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OVERVIEW OF SPONDYLOARTHRITIS — Spondyloarthritis (SpA) is a family of arthritis-associated diseases. The most common diseases in this group are ankylosing spondylitis (AS) and nonradiographic axial SpA (nr-axSpA).
Diseases in the SpA family fall into one of two groups, axial SpA (axSpA) and peripheral SpA, but some patients have both axial and peripheral features:
●Axial SpA – These conditions predominantly involve the spine. AS and nr-axSpA are both types of axSpA. Sometimes these patients also show minor features of peripheral spondyloarthritis.
●Peripheral SpA – These conditions predominantly affect the joints of the arms and legs, heels, and entire fingers and toes. Patients might also have minor back pain.
Some patients with SpA have psoriatic arthritis, reactive arthritis, or arthritis associated with inflammatory bowel disease (ulcerative colitis or Crohn disease).
This topic discusses the symptoms, diagnostic tests, treatment, and complications of axSpA and peripheral SpA in people who do not have psoriasis, reactive arthritis, or inflammatory bowel diseases.
Separate topic reviews discuss reactive arthritis, psoriatic arthritis, and inflammatory bowel diseases. (See "Patient education: Reactive arthritis (Beyond the Basics)" and "Patient education: Psoriatic arthritis (Beyond the Basics)" and "Patient education: Ulcerative colitis (Beyond the Basics)" and "Patient education: Crohn disease (Beyond the Basics)".)
Separate topic reviews are also available that discuss in more detail some of the medications used to treat axSpA as well as exercises, such as stretching and strengthening, that can help. (See "Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics)" and "Patient education: Arthritis and exercise (Beyond the Basics)".)
AXIAL SPONDYLOARTHRITIS SPECTRUM OF SEVERITY — All people with axial spondyloarthritis (axSpA) and some people with peripheral SpA experience back pain. For axSpA, there is a wide spectrum in terms of the pain and disability caused by the disease:
●At one end of the spectrum are people who, on X-ray, do not show any changes in the sacroiliac joints (the joints that connect the bottom of the spine to the pelvis) or the vertebrae (the bones of the spine). This is called nonradiographic axSpA (nr-axSpA); "nonradiographic" means not visible on X-ray. A more sensitive test, usually magnetic resonance imaging (MRI), is needed to detect changes in the sacroiliac joints in these patients.
●Over time, some people in the nr-axSpA category develop signs of radiologic changes, especially of the sacroiliac joints. Once the sacroiliac joints are clearly affected on X-ray, a person is said to have ankylosing spondylitis (AS). AS is also called "radiographic axial spondyloarthritis."
●At the other end of the spectrum, in some people with AS, the sacroiliac joints as well as the vertebrae become fused into what doctors call a "bamboo spine."
Many people with nr-axSpA do not go on to have AS, and many people with AS do not advance to "bamboo spine." The same treatments are effective in both nr-axSpA and AS.
In patients with peripheral SpA, back pain might be present, but only as a minor symptom. Patients with peripheral SpA might also have X-ray or MRI changes of the sacroiliac joints; much less change is seen in the vertebrae than in the sacroiliac joints.
AXIAL SPONDYLOARTHRITIS SIGNS AND SYMPTOMS — The most common symptom of axial spondyloarthritis (axSpA) is pain in the lower back. Some people also have pain, stiffness, and limited mobility outside the spine, such as in the hips, knees, and heels. (See "Clinical manifestations of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults".)
Spinal pain — Spinal pain, almost always in the lower back, is usually the first and most common symptom of axSpA. The pain generally has some of the following characteristics:
●Begins in early adulthood (before 45 years of age)
●Has a gradual onset (rather than sudden onset after an acute injury or a disc problem)
●Lasts longer than three months
●Is worse after rest (eg, in the morning)
●Improves with activity
●Wakes you up in the second half of the night
●Can cause morning stiffness lasting more than 30 minutes
●Can be associated with buttock pain that alternates between the left and right sides
Limited spinal flexibility — Limited flexibility of the back and neck is more severe in ankylosing spondylitis (AS) than with nonradiographic axSpA (nr-axSpA). In AS, the degree of inflexibility ranges from minor to complete inflexibility. Limitations in flexibility of the back and neck can make it hard to do normal daily activities, such as putting on shoes and stockings. The most serious consequence is developing an irreversible head-forward "hunchback" posture. More normal posture can often be maintained by regularly performing posture training exercises. (See 'Physical therapy, exercise, and posture training for axial spondyloarthritis' below.)
You can test yourself for a hunchback posture by standing against a wall, with your back and heels touching the wall. Normally it is possible to touch the wall with the back of the head while keeping the chin parallel to the floor. If you cannot touch the wall with the back of the head, this indicates that you have a significant head-forward hunchback posture. If you are not already doing physical therapy and posture training to help with this, your doctor can help you get started.
Other symptoms — Other symptoms of axSpA can include:
●Fatigue and sleeplessness – Inflammation in axSpA can affect the entire person, causing fatigue and sleeplessness.
●Anxiety and depression – These problems sometimes affect people with axSpA.
●Hip pain – Arthritis of the hips is relatively common in AS, but much less so in nr-axSpA. Hip arthritis can cause pain in the groin or buttocks or difficulty walking.
●Heel pain – A common area of inflammation is the heel. This can cause pain at the back of the heel (Achilles tendinitis) and in the sole of the foot (plantar fasciitis).
●Shoulder pain – Inflammation of the tendon and bone may cause shoulder pain and limited mobility of the affected shoulder(s).
●Arthritis in other joints – Pain, stiffness, and swelling of other joints may occur. Arthritis may affect a single joint (monoarthritis) or a few joints (oligoarthritis). This is mainly seen in the hips, knees, ankles, heels, and feet.
●"Sausage-digits" – Sausage-shaped swelling can affect one or several toes and fingers.
●Other organs – Body systems other than the joints can be affected. (See 'Problems outside the spine or the joints' below.)
The combination of symptoms varies from person to person. The diagnosis of AS or nr-axSpA must be made by a clinician and cannot be made using an itemized checklist. It depends on the combination of symptoms, signs, laboratory test results, and imaging findings. (See 'Axial and peripheral spondyloarthritis diagnosis' below.)
PERIPHERAL SPONDYLOARTHRITIS SIGNS AND SYMPTOMS — People with peripheral spondyloarthritis (SpA) might have one or all of the following three features:
●Arthritis in joints of the hands, wrists, elbows, feet, ankles, and knees – Affected joints show pain, stiffness, and swelling. Arthritis may affect a single joint (monoarthritis) or a few joints (oligoarthritis). The most commonly affected joints are the knees, ankles, and feet.
●Enthesitis – Enthesitis (or enthesopathy) refers to inflammation around the enthesis, which is the site of insertion (attachment) of ligaments, tendons, joint capsule, or fascia to the surface of the bone. A common area of inflammation is the heel. This can cause pain at the back of the heel (Achilles tendinitis) and in the sole of the foot (plantar fasciitis). However, any enthesis can be affected in peripheral SpA (for example, in the shoulders, elbows, and knees).
●"Sausage-digits" – Sausage-shaped swelling can affect one or several toes and fingers.
People with peripheral SpA might also have the same spinal pain and the other features described in axial SpA (axSpA), but the spinal pain is not the major feature. Diagnosis has to be made by a clinician and not from a checklist.
MEASUREMENT OF DISEASE ACTIVITY — The severity of certain spondyloarthritis (SpA) symptoms varies greatly between people and also fluctuates in each individual. Periods in which a person's symptoms become worse are called "flares." The goal of therapy is major improvement of symptoms, to achieve a "partial" or "complete" remission. Because several symptoms are involved, it can be useful to combine estimates of the severity of each of the major symptoms (pain, tenderness, and fatigue) into one number. This provides a simple way of measuring and tracking overall "disease activity."
One way to measure the disease activity of axial SpA (axSpA) without obtaining laboratory tests is by using a questionnaire that you can complete on your own called the "Bath Ankylosing Spondylitis Disease Activity Index" (BASDAI) (calculator 1). Another calculator of disease activity is the "Ankylosing Spondylitis Disease Activity Score" (ASDAS), also available online. This score is partly dependent on certain blood test results. This type of information can help your doctors decide what treatments to try and whether or not a treatment you have started is effective.
Because back pain is not the major feature of peripheral SpA, the BASDAI and ASDAS scores are less useful as measurements of disease activity in peripheral SpA. Your doctors will use the number of joints affected, severity of pain, and impairment of function to estimate the disease severity. For example, your doctor will consider that the peripheral SpA has improved if the number and/or the intensity of joint pain have diminished.
SPONDYLOARTHRITIS RISK FACTORS — The symptoms of ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) usually start between the ages of 20 and 30 years.
The disease can be more common in certain families. For example, a person's risk of developing axSpA increases if a first-degree relative (parent, sibling, or child) has axSpA. The presence of a gene called human leukocyte antigen (HLA) B27 also increases the risk of developing axSpA.
Smoking is one of the most important risk factors you can change by yourself, as smokers have more pain and disability than nonsmokers. If you are a smoker and have been diagnosed with axSpA, you should try to quit as soon as possible. Your health care provider can help you make a plan to quit. (See "Patient education: Quitting smoking (Beyond the Basics)".)
The only known risk factor for peripheral SpA is the gene HLA-B27.
AXIAL AND PERIPHERAL SPONDYLOARTHRITIS DIAGNOSIS — Ultimately, the diagnosis of axial spondyloarthritis (axSpA) and peripheral SpA must be made by an experienced clinician and is based upon a combination of symptoms, physical examination, blood tests, and imaging tests such as X-ray and magnetic resonance imaging (MRI). Based on the results, a clinician can assign a degree of probability to whether axSpA is causing your symptoms. The diagnosis cannot be made by ticking a checklist.
For some people, observations for a number of months might be necessary before a clinician can be confident of the diagnosis. In general, axSpA should be considered if you have daily back pain for more than three months that starts before the age of 45, especially if this back pain is predominantly present in the morning, wakes you up at night, and improves after movement. The diagnosis of peripheral SpA should be considered if you have four or fewer swollen joints in the lower extremities that are not symmetrically distributed, especially if associated with swelling in the heel(s) or diffuse sausage-like swellings in some of the toes or fingers. (See "Diagnosis and differential diagnosis of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults".)
Blood tests — There are no blood tests that, by themselves, can definitively diagnose or exclude axSpA or peripheral SpA. However, testing for the presence of one particular type of the human leukocyte antigen (HLA) gene, HLA-B27, can be helpful in certain people. AxSpA or peripheral SpA is less likely in a person with a negative test for HLA-B27 who is white and of European descent. Tests for proteins called "acute phase reactants" are sometimes helpful but are not diagnostic for axSpA or peripheral SpA; these tests, which are markers of inflammation in the body, include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) tests.
Imaging tests — Most people with axSpA and some with peripheral SpA develop characteristic changes in the sacroiliac joints. These are the joints that connect the base of the spine (sacrum) to the large pelvic bone (ilium) on both sides. In ankylosing spondylitis (AS), these changes can be seen on radiograph (X-ray) images.
Imaging tests such as MRI detect the disease earlier than plain X-rays. In nonradiographic axSpA (nr-axSpA) and in some patients with peripheral SpA, findings suggesting inflammation in the sacroiliac joints may be present on MRI when the X-rays are negative. The interpretation of both the X-ray and the MRI requires training and, to a certain extent, is observer-dependent. Two clinicians might not agree on the same X-ray or MRI. MRI changes suggestive of SpA can sometimes be seen even in healthy people. Imaging tests should always be interpreted in the context of the symptoms, physical examination, and blood tests.
In people already diagnosed with AS, radiographs of the vertebrae are also useful in assessing the degree of structural damage to the spine.
TREATMENT OF AXIAL AND PERIPHERAL SPONDYLOARTHRITIS — The treatment approaches to ankylosing spondylitis (AS), nonradiographic axial spondyloarthritis (nr-axSpA), and peripheral SpA are similar in many ways. A number of treatments are available; the selection is tailored for each individual, based on the characteristics and severity of the disease. Treatment may include some or all of the following:
Physical therapy, exercise, and posture training for axial spondyloarthritis — It is best to start exercising as soon as possible after being diagnosed with axSpA and to continue exercising regularly. Exercise should be part of the treatment program for everyone with axSpA. It can include home exercises, individual or group exercise with a physical therapist, or individual physical therapy treatments. It can be "land-based" or in a pool, with or without additional therapies. Optimally, you should be evaluated and given instructions by a physical therapist and be monitored periodically.
The minimum exercise program includes core strengthening and should also contain cardiovascular exercises, isometric strengthening (exercising muscles while holding a position rather than through motion), breathing, stretching, and dynamic movements. (See "Patient education: Arthritis and exercise (Beyond the Basics)".)
Because axSpA can lead to the spine becoming "frozen" in an awkward posture, posture training is very important. Modern sedentary life often involves sitting in a slumped posture in front of a computer, which causes shortening of the muscles at the back of the thighs, tilting of the hips forward, weakening of the muscles of the upper back, and a tendency to bend and hold the neck and head too far forward. A vigorous posture training program should be aimed at compensating for these issues. Instructions on posture-maintaining exercises can be found on the Spondylitis Association of America website.
Other exercises with a mind-body component may be of benefit, including tai chi and Pilates. (See 'Complementary (alternative) medicines' below.)
Instructions on exercises designed for people with axSpA are also available. (See 'Where to get more information' below.)
The effect of exercises has not been formally evaluated in peripheral SpA.
Support groups — Support groups for SpA are available in the United States (Spondylitis Association of America) and many other countries. Participating in a support group can be a helpful coping strategy, especially if you are struggling with your condition and how it has impacted your life.
Safety issues for axial spondyloarthritis — A fused, immobile, inflexible spine is more easily fractured than a normal spine. Because of the increased risk of serious spinal injury from even minor falls or other accidents, people with axSpA with an inflexible spine should take care to avoid such mishaps. Safety measures you can take include the following:
●Limit the amount of alcohol you drink. Opioid pain medications (such as codeine) and sedatives (sleeping pills) should be used cautiously, if at all, since these also increase the risk of falling.
●Modify your home to decrease your risk of falling. Shower or tub grab-bars and nightlights decrease the chance of a fall. Remove or secure loose rugs, and keep walkways free of clutter, electrical cords, and other things that could be tripped over.
●Take precautions in the car. Seatbelts reduce the risk of injury in a car crash and should always be worn while driving or riding in a vehicle. A wraparound rearview mirror can improve visibility while driving if you cannot turn your head and neck.
●To avoid developing deformities of the neck, use a thin, rather than thick, pillow for sleeping.
●If you have an inflexible spine, avoid contact sports and other high-impact activities.
●Perform fall-prevention exercises as part of your exercise program.
Diet — There are no special dietary recommendations for SpA other than maintaining a healthy diet. There is a lack of evidence for benefit from the intake of probiotics.
Medications
Nonsteroidal antiinflammatory drugs — Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used to control pain and stiffness. NSAIDs need to be taken on a regular basis for several weeks before their maximum effect can be judged. If one NSAID is not effective, your doctor might recommend a different one. (See "Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)".)
Opioids — Opioids are a group of medications that can relieve pain in certain situations. Opioids can cause side effects, some of which can be serious. They can also lead to misuse and addiction in some people. In general, people with SpA and chronic pain should not use opioids. You should only take them if your clinician has prescribed them after a detailed discussion about their relative risks and benefits.
Glucocorticoids (steroids) — Some clinicians may also recommend a glucocorticoid (steroid) injection into particularly painful or swollen joints or digits (fingers and toes), especially if only one or two areas are causing the most pain. Glucocorticoid injections might also be helpful for inflammation of a tendon or bursa or the sacroiliac joints.
In contrast, oral glucocorticoids (pills) are not a standard part of the treatment of SpA.
Sulfasalazine and methotrexate — Sulfasalazine is a disease-modifying antirheumatic drug (DMARD) that may be prescribed for people with peripheral SpA and also those with axSpA who also suffer from peripheral arthritis (affecting joints outside the spine). This drug provides some relief of arthritis symptoms but is not helpful for axial (spine) symptoms. It may be given along with NSAIDs. Methotrexate might also be effective for peripheral arthritis but is not for axial symptoms. (See "Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics)" and "Patient education: Sulfasalazine and the 5-aminosalicylates (Beyond the Basics)".)
Anti-tumor necrosis factor therapy — A group of medicines known as anti-tumor necrosis factor agents (anti-TNF agents or TNF inhibitors) are often effective in the treatment of axSpA and peripheral SpA. Examples of anti-TNF medications include infliximab, etanercept, adalimumab, certolizumab pegol, and golimumab. People who do not respond to one anti-TNF treatment may respond to another. Improvement in symptoms is common and may occur within a few weeks of starting the drugs.
Not every person with SpA needs anti-TNF therapy. In general, people with active disease in the spine or swollen and painful joints or heels or digits who have not responded fully to NSAIDs may be candidates. (See 'Measurement of disease activity' above.)
Your clinician may also recommend a glucocorticoid (steroid) injection into painful or swollen peripheral joints before starting an anti-TNF drug if these areas continue to bother you despite using NSAIDs (see 'Glucocorticoids (steroids)' above) or DMARD therapy. The decision to use anti-TNF therapy depends upon several factors, including the risk of side effects, and should be discussed with your clinician.
Anti-interleukin 17 therapy — These medications include secukinumab (brand name: Cosentyx) and ixekizumab (brand name: Taltz). They are alternative treatment options for some people who do not respond adequately to anti-TNF therapy. Either secukinumab or ixekizumab can also be used in place of anti-TNF therapy, particularly in people who cannot take those medications for some reason.
Janus kinase inhibitors — Tofacitinib, a member of a drug class called Janus kinase (JAK) inhibitors, is available in Europe and the United States for treatment of some patients with AS. In contrast to the TNF and interleukin (IL) 17 inhibitors, tofacitinib is taken orally instead of by injections.
Surgery — Hip or spine surgery may be beneficial in some people with axSpA. Surgical procedures may include one or more of the following:
●Total hip replacement (arthroplasty) – Insertion of an artificial (prosthetic) hip may be recommended if you have severe, persistent hip pain or severely limited mobility due to hip joint arthritis. (See "Patient education: Total hip replacement (Beyond the Basics)".)
●Spinal surgery – Fusion of the bones in the cervical (upper) spine may be recommended for a very small number of people who develop dislocation of these bones. Such surgery may help prevent spinal cord damage.
●Wedge osteotomy – Wedge osteotomy involves the removal of a wedge-shaped piece of bone from a vertebra, followed by realignment of the spine. The spine is then braced and is allowed to heal in a better position. This type of procedure may be recommended for people who have severe deformities of the neck and upper back.
In general, people with peripheral SpA do not require surgery.
Complementary (alternative) medicines — Exercises with a mind-body component, including tai chi and Pilates, may help some people. Evidence is lacking for benefit from complementary and alternative therapies (ie, treatments or techniques that are not part of mainstream medicine), such as probiotics.
HOW DO I COPE WITH SPONDYLOARTHRITIS?
Psychological well-being — In addition to physical symptoms, some people with spondyloarthritis (SpA) also have feelings of sadness or frustration, and a sense that they are missing out on a lot of activities or letting people down. Brain imaging studies show that some people with ankylosing spondylitis (AS) even have changes in activities and structures of the brain associated with mood (happiness, sadness, etc).
There are two types of coping strategies. One is passive coping, in which you rely totally on medications or your clinicians for help. The other is active coping, in which you rebuild your psychological defense systems through approaches such as mindfulness, cognitive behavior therapy, and positive psychology. Aerobic exercises and participating in patient-organized support groups are also types of active coping strategies that can help. (See 'Support groups' above.)
Physical limitations — SpA can affect daily life in various ways. Dressing, reaching, rising from a chair, getting up from the floor, standing, climbing steps, looking to the side or over the shoulder, exercising, and doing household and other work-related tasks can become more difficult as a result of the limited joint and spinal motion.
Depending on your degree of physical limitation, you may need help from family and friends to do your normal daily activities. A web-based, self-administered questionnaire (the Bath Ankylosing Spondylitis Functional Index [BASFI]) is available for assessing the degree of functional impairment in patients with axSpA. More In-depth evaluations into the quality of life and psychological well-being include the Ankylosing Spondylitis Quality of Life (ASQoL) Questionnaire for axSpA and the Assessment of SpondyloArthritis international Society (ASAS) Health Index for SpA.
If you are struggling to cope with your disease in any way, talk to your health care providers and support groups. They can suggest different resources and approaches that can help.
PROBLEMS OUTSIDE THE SPINE OR THE JOINTS — Among the possible clinical problems outside the spine and the joints, the most frequent is anterior uveitis. To a lesser extent, people with axial spondyloarthritis (axSpA) might suffer from psoriasis or inflammatory bowel disease.
●Anterior uveitis – Uveitis, or inflammation of part of the eye, is the most common SpA-related problem that does not involve the joints. Anterior uveitis affects the iris (the colored part of the eye). It causes pain in the eye, blurring of vision, and light sensitivity. Uveitis requires immediate medical attention and treatment with eye medications. It is usually responsive to treatment with eye drops and often resolves within several months.
●Psoriasis – Psoriasis is a skin condition that might affect people with SpA. In psoriasis, areas of the skin are thickened and red, and these may be covered with white or silvery scales. Sometimes the nails are involved. (See "Patient education: Psoriasis (Beyond the Basics)".)
●Inflammatory bowel disease – Crohn disease or ulcerative colitis, which is an inflammatory condition of the bowel, sometimes coexists with SpA. Inflammatory bowel disease can cause abdominal pain or cramps, diarrhea, and bloody bowel movements. Also, shallow ulcerations in the lining of the bowels are observed in some people with SpA. Such ulcerations do not usually cause any symptoms. (See "Patient education: Crohn disease (Beyond the Basics)" and "Patient education: Ulcerative colitis (Beyond the Basics)".)
●Depression and fibromyalgia – Some patients with SpA also develop depression, anxiety, and sometimes pain from fibromyalgia (a chronic disorder that causes widespread pain, fatigue, poor sleep, and poor concentration). These conditions should be evaluated and treated as well. (See "Patient education: Depression in adults (Beyond the Basics)" and "Patient education: Fibromyalgia (Beyond the Basics)".)
●Cardiovascular disease – There is a possibility that people with SpA may have a higher risk for cardiovascular diseases such as heart attack. Because of this, it is a good idea to minimize other factors that may increase this risk. This includes avoiding smoking, leading a healthy lifestyle, and getting treatment for high blood pressure.
COMPLICATIONS OF LONGSTANDING ANKYLOSING SPONDYLITIS — The following complications may happen in people with advanced ankylosing spondylitis (AS), although they are rare.
●Spinal fractures and spinal cord injuries – Spinal fractures and spinal cord injuries are, respectively, 4 and 11 times more common in patients with AS than in the general population. Most of the acute fractures occur in the neck. Because a spine affected by AS is more easily fractured than a healthy spine, in many cases, injury can result from even a low-impact activity or incident. Patients with spinal cord injuries may have only minor initial neurologic symptoms such as neck pain, numbness, or weakness.
Any neck or spine injury requires immobilization, consultation with a doctor, and evaluation in an emergency facility. More than half of neck fractures in people with AS are undetectable by plain radiograph (X-ray). Computed tomography (CT) and magnetic resonance imaging (MRI) are more sensitive imaging techniques.
●Neurologic problems – Cauda equina syndrome is a rare complication that occurs in people with longstanding disease who have severe stiffening of the spine. The symptoms result from damage to many nerves in the lower back and include abnormal sensation and weakness of the lower extremities and difficulty with bladder and bowel control. Men may experience erectile dysfunction or impotence.
●Heart valve disease – The most serious problem that can affect the heart is a leaking aortic valve (aortic regurgitation), which can cause symptoms of heart failure, including leg or ankle swelling (edema) and shortness of breath during exercise or exertion. This requires monitoring and, in some cases, treatment with medications or even surgery. (See "Patient education: Heart failure (Beyond the Basics)".)
●Pulmonary (lung) disease – Many people with AS are unable to fully expand the chest normally during breathing because of stiffness between the ribs and the spine. In some cases, there are actual changes in the lung tissues. This may or may not cause breathing problems.
Because the severity and outcome of axial spondyloarthritis (axSpA) vary tremendously from person to person, treatment must be tailored to each individual. However, everyone with axSpA can benefit from the following:
●Stop smoking cigarettes, if you smoke. People who smoke and have AS can have problems with their breathing. AS can limit the movement of the chest and can reduce the amount of air the lungs can hold (see "Patient education: Quitting smoking (Beyond the Basics)"). People who smoke also progress to ankylosis of the spine more quickly.
●Maintain correct upright and sitting posture and participate in an exercise program. (See 'Physical therapy, exercise, and posture training for axial spondyloarthritis' above and "Patient education: Arthritis and exercise (Beyond the Basics)".)
WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Ankylosing spondylitis (The Basics)
Patient education: Physical activity for people with arthritis (The Basics)
Patient education: Reactive arthritis (The Basics)
Patient education: Uveitis (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics)
Patient education: Arthritis and exercise (Beyond the Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Patient education: Sulfasalazine and the 5-aminosalicylates (Beyond the Basics)
Patient education: Total hip replacement (Beyond the Basics)
Patient education: Quitting smoking (Beyond the Basics)
Patient education: Calcium and vitamin D for bone health (Beyond the Basics)
Patient education: Bone density testing (Beyond the Basics)
Patient education: Osteoporosis prevention and treatment (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Clinical manifestations of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults
Diagnosis and differential diagnosis of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults
Chest wall diseases and restrictive physiology
Pathogenesis of spondyloarthritis
Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults
Clinical manifestations and diagnosis of peripheral spondyloarthritis in adults
The following organizations also provide reliable health information.
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/healthtopics.html)
●Spondylitis Association of America
●National Ankylosing Spondylitis Society
●Spondyloarthritis Research and Treatment Network
●National Institute of Arthritis and Musculoskeletal and Skin Diseases
(301) 496-8188
●American College of Rheumatology/Association of Rheumatology
(404) 633-3777
●The Arthritis Foundation
(800) 283-7800
●Canadian Spondylitis Association
●University Health Network Toronto Western Hospital
