Spondyloarthritis (SpA) represents a group of inflammatory rheumatic conditions with some shared characteristics:

• Spinal and pelvic joint inflammation causes pain and stiffness.

• Enthesitis: inflammation where tendons or ligaments join bones. If you've ever had Achilles tendonitis, you've experienced enthesitis.

• The HLA-B27 gene is linked to SpA. However, possessing this gene doesn't guarantee the onset of any SpA-related conditions. In fact, 98% of carriers remain symptom-free. Interestingly, while people of African descent rarely carry this gene, they can still develop SpA.

The SpA Spectrum

The most prevalent type, axial spondyloarthritis (axSpA), encompasses both ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA). Both primarily affect the spine and pelvic joints. AS also termed radiographic axSpA, can cause visible bone damage on X-rays, potentially reducing spinal mobility. Nr-axSpA doesn't exhibit X-ray visible damage and was once thought to be an early AS stage. However, they're now viewed as points on a spectrum rather than distinct stages of one disease.

Other SpA variants include:

• Psoriatic arthritis (PsA)

• Reactive arthritis, often infection-induced

• Enteropathic arthritis, linked to conditions like Crohn’s disease and ulcerative colitis

Key Symptoms

The main symptoms of AS and nr-axSpA include low back pain. Identifying SpA can be challenging due to the vast potential causes of back pain. However, indications include prolonged pain and stiffness, improvement with movement, and heightened morning stiffness.

Who's At Risk?

Though once believed that AS affected men more, it's now recognized that women were underdiagnosed. New findings suggest both genders are equally at risk.

What Triggers It?

The exact cause of SpA remains elusive. While the HLA-B27 gene is common in those with axSpA, it doesn't solely cause arthritis. Several potential triggers are being studied, including back mechanical stress and gut microbe imbalances.

Diagnosis and Treatment

Diagnosis can be tricky due to dated criteria and overlapping symptoms. However, experienced doctors familiar with SpA manifestations are crucial. Treatment primarily includes nonsteroidal anti-inflammatories (NSAIDs). If NSAIDs don't provide relief, biologic medications, like tumor necrosis factor (TNF) blockers, may be considered, although they're expensive and carry potential side effects. Physical therapy and exercises are essential, especially swimming, to maintain spinal health and mobility.

Dr. John Flynn, an expert at Johns Hopkins Medicine, highly recommends exercise for everyone with SpA, emphasizing its potential to decelerate disease progression.