Spondyloarthropathy (SpA) — also called spondyloarthritis — is a family of related inflammatory arthritis conditions that primarily affect the spine and sacroiliac joints, though they can also involve the peripheral joints, skin, eyes, and bowel. Dr. Adam Elisha, DO, is a board-certified rheumatologist at St. Luke’s Rheumatology Associates in Duluth, MN with expertise in diagnosing and managing all forms of spondyloarthritis.
Types of Spondyloarthropathy
- Ankylosing Spondylitis (AS): The classic form of axial SpA, causing chronic inflammation of the spine and sacroiliac joints. Over time, this can lead to fusion of spinal vertebrae, resulting in reduced spinal flexibility and a stooped posture.
- Non-radiographic Axial SpA (nr-axSpA): Active inflammation of the sacroiliac joints and spine without visible structural changes on X-ray. Diagnosed with MRI and clinical criteria.
- Psoriatic Arthritis (PsA): Inflammatory arthritis occurring in patients with psoriasis, affecting peripheral joints, tendons (enthesitis), fingers and toes (dactylitis), and the spine.
- Reactive Arthritis: Develops after certain gastrointestinal or genitourinary infections; characterized by joint inflammation, urethritis, and eye inflammation.
- Enteropathic Arthritis: Arthritis associated with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
Symptoms of Spondyloarthritis
The hallmark symptom is inflammatory back pain — which is distinguishable from mechanical back pain by its characteristics: onset before age 40, gradual onset, improvement with exercise (not rest), worsening with inactivity, and nighttime awakening due to pain. Other features include:
- Buttock pain (alternating, from sacroiliac joints)
- Enthesitis — pain and inflammation where tendons and ligaments attach to bone (commonly the Achilles tendon, plantar fascia, and knee)
- Dactylitis — “sausage digit” swelling of an entire finger or toe
- Uveitis — eye inflammation causing red, painful eyes and light sensitivity
- Skin psoriasis or nail changes
- Bowel symptoms suggesting inflammatory bowel disease
Diagnosis and Treatment
Diagnosis of spondyloarthritis is based on clinical features, HLA-B27 gene testing, inflammatory markers, X-rays of the sacroiliac joints and spine, and MRI when early disease is suspected. Treatment includes:
- NSAIDs: First-line treatment that relieves pain and stiffness and can slow radiographic progression in some patients.
- Physical therapy: Essential for maintaining spinal flexibility and posture — particularly important in ankylosing spondylitis.
- TNF inhibitors: Biologic medications (such as adalimumab, etanercept, infliximab) that are highly effective for both axial and peripheral disease.
- IL-17 inhibitors (such as secukinumab, ixekizumab): Particularly effective for ankylosing spondylitis and psoriatic arthritis.
- JAK inhibitors: Oral targeted therapies used for psoriatic arthritis and axial SpA.
Spondyloarthritis Care in Duluth, MN
Many patients with spondyloarthritis wait years before receiving a correct diagnosis. If you have chronic inflammatory back pain, recurring heel pain, skin psoriasis with joint symptoms, or eye inflammation alongside joint problems, a consultation with a rheumatologist is important. Contact Dr. Adam Elisha at St. Luke’s Rheumatology Associates in Duluth at (218) 249-6960.