Spondyloarthritis guide

Spondyloarthritis is an umbrella term used to describe several types of inflammatory arthritis. These include axial spondyloarthritis, psoriatic arthritis, reactive arthritis, enteropathic arthritis and eye inflammation (uveitis).

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How does spondyloarthritis differ from rheumatoid arthritis?

The main difference between these two main types of inflammatory arthritis lies in the pattern of joints they affect and the presence of particular antibodies in the blood.

People with rheumatoid arthritis tend to have a positive rheumatoid factor and cyclic citrullinated peptide (CCP) – both of which are types of blood antibody. For this reason, the condition is also referred to as seropositive arthritis.

People with spondyloarthritis, however, don't have antibodies in their blood. So the condition is also referred to as seronegative arthritis.

Prevalence of spondyloarthritis is thought to be between one and two per cent of the UK population – roughly the same as that of rheumatoid arthritis.

Read more about rheumatoid arthritis

What is spondyloarthritis of the spine?

Spondyloarthritis of the spine, or axial spondyloarthritis, is a type of inflammatory arthritis that primarily affects the spine or back, although pain and swelling can develop in other joints and tendons. It includes ankylosing spondyloarthritis.

What is the cause of spondyloarthritis?

The exact causes of spondyloarthritis aren't known, but many types – particularly ankylosing spondylitis – are linked to a particular inherited gene, known as HLA-B27.

Other types of spondyloarthritis may be hereditary, but expert believe other factors – including some kind of trigger for the immune system – are also to blame.

What are the symptoms of spondyloarthritis?

Some symptoms are common across the various types of spondyloarthritis. These include: 

• lower back pain and stiffness 
• early morning joint and muscle stiffness that tends to ease after exercise 
• inflamed tendons at the point where they attach to bones 
• inflammation in different joints on each side of the body
• extreme tiredness 
• eye inflammation

Remember, the prevalence and severity of symptoms depends on the specific condition, and can vary from one individual to the next.

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What is the spondyloarthritis prognosis?

Spondyloarthritis is a chronic condition. Symptoms tend to develop over a few days, or longer – although in some cases, they may appear very quickly.

When the inflammation is at its most active, you may feel exhausted and unwell. There is no spondyloarthritis cure – but by learning how to manage your condition with appropriate treatment and lifestyle changes, you should still be able to lead a normal, active life.

How is spondyloarthritis diagnosed?

It can take a while to receive a specific diagnosis of spondyloarthritis. When you first consult your doctor, do take along detailed notes of your symptoms as this may offer some clues and so help speed things up.

The main defining factors will, of course, be the inflammatory arthritis symptoms. These may include joint pain or swelling, back pain, a sausage-shaped finger or toe, and pain or stiffness in the Achilles tendons and heels.

Blood test results can sometimes appear normal, even if you have pain and swelling. So your GP may refer you to a rheumatologist for further investigations, regardless of blood test results. A couple of examples? Your skin may be checked for psoriasis symptoms, which could suggest psoriatic arthritis. You might also be asked if you have recently had an infection or food poisoning, both of which may be the cause of reactive arthritis.

Learn more about psoriatic arthritis

Who can help with spondyloarthritis?

Aside from a rheumatologist, your GP may refer you to any of a number of experts who can advise you on the best way to manage your condition.

• A physiotherapist can suggest exercises to mobilise and strengthen joints and muscles.
• An occupational therapist can recommend mobility aids and adaptations for the home.
• A pain management course could be very useful, too.

Learn more about managing arthritis pain

What is the treatment for spondyloarthritis?

Spondyloarthritis is treated in a similar way to rheumatoid arthritis. Various types of medication are available.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Nurofen) or diclofenac (Voltarol), may be used to reduce pain and swelling.

Steroids are used to suppress severe inflammation. They can be injected directly into the joints or surrounding muscles. However, steroids may have serious side effects when used long-term, so do discuss your options thoroughly with your doctor.

Disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate, sulfasalazine and hydroxychloroquine, can be used to treat severe symptoms. If DMARDs aren't effective, you may be eligible for a relatively new class of drugs, known as biologics. A type of biologic called TNF inhibitors are currently the most frequently used.

Learn more about arthritis medicines

How can I help myself if I have spondyloarthritis?

Lifestyle factors can make a big difference to the way you manage your spondyloarthritis.

Regular exercise is important to keep joints mobile and strengthen the surrounding muscles – but do learn to pace yourself and take a break from physical activity if the pain is severe. Aim to get moving as soon as possible after a flare-up.

Swimming in a heated pool is especially beneficial as the warm water will help relax your joints and support your body

Relaxation techniques and stretching exercises, such as yoga or tai chi, will help you maintain flexibility, manage pain and sleep better at night. Speak to your doctor or a physiotherapist about what form of exercise may work best for you.

It's also important to eat a healthy, balanced diet with plenty of vitamin-rich fresh fruit and vegetables.

New ways to beat arthritis

How can I cope with spondyloarthritis pain?

If your medication isn't working as well as you'd hoped – or you're concerned about side effects – discuss the alternatives with your doctor as soon as possible.

Aside from medication, there are plenty of approaches you can try to ease the pain during a flare-up. If there's no numbness around the painful joint or in the limb, ice packs and heat pads – sometimes used alternately – can relieve the swelling and discomfort, for instance. A TENS machine may also be beneficial..

For more help and information about spondyloarthritis

For more information on spondyloarthritis, download your free factsheet from www.arthritiscare.org.uk.

For facts, support and guidance on all aspects of arthritis, call Arthritis Care’s free Helpline on 0808 800 4050. It's open Monday to Friday, 09:30-17:00.

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