By Jessica Walsh, MD
We hear a few different terms to describe ankylosing spondylitis (AS) and related diseases: Spondyloarthritis, spondyloarthritides and spondyloarthropathy. . . Is there a difference?
Spondyloarthritis and spondyloarthropathy are often used interchangeably. Some experts prefer the term spondyloarthritis rather than spondyloarthropathy because the ending "arthritis" indicates inflammation of the joint, whereas the ending "arthropathy" can refer to any type of joint disease. Inflammation is a key feature that helps distinguish spondyloarthritis from other types of arthritis, including wear-and-tear arthritis, such as osteoarthritis. Spondyloarthritides is the plural form of spondyloarthritis.
How is this group of diseases related? Why is it sometimes called a "family" of conditions?
These diseases look and behave in similar ways because they share overlapping disease features. Common features of spondyloarthritis include inflammation in the spine, pelvis, other joints, intestine, eyes [Editor's note: please see side bar on Uveitis / Iritis to the right], and heels. This family of diseases is divided into individual categories according to the predominant disease feature(s). For example, inflammation of the intestine can occur with any type of spondyloarthritis, but is most pronounced in patients with IBDassociated arthritis (also called enteropathic arthritis).
What does "seronegative" mean? How does it relate to this group of diseases?
Seronegative means that specific blood tests used to help diagnose rheumatoid arthritis are negative. In some instances, these blood tests are helpful in determining whether a person has rheumatoid arthritis or spondyloarthritis. In most cases, a diagnosis of spondyloarthritis can be made without these blood tests.
Is ankylosing spondylitis (AS) considered the "primary" disease? Why or why not?
Can you give us a key symptom or "feature" of each of the conditions in this group? What makes each one distinct or different from the others?
Can one of these conditions share symptoms or complications with another one of the conditions? In general terms, do symptoms overlap? If so, how? What are the main similarities - if any?
Why would a doctor diagnose one form of spondyloarthritis over another?
Can a diagnosis change from, say, undifferentiated spondyloarthritis (USpA) to ankylosing spondylitis or another one of these conditions? Why would this occur?
Yes. The diseases can evolve or change over time, since not all symptoms occur at once. For example, the previously discussed person with USpA with iritis, enthesitis, and knee swelling could develop back pain and inflammatory changes on x-rays that would lead to the diagnosis of ankylosing spondylitis.
Q: Are men and women affected at different rates between these diseases? Can you give us some details on how these rates were determined?
Similar numbers of men and women are affected with spondyloarthritis. In the past, it was thought that ankylosing spondylitis was more common in men than women. More recent studies suggest that ankylosing spondylitis occurs in similar numbers of men and women. Early estimates of the occurence of ankylosing spondylitis suggested that ankylosing spondylitis occurred 9-10 times more frequently in men than women. However, there were problems with how these early studies were done. More recent studies reported that men are 2 to 3 times more likely than women to have ankylosing spondylitis. These studies use relatively narrow definitions of ankylosing spondylitis that rely on classic manifestations of inflammatory back pain and damage on x-rays. Classic inflammatory back pain may be the initial symptom in men more frequently than in women, and women may have less x-ray damage than men. Despite these differences, the overall disease severity is similar in men and women.
When broader definitions are used to identify people with spondyloarthritis in the pelvis and/or spine (axial spondyloarthritis), the prevalence is similar in men and women.
How are these conditions treated? Are there any notable differences in treatment such as prescribed medications?
There are several treatment options for various types of spondyloarthritis. The treatments for each disease overlap, but they are not identical. For example, certain treatments may simultaneously help with psoriasis, inflammatory bowel disease, enthesitis, and arthritis. Other treatments may help with one or two disease features, but not the others. There are even some treatments that may help with one disease feature, but make another feature worse. Treatments need to be tailored for each individual, according to the type and severity of specific disease features. Many other factors must also be considered when selecting therapies, including other medical conditions, access to therapies, and the preferences of patients.
Please see our medications guide for more information.
Is there a known cause for these diseases?
We know that there are several specific genes that increase the risk of developing spondyloarthritis. HLA-B27 is the best studied gene and it associates most strongly with inflammation in the pelvis (sacroiliac joints) and spine. Most people with HLA-B27 and other high risk genes never develop spondyloarthritis. We don't yet understand why some people develop disease and others don't. There are also studies suggesting that things in our environment may cause disease. For example, specific types of infections may trigger disease. However, environmental triggers are not known for most people who develop spondyloarthritis. There is much research that needs to be done to better understand why certain people get these diseases.
Is there a cure?
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