyloarthropathy." "Seronegative" means that the blood test for RA is negative. No specific antibody has yet been found for spondyloarthritis (SpA).

• Enthesitis: Another important symptom of spondyloarthritis is inflammation (enthesitis) in your entheses . Doctors look for this when diagnosing the condition. Entheses are fibrous connective tissue. More specifically, they are the "joints" where your tendons and ligaments connect to your bones. Spondyloarthritis can cause enthesitis in various parts of the body. The heels and knees are the most common places where this condition is seen.

• HLA-B27 gene: Between 80% and 95% of people with spondyloarthritis of Northern European descent have the HLA-B27 gene . This gene is less common in people with the disease in other ethnic groups. Also, having this gene does not automatically cause the disease. However, it is common enough that a doctor may test for this gene to help diagnose the disease.

How common is this disease?

Although many people don't know much about it, spondyloarthritis is actually a condition that is even more common than rheumatoid arthritis . It is estimated that approximately 0.5% to 2% of the world's population has some form of spondyloarthropathy.

What are the main types of spondyloarthritis?

There are several distinct diseases that fall under the general heading of spondyloarthritis. Doctors divide these into two main categories: axial spondyloarthritis and peripheral spondyloarthritis .

Axial Spondyloarthritis

It mainly affects the joints of your axial skeleton , which is the neck, chest, and spine . As the disease progresses, other joints and possibly organs can be affected.

Ankylosing Spondylitis is a severe form of axial spondyloarthritis. It is characterized by marked changes in the bones of the spine, called ankylosis (fusion of the bones together). Overall, it is the most common type of spondyloarthritis.

Peripheral Spondyloarthritis

This type first affects your peripheral joints and entheses. That is, the joints outside the axial skeleton (for example, the joints in the limbs). As the disease progresses, the spine may be affected or even destroyed.

Peripheral spondyloarthritis usually involves inflammation in other organs as well. Different types can affect different organs (such as the eyes, skin, and intestines). However, the symptoms can be somewhat similar. Some of the main types are:

• Psoriatic Arthritis: This is an arthritis condition that occurs along with psoriasis , an autoimmune skin disease that causes an inflammatory skin rash. (In our part of the world, this is also called "scaly skin"). It often affects the small joints of the hands and feet, causing swelling and pain in the fingers.
• Enteropathic Arthritis: This is an arthritis condition that occurs along with Inflammatory Bowel Disease (IBD) . "Enteropathic" means it involves your intestines.
• Reactive arthritis: This is an autoimmune condition that occurs in response to an infection in your intestines or urinary tract. It can affect your eyes, skin, bladder, genitals, or intestines. It is usually temporary, but can last up to 12 months. In some people, it can turn into chronic arthritis.

Undifferentiated Spondyloarthritis

This is the diagnosis given if your symptoms generally fit those of spondyloarthritis, but do not fit neatly into any specific subtype.

Juvenile Spondyloarthritis

This is a condition of spondyloarthritis that occurs in childhood, usually before the age of 16. Children may develop a specific type or a combination of different types.

What are the symptoms of Spondyloarthritis?

The symptoms of different types of spondyloarthritis can often be similar. Although some symptoms are more specific to certain types, any of the symptoms can be seen in any type.

The main symptoms may be:

• Pain in the lower back, sometimes radiating to the buttocks (sacroiliitis). For some people, this may feel like pain coming from the inside of the hip bone.
• The stiffness in the joints in the morning, which eases a little when you move around. It's like when you wake up in the morning, your body feels like wood, and it only loosens up when you move around a little.
• Pain in the middle and upper back, chest muscle pain, or neck pain.
• Gradual curvature of the spine (like scoliosis).
• Pain and stiffness in the joints of the limbs – hips, shoulders, knees, elbows, wrists, ankles.
• Severe swelling of the fingers ("sausage fingers" or dactylitis). This is when one finger or toe becomes completely swollen, looking like a sausage.
• Digestive system symptoms, for example, stomach pain and diarrhea.
• Pain and inflammation of the urinary tract.
• Itchy, scaly skin rash (psoriasis).
• Small pits in the nails (nail psoriasis).
• Chronic fatigue.
• The food is tasteless.
• Inflammation of the eyes (uveitis). This can cause redness, pain, and sensitivity to light.
• Mouth sores.
• Heel pain (due to enthesitis).
• Formation of small bone spurs.

Importantly, symptoms of spondyloarthritis usually begin to appear earlier than other types of arthritis, usually before the age of 45. These symptoms may start slowly and gradually worsen. In most cases, these symptoms are persistent.

What are the causes of spondyloarthritis?

Spondyloarthritis symptoms are caused by chronic inflammation in your joints and other tissues. This inflammation is caused automatically by your own immune system . This is what we call an autoimmune disease .

Researchers still don't fully understand why these autoimmune diseases occur. However, it seems likely that several factors play a role. Many autoimmune conditions, including spondyloarthritis, appear to have a genetic component .

The HLA (Human Leukocyte Antigen) family of genes is often linked to inflammatory arthritis. A protein produced by these genes is used by the immune system to tell the difference between your own cells and foreign cells. Some variations in these genes can cause the immune system to malfunction. This can cause the immune system to misidentify your own cells and attack your own cells.

What are the triggers for spondyloarthritis?

Although there is a genetic influence, it is not the only cause of the disease. Although many people with spondyloarthritis have the HLA-B27 gene , not everyone with that gene will develop spondyloarthritis.

Something else needs to trigger this process. Researchers have different ideas about what triggers this. Some of these include severe infections, environmental toxins, smoking, and alcohol use.

One theory is that spondyloarthritis may be linked to an imbalance (dysbiosis) in your gut microbiome . People with spondyloarthritis (SpA) have a lower diversity of gut microbes, which makes it easier for harmful microbes to thrive. This imbalance in the gut (`gut dysbiosis`) can make you more susceptible to infections, cause chronic inflammation in the gut, and weaken your immune system. The mix of your gut microbes is also something you inherit to some extent at birth.

How is spondyloarthritis diagnosed?

Spondyloarthritis can be a bit tricky to diagnose, especially if you don't have a clear set of symptoms. Some people just have joint pain and stiffness, and there could be many other causes.

A doctor will first ask you about your symptoms and check for other symptoms that you haven't mentioned but may be related. They will also ask about your health history and your family's health history.

Then, your spine or other joints will be physically examined to see how far you can move them. X-rays will be taken to look for evidence of arthritis or enthesitis, but this evidence is not always visible on the images.

Blood tests can also be done to check for signs of inflammation or autoimmune disease. They can also test for the HLA-B27 gene . These tests can help differentiate spondyloarthritis (SpA) from other diseases.

What are the treatments for spondyloarthritis?

Treatment depends on your specific symptoms. Doctors follow a step-by-step approach to treatment, starting with exercise and over-the-counter pain relievers (OTC nonsteroidal anti-inflammatory drugs / NSAIDs) .

If these aren't enough to control your pain and inflammation, your doctor may suggest:

• Cortisone shots are given periodically to reduce localized pain.
• Conventional or biologic DMARDs (Disease-Modifying Anti-Rheumatic Drugs / DMARDs). These are drugs that modify the nature of the disease.

For some specific types of spondyloarthritis, such as psoriatic arthritis and enteropathic arthritis, there are other treatments that are specific to the underlying condition (psoriasis or inflammatory bowel disease (IBD)).

How serious is this situation? How do we move forward?

If inflammatory arthritis becomes severe and lasts a long time, some serious complications can occur. However, these complications usually affect your quality of life rather than your lifespan. For example, you may have reduced joint mobility and an increased risk of bone fractures. However, not everyone will develop severe symptoms, and treatment can help to control the progression of the disease.

The rate at which spondyloarthritis progresses varies from person to person. For some, it progresses slowly and can be easily controlled with treatment. For others, it can progress to ankylosing spondylitis, a condition that causes spinal fusion, within a few years.

The severity of your inflammation affects how quickly spondyloarthritis progresses. Following your treatment exactly can help control inflammation and prevent complications.

What can you do when living with spondyloarthritis?

For anyone with arthritis, regular exercise is essential to maintain as much joint mobility as possible. Many doctors say this is more important and effective than any medication.

If you're not sure what type of exercise is right for you, ask your doctor. Many doctors recommend physical therapy that targets specific joints or problem areas.

Spondyloarthritis is a group of related, yet distinct, diseases. Although doctors identify them by their similarities, each type – and each person’s disease – is unique.

For many people, spondyloarthritis is a lifelong condition. However, the extent to which it affects your life can vary. Your doctor will be your best partner in managing your symptoms and what you can expect personally.

The most important things for you to remember

Okay, so we've talked a lot about spondyloarthritis. In short, here are some things to keep in mind:

• Spondyloarthritis is an inflammatory arthritis condition that occurs in the joints of the spine.
• This is an autoimmune disease ; that means your own immune system attacks your joints.
• The main symptoms are back pain (especially worse in the morning), joint stiffness, and enthesitis (inflammation of the joints where tendons attach to bones).
• The gene HLA-B27 may be involved, but it is not the only cause.
• There are different types, such as Ankylosing Spondylitis and Psoriatic Arthritis.
• Symptoms, tests, and sometimes genetic tests are used to diagnose the disease.
• Treatment includes exercise, painkillers, and sometimes specific medications (DMARDs) .
• Regular exercise and following medical advice are very important to manage this condition.

If you have these symptoms, don't be afraid to see a doctor and get advice. Early diagnosis and treatment will go a long way in maintaining your quality of life.

` Spondyloarthritis, Spondyloarthropathy, Back arthritis, Joint inflammation, Back pain, Autoimmune diseases, HLA-B27, Ankylosing Spondylitis, Psoriatic Arthritis