From the Guidelines
Spondyloarthritis symptoms typically include inflammatory back pain, morning stiffness, and peripheral joint involvement, which can be effectively managed with treatments such as NSAIDs, physical therapy, and biologics, as recommended by the 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 1. The symptoms of spondyloarthritis can vary widely among patients, but commonly include:
- Inflammatory back pain that improves with activity and worsens with rest
- Morning stiffness lasting more than 30 minutes
- Pain that may wake patients at night
- Peripheral joint involvement, particularly in the lower limbs
- Enthesitis, commonly affecting the Achilles tendon and plantar fascia
- Extra-articular manifestations such as uveitis, psoriasis, and inflammatory bowel disease
- Dactylitis, or "sausage digits"
- Fatigue, which can significantly impact quality of life These symptoms often begin gradually in early adulthood, typically between the ages of 20-40, and may progress to cause spinal fusion and decreased mobility if left untreated. The goals of treatment, as outlined in the 2019 update, are to alleviate symptoms, improve functioning, maintain the ability to work, decrease disease complications, and forestall skeletal damage as much as possible 1. Early diagnosis is crucial, as treatments like NSAIDs (such as naproxen 500mg twice daily or indomethacin 25mg three times daily), physical therapy, and in more severe cases, biologics like TNF inhibitors (adalimumab, etanercept) or IL-17 inhibitors (secukinumab) can effectively manage symptoms and potentially prevent disease progression. The condition has a genetic component, with HLA-B27 positivity common in many patients, explaining why it often runs in families, as noted in the 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations 1.
From the Research
Spondyloarthritis Symptoms
- Chronic back pain and spinal stiffness are typical initial symptoms of axial spondyloarthritis 2
- Peripheral manifestations such as enthesitis, arthritis, and dactylitis are also common 2
- Extra-musculoskeletal manifestations like uveitis, inflammatory bowel disease, and psoriasis can occur 2
Diagnosis and Assessment
- Timely and accurate diagnosis is challenging and relies on identifying a clinical pattern with a combination of clinical, laboratory, and imaging findings 2
- The Assessment in SpondyloArthritis international Society classification criteria for axial spondyloarthritis are widely used for research 2
- Persistent disease activity, assessed mainly by the Axial Spondyloarthritis Disease Activity Score, leads to irreversible structural damage and functional impairment 2
Treatment Options
- Non-steroidal anti-inflammatory drugs (NSAIDs) remain first-line pharmacotherapy for axial spondyloarthritis 3, 4, 2
- Tumor necrosis factor, IL-17, and Janus kinase inhibitors are considered second-line therapies 2, 5
- Biologic disease-modifying antirheumatic drugs (bDMARDs) have substantially changed the management of spondyloarthritis 5
- Emerging treatment options include dual IL-17A and F inhibitor bimekizumab, IL-17 receptor blocker brodalumab, and JAK inhibitors baricitinib, filgotinib, and upadacitinib 5