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What is spondyloarthritis?

by Josephine Andrews
Published: Last Updated on 113 views

Spondyloarthritis describes a group of inflammatory rheumatic diseases. These primarily affect the joints of the spine, but also those of the legs and arms and the tendons. Those affected often experience back pain and stiff joints. In addition to medication, exercise is the most important pillar in the treatment of spondyloarthritis. Read more about the causes, symptoms, progression and treatment here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

M45 M47 M49 M46 M48

quick overview

  • Description: Inflammatory rheumatic disease of the spine , joints and/or tendons
  • Symptoms: back pain , morning stiffness, swollen fingers or knees, less common inflammation of the eyes, skin and intestines
  • Causes: The exact causes are unclear. Doctors suspect that a specific blood characteristic ( HLA-B27 ) increases the risk of spondyloarthritis.
  • Diagnosis: Talk to the doctor, physical examination, blood test , X-ray , MRI
  • Treatment: A combination of exercise and physiotherapy as well as medication (e.g. painkillers, biologics, cortisone) can be used for treatment.
  • Course: The course of the disease varies. However, consistent treatment helps to significantly alleviate the symptoms and positively influence the further course of the disease.
  • Prevention: Since the exact causes of spondyloarthritis are unknown, the disease can only be prevented to a limited extent. In order to have a positive influence on the course, it is important that those affected remain active, get enough exercise and take their medication regularly.

What is spondyloarthritis?

Spondyloarthritis (SpA for short) is what doctors call a group of inflammatory rheumatic diseases that primarily affect the spine, the joints in the arms and legs and/or the tendons. These are so-called autoimmune diseases, in which the body forms antibodies against the body’s own tissue and thus fights it for reasons that have not yet been clarified. The individual spondyloarthritides are similar in their symptoms and blood values.

In contrast to rheumatoid arthritis (RA), no rheumatoid factor can be found in the blood of those affected in the disease group of spondyloarthritis – this is why one also speaks of “seronegative” spondyloarthritis. In addition, people with spondyloarthritis often have the so-called HLA variant HLA-B27 (a specific protein on the surface of almost all body cells).

The individual clinical pictures partially overlap and merge into one another. One distinguishes between:

Axial spondylitis (axSpA)

In axial spondylitis, the joints of the axial skeleton are affected. The axial skeleton refers to the bones that form the torso, including the spine and the bones of the chest.

Axial spondylitis includes ankylosing spondylitis (AS) and its early form, non-radiographic axial spondyloarthritis (nr-axSpA). In the latter case, the inflammation cannot be recognized by a standard X-ray.

Psoriatic arthritis (PsA)

Psoriatic arthritis is an inflammatory disease that usually affects multiple joints (such as hands, feet, elbows, knees, and vertebrae). People with psoriasis sometimes develop joint inflammation – which is why it is also called psoriasis arthritis.

Reactive arthritis (ReA)

Reactive arthritis (also post-infectious arthritis or Reiter’s disease) is an inflammatory rheumatic disease that occurs as a result of an infection (usually with bacteria ) primarily of the intestine, the urethra or the respiratory tract. It usually affects one or more large leg joints (eg hip, knee and ankle joints).

Enteropathic arthritis (EA or SpACED)

Enteropathic arthritis is the term used to describe rheumatic joint inflammation that occurs in people with chronic inflammatory bowel diseases (IBD) such as Crohn’s disease or ulcerative colitis and other gastrointestinal diseases (e.g. Whipple’s disease or after gastric bypass surgery). It mainly develops in the joints of the knees and fingers as well as in the sacroiliac joints (sacroiliac joints).

Undifferentiated spondyloarthritis (USPA)

In the case of spondyloarthritis that cannot be assigned to any of the diseases listed, doctors speak of undifferentiated spondyloarthritis.

Juvenile spondyloarthritis (JSpA)

If spondyloarthritis occurs in children and adolescents up to the age of 16, it is referred to as juvenile spondyloarthritis. This includes forms of the disease similar to spondyloarthritis in adults.

A distinction is made between axial and peripheral spondyloarthritis, depending on whether the symptoms mainly occur on the back or on the axis of the body (eg on the spine and the sacrum-iliac joints) or on the arms and legs (the peripheral joints) .

How common is spondyloarthritis?

Doctors estimate that spondyloarthritis affects about 0.4 to 2 percent of the population. The number of people affected varies worldwide depending on the region or the frequency of the HLA-B27 characteristic in the population. People from northern areas (like Alaska, Siberia, Scandinavia) seem to be most commonly affected by spondyloarthritis. Afro-American people, on the other hand, seem to develop spondyloarthritis significantly less frequently than other ethnic groups.

Men also get sick more often than women (gender ratio 2:1). Ankylosing spondylitis (Bechterew’s disease) and undifferentiated spondyloarthritis are the most common. Reactive arthritis is the least common.

What are the symptoms of spondyloarthritis?

Spondyloarthritis usually affects a few larger joints (oligoarthritis) – especially the joints in the back, especially the sacrum-iliac joints, as well as the knee joint and the ankles. People with spondyloarthritis also often have reduced bone density (osteopenia, osteoporosis ), which makes them more susceptible to fractures.

The main symptom of axial spondyloarthritis is chronic back pain, which means it lasts longer than twelve weeks. Typically, the pain occurs in people under the age of 40 and develops gradually. For most sufferers, the pain increases during sleep. As a result, they often wake up in the second half of the night and walk around, as this can relieve the pain somewhat.

Over the years, the spine usually becomes increasingly stiff. In the morning, the joints are often difficult to move and feel stiff (morning stiffness). During the day, the symptoms usually improve with exercise (but not with rest). In addition to the pain and stiffened joints, those affected also often report fatigue .

The rarer peripheral spondyloarthritis usually affects the arms and legs as well as the hands and feet. Typically, the joints are not equally inflamed on both sides of the body (asymmetric). The knee joints, ankles and individual fingers or toes are often inflamed and severely swollen.

Fingers with all three joints are often affected. The individual fingers are red and swollen (dactylitis), which is why they are colloquially called “sausage fingers”. The pain is usually minor.

In some cases, the tendons or ligaments that attach to bone (common in the heels or Achilles tendon ) are inflamed (enthesitis). These spots are usually tender and painful.

The eyes may also become increasingly inflamed with spondyloarthritis. The outer skin of the eye is often only slightly inflamed (conjunctivitis). Or there is severe inflammation of the iris, which often lasts for several months.

In up to two thirds of all those affected, the intestinal mucosa is also inflamed, which many affected people often do not notice. About 20 percent of people with inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis also have symptoms of spondyloarthritis.

In 10 to 20 percent of all patients, spondyloarthritis occurs together with psoriasis (psoriasis = chronic skin disease in which red patches and silver-white scales form on the skin).

In some cases, the heart , lungs, and kidneys are affected by the inflammation.

How does spondyloarthritis develop?

The exact cause of spondyloarthritis is not yet known. However, doctors suspect that people with spondyloarthritis are at some genetic risk. For example, the characteristic HLA-B27 can be detected in the blood of almost all those affected. HLA-B27 is the abbreviation for “Human Leukocyte Antigen B27”. This is a protein on the surface of almost all body cells of people who carry the blueprint for this protein in their genome. Spondyloarthritis and certain other inflammatory rheumatic diseases are more common in these people. However, it does not mean that they will inevitably become ill: HLA-B27 can also be detected in the blood of many healthy people.

Psoriatic arthritis occurs in connection with psoriasis (psoriasis). Reactive arthritis often develops after a gastrointestinal or urinary tract infection (such as a bladder infection ). How exactly it comes to joint inflammation, however, is not yet clear.

How does the doctor make a diagnosis?

In the case of symptoms that indicate spondyloarthritis, the family doctor is the first point of contact. If spondyloarthritis is suspected and for further examinations – especially in people under 45 years of age with chronic back pain – the family doctor may refer you to a specialist in internal medicine with a focus on rheumatology or a pediatrician with additional training as a rheumatologist.

conversation with the doctor

The doctor first conducts a detailed discussion ( anamnesis ) with the person concerned. Among other things, he asks questions about existing complaints (such as back pain, morning stiffness, tiredness, swollen knees or fingers). He also asks questions about possible previous illnesses (such as psoriasis, chronic intestinal diseases or infections) and lifestyle habits.

Physical examination

He then performs a physical exam to assess the mobility of the spine, any changes in posture and the condition of all joints (for example, are they stiff, swollen or painful?).

blood test

To further diagnose spondyloarthritis, the doctor will do a blood test. Among other things, he determines the inflammation values. The doctor also examines whether the HLA-B27 marker can be detected in the patient’s blood, which is often the case with inflammatory rheumatic diseases. About 60 to 85 percent of all patients with axial spondyloarthritis are HLA-B27 positive. However, if HLA-B27 is detected, this does not automatically mean that a rheumatic disease is present. It just gives the doctor more clues that it might be spondyloarthritis.

In order to rule out rheumatoid arthritis as the cause, the doctor has determined the rheumatoid factor in the blood. In the case of spondyloarthritis, this cannot be demonstrated.

imaging procedures

In order to determine whether and to what extent the joints have changed, the doctor carries out an X-ray examination. Here he mainly takes pictures of the spine, especially the sacroiliac joints. In the early stages of the disease, the joints often appear normal on X-rays. Changes in the joints due to spondyloarthritis are often not visible on X-rays until years after the symptoms appear.

At the beginning of the disease, X-rays alone are usually not sufficient to diagnose spondyloarthritis. However, some other, non-inflammatory diseases (e.g. a herniated disc ) can be ruled out as the cause of the back pain.

In order to detect spondyloarthritis in the early phase, the doctor carries out further imaging procedures, for example magnetic resonance imaging. Active inflammation can often be seen in the early stages on the MRI scans.

It is not a single symptom that is decisive for the diagnosis of spondyloarthritis, but the combination of the symptoms that occur, the laboratory results, the physical examination and the imaging tests.

How is spondyloarthritis treated?

exercise and physical therapy

The most important measure in spondyloarthritis is regular exercise to improve or at least maintain mobility in the spine. Regular exercise in everyday life (eg climbing stairs, walking ) as well as special exercise therapies help to stay active and relieve pain.

Both movement therapies in the group and individual physiotherapy or ergotherapy , which are accompanied by a trained therapist, are suitable for this. This contributes significantly to making stiff joints mobile again or maintaining their mobility.

Doctors recommend those affected to practice joint-gentle sports such as swimming , Nordic walking or cycling several times a week. There is also the possibility that they will prescribe targeted physiotherapy.

Additional measures, such as massages or ultrasound therapy, are offered for spondyloarthritis to relieve tension and relieve pain. However, the statutory health insurance companies do not always cover the costs for this. You should therefore inquire with your health insurance company beforehand about the assumption of costs.

In addition, people with spondyloarthritis should stop smoking, as this worsens the course of the disease.


In the case of spondyloarthritis, the doctor primarily prescribes so-called non-steroidal anti-inflammatory drugs (NSAIDs) with active ingredients such as diclofenac or ibuprofen . Alternatively, COX-2 inhibitors (such as celecoxib or etoricoxib) can be considered. These drugs have analgesic and anti-inflammatory effects. This usually improves the mobility of the spine. The duration and dosage of the treatment depend on how severe the symptoms are.

If NSAIDs and COX-2 inhibitors are not effective enough or are not well tolerated, the doctor may switch to therapy with biologics. These drugs interfere with the body’s immunological inflammatory response by inhibiting inflammatory messengers. The most important group are the so-called TNF-alpha blockers. The doctor administers the active ingredients (such as adalimumab or secukinumab) to the patient with a syringe or via an infusion into a vein. The preparations are generally very effective in reducing spinal pain and inflammation in people with spondyloarthritis. Complaints such as morning stiffness or tiredness can often be improved with it.

If the symptoms of the peripheral joints (eg arms or legs) and not the spine are in the foreground, the doctor often prescribes the active ingredients methotrexate or sulfasalazine . They relieve pain and inflammation in the joints of the limbs.

In the case of severe inflammation and pain, the doctor administers injections of a glucocorticoid (cortisone) directly into the joints or tendons. They usually provide those affected with relief quickly.

Doctors usually prescribe antibiotics for people with reactive spondyloarthritis that develops after a bacterial infection. If you have psoriatic arthritis,

the treatment of psoriasis by the dermatologist is important. If the eyes, skin or other organs such as the intestines are affected, the doctor treating you will also refer you to an ophthalmologist, dermatologist or gastroenterologist.


Some patients require surgery for spondyloarthritis. This is the case, for example, when there are broken bones or other injuries to the spine.

In some cases, it is necessary to surgically correct the vertebral joints, especially in the neck, if these are severely changed or stiffened and the affected person is in severe pain.

In severe cases, spondyloarthritis restricts movement to such an extent that those affected are unable to work. It therefore makes sense to protect yourself against this case with disability insurance or a pension.

How does spondyloarthritis progress?

The severity of spondyloarthritis varies from patient to patient. The various forms of spondyloarthritis and thus also the symptoms often flow into one another.

The first symptoms often appear between the ages of 20 and 30. Back pain usually occurs first. As the disease progresses, the axial skeleton (eg spine, bones of the chest) increasingly ossifies or stiffens in many of those affected. As a result, the patients are physically restricted and unable to move well. This significantly affects the quality of life.

In many cases, the back pain associated with spondyloarthritis is initially misinterpreted. As a result, many people with spondyloarthritis often have symptoms for years before they receive the right diagnosis and treatment.

If spondyloarthritis is treated consistently, it is usually possible to slow the progression of the disease. Many people with spondyloarthritis also respond very well to painkillers and other medications, which greatly improves the quality of life for those affected.

How can you prevent spondyloarthritis?

Since the exact causes of spondyloarthritis are not known, the disease can only be prevented to a limited extent. However, in order to positively influence the course of the disease, it is important that you keep your spine flexible and prevent joint inflammation with a healthy immune system. The following measures are important for this:

  • Stay active and get enough exercise in everyday life.
  • Go to physical therapy consistently.
  • Maintain an upright posture.
  • Take your medication regularly.
  • Avoid stress.
  • Eat a healthy diet (especially little meat, lots of vegetables).
  • Avoid being overweight .
  • Don’t smoke.

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