From the Guidelines
No, spondylosis is not a form of rheumatoid arthritis. Spondylosis refers to age-related degeneration of the spine, primarily affecting the vertebrae and discs, and is considered a type of osteoarthritis or degenerative joint disease. It develops gradually due to normal wear and tear on the spine as people age. In contrast, rheumatoid arthritis is an autoimmune inflammatory condition where the immune system mistakenly attacks the body's own tissues, particularly the synovial lining of joints. While both conditions can affect the spine and cause pain, they have different underlying causes, progression patterns, and treatments.
Key Differences
- Spondylosis is typically managed with pain medications like NSAIDs, physical therapy, and occasionally surgery in severe cases.
- Rheumatoid arthritis requires specific disease-modifying antirheumatic drugs (DMARDs) and biologics to suppress the immune system and control inflammation.
Treatment Recommendations
According to the most recent guidelines, such as the 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis 1, the treatment of axial spondyloarthritis (SpA) should focus on alleviating symptoms, improving functioning, and maintaining the ability to work.
Important Considerations
- Understanding the distinction between spondylosis and rheumatoid arthritis is crucial for proper diagnosis and treatment planning.
- The goals of treatment for axial SpA include alleviating symptoms, improving functioning, maintaining the ability to work, decreasing disease complications, and forestalling skeletal damage as much as possible, as stated in the 2019 update 1.
From the Research
Definition and Classification
- Spondylosis is not a form of rheumatoid arthritis, as it is a distinct condition characterized by inflammation at the entheses, the sites of attachment of tendons and ligaments to bone 2.
- Spondyloarthritis (SpA) is a term used to describe a group of diseases that are clinically, pathologically, and genetically related to ankylosing spondylitis (AS) and Reiter's syndrome (RS), rather than to rheumatoid arthritis (RA) 2.
Pathophysiology
- Rheumatoid arthritis and ankylosing spondylitis are two distinct chronic inflammatory skeletal diseases with different pathophysiological mechanisms 3.
- The primary site of inflammation in ankylosing spondylitis is located at the enthesis or subchondral bone marrow, whereas in rheumatoid arthritis, joint inflammation originates in the synovial membrane of peripheral joints 4.
Clinical Manifestations
- Spondyloarthritis and rheumatoid arthritis can present with overlapping clinical characteristics, including inflammation and destruction of joints, pain, and diminished functional ability 5.
- However, certain clinical symptoms and signs, such as enthesal abnormalities, psoriasis, and dactylitis, are more commonly associated with spondyloarthritis than rheumatoid arthritis 5.
Diagnosis and Treatment
- Misclassification of spondyloarthritis as rheumatoid arthritis can lead to delayed diagnosis and suboptimal therapeutic outcomes 5.
- Advanced imaging techniques can help distinguish between spondyloarthritis and rheumatoid arthritis, reducing misclassification and delayed diagnosis 5.
- Treatment options for ankylosing spondylitis, a form of spondyloarthritis, include nonselective and COX-2-selective NSAIDs, sulfasalazine, and anti-TNF-alpha agents 6.