Spondyloarthritis

1 in 100

Nearly 1 in 100 Americans have spondyloarthritis, about 1% of the population.

17-45

The typical age of onset spondyloarthritis is between 17 and 45.

1.7M-2.7M

people in the U.S are estimated to have axial spondyloarthritis.

What is spondyloarthritis?

Spondyloarthritis is an umbrella term for several chronic inflammatory conditions that are characterized by inflammation in the spine (“spondylitis”) and joints (“arthritis”). Researchers are generally unsure about what causes the group of conditions, but know that they are immune-mediated, which means that they all involve inflammation that likely result from an abnormal response from your immune system. 

The types of spondyloarthritis include: ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis, undifferentiated spondyloarthritis, and juvenile spondyloarthritis.

Who is affected?

Anyone can be diagnosed with spondyloarthritis, and ages of diagnosis vary for each type of the condition. Juvenile spondyloarthritis typically produces symptoms before age 16, while ankylosing spondylitis generally starts between ages 20 and 30. [1] [2]

Researchers are unsure about what causes spondyloarthritis, but the main gene involved in all types is HLA-B27. If you have the gene, you may be more at risk of developing the condition. [3]

About six percent of the general population has this gene, and a blood test helps you determine whether you have it. [4] A positive test result means that you have proteins called antigens on your disease-fighting white blood cells, and that you are more at risk of developing spondyloarthritis. But not everybody with HLA-B27 develops the condition. 

What happens in your body?

For many people with spondyloarthritis, the first and primary symptom is pain in the lower back and hips, especially after inactivity and in the morning. Pain can occur in other areas as well, and can range from mild to severe.

Common symptoms of spondyloarthritis include: [5] [6] [7]

Ankylosing spondylitis

  • Lower back and buttock pain and stiffnes
  • Pain or swelling in the heel or foot
  • Pain in your ribcage, such as when you exhal
  • Reactive arthritis
    • Joint pain and stiffness in knees, ankles, and feet
    • Eye inflammation

Psoriatic arthritis

  • Stiffness, pain, and tenderness in one or more joints
  • Swollen fingers and toes, which can resemble sausages

Enteropathic arthritis

  • Stiff, sore back
  • Full body aches
  • Abdominal pain
  • Diarrhea

Undifferentiated spondyloarthritis

  • Back pain
  • General stiffness of the body
  • A history of swelling in the feet and hands

Juvenile spondyloarthritis

  • Pain around the heels or toes, around the knee, and in the lower back

How do I know if I have spondyloarthritis?

It is important to get an accurate diagnosis as quickly as possible to make sure that the condition does not worsen. The best way to do this is by visiting your doctor and, if possible, getting a referral to visit a rheumatologist, a doctor who specializes in treating spondyloarthritis.

Some ways that your doctor can assess whether you have the condition is through reviewing your medical history, and conducting a physical examination or lab tests (such as blood tests and imaging tests).

How is it treated?

There is no known cure for spondyloarthritis, but integrative interventions have shown to reduce pain and discomfort and improve quality of life by slowing the condition’s progression and easing the severity of symptoms. [8]

Integrative interventions offer a holistic approach to treatment. Instead of just conventional medicine, integrative treatments combine conventional medicine with nutritional tools, mind-body medicine, and manual medicine for a holistic approach to treating spondyloarthritis.

For those new to integrative medicine, learn more here

Conventional Medicine

Many people with spondyloarthritis find that certain medications work for them and others do not. So, in order to find an effective conventional treatment, people with spondyloarthritis often work with their doctors to determine which medication works best with their body and needs. 

With the right medication, it is possible to manage symptoms and prevent the rapid worsening of the condition. Before starting to take any medication, be sure to ask your doctor about possible side effects. And if you notice any of the side effects once you start your treatment, let your doctor know as soon as possible.

Examples of conventional treatments:

  • Non-steroidal anti-inflammatory drugs (common name: ibuprofen), or NSAIDs, are commonly used treatments for inflammation and pain resulting from spondyloarthritis. [6]

  • DMARDs (such as sulfasalazine) may relieve spondyloarthritis symptoms and prevent joint damage. [6]

  • Biologics (also known as biologic response modifiers) are a class of drugs that can treat symptoms of spondyloarthritis. [6]

  • Cortisone injections (also called corticosteroids) are steroid drugs that can be taken by injection, and may help to reduce joint swelling in targeted areas.[6]

Mind-Body Medicine

Research shows that gentle, low-intensity mind-body treatments can help spondyloarthritis patients with mobility, mood, decreased pain, and more. There are a wide variety of mind-body treatments for spondyloarthritis, ranging from deep breathing to aqua-therapy.

When living with chronic pain, engaging in regular movement and exercise may feel difficult and unnecessary. But doing so can actually improve your symptoms. 

Before starting a physical exercise regimen, consult with your doctor about what might be the best activities for you and your body.

Examples of mind-body medicine:

  • Tai chi, a mind-body exercise that originated from China, incorporates slow, gentle movements with breathing exercises. Research conducted by the Hartford Hospital found that tai chi brings emotional wellbeing, improved strength, and improved balance to individuals with chronic pain.

  • Yoga comes in many different styles, often engaging both the body and the mind through controlled breathing and stretching. Researchers have concluded that yoga therapy may help sedentary individuals with arthritis safely increase physical activity, and improve physical and psychological health.

  • Aquatic exercises such as swimming and water aerobics strengthen your core. A study conducted by researchers in Australia found that water-based exercises may have benefits for improving bone health.

  • Weight management and healthy nutritional intake are key in reducing health risks. A study from the National Institute of Health found that weight management from diet and exercise are beneficial for alleviating pain. Nutritional intake also plays an important role in managing spondyloarthritis.

  • Relaxation therapies like deep breathing techniques, meditation, and biofeedback can help patients ease anxiety and better manage chronic pain. A study demonstrated that mindfulness programs produced significant improvements in anxiety, depression, cognitive psychosocial abilities, and overall functioning.

Manual Medicine

Manual treatments are administered by certified clinicians, using physical pressure and stimulation on the body to reduce spondyloarthritis symptoms. Treatments can vary in intensity and incorporate other elements such as heat and aromatherapy to enhance relief. 

Examples of manual medicine:

  • A widely-adopted Chinese treatment administered by certified acupuncturists who insert very thin needles at strategic points on the body to support overall wellness. A randomized control study demonstrated that patients who received acupuncture showed  improvements in pain.

  • Licensed massage therapists use different techniques, like shiatsu, hot stone, and Swedish massage, to provide temporary pain relief. A Mayo Clinic study concluded that massage therapy is particularly helpful for muscle pain, and that it can also help reduce anxiety.

  • Physical therapy can help with physical strengthening, mobility, and overall functionality. A study conducted by researchers in Sweden found that physical therapy techniques were suitable for addressing musculoskeletal conditions as well as with chronic back pain.

  • Osteopathic manipulative treatment, or OMT, is a form of manual therapy used by osteopathic physicians (DOs). A study published in The New England Journal of Medicine demonstrated that osteopathic manual care had similar clinical results to standard medical care, but required fewer medications.

Nutritional Tools

Nutrition plays a crucial role in your overall health, and is a tool you can use to combat joint damage, reduce inflammation, and manage other spondyloarthritis symptoms. 

Just like with conventional, mind-body, and manual medicines, there is not one ideal treatment for every spondyloarthritis patient. When selecting nutritional tools to treat your condition, it is best to consult with your doctor or work with a dietitian, naturopath, or nutritionist to find out the best diet for you.

Examples of nutritional tools:

  • Anti-inflammatory diets

    • Anti-inflammatory diets include nutrient-dense foods that contain antioxidants and intend to reduce inflammation in the body. A popular anti-inflammatory diet is the Mediterranean diet which has been shown to reduce signs of inflammation.

  • Plant-based diets

    • Vegetarian and vegan diets have shown to promote gut health, which may have an anti-inflammatory impact. A study conducted by the Physicians Committee for Responsible Medicine demonstrated that plant based diets improve joint pain, tenderness, and swelling.

  • Elimination

    • While some foods can help reduce symptoms, other foods may trigger them. An elimination diet, which is an eating plan that eliminates certain foods or food groups believed to be causing negative bodily reactions, can help you figure out which foods are triggering those symptoms and bring you closer to your ideal diet.

  • Fish

    • Research suggests that eating fish may reduce joint inflammation for those with rheumatoid arthritis. This may help with symptoms of lupus.

  • Fruits and vegetables

    • Fruits and vegetables have antioxidants, which support your immune system and may fight inflammation.

  • Nuts

    • Nuts are rich in healthy fat, protein, and fiber, and help fight inflammation.

  • Beans

    • Beans (like red, pinto, navy, and black beans) are rich in fiber and protein, and are full of both antioxidants and anti-inflammatory properties.

  • Olive oil

    • This heart-healthy ingredient contains healthy fat, antioxidants, and oleocanthal, an anti-inflammatory compound.  

  • Onions

    • These simple, flavor-rich vegetables are packed with antioxidants and may help reduce inflammation, improve heart health, and help control cholesterol levels.

  • Fiber

    • Fiber is found in foods like beans, whole grain breads, and fresh vegetables. It makes you feel fuller for longer and boosts digestive health. It also may help reduce inflammation.

  • Fish oils

    • Fish oils may reduce inflammation. A study found that there patients with rheumatoid arthritis who consumed dietary fish oil as part of their diet reported ideal and improved health status.

  • Gamma linolenic acid (GLA)

    • Gamma linolenic acid is mostly found in plant seed oils like borage seed, evening primrose, and blackcurrant seed oil.      

  • Turmeric

    • Turmeric is a spice from the turmeric plant that has anti-inflammatory properties. A study indicated that turmeric can be used as a source for alleviating chronic pain.

  • Folic acid

    • Folic and folinic acid supplements have been shown to improve liver function and ease gastrointestinal intolerance (the digestive system’s difficulty processing certain foods, which can lead stomach pain and bloating). 

  • Antioxidants

    • Antioxidants can help prevent cell damage. A study conducted by researchers in Italy found that antioxidants can be beneficial for bone growth and strength.

  • Probiotics

    • Studies show that probiotic supplements may help improve gut health and even lead to lower levels of inflammation.

  • Pomegranate

    •  A study by researchers in France demonstrated that pomegranate peel extract significantly prevented the decrease in bone mineral density.

  • Green tea extract

    • A University of Michigan study showed that green tea extract may help reduce overall joint inflammation and damage.

  • [1] Juvenile Spondyloarthritis. SAA. https://spondylitis.org/about-spondylitis/types-of-spondylitis/juvenile-spondyloarthritis/. Published July 1, 2020. Accessed July 24, 2020. 
  • [2] Juvenile Spondyloarthritis. Cincinnati Childrens. https://www.cincinnatichildrens.org/health/j/spondyloarthritis. Accessed July 24, 2020. 
  • [3] López-Medina C, Moltó A. Update on the epidemiology, risk factors, and disease outcomes of axial spondyloarthritis. Best Practice & Research Clinical Rheumatology. https://www.sciencedirect.com/science/article/abs/pii/S152169421830069X. Published November 16, 2018. Accessed July 24, 2020. 
  • [4] Reveille JD, Hirsch R, Dillon CF, Carroll MD, Weisman MH. The prevalence of HLA-B27 in the US: data from the US National Health and Nutrition Examination Survey, 2009. Arthritis Rheum. 2012;64(5):1407-1411. doi:10.1002/art.33503 
  • [5]Spondyloarthritis. Spondyloarthritis Symptoms and Treatment – Brigham and Women's Hospital. https://www.brighamandwomens.org/medicine/rheumatology-immunology-allergy/services/spondyloarthritis. Accessed July 24, 2020. 
  • [6] Spondyloarthritis. rheumatology.org. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Spondyloarthritis. Accessed July 24, 2020. 
  • [7] Spondyloarthritis. https://www.arthritis.org/diseases/spondyloarthritis. Accessed July 24, 2020. 
  • [8] Fernández García R, Sánchez Sánchez Lde C, López Rodríguez Mdel M, Sánchez Granados G. Efectos de un programa de ejercicio físico y relajación en el medio acuático en pacientes con espondiloartritis: ensayo clínico aleatorizado [Effects of an exercise and relaxation aquatic program in patients with spondyloarthritis: A randomized trial]. Med Clin (Barc). 2015;145(9):380-384. doi:10.1016/j.medcli.2014.10.015 
  • [9] Spondylitis Association of America - Ankylosing Spondylitis. (2020, March 01). Retrieved July 12, 2020, from https://spondylitis.org/ 
  • [10] Arthritis Foundation. Arthritis By the Numbers. 2019; v3; 4100.17.10445 
The information on this page is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek medical advice from your physician or health provider for your specific needs.