Spondyloarthritis

What is this disease?

Spondyloarthritis is the name for a group of diseases in which the spine and other parts of the body become inflamed. Two forms are seen most:

• Ankylosing spondylitis and non-radiographic axial spondyloarthritis. Both affect the spine. In the first, changes show on X-ray. In the second, they can sometimes be seen only on MRI.
• Psoriatic arthritis. It affects the joints and appears in some people with the skin disease psoriasis, sometimes years later.

The exact cause is not clear. Ankylosing spondylitis has been linked to a gene called HLA-B27.

What are the signs?

In the axial form:

• Back pain and stiffness that develop slowly over months or years and may come and go
• Pain and swelling elsewhere, such as where a tendon joins a bone
• Extreme tiredness
• Sometimes a painful red eye (uveitis)

This form usually begins in teenagers and young adults.

In psoriatic arthritis:

• Pain, swelling and stiffness in one or more joints
• A whole finger or toe that swells
• Nails that change colour or develop tiny pits
• Tiredness

Symptoms can be worse first thing in the morning and improve with movement.

How is it checked?

Blood tests, imaging (X-ray, ultrasound and MRI) and sometimes a joint fluid test. Your doctor looks at the back, joints, skin and nails together.

What does treatment generally look like?

These diseases have no definite cure and existing damage does not reverse, but treatment eases symptoms and helps delay progress. The course differs greatly from one person to another.

• Exercise and physiotherapy: to reduce pain and stiffness and keep the spine flexible.
• Anti-inflammatory medicines: for pain and inflammation.
• Disease-modifying medicines (DMARDs): in moderate to severe psoriatic arthritis. They take months to work.
• Biologics: such as TNF inhibitors.
• Steroid injections into a joint: in some cases.
• Surgery: rarely needed.

What can you do yourself?

• Exercise regularly. Walking, swimming and yoga put little strain on the joints.
• Do not smoke.
• If you are overweight, lose weight to reduce pressure on your joints.
• Do not use herbal remedies, which may interfere with your medicines.

When should you get help urgently?

• Eye: eye pain, sensitivity to light, very red eyes or blurred vision need checking the same day. Loss of vision is an emergency.
• Back: back pain with weakness, numbness or tingling in both legs, numbness around the genitals, or new trouble with bladder or bowels is an emergency.
• Spine: sudden severe spine pain may be a fracture, because this disease can weaken the bones.

See the full list of warning signs.