Spondyloarthritis (or spondyloarthropathy) is the name of a family of inflammatory rheumatic diseases that cause arthritis. It differs from other types of arthritis because it includes areas where ligaments and tendons attach to the bones. Symptoms are present in two main ways. The first is inflammation, causing pain and stiffness, most often the spine. Some forms may affect the arms and legs, shoulder, and ankle. The second type is bone destruction, which causes spinal deformities and poor shoulder and hip function. In this article, we will consider the treatment of seronegative spondylitis.
The most common is ankylosing spondylitis, which affects mainly the spine. Others include:
- Axial spondylitis, which affects mainly the spine and pelvic joints.
- Peripheral spondylitis, affecting mainly the arms and legs.
- Reactive arthritis (formerly known as Reiter syndrome).
- Psoriatic arthritis.
- Enteropathic arthritis/spondylitis associated with inflammatory bowel disease (ulcerative colitis and Crohn’s disease).
Treatment of seronegative spondylitis
All patients should undergo physical therapy and perform joint-oriented exercises. Most recommended are exercises that help stretch the spine and mobility.
There are many drug treatment options. The first lines of treatment are NSAIDs, such as naproxen and ibuprofen. Given the right dose and duration, these drugs give great help to most patients.
For articular edema that is localized (not common), injection or injection of corticosteroid drugs into the joints or tendon sheaths (membrane around the tendon) can be effective.
For patients who do not respond to the above treatment lines, anti-rheumatic disease-modifying agents such as sulfasalazine may be effective. These drugs relieve symptoms and can prevent joint damage. This class of drugs is mainly useful in patients with arthritis, which also affects the joints of the arms and legs.
Although they may be effective, oral corticosteroids are not recommended. This is due to the fact that the required high dose will lead to many side effects.
Antibiotics are an option only for patients with reactive arthritis.
TNF blockers – alpha (a newer class of drugs known as biologicals) are very effective in treating seronegative spondylitis of the symptoms of spinal and peripheral spondylitis of the joints. TNF blockers – alpha, approved by the Food and Drug Administration for patients with seronegative spondylitis:
- Infliximab, which is administered intravenously (by intravenous infusion) every 6-8 weeks at a dose of 5 mg/kg.
- Etanercept prescribed by injection of 50 mg under the skin once a week.
- Adalimumab, administered at a dose of 40 mg every week under the skin.
- Golimumab, administered at a dose of 50 mg once a month under the skin.
However, anti-TNF treatment is expensive and has no side effects, including an increased risk of serious infections. Biological products can cause the development of active infection in patients with latent tuberculosis (without symptoms). Therefore, you and your doctor should weigh the benefits and risks when considering biological treatments. Those with arthritis in the knees, ankles, elbows, wrists, arms, and legs should try anti-rheumatic drugs before treatment with anti-TNF.
Surgical treatment is very beneficial for some patients. A complete hip replacement is very useful for patients with hip pain and disability due to joint destruction from cartilage loss. Spinal surgery is rarely necessary, except for those with traumatic fractures (broken bones due to trauma), or for the correction of excessive neck flexion deformations when the patient cannot straighten his neck.
Broader health effects
Other problems may occur in patients with spondylitis. You should discuss possible complications with your doctor. These may include:
- Osteoporosis occurs in half of the patients with ankylosing spondylitis, especially in those whose spine is fused. Osteoporosis may increase the risk of a spinal fracture.
- Inflammation of the part of the eye called uveitis that occurs in about 40% of patients with spondylitis. Symptoms of uveitis include redness and pain in the eyes. Steroid eye drops are most often effective, although severe cases may require other treatments by an ophthalmologist.
- Inflammation of the aortic valve in the heart, which may occur over time in patients with spondylitis. Your doctor should check your heart to make sure you do not have this problem.
- Psoriasis, a spotty skin disease that, if severe, will need treatment by a dermatologist.
- Intestinal inflammation, which can be so severe that it requires treatment by a gastroenterologist (a doctor specializing in diseases of the digestive system).
Life with seronegative spondylitis
Pain, fatigue, and stiffness can be continuous or intermittent. Despite these symptoms, most patients lead a productive life and have a normal life expectancy, especially with the use of new methods, for the treatment of seronegative spondylitis. There are things you can do to improve your health. Frequent exercise is necessary to maintain healthy joints and heart. If you smoke, quit smoking. Smoking exacerbates seronegative spondylitis and can accelerate the speed of fusion of the vertebrae. Patient support groups provide support and helpful information.
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