{"id":8565,"date":"2021-11-30T07:46:06","date_gmt":"2021-11-30T05:46:06","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/rheumatology\/spondyloarthritides\/"},"modified":"2022-04-23T14:55:55","modified_gmt":"2022-04-23T12:55:55","slug":"spondyloarthritides","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/spondyloarthritides\/","title":{"rendered":"Spondyloarthritis\/spondyloarthritides (SpA)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Spondyloarthritis (singular for spondyloarthritides, or simply SpA) is a broad and heterogeneous group of inflammatory joint diseases.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The term SpA engulfs a variety of disorders, with the most prominent ones being:<ul><li>Ankylosing spondylitis (AS)<\/li><li>Reactive arthritis (ReA)<\/li><li>Psoriatic arthritis (PsA)<\/li><li>Enteropathic arthritis (EA)<\/li><li>Undifferentiated spondyloarthritis<\/li><\/ul><\/li><li><strong>Etiology<\/strong>. SpA have a complex environmental and genetic background.<ul><li><strong>Genetics<\/strong>. HLA-B27<\/li><\/ul><\/li><li><strong>Classification.<\/strong> The newest classification system divides SpA based on the clinical manifestation, into two groups: <strong>axial<\/strong>, and <strong>peripheral SpA<\/strong> (see Table 1).<ul><li>In axial SpA, the spine and sacroiliac joints are affected.<\/li><li>In peripheral SpA, the joints of the extremities are affected.<\/li><\/ul><\/li><li><strong>Diagnosis<\/strong><ul><li>Inflammation markers (CRP, ESR)<\/li><li>Serology (ACPA, RF)<\/li><li>Radiological imaging; MRI is superior for early detection of sacroiliitis<\/li><\/ul><\/li><li><strong>Treatment<\/strong><ul><li>Exercise<\/li><li>NSAIDs<\/li><\/ul><ul><li>Corticosteroids<ul><li>Intra-articular for oligoarthritis<\/li><\/ul><ul><li>Systemic corticosteroids should be avoided in PsA<\/li><\/ul><\/li><li>DMARDs<ul><li>Sulfasalazine for less severe forms, methotrexate and biologics for more severe forms<\/li><\/ul><ul><li>TNF-alpha inhibitors (adalimumab, infliximab)<\/li><li>IL-17 inhibitors (secukinumab) for AS and PsA<\/li><li>IL-12\/23 inhibitors (ustekinumab) for PsA and EA<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Classification<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><thead><tr><th>Group<\/th><th>Conditions<\/th><\/tr><\/thead><tbody><tr><td><strong>Axial spondyloarthritis<\/strong> (AxSpA)<\/td><td>Non-radiographic AxSpA<br>Radiographic AxSpA<\/td><\/tr><tr><td><strong>Peripheral spondyloarthritis<\/strong> (pSpA)<\/td><td>Reactive arthritis<br>Psoriatic arthritis<br>Enteropathic arthritis<br>Undifferentiated spondyloarthritis<\/td><\/tr><\/tbody><\/table><figcaption><strong>Table 1.<\/strong> Classification of spondyloarthritis.<\/figcaption><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Axial SpA (AxSpA)<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">In AxSpA, the spine and sacroiliac joints are affected. It is a group of diseases with the most prominent one being <strong>ankylosing spondylitis<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Typically appears at young age, as a chronic lower back pain (>3 months).<\/li><li>Non-radiographic AxSpA describes an early or less severe forms.<\/li><li>The radiographic pSpA is synonymous for <strong>ankylosing spondylitis<\/strong>.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Peripheral SpA (pSpA)<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">In pSpA, the joints of the extremities are affected; the shoulder, elbow, hand and wrist, knee, ankle and feet joints.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is an umbrella term to unify the following entities (although they are often used instead of pSpA):<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Reactive arthritis<\/li><li>Psoriatic arthritis<\/li><li>Enteropathic arthritis<\/li><li>Undifferentiated spondyloarthritis<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Conditions<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Ankylosing spondylitis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">AS is characterized by inflammation of the joints of the spine and sacroiliac joints at the attachment sites of ligaments to bones.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Presents with a dull LBP in the gluteal and lumbar region during young adulthood (LBP in patients &gt;45 years old suggests mechanical origin).<\/li><li>The pain worsens at rest (especially during sleep) and improves with movement.<\/li><li>Progresses with an ascending pattern of affected joints (lumbar &gt; thoracic &gt; cervical).<\/li><li>Chronic inflammation leads to cartilage metaplasia and new bone formation.<\/li><li>The end result is the ankylosis and fusion of the spine (&#8220;Bamboo spine&#8221;).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Reactive arthritis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">ReA is defined as arthritis triggered by an extra-articular infection (typically Gram-negative, most often of the GI or UTI). Lasts from several months up to a year, and resolves on its own in most cases.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Psoriatic arthritis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">PsA appears in about 30% of psoriasis patients.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>It is considered as a severe form of psoriasis, typically developing within a few years of the onset of psoriasis.<\/li><li>Presents with asymmetrical inflammation of the joints. The joints are warm and erythematous.<\/li><li>Compared to RA, the DIP are often involved.<\/li><li>Pencil-in-cup deformity in late disease.<\/li><li>May involve the SI joints and spine.<\/li><li>PsA mutilans is the most severe form of PsA.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Enteropathic arthritis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">EA is involved with inflammatory bowel disease (more common in CD than UC). The intestinal symptoms do not correlate with the severity of spondylitis. <\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Undifferentiated spondyloarthritis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<p class=\"wp-block-paragraph\">Forms of SpA that do not fit into any of the mentioned categories.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">References<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<ol class=\"wp-block-list\"><li>Rudwaleit M, Landewe R, van der Heijde D, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal.\u00a0<em>Annals of the Rheumatic Diseases<\/em>. 2009;68(6):770-776. doi:10.1136\/ard.2009.108217<\/li><li>Rudwaleit M, van der Heijde D, Landew\u00e9 R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection.\u00a0<em>Annals of the rheumatic diseases<\/em>. 2009;68(6):777-783. doi:10.1136\/ard.2009.108233<\/li><li>Proft F, Poddubnyy D. Ankylosing spondylitis and axial spondyloarthritis: recent insights and impact of new classification criteria.\u00a0<em>Therapeutic Advances in Musculoskeletal Disease<\/em>. 2018;10(5-6):129-139. doi:10.1177\/1759720&#215;18773726<\/li><\/ol>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Axial SpA (AxSpA)<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Peripheral SpA (pSpA)<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Conditions<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Ankylosing spondylitis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Reactive arthritis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Psoriatic arthritis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Enteropathic arthritis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Undifferentiated spondyloarthritis<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">References<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>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. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":8424,"menu_order":5,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8565","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Spondyloarthritis\/spondyloarthritides (SpA) &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/spondyloarthritides\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/spondyloarthritides\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/spondyloarthritides\\\/\",\"name\":\"Spondyloarthritis\\\/spondyloarthritides (SpA) &#8211; 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