Spondyloarthritis: Causes, Symptoms, Treatment, Exercise

Spondyloarthritis cannot be termed as the same as arthritis since this condition involves the sites where ligaments and tendons get attached to the bones. The clinical presentation of Spondyloarthritis is in two forms, in the first form there is inflammation resulting in pain and stiffness more often than not of the spine, although sometimes it can affect the extremities as well. The second form is bone destruction resulting in deformities of spine and impaired function of the shoulders and hips.

One type of Spondyloarthritis known as ankylosing spondylitis is considered to be hereditary. There are numerous genes which cause this problem of which the main gene that causes this condition is the HLA-B27 gene. Another type of Spondyloarthritis known as enteropathic arthritis is caused due to uncertain reasons. Studies suggest that it may be caused due to some type of bacteria infiltrating the bowel. This form of Spondyloarthritis is found more in people who are carriers of the HLA-B27 gene.

Below mentioned are some common facts about Spondyloarthritis:

• In majority of cases of Spondyloarthritis, the presenting symptom is low back pain. This form of Spondyloarthritis is called as axial spondyloarthritis.
• In some cases, the presenting symptom is pain and swelling in the upper and lower extremities. This form of Spondyloarthritis is also called as Peripheral Spondyloarthritis.
• Many people with Axial Spondyloarthritis go on to develop some degree of spinal fusion which is a condition called as ankylosing spondylitis.
• NSAIDs are used more often than not for treating this condition which reduces the swelling and inflammation. In case if someone does not respond to NSAIDs then another class of drugs called as TNF blockers are used for symptom relief.
• Another more effective way of treating Spondyloarthritis is frequent and diligent back exercises.

Some of the symptoms of Spondyloarthritis are:

• Severe low back pain
• Buttock pain in one or both buttocks
• Inflammation at the site where the tendon or ligament attaches to bone
• Peripheral Arthritis
• Arthritis of small joints
• Swelling of the fingers or toes
• Severe heel pain
• Persistent fatigue.

In order to diagnose Spondyloarthritis, the treating physician will begin with taking a detailed history of the patient. The next step is to conduct a detailed physical examination of the affected body part to look for any tenderness to palpation. Once the history taking and physical examination is over, then the physician may order radiographic studies like x-rays or CT scan of the SI joints or the pelvis to look at the internal structures of these joints. In case of Spondyloarthritis, there will be clear changes to the SI joints indicating sacroiliitis which virtually confirms the diagnosis of Spondyloarthritis. In case if the x-ray images are inconclusive but the symptoms are highly suspicious of Spondyloarthritis the physician may order an MRI scan to look at the structures better.

The treating physician may also order blood tests to see if the patient is a carrier of the HLA-B27 gene, although people having this gene do not always develop this condition.

Conservative approach is the frontline treatment for Spondyloarthritis. The best way to treat this condition is to do physical therapy and perform exercises directed towards the affected joint. The exercises that are most effective are those which involve spinal extension and increases spine mobility.

Pharmacotherapy is also used for treatment of Spondyloarthritis. Medications of choice are NSAIDs like Tylenol or ibuprofen which are quite effective in calming down inflammation and pain if given at the recommended dosage.

In case if the swelling is localized to a particular joint then steroid injections have also shown to be quite effective.

For people who are unresponsive to the treatment modalities mentioned above for Spondyloarthritis then another class of drugs called as disease modifying antirheumatic drugs or DMARDs are used. Sulfasalazine is a medication which comes under this category and is shown to be quite effective in treating Spondyloarthritis. It is especially effective for those people who have arthritis affecting the joints of arms and legs.

A more novel method of treatment for Spondyloarthritis is the TNF-alpha blockers. These medications have shown a lot of promise in treating Spondyloarthritis effectively. Some of the FDA approved medications under this category are:

• Remicade which is given intravenously every 6-8 weeks
• Enbrel given in the form of an injection once weekly
• Humira which is injected every other week
• Simponi which is injected once a month.

However this form of treatment for Spondyloarthritis is quite expensive and it has its own side effect profile. As an example, a person with latent TB may develop an active infection due to the use of this class of medications. Hence it is extremely vital for concerned people to consult with their treating physician about the risk benefit ratio before starting this form of treatment.

In some people, surgery has shown to be quite effective in the form of hip replacement surgery for people with severe hip pain. In cases of traumatic fractures to the spine spinal surgery is an option.

Here it should be mentioned that before starting any form of exercise of fitness program it is imperative to consult with the treating physician who can give best advice as to which exercise to do. Some of the exercises which can be useful for Spondyloarthritis are:

Flexibility Exercise for Spondyloarthritis: In order to improve the flexibility and mobility of the joints you can start by moving the joints as far as possible and do muscle stretches. Yoga can also be a helpful way to remain flexible.

Muscle Strengthening Exercise For Spondyloarthritis: If your muscles are strong then they will take much pressure away from the joints. To make the muscles strong, you can make use of dumbbells or light weights.

Fitness: If a person is fit and active then most of the body functions smoothly. To stay fit, you can perform daily exercises on a treadmill or elliptical machine. Even a brisk walk daily can be helpful.

One can also practice some low impact exercises to stay not only fit but improve your overall condition. Some of these exercises are:

• Brisk walking
• Hydrotherapy or swimming
• Strength training
• Tai-Chi
• Yoga
• Pilates
• Cycling
• Dancing.

People with Spondyloarthritis may have to battle with pain, fatigue and joint stiffness off and on or at times continuously. With specific coping mechanisms, majority of people can be productive at their workplace and live a normal lifestyle, especially with the advances that medical science has made with newer treatments coming up for Spondyloarthritis, but there are certain things which an individual with Spondyloarthritis can do to improve the quality of life and those are doing diligent exercises to strengthen the back, avoid smoking, and eat a healthy diet. There are also different support groups available who also help people cope up with Spondyloarthritis.

Also Read:

• What is Cervical Spondyloarthritis & How is it Treated?