Spondyloarthropathy

Description, Causes and Risk Factors:

Spondyloarthropathies are chronic rheumatoid diseases that cause pain and inflammation in the body's major joins, primarily the lower back and spine, where ligament connects to bones. There are several different varieties of spondyloarthropathy but each one presents with the same basic symptoms - pain and limited motion in the lower back and spine, stiff and swollen knees and ankles as well as fever and fatigue.

Almost all spondyloarthropathies present with the worst symptoms after the patient wakes in the morning with the symptoms growing less severe throughout the duration of the day. Exercise has also been shown to reduce the severity of symptoms as many patients have indicated the symptoms are the least severe if present at all following a period of exercise.

A strong genetic association with Class 1 HLA B27 gene (on chromosome 6) is described. Clinically they present with swelling of joints or an enthesopathy - inflammation of tendon insertions into bone. There is pain swelling and joint stiffness. The joint distribution depends on the subtype of the disease. Spinal involvement is characterised by sacroiliitis and inflammatory back pain. The latter consists of pain stiffness and progressive spinal restriction.

Hereditary factors are noted and there is a possibility of different variants of these syndromes, occuring within families. Pathogenesis is felt to be related to an autoimmune phenomenon - with molecular mimicry. There is a cross reaction between an environmental and the bodies' own tissues. The environmental agent is thought by many to be an infective organism. This in fact is identified in certain subsets of the spondyloarthropathies, and these subsets are called reactive arthropathies.

The organisms may include:

Chlamydia - usually from urogenital source.

  • Streptococcus - from airway/respiratory/skin infection source.
  • Yersinia.
  • Campylobacter.
  • Salmonella.
  • Shigella - from bowel source.
  • Klebsiella - from bowel source.

A general difference between spondyloarthropathies and juvenile spondyloarthropathies is that in adults, the spine generally is affected, while in children the arms and legs are more frequently affected. Children may have 4 or fewer joints that are painful or swollen (typically the knees or ankles), inflammation of a part of the eye (iritis), and neck pain and stiffness.

Once the condition develops there are really no treatments that will stop its progression. Instead, treatments aim to prevent deformity or to prevent the advancement of deformity by focusing on better posture. Hip replacement surgery may be involved if the condition affects the hip in a severe way while severe spinal involvement may necessitate a spinal wedge osteotomy.

Symptoms:

Spondyloarthropathies often cause:

Low back pain that may spread into the buttock.

  • Morning stiffness that gets better during the day and after exercise.
  • Fatigue.

Although spondyloarthropathies all result in joint pain, each type also has specific symptoms.

Ankylosing spondylitis (AS) causes stiffness and low back pain. Over time, the pain usually moves from the lower back into the upper back. In severe cases, the affected joints in the spine fuse camera together, causing severe back stiffness. Other areas (such as the hips, chest wall, and heels) may also be affected. In children, symptoms usually begin in the hips, knees, heels, or big toes and later progress to the spine.

  • Reiter's syndrome causes pain, swelling, and inflammation of the joints, especially in the sacroiliac joint, the attachment between the lower back and pelvis, and in the fingers, toes, and feet. The fingers and toes may swell, causing a "sausage digit." Reiter's syndrome can also cause fever, weight loss, skin rash, and inflammation. In children, the joints of the lower legs are most commonly affected.
  • Enteropathic arthritis is spinal arthritis that also involves inflammation of the intestinal wall. Symptoms can come and go. And when the abdominal pain is flaring, this arthritis may also flare. The arthritis typically affects large joints, such as the knees, hips, ankles, and elbows. In children, the arthritis may begin before the intestinal inflammation.
  • Psoriatic arthritis is a form of arthritis associated with a skin condition called psoriasis. The psoriasis symptoms (scaly red patches on the skin) often precede the arthritis symptoms, sometimes by many years. The severity of the rash does not mirror the severity of the arthritis. The fingernails and toenails may show pitting or thickening and yellowing. The joint problems involve large joints, such as the hips and sacroiliac joints. Swelling of entire toes or fingers, resulting in sausage digits, also occurs.

Diagnosis:

After a family history is taken, there will be a series of diagnostic tests run. These tests include blood tests, physical examinations and x-rays. The presence of HLA-B27 is also a strong indication that the patient is suffering from Spondyloarthropathy. There may also be elevated levels of alkaline phosphate and serum immunoglobulin A (IgA) present although this is not true in all cases.

In order for a patient to be diagnosed with spondyloarthropathy, there must be several factors present in the x-rays. There will be superficial bone erosions present as well as patchy sclerosis, bilateral sacroiliac involvement, bamboo spine and squaring of vertebral bodies. Likely the biggest factor that indicates spondyloarthropathy, however, is certainly the lack of the rheumatoid factor in the blood.

The genetic markers are identified in many of these arthropathies as associated with the B27 tissue type.The associations with the B27 and diseases vary to a degree. In The Northern hemisphere, the B27 tissue type is seen in 6-14% of the population.The more north geographically, greater the incidence of B27 positivity.2-10% of these B27+ve people develop one of the spondyloarthropathies.A first degree family history of a B27 related disease increases the risk to 10%

Treatment:

While the most effective way to relieve the pain caused by spondyloarthropathy is with medication, several studies have shown the best way to prevent the spinal deformity common with this condition is to focus on correct posture. In more severe cases light weight braces and supports are used to help the patient practice better posture, but in many cases, the braces and supports are not needed.

Deep breathing and stretching exercises also have been shown as effective methods for slowing the progression of the symptoms of spondyloarthropathy. There is also a lot of focus placed on ensuring proper posture when sitting as well because this tends to be the time when most people slouch. This may be a more difficult task to accomplish and many patients will find proper posture uncomfortable and possibly even painful in the beginning, but in time holding the position will get easier.

Anti-inflammatory medications such as indomethacin, aspirin and sulindac can help relieve the pain and inflammation that spondyloarthropathy causes. Although the symptoms may not be eliminated completely and some discomfort may still occur, it will be much less significant.

Studies have shown that corticosteroid treatments or treatments with medications that suppress the immune system can help relieve the pain patients suffering from spondyloarthropathy experience. Certain drugs that block cell growth such as cytotoxic drugs have been shown as beneficial to patients who do not respond well to corticosteroid treatment.

If the hip has been affected by the condition, hip replacement surgery is often necessary. Surgery may also be required if there has been severe spinal involvement. Surgery is only required when the condition is severe and does not respond to other forms of treatment with the surgical option only being presented as a last resort.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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