Spondyloarthritis / Spondyloarthropathy

“Spondyloarthritis” (SpA), also known as “spondyloarthropathy,” is a term which describes a group of inflammatory rheumatic diseases that cause arthritis. Spondyloarthritis conditions differ from other types of arthritis, because they involves the parts of the body where the ligaments or tendons attach to the bones (called “entheses”). Enthesitis (the inflammation of an enthesis or multiple entheses) is a common feature of these diseases. Males are more likely to be affected than females, and many but not all people with spondyloarthritis have a positive genetic marker called HLA-B27.

Forms of spondyloarthritis include:

• ankylosing spondylitis (AS) and juvenile AS
• psoriatic arthritis
• reactive arthritis
• enthesitis-related arthritis (ERA), a form of juvenile idiopathic arthritis
• enteropathic arthritis, which is associated with inflammatory bowel disease (IBD)

Symptoms

Many people with spondyloarthritis have pain and swelling in the joints of the lower extremities, such as the hips, knees and ankles. Pain in the back of the heel (at the Achilles tendon) is also common. Some patients have lower back pain, which may originate either in the spine or in the sacroiliac joints (the joints that connect the spine to the pelvis). The pain is usually worst in the morning, and may be accompanied by stiffness. People with longstanding inflammation in the spine or sacroiliac joints may have difficulty with mobility. Depending on the type of spondyloarthritis, patients may have other symptoms, including inflammation of the eye (uveitis), pain with urination, certain rashes or diarrhea and abdominal pain.

Treatment

Treatment varies depending on the patient’s symptoms, age and other associated conditions. Physical therapy is recommended to help strengthen the joints and promote mobility. When medication is necessary, NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen are typically prescribed first. If symptoms persist, immunosuppressive medicine may be required. In patients with inflammatory bowel disease, a rheumatologist or pediatric rheumatologist will work closely with a gastroenterologist to treat the IBD and the arthritis simultaneously.

Updated: 10/21/2022

Reviewed and updated by Theodore R. Fields, MD, FACP and Sarah Faith Taber, MD.