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Spine Extremity Arthritis

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Arthritis – Spine/Extremities

 

What is it?

Spondyloarthritis, also referred to as spondylitis or SpA, is an umbrella term covering the different types of arthritis that affect the spine. This is caused by an inflammation of both the joints and the enthesis (areas where the tendons and ligaments attach to the bones). The disease has two broad classifications, namely axial spondyloarthritis and peripheral spondyloarthritis. These inflammation projects axially, along the spine and pelvis in the former, and peripherally i.e. along the limbs in the later.

Specific types of spondyloarthritis are reactive arthritis, psoriatic arthritis, enteropathic arthritis, juvenile enthesitis-related arthritis, and undifferentiated spondyloarthritis. The most common form of spondyloarthritis, however, is Ankylosing Spondylitis.

At its simplest, ankylosing spondylitis is an inflammatory condition that damages the joints in the spine. Although the spine is the primary site of the disease, other joints may get affected as well. In more severe cases, the body’s response to the inflammation can lead to a condition called ankylosis where calcium is deposited at sites where the ligaments attach to the bones in the spine. This stiffens the vertebrae and reduces the flexibility of the spine. New bone fragments form in the spine causing sections of the spine to fuse together.

Ankylosing spondylitis begins in the joints between the pelvis and the spine and may very well spread right up to the neck. Sometimes, the effect can go even further, inflaming other joints, or the eyes.

 

How common is it and who is at risk?

While no global figures are available, ankylosing spondylitis is uncontested as the most prevalent form of spondyloarthritis, a blanket term for the types of arthritis that affect the spine. Three times more men than women are patients of ankylosing spondylitis, although it is unclear why. Heredity may also be a factor in being diagnosed with the disease as research reveals that most people suffering from ankylosing spondylitis have the HLA-B27 gene. However, many people with this gene exist who do not have this condition.

The onset of the disease occurs somewhere between late adolescence and young adulthood.

 

What are the symptoms?

Basic symptoms are pain and stiffness concentrated to the lower back, especially felt after waking up from a long period of inactivity. If the pain lasts for 30 minutes or longer of being awake, it can be distinguished as more likely being from developing ankylosing spondylitis than any other condition. The pain may also cause you to wake up during the middle of the night. For children and teenagers, however, the first symptoms registered may be pain and swelling of the hip and the knees.

Moreover, the disease may also cause pain in the pelvis, buttocks or the back of the thighs. Areas most affected by ankylosing spondylitis are the joints at the base of the spine and pelvis, the cartilage between the breastbone and ribs, sites where ligaments attach to the bones in the spine or sometimes along the heel and at the hip and shoulder joints. The neck may also ache, particularly for those who have long hour desk jobs. Fatigue is also an expected symptom. This can be a result of the pain caused by the condition or may result from depression and weariness arising from the effect on the quality of life of the affected individual.

Inflammation can occur in any of the enthesis sites and may flare up or regress at different periods of time. In more mild cases of the disease, the inflammation can stay restricted to sacroiliac joints, the joints between the spine and pelvis, and may even be virtually unnoticeable before resolving itself. In other cases, however, the pain is severe enough to restrict the full range of back movements and causes problems in activities involving bending or turning or twisting of the back.

Tenderness experienced in different parts of the body is often a sign of ankylosing spondylitis as well. Tenderness at the heel can occur, causing discomfort when standing on hard floors or wearing certain types of shoes. One may also feel uncomfortable sitting down due to tenderness developing at the base fo the pelvis. The tightness of the chest is not uncommon. If the upper portion of the spine is affected, called the thoracic spine, may constrict the movement of the joints between the breastbone and the ribs. This can make it hard to inhale or exhale deeply, cough or sneeze. The ribs may feel tender and may cause shortness of breath.

In the more serious cases, the eyes may become inflamed. Initially characterized by a bloodshot and watery look, the eye may feel prickly at first and may grow more painful as the inflammation progresses. The condition may cause discomfort when looking at bright lights or may cause blurred vision, which can be quite dangerous. Inflammation of the bowel can occur as well, causing symptoms like a long period of diarrhea or the passing of bloody stool.

Ankylosing spondylitis symptoms develop gradually, over several months or even years. They may come and go, get better or worse with the passage of time.

 

How is it diagnosed?

The first stage of the diagnosis will be a physical examination where the doctor may ask the patient to bend down at certain angles to determine the range of movement and flexibility in the spine. The doctor will also determine the areas affected by pressing down on different sites to observe the pain response of the patient. This will also be done by moving the patient’s legs in different directions. Additionally, the patient will be required to take deep breaths to ascertain whether the disease is causing any difficulty in expanding the chest.

After the initial tests, X-rays and MRIs can be conducted to show any changes caused to the joints and bones. X-rays can only show changes that occur in the later stages of the disease like the fusing of bone fragments. MRIs prove more effective, showing evidence of ankylosing spondylitis in the soft tissues in the joints.

Though there are no lab tests specifically geared towards diagnosing ankylosing spondylitis, some blood tests can be conducted to check for markers that rule out other causes of inflammation. While blood can be tested for the HLA-B27 gene, it is inconclusive as most people with the gene do not exhibit signs of ankylosing spondylitis.

 

What are the treatment options available?

If addressed early on, before any irreversible deformation occurs, ankylosing spondylitis treatment proves quite successful. The treatment hopes to relieve stiffness and pain in the body and prevent any possible spinal deformity.

In terms of medication, nonsteroidal anti-inflammatory drugs are most commonly prescribed to treat ankylosing spondylitis as they relieve inflammation and pain. If these medicines do not fulfill the goal, biologic medication like TNF blockers may be recommended to reduce pain and swelling. TNF blockers are injected into the skin.

Additionally, physical therapy and regular exercise are also recommended to enhance flexibility and keep the body from stiffening. It can also help in pain relief.

Only in very severe cases will surgery be required for treatment. Surgical procedures may be recommended for hip replacement or joint repair.

 

References

https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808

https://www.arthritis.org/about-arthritis/types/spondyloarthritis/

https://www.versusarthritis.org/about-arthritis/conditions/ankylosing-spondylitis/

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