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Spondyloarthritis Factsheet

  • SpA comprises a group of inflammatory arthritides with a common genetic predisposition2

  • The group of SpA conditions impacts up to 2% of white populations in the EU and in North America1

  • Men are 2.5 times more likely to be affected by any form of SpA than women1

  • SpA is closely related to the presence of the HLA-B27 gene2

What is SpA?

Spondyloarthritis (SpA) is the term given to a group of diseases sharing common clinical and genetic features.1 SpAs can be classified into two main groups given the varying conditions which impact patients:1

Axial SpA – this can be characterized by the involvement of the spine or sacroiliac joints, comprising the following sub-types of inflammatory arthritis:1

· Ankylosing spondylitis (AS)

· Non-radiographic axial (nr SpA)

· Certain forms of psoriatic arthritis (PsA)

· Arthritis associated with inflammatory bowel disease (IBD) i.e., Crohn’s disease or ulcerative colitis

Peripheral SpA often characterized by peripheral arthritis, enthesitis (heel pain) and dactylitis (swelling of the finger) comprising the following:1

· PsA

· Arthritis associated with inflammatory bowel disease

· Reactive arthritis

· Certain forms of undifferentiated arthritis which meet the SpA criteria

How is it caused?

SpA is commonly attributed to genetic factors.2 Research has pointed to a certain molecule – the HLA-B27 antigen, present in over 90% of patients with AS 2 and in approximately 70% of people who have any form of SpA.1 The risks of developing AS in people who carry the HLA-B27 gene are as high as 5-7%.2

How common is it?

Studies have revealed that the prevalence of AS is approximately 0.5% in white populations across Europe and North America. 1.5% to 2% of both European and North American white populations are affected by the wider group of SpAs. Males are also 2.5 times more likely to be affected than females.1

What are the symptoms?

A key symptom for axial SpA is back pain. Whilst back pain is a common condition affecting two-thirds of the world population, back pain associated with axial SpA can be differentiated by the following features:1

· Inflammatory back pain lasting more than three months which usually starts before the age of 45

· Inflammatory back pain intensifying in the second half of the night or early morning that improves with exercise

· Morning stiffness

· Alternating buttock pain

Other symptoms often associated with the wider group of SpA include:3

· Fatigue

· Inflammation of the tendons

· Inflammation of the joints

· Eye inflammation (uveitus)

How is SpA diagnosed?

Imaging can play a crucial role in the diagnosis of SpA. When diagnosing axial involvement in particular, measurements are taken to determine the presence of inflammation of the sacroiliac joints. This is scored using a grading system of 0 - 4; with 0 reading normal and 4 reading a severe abnormaility.1 Both computed tomography (CT) and magnetic resonance imaging (MRI) are used to aid diagnosis. MRI has become the routine standard of practice in diagnosis as it is able to visualise both structural damage and active inflammation which may occur prior to any structural changes.1

Laboratory tests to determine the presence of the HLA-B27 antigen have been conducted in the diagnostic process, due to the prevalence of this gene in patients with AS and SpA.1

Is SpA treatable?

As SpA comprises varying types of inflammatory arthritis, treatment will be dependent on the type and severity of the condition and according to the individual. Some methods of treatment are similar to those used to treat other forms of arthritis and can include any of the following:3

· Non-steroidal anti-inflammatory drugs (NSAIDs) - to reduce inflammation and pain

· Steroids – to suppress severe inflammation

· Disease-modifying anti-rheumatic drugs (DMARDs) – these include methotrexate, sulfasalazine and hydroxychloroquine to treat severe symptoms that last more than a few months

· Biologic drugs – to treat severe symptoms, inadequately controlled with DMARDs

Non-medicinal treatments can also be used to manage the onset of a flare-up. Such methods include:3

· Ice packs and heat pads which help to relieve joint pain and swelling

· In some instances a transcutaneous electrical nerve stimulation machine (TENS) may help

· A healthy diet

· Exercise, particularly swimming in a heated pool which can help relax joint


1. Poddubnyy D. Improving diagnosis of ankylosing spondylitis and spondyloarthritis in general Int. J. Clin. R heumatol. 655-667 (2011) 6(6)

2. Braun J, Sieper J. Early diagnosis of spondyloarthritis. Nature Clinical Practice Rheumatology 2006; 2:536-545

3. Arthritis Care. Spondyloarthritis Factsheet. http://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=2&ved=0CCkQFjAB&url=http%3A%2F%2Fwww.arthritiscare.org.uk%2F%403235%2FListedbytype%2FFactsheets%2Fmain_content%2FSpondyloarthritisFactsheetjune2011.pdf&ei=mk1PUJbVLYnNsgb534GYDQ&usg=AFQjCNGPcLOPVkRkRuHqlOKoO57UGwS2MA&sig2=FO5RLdySTUs__WBUr8M51g (accessed September 2012)

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