SpondyloarthritisIn spondyloarthritides, a malfunction of the immune system triggers inflammatory processes. The exact reasons for the overreaction of the immune system are not known. However, it is known that a hereditary predisposition plays a role. Many people with spondyloarthritis carry a specific hereditary trait, the MHC antigen HLA-B2.
List of doctors Spondyloarthritis
Prof. Dr. med. Mazda Farshad, MPH (FACS)
Orthopedics and Spine Surgery Zurich
Prof. Dr. med. Jurgen Harms
PD Dr. med. Christian T. Ulrich
PD Dr. med. Uwe Vieweg
Information about spondyloarthritis
What is spondyloarthritis?
The term spondyloarthritides is used to describe a group of different inflammatory joint diseases with similar symptoms. Mostly the small joints of the spine are affected. The sacroiliac joints affected by the inflammation. However, there are also forms in which an inflammation of individual or several other joints (arthritis), the attachment areas of the tendons and ligaments (enthesitis) or the finger or toe joints (dactylitis) is in the foreground.
In addition to similar symptoms, the associated diseases have other common features: a familial cluster, an association with the hereditary trait HLA B27 and the absence of rheumatoid factors.
Which diseases belong to the spondyloarthritises?
The most important diseases in the spondyloarthritides include ankylosing spondylitis , the reactive arthritis, the enteropathic arthritis and the Psoriatic Arthritis :
Bekhterev's disease is a chronic inflammatory rheumatic disease of the vertebral joints and sacro-iliac joints. Over time, the disease can lead to ossification of the vertebral joints and consequently to stiffening and of the spine lead to.
Reactive arthritis is an inflammation of the joint that has developed as a result of a bacterial infection, such as a urinary tract infection or a gastrointestinal infection. An excessive immune reaction to the infection causes an inflammation in the joints. However, no pathogens can be detected in the joints. A special form is Reiter's syndrome, consisting of joint inflammation, urethritis or cervicitis and conjunctivitis.
Enteropathic arthritis is a spondyloarthritis that occurs in association with inflammatory bowel disease such as Crohn's disease and Ulcerative colitis occurs. Some other gastrointestinal diseases, such as Whipple's disease, can also cause spondyloarthritis. Tendonitis or periostitis can also be signs of enteropathic arthritis.
psoriasis (psoriasis) is a mostly chronic disease that occurs in relapses Inflammatory skin disease . Typical are red patches with scales, which are very itchy. The reason for the disease is an autoimmune reaction. Many people with psoriasis also suffer from inflammation of the joints and tendon sheaths. This is called psoriatic arthritis.
How does spondyloarthritis occur??
In spondyloarthritides, a malfunction of the immune system triggers inflammatory processes. The exact reasons for the overreaction of the immune system are not known. It is known, however, that a hereditary predisposition plays a role. Many people with spondyloarthritis carry a certain hereditary trait, the MHC antigen HLA-B27; in ankylosing spondylitis, as many as 80 percent of patients carry this trait. However, hereditary predispositions are not solely responsible for a disease. There are many people who carry the hereditary trait and do not get sick.
Additional factors seem to be involved in the development of the disease. Especially from reactive arthritis it is known that certain bacteria can trigger the excessive immune reaction. It is amed that bacteria also play a role in enteropathic arthritis.
What are the symptoms of spondyloarthritis?
The diseases have similar clinical symptoms. Typical are Chronic back pain by the inflammation of the small joints of the spine. The pain often improves with exercise, but not with rest.
Sometimes other joints are also affected, for example the hip joints. Also the small joints of the fingers. Toes can be inflamed. The joints are then swollen and painful. Especially in the morning they are stiff.
If all the joints of the finger or toe are affected, the whole finger or toe swells painfully (dactylitis). These so-called "sausage fingers" or "sausage toes" are characteristic of spondyloarthritides, especially psoriatic arthritis.
However, the inflammations are not only limited to joints, other regions can also be affected, for example tendon sheaths and the tendon insertions on the bones or even the eyes.
Spondyloarthritides often run chronically or in relapses.
Ankylosing spondylitis is a chronic progressive disease that usually occurs between the ages of 20 and 30. and 40. Age of onset. As a result of the inflammation, the vertebral joints ossify in many patients, limiting the mobility of the spine.
Reactive arthritis often occurs already in children and teenagers. In some patients the disease heals after weeks or months, others get new attacks, and in some patients it remains chronic.
Psoriatic arthritis also progresses in phases, with periods of severe inflammation and periods without symptoms.
The arthritis in Crohn's disease or ulcerative colitis usually heals completely within a few weeks, rarely it takes longer than a year. However, the disease can also recur in this case.
How spondyloarthritis is diagnosed?
The typical back and joint pain and any other complaints, as well as cases of the disease in the family, provide initial indications of the disease. If psoriasis or chronic intestinal disease are present at the same time, spondyloarthritis is probable.
In case of suspicion, the doctor initiates further examinations. At X-rays characteristic changes are often seen. In addition, a blood test is performed: In many cases, an HLA-B-27 test is positive. Rheumatism factors can be used in contrast to the rheumatoid arthritis do not verify.
In the early stages of the disease, bony changes in the spine may not yet be visible on the x-ray. In these cases Magnetic resonance imaging (MRI) provide information: MRI can visualize inflammation in the spine, joints and tendon attachments.
How spondyloarthritides are treated?
Usually, non-steroidal anti-inflammatory drugs are given for pain and inflammation. These include, for example, ibuprofen or diclofenac. These are often effective.
In patients for whom these medications are not sufficient, treatment with biologics can help. Biologics are artificially produced antibodies that inhibit certain messenger substances. In ankylosing spondylitis, so-called TNF-alpha blockers and IL-17 inhibitors are used: these inhibit inflammation and work well in ankylosing spondylitis patients or in Chron's disease, which is the.
So-called basic therapeutics from rheumatism therapy such as methotrexate, cyclosporine or leflunomide are often used for psoriatic arthritis, they are also used for long-term reactive arthritis.
For joint pain outside the spine, the doctor may inject a glucocorticoid into the joint. This helps against the inflammation and the pain. For mild joint pain, sulfasalazine is also used; for severe forms or involvement of the spine, it helps less well.
Additional exercise therapy is especially important for ankylosing spondylitis. It maintains mobility, reduces pain, improves posture, and can prevent stiffening into bad posture.
Which doctors and clinics are specialists in spondyloarthritides?
Rheumatologists are the right people to talk to about spondyloarthritides. You are well versed in inflammatory joint disease.
We can help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in spondyloarthritis and are awaiting your inquiry or request for treatment.