Spondyloarthritis Definition, Reason, Symptoms, Treatment & Prevention

Definition

Spondyloarthritis is a group of autoimmune rheumatic diseases that have the same symptoms, in the form of inflammation both in the joints and outside the joints, which is associated with the HLA-B27 antigen.

The joints involved in spondyloarthritis include the spine (spondylitis), the sacroiliac joints ( sacroiliitis ), and the peripheral joints.

The autoimmune condition spondyloarthritis also includes enthesitis (inflammation of the area where a ligament or tendon attaches to a bone) and dactylitis (sausage finger).

Based on the main symptoms, spondyloarthritis is generally classified into:

Axial spondyloarthritis

Predominant involvement of the sacroiliac joints and/or spine. Axial spondyloarthritis consists of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA).

Spondyloarthritis Peripheral

Predominant peripheral symptoms, such as arthritis, enthesitis, and dactylitis. Peripheral spondyloarthritis consists of psoriatic arthritis (PsA), reactive arthritis, enteropathic arthritis, and non-specific spondyloarthritis.

Spondyloarthritis

Medical specialist	Internal medicine specialist or internal medicine specialist subspecialty in rheumatology
Symptoms	Lower back and buttock pain, stiff joints, joint pain, swollen fingers, finger pain, heel pain.
risk factor	Genetics, family history of spondyloarthritis, psoriasis, colitis, alcohol consumption, smoking, severe stress, urinary tract infections (UTIs), and gastrointestinal infections.
diagnosis	Blood test, ultrasound, MRI, X-ray.
Treatment	Physical exercise and rehabilitation, as well as drugs.
Drug	NSAIDS, conventional DMARDs, biologic DMARDs, corticosteroid injectable drugs.
Complications	Bone disorders, osteoporosis, spinal fractures, inflammation of the eyes, and heart disease.
When to See a Doctor?	If you experience symptoms of spondyloarthritis and are included in a risk group.

Spondyloarthritis Symptoms

Here are some symptoms  of spondyloarthritis  that you need to understand:

• Inflammatory low back pain (inflammation) in the lower back and buttocks in people under 45 years and lasts 3 months or more. Low back pain at night, sometimes the patient wakes up in the middle of the night because of low back pain
• Stiffness or limited range of motion in the morning, more than one hour
• Joint pain that increases with rest and decreases with exercise or movement
• Pain and swelling in the fingers like sausages (dactylitis)
• Pain in the heel or back of the heel
• Other symptoms outside the joints, such as red eyes, pain in the eyes, diarrhea and prolonged abdominal pain, reddish, scaly and itchy skin, recurring fever, feeling tired easily

Spondyloarthritis Reason

The cause of spondyloarthritis is not known for sure. However, there are several genes that play a role in the occurrence of this disease. The most studied gene is HLA-B27.

Even so, it does not mean that people who have HLA-B27 gene disorders will definitely get spondyloarthritis. Because the emergence of this disease also involves many other factors.

Until now, further research is still needed to determine a more certain cause of spondyloarthritis.

Risk Factors

Spondyloarthritis can appear in a person when there are risk factors such as:

• Genetik human leukocyte antigen (HLA)-B27
• Family history of spondyloarthritis or psoriasis
• Presence of psoriasis
• Presence of  inflammatory bowel disease  or inflammation of the intestines
• Urinary tract or gastrointestinal infection in the last 2-6 weeks
• Excessive alcohol consumption
• Smoking
• Severe psychological stress

Diagnosis 

In making a diagnosis of spondyloarthritis, the doctor must carry out a series of examinations in the form of medical interviews, physical examinations, and supporting examinations. The medical interview includes questions regarding symptoms and risk factors.

After the interview, the doctor will carry out investigations to help diagnose or rule out other diagnoses whose symptoms resemble spondyloarthritis.

The supporting examinations carried out to diagnose spondyloarthritis include:

1. Blood Test

Actually, there is no definite blood test to diagnose spondyloarthritis. However, blood tests are needed to rule out other similar diagnoses.

Blood tests carried out included routine blood tests, erythrocyte sedimentation rate (ESR),  C-reactive protein  (CRP), uric acid, rheumatoid factor, and HLAB-27.

2. Conventional Radiography (X-Ray)

X-ray is often used as an initial imaging modality, and is able to assess and quantify the structural changes associated with spondyloarthritis.

3. Magnetic Resonance Imaging (MRI)

MRI may be considered as first-line imaging in patients with an early duration of symptoms, or in children and adolescents because it may detect manifestations of spondyloarthritis that are not yet visible on  X-ray.

4. Ultrasound (USG) Joints

Ultrasound examination can be used to monitor disease activity and help identify inflammation in the area around the tendon insertion or enthesitis.

Spondyloarthritis Treatment

The goal of treating spondyloarthritis is to overcome inflammation, reduce pain, and prevent joint damage and complications. That way, patients can carry out their activities as usual and maximize their quality of life.

Treatment of autoimmune  spondyloarthritis  can include:

1. Physical Exercise and Rehabilitation

Aims to reduce pain and increase muscle strength and flexibility, thereby preventing joint stiffness.

2. Drugs

Some drugs that can be given in conditions of spondyloarthritis, namely:

• Non-steroidal anti-inflammatory drugs (NSAIDs):  Diclofenac,  ibuprofen,  meloxicam, etoricoxib, or celecoxib
• Disease-modifying anti-rheumatic drugs (DMARD) konvensional: Methotrexate dan sulfasalazine
• DMARD biologics:  TNF-ɑ inhibitors  (infliximab,  etanercept, adalimumab, and golimumab),  interleukin-17 inhibitors  (secukinumab or ixekizumab)
• Inject corticosteroid drugs in the problematic joints

Prevention

Because the cause of spondyloarthritis is not specifically known and there is genetic involvement, there is no effective way to prevent it other than reducing various modifiable risk factors.

Here are ways that help prevent  spondyloarthritis :

• Do not smoke
• Limit alcohol consumption
• Be active and exercise regularly
• Eat a balanced nutritious diet
• Maintain an ideal body weight so that obesity does not occur which can put more burden on joints and bones

Complications

Spondyloarthritis can cause various complications if not treated properly.

In axial spondyloarthritis, complications that can occur are abnormalities in the bones due to damage, and abnormalities in the formation of the spine which trigger damage to the joint structure and cause fusion of the spinal joints.

This condition will make the spine stiff, thus changing the posture to become more hunchback. The hardest thing is to limit the movement and the patient will be difficult to move.

Apart from the joints, complications of axial spondyloarthritis can include osteoporosis (thinning bones), spinal fractures, inflammation of the eyes, and heart disease due to inflammation of the aorta.

When to See a Doctor?

Patients who are suspected of having symptoms of spondyloarthritis as mentioned above should be referred to a specialist in internal medicine or a specialist in internal medicine, subspecialty in rheumatology.