Spondyloarthritis

I. Definition of Disease
Spondyloarthritis (or spondyloarthropathy) is the name for a family of inflammatory
rheumatic diseases that cause arthritis. It differs from other types of arthritis, because it
involves the sites are where ligaments and tendons attach to bones called “entheses.”
Symptoms present in two main ways. The first is inflammation causing pain and stiffness,
most often of the spine. Some forms can affect the hands and feet or arms and legs. The
second type is bone destruction causing deformities of the spine and poor function of the
shoulders and hips.

II. Narrative Pathophysiology

A. Predisposing Factors
a. Age- start in the teens and 20s
b. Male - strikes males two to three times more often than females
c. Genetics- Family members of affected people are at higher risk,
depending partly on whether they inherited the HLA-B27 gene.

B. Precipitating Factors
a. Environmental Factors -such as radiotion
b. Infection ( Bacteria & Viruses) Cross-reactivity

C. Pathophysiology
Ankylosing spondylitis begins with inflammation of fibrocartilage in cartilaginous joints.
The sacroiliac joint is affected first, usually before any damage can be radiographically
detected. Inflammatory cells infiltrate the fibrous tissue of the joint capsule, the cartilage
that surrounds intervertebral disks, the entheses, and the periosteum. As inflammatory
cells (chiefly macrophages) and lymphocytes infiltrate and erode bone and fibrocartilage
in joint structures, repair begins. Repair of cartilaginous structures begins with the
proliferation of fibroblasts. Fibroblasts synthesize and secrete collagen. The collagen
becomes organized into fibrous scar tissue that eventually undergoes calcification and
ossification. With time, all the cartilaginous structures of the joint are replaced by ossified
scar tissue, causing the joint to fuse, or lose flexibility. Repair of eroded bone begins with
osteoblast activation and proliferation. Osteoblasts lay down new bone (callus), which is
remodeled and replaced by compact, lamellar bone. Bone repair changes the contour of
the bone’s surface because the new bone grows outward to form a new enthesis with the
end of the eroded ligament. The new enthesis, which forms on top of the old one, is called
a syndesmophyte. As calcification of the spinal ligaments progresses, the vertebral bodies
lose their concave anterior contour and appear square. The spine assumes the classic
bamboo spine appearance of ankylosing spondylitis.

D. Clinical Manifestation
 Spondyloarthropathies often cause:
o Low back pain that may spread into the buttock.
o Morning stiffness, especially in the back or neck, that gets better during the
day and after exercise.
o Fatigue.
 Ankylosing spondylitis
o causes stiffness and low back pain. Over time, the pain usually moves from
the lower back into the upper back. In severe cases, the affected joints in the
spine fuse camera.gif together, causing severe back stiffness. Other areas
(such as the hips, chest wall, and heels) may also be affected. In children,
symptoms usually begin in the hips, knees, heels, or big toes and later
progress to the spine.
 Reactive arthritis
o causes pain, swelling, and inflammation of the joints, especially in the
sacroiliac joint, the attachment between the lower back and pelvis, and in the
fingers, toes, and feet. The fingers and toes may swell, causing a "sausage
digit." Reactive arthritis can also cause fever, weight loss, skin rash, and
inflammation. In children, the joints of the lower legs are most commonly
affected.
 Psoriatic arthritis
o is a form of arthritis associated with a skin condition called psoriasis. The
psoriasis symptoms (scaly red patches on the skin) often precede the arthritis
symptoms, sometimes by many years. The severity of the rash does not mirror
the severity of the arthritis. The fingernails and toenails may show pitting or
thickening and yellowing. The joint problems involve large joints, such as the
hips and sacroiliac joints. Swelling of entire toes or fingers, resulting in
sausage digits, also occurs.
E. Diagnostic Test
 Spondyloarthropathies are diagnosed through
o medical history
o lab tests blood can be tested for the HLA-B27 gene,
o X-ray or MRI, and by symptoms of joint and tissue inflammation,
morning stiffness, and other symptoms unique to a specific
spondyloarthropathy (such as scaly skin in psoriatic arthritis

F. Management
 Medical Management Medical management of spondyloarthropathies
focuses on treating pain and maintaining mobility by suppressing
inflammation. For the patient with ankylosing spondylitis, good body
positioning and posture are essential, so that if ankylosis (fixation) does occur,
the patient is in the most functional position. Maintaining range of motion with
a regular exercise and muscle-strengthening program is especially important

 Pharmacologic Management NSAIDs and corticosteroids often produce

marked improvement in back, skin, and joint symptoms. Sulfasalazine
(Azulfidine) and methotrexate (Rheumatrex) may help with peripheral joint
disease. Methotrexate is also used to control psoriasis. More recently, anti-
TNF therapy is under investigation for treatment of the spondyloarthropathies
 Surgical Management Surgical treatment is very helpful in some patients.
Total hip replacement is very useful for those 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 injury) or to
correct excess flexion deformities of the neck, where the patient cannot
straighten the neck.

G. Nursing Diagnosis
a. Acute Pain
b. Activity Intolerance
c. Impaired physical mobility
 H. Nursing Management
Major nursing interventions in the spondyloarthropathies are related to symptom
management and maintenance of optimal functioning.
 Exercise
 physical therapy
 good posture practices
 applying heat/cold to help relax muscles and reduce joint pain

 Patients may also express concerns about leisure and recreational activities.

REFERENCES:
Reveille, J. D., MD. (2013, November). Retrieved from https://www.rheumatology.org/I-Am-
A/Patient-Caregiver/Diseases-Conditions/Spondyloarthritis
Suzane Smeltzerm, B. B. (2008). Brunner & Suddarth's Textbook of Medical- Surgical Nursing
- twelfth edition . Walnut Street, Philadelphia: Lippincott Williams & Wilkins .