Spondylarthritis (Ankylosing spondylitis)

The spondyloarthritides include the following diseases: ankylosing spondylitis, psoriatic arthritis, reactive Arthritis and enteropathic arthritis. These are characterized by inflammation of the sacroiliac joints and the spine, as well as of peripheral joints and of the points of attachment of tendons to bones (entheses) following activation of the immune system. Genetic (strong association with HLA-B27) and environmental factors contribute to disease development. Uncontrolled repair mechanisms after decline of inflammation may lead to proliferative bone changes and characteristic bony bridges between vertebral bodies ultimately leading to a major deterioration of spinal mobility.

Signs and Symptoms

The back pain is inflammatory in nature, meaning that the onset is insidious, usually at an age under 35 years, that it worsens with immobility, especially at night and early morning and that it tends to ease with physical activity and exercise. Moreover, the pain is associated with a significant morning stiffness. Inflammation at the entheses may occur at multiple locations, most prominently at the heel. The bigger joints of the lower extremities are usually afflicted. Extra-skeletal inflammatory manifestations include affection of the eye (uveitis), the skin (psoriasis) and the bowel.

Diagnosis

Magnetic Resonance Imaging allows the early detection of inflammatory lesions of the spine and sacroiliac joints. Later on, bony proliferative changes may be seen on conventional radiographs. The clinician is supported by ultrasonography with regard to the evaluation of the inflamed joints and entheses.

Treatment

Physical execise is essential for the preservation of spinal mobility. Non-steroidal anti-inflammatory drugs are the pharmacological treatment of first choice. For patients with insufficient response to these medications and persistently active disease, treatment with inhibitors of tumor necrosis factor-alpha (TNF) may be considered. Conventional disease-modifying drugs like Sulfasalazine, Methotrexate and Leflunomide are only prescribed for peripheral arthritis. Blockers of Interleukin12/23 and of phosphodiesterase-4 are also available for psoriatic arthritis.

Cooperation

Our team has established important collaborations within the following institutions: The Swiss Clinical Quality Management Program (SCQM), the ASAS (Assessment of SpondyloArthritis international Society) and the GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis).