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Arthritis in Spine – Spondyloarthropathies

These are a group of disorders which involve spine along with other parts of the body causing painful and stiff joints.

The exact cause of most of these conditions is not known. They all involve the immune systems (body’s own defence mechanism against viruses, bacteria etc.). Some of the common conditions are

  • Ankylosing spondylitis
  • Ulcerative colitis
  • Enteropathic spondylitis
  • Psoriatic spondylitis
  • Crohn’s disease
  • Juvenile rheumatoid arthritis
  • Undifferentiated spondyloarthropathy

Typically they all present with back pain of longer duration – usually in months. Patient experiences early morning stiffness – i.e. tightness of the spine after getting up in the morning which slowly weans off within half an hour to one hour. There may be associated weight loss, loss of appetite etc. If left untreated they all invariably develop permanent stiffness in the spine.

In Ortho one these patients are investigated initially with basic blood investigations like CRP and ESR. If found elevated along with the clinical parameters then they are categorized in to either Arthritis panel 1 or Arthritis panel 2. Then depending on the blood reports their treatment will be started.
Each type of disorder needs specialized therapies. Extreme importance is given to exercise therapy. We try to avoid pain killers to the maximum. There are other pain management modalities and special injection techniques available to relieve the pain. Thus these patients are started on disease modifying medications directly which helps in early control of the disorder rather than just giving symptomatic relief.

Condition Percent of people with the
condition who are HLA-B27 positive
Ankylosing Spondylitis
  • Caucasians: 92%
  • African-Americans:50%

 

Reactive arthritis (Reiter’s Syndrome) 60-80%
Enteropathic spondylitis or spondylitis associated with inflammatory bowel disease  (including Crohn’s disease and ulcerative colitis) 60%
Psoriatic arthritis 60%
Isolated acute anterior uveitis 50%
Reiter’s disease
Juvenile rheumatoid arthritis
Undifferentiated spondyloarthropathy[4][5] (USpA) 20 – 25 %

Some sources also include Behcet’s disease and Whipple’s disease.

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