Spondyloarthritis (singular for spondyloarthritides, or simply SpA) is a broad and heterogeneous group of inflammatory joint diseases.
- The term SpA engulfs a variety of disorders, with the most prominent ones being:
- Ankylosing spondylitis (AS)
- Reactive arthritis (ReA)
- Psoriatic arthritis (PsA)
- Enteropathic arthritis (EA)
- Undifferentiated spondyloarthritis
- Etiology. SpA have a complex environmental and genetic background.
- Genetics. HLA-B27
- Classification. The newest classification system divides SpA based on the clinical manifestation, into two groups: axial, and peripheral SpA (see Table 1).
- In axial SpA, the spine and sacroiliac joints are affected.
- In peripheral SpA, the joints of the extremities are affected.
- Diagnosis
- Inflammation markers (CRP, ESR)
- Serology (ACPA, RF)
- Radiological imaging; MRI is superior for early detection of sacroiliitis
- Treatment
- Exercise
- NSAIDs
- Corticosteroids
- Intra-articular for oligoarthritis
- Systemic corticosteroids should be avoided in PsA
- DMARDs
- Sulfasalazine for less severe forms, methotrexate and biologics for more severe forms
- TNF-alpha inhibitors (adalimumab, infliximab)
- IL-17 inhibitors (secukinumab) for AS and PsA
- IL-12/23 inhibitors (ustekinumab) for PsA and EA