Spondylitis Overview

Spondylitis defined

Spondylitis is an umbrella term that is often used by physicians to refer to a group of chronic conditions that involve inflammation of the spinal vertebrae or facet joints. This group includes ankylosing spondylitis, psoriatic arthritis, undifferentiated spondyloarthropathy, juvenile spondyloarthropathy, reactive arthritis and enteropathic arthritis. While these conditions are each characterized by distinct symptoms, they share many common features as well. Most notably, the symptoms associated with spondylitis are inflammatory, rather than mechanical, in nature. The inflammation caused by spondylitis can lead to chronic pain, restricted range of motion, stiffness and, in severe cases, fusion of the spinal bones.

Types of spondyloathritis

Spondylitis, or more accurately, ankylosing spondylitis, is one of several conditions that fall under the broader term of “spondyloathritis.” This family of related diseases includes the following:

  • Ankylosing spondylitis is an arthritic condition that causes pain and stiffness in the hips, back and sometimes the extremities. Although it is characterized by a number of symptoms, its chief calling cards are sacroiliac (pelvic) pain and spinal bone fusion. The term “ankylosing” means stiffening of the joints, while “spondylitis” refers specifically to the spinal vertebrae. If ankylosing spondylitis is left untreated, the affected vertebrae can potentially fuse together, which can cause spinal damage and other complications. A form of seronegative arthritis, ankylosing spondylitis does not produce indicators in the blood that would classify it as rheumatoid arthritis. A patient who is diagnosed with ankylosing spondylitis may ultimately require surgery if the spine fuses in such a way that it becomes distorted.
  • Psoriatic arthritis is an inflammation of the joints that sometimes accompanies psoriasis, a scaly skin rash that appears most often on the elbows, knees and scalp. The psoriasis usually precedes the arthritis, and the two conditions can appear separately with a span of symptom-free time in between – sometimes as much as 20 years. When the spinal joints are affected, the condition is referred to as psoriatic spondylitis. This systemic type of spondylitis can affect other organs as well.
  • Undifferentiated spondyloarthropathy may be diagnosed in the early stages of spondylitis, when certain symptoms, such as inflammatory back pain, have manifested but not yet progressed to the point that a physician can make a definitive diagnosis. Because the symptoms can be very similar to those associated with fibromyalgia and other conditions that cause widespread muscle and soft tissue pain, an accurate diagnosis is essential to ensure the most appropriate treatment. Over time, some patients with undifferentiated spondyloarthropathy eventually develop more well-defined forms of spondylitis that can be further classified, which can allow for more refined treatment.
  • Juvenile spondyloarthropathy, which is also known as juvenile-onset spondyloarthritis, encompasses a group of childhood rheumatic conditions, all of which cause long-term arthritis that first appears prior to age 16. These conditions include undifferentiated spondyloarthropathy, juvenile ankylosing spondylitis, psoriatic arthritis, reactive arthritis and spondylitis of inflammatory bowel diseases. The symptoms of juvenile spondyloarthropathy tend to be episodic and unpredictable, which can complicate the diagnostic process. Frequently, a patient will first notice tenderness at the sites where ligaments and tendons attach to bone (a type of inflammation known as enthesitis). Months or years later, other joints may be affected, including the facet and sacroiliac joints.
  • Reactive arthritis is a type of arthritis that causes inflammation and pain in the joints, eyes, skin, bladder, genitals and mucus membranes. So named because it is believed to occur as a reaction to an infection in the gastrointestinal tract or elsewhere in the body, reactive arthritis can be difficult to diagnose. The hallmarks of this type of spondylitis include swelling in the hands and feet, persistent low back pain and general stiffness that improves with physical activity.
  • Enteropathic arthritis is a form of chronic arthritis associated with ulcerative colitis, Crohn’s disease and other types of inflammatory bowel disease (IBD). As part of the body’s immune system, the gastrointestinal tract plays an important role in preventing infection. Some experts believe that the long-term intestinal inflammation associated with IBD can damage the bowel. As a result, bacteria can cross the compromised bowel wall and circulate through the bloodstream. Common symptoms of enteropathic arthritis include inflammation of the peripheral (arm and leg) joints, abdominal pain and bloody diarrhea.

Other types of arthritis

Similar to other joints in the body, the joints in the neck and back (facet joints) are susceptible to many different types of arthritis. Two of the most common forms of arthritis are rheumatoid arthritis and osteoarthritis. Even though they’re both called arthritis, these two conditions are quite different. Here’s why:

  • Rheumatoid arthritis is a chronic and progressive condition that can cause joint inflammation throughout the entire body. For reasons that are not fully understood, this autoimmune disease triggers the body’s immune system to attack the joints. Some theories suggest that the cause may be related to a virus or bacterial infection. When the immune system is triggered, white blood cells travel via the bloodstream into the synovial membranes, the soft tissues that line the joints. These immune cells produce inflammatory substances that can irritate the joint lining and invade the joint cartilage. When the cartilage becomes damaged, painful bone-on-bone contact can occur in the joint, which can interfere with joint function.
  • Osteoarthritis, which is sometimes referred to as degenerative joint disease, is a chronic condition of the joints. Specifically, this type of arthritis causes the cartilage, a cushioning surface that lines the joints and facilitates smooth movement, to break down and lose effectiveness. As a result, the bones within the joint can rub painfully together, leading to further pain and joint damage. While it can affect any joint, osteoarthritis occurs most often in weight-bearing joints, including those in the neck, lower back, hips and knees.

Treatment options

Although these and other arthritic conditions can cause pain, stiffness and other symptoms that can significantly impact a patient’s quality of life, conservative treatment — which addresses the symptoms rather than their underlying cause — is usually the most effective way to achieve relief. Specifically, mild to moderate cases of spondylitis tend to respond well to pain relievers and some specialized medicines that seek to slow the arthritic process. Additionally, exercise can enhance flexibility, increase strength and improve posture and thus is an important component of any spondylitis treatment plan.

Laser Spine Institute does not offer minimally invasive spine surgery to treat spondylitis. However, if you have spondylitis, please contact our Care Team. We can help you find conservative treatment options to help relieve some of your pain.
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