Spondyloarthritides

Spondyloarthritides (SpA) are a diverse group of chronic, inflammatory joint and spine disorders. Although they share some genetic causes and clinical features, each condition within the group has different symptoms and outcomes.

The most common symptoms for spondyloarthritides are inflammatory back pain and enthesitis, a joint inflammation in the area where ligaments and tendons attach to the bone.

Although SpA may mimic the symptoms of arthritis, the conditions differ. Spondyloarthritides affect the areas where ligaments and tendons attach to bones (entheses), such as the knee, foot and hip, but do not cause inflammation of the joint lining (synovitis).

Spondyloarthritides are sometimes called spondyloarthropathies.

The most common types of SpA in children are:

• Juvenile ankylosing spondylitis
• Reactive arthritis, (formerly known as Reiter’s syndrome)
• Psoriatic arthritis
• Enteropathic arthritis, which is linked to inflammatory bowel disease
• Undifferentiated spondyloarthropathy

Symptoms of spondyloarthritides usually appear in one of three ways:

• As inflammation of the spine, lower back and pelvis
• As inflammation of the extremities
• As degeneration and inflammation of major joints

When there is inflammation of the spine or between the lower back and the pelvis, it is called axial spondyloarthritis. The condition can cause pain in the lower back and pelvis.

When there is inflammation of the extremities — the hands and feet, or arms and legs — the condition is called peripheral spondyloarthritis. It causes stiffness and pain in the affected areas.

In other SpA, symptoms include the degeneration and destruction of joint areas where ligaments and tendons are attached to bone.

In addition to causing some deformation of the spine, spondyloarthritides can also affect shoulder and hip function.

Although experts haven’t yet determined the exact cause of spondyloarthritides, they know this group of conditions tends to run in families. There is strong evidence that the HLA-B27 gene contributes to ankylosing spondylitis, a form of arthritis that causes chronic inflammation of the spine joints.

To confirm spondyloarthritides a doctor will begin by asking you and your child questions to develop a medical history. Questions may include:

• Where is the pain?
• Which joints are affected?
• If you have back pain, is it better if you exercise? Does it hurt more after inactivity or first thing in the morning?
• Do you have stomach or gastrointestinal discomfort?
• Do you have any skin conditions?

The doctor will also conduct a physical exam of your child, and may order blood or imaging tests. One of the tests may check for the presence of the HLA-B27 gene. Although this gene is not present in everyone who has SpA, and may be found in many people who do not have the conditions, the blood test can provide value by helping to support a diagnosis.

Imaging tests, such as X-ray and MRI, may also be used to confirm your child’s diagnosis.

Treatment for SpA can vary depending on your child’s symptoms, age and development, and other conditions. It may include medications and/or physical therapy.

In most cases, your child’s doctor will recommend physical therapy and exercises to strengthen your child’s joints, stretch part of the back, and promote mobility.

If medication is needed, your child’s doctor will likely prescribe a nonsteroidal anti-inflammatory drug such as ibuprofen, naproxen, meloxicam or indomethacin. These drugs can help block pain and reduce inflammation.

For patients who need more powerful medication, disease-modifying antirheumatic drugs (DMARDs) are frequently prescribed. These medications relieve inflammation, decrease pain, and slow the progression of joint damage.

Spondyloarthritides are chronic conditions, but with treatment and careful monitoring, most children with these conditions can lead regular lives and have a normal lifespan.

Children with SpA should receive long-term monitoring. Regular visits to a pediatric rheumatologist are recommended.

Talk to your child’s physician about how frequently your child should be examined and if you notice any changes in your child’s condition.