Spondylitis, locomotor system disease

Written by: Dr. Jesús Tornero Molina
Edited by: Top Doctors®

Ankylosing or ankylosing spondylitis is an inflammatory disease of the locomotor system that affects the joints of the vertebral column and may end up welding or fusing the vertebrae together, causing a great rigidity and limitation of mobility.

The disease is more frequent in males, and usually appears between 20 and 30 years of age; Affects 0.5% of the adult population. It is more common in the white race than in the black race.

This condition can affect only the spine, both cervical and dorsal or lumbar, including also the sacroiliac joints. At other times, spondylitis affects the spine and the peripheral joints of the extremities. Occasionally, inflammation of the tendons may be added to the points of attachment to the bone, the Achilles tendon, the plantar fascia, and the patellar tendon.

This disease presents familial aggregation and an important genetic base. It can be associated with other diseases such as psoriasis or certain inflammatory bowel or ocular diseases (ulcerative colitis, Crohn's disease, uveitis).

Lumbar spine radiograph showing welding between vertebrae in a patient with advanced spondylitis.
Figure 1. Lumbar spine radiograph showing welding between vertebrae in a patient with advanced spondylitis.

Causes of Spondylitis

I do not know exactly the cause. There is an undeniable genetic substrate that is evidenced by the frequent association in certain families, the greater frequency of presentation when having other relatives with the disease and the association with a genetic marker that is the HLA-B27 histocompatibility antigen. The latter is detected in more than 90% of patients with spondylitis.

This genetic basis would facilitate the action of environmental agents in the production of inflammatory disease, probably by changes or modifications of the intestinal microbiota. All this would trigger a chronic inflammatory process that would damage the joints between the vertebrae and osify them, welding and fusing them.


Is there any possibility of preventing spondylitis?

No, there is no way to prevent the disease. The genetic component is unchangeable; If a person inherits from their parents the HLA-B27 has a 20-25% probability of ending up suffering the disease. In the white race this antigen appears in 6-10% of the general population: eye because having HLA-B27 does not mean that the disease is present.


Symptomatology of spondylitis

Typically, it manifests with low back pain; This pain, unlike the usual lumbago, usually appears at night, at dawn, awakens the patient and forces him to get out of bed and walk around the room to notice relief. It is accompanied by intense morning spinal stiffness. In general, patients are better at exercising and moving than at rest.

Arthritis may also be associated, ie inflammation of a joint of the extremities, especially in the lower limbs: knee, ankle, feet. As the disease also affects the areas of attachment of the tendons to the bones, tendinitis. In addition to these symptoms of the locomotor system, ocular, genitoruinary, intestinal or mucosal and skin symptoms are sometimes associated: conjunctivitis, uveitis, chronic diarrhea, prostatitis or psoriasis of the skin.

Figure 2. Inflammation of the sacroiliac joints radiologically visible in a patient with spondylitis

Spondylitis: Treatment

Early diagnosis is essential to maintain the window of opportunity provided by the inflammatory process before stiffening joints. The basis for the diagnosis is clinical suspicion and demonstration by an analytical-radiological test of the existence of joint and spinal inflammation. A simple x-ray of the skeleton and a simple blood test may suffice; In more complicated cases it is necessary to resort to magnetic resonance imaging or computerized tomography (CT scan).

Adequate treatment is usually effective.. It includes rehabilitative physical therapy, non-steroidal anti-inflammatory drugs and so-called biological therapies. The latter are indicated when previous attempts fail. Anti-TNF agents (etanercept, infliximab, adalimumab, certolizumab, golimumab) and secukinumab. In general, the prognosis, when properly diagnosed and treated, is good; You can eliminate pain and inflammation and correct spinal deformity.

In any case, it is advisable to visit a doctor specialized in Rheumatology and an adequate, close and active follow-up, for the timely control of the disease.

Figure 3. Magnetic resonance imaging in a patient with ankylosing spondylitis. The bony puenets are shown that weld the vertebral bodies together.



*Translated with Google translator. We apologize for any imperfection

By Dr. Jesús Tornero Molina

Renowned specialist in rheumatology, Dr. Tornero Molina is an expert in pathology Arthritis, Osteoarthritis, Osteoporosis, Spondylitis, Polimagia Rheumatic and Collagenosis, among others. He is Head of the Section of Rheumatology at the University Hospital of Guadalajara since 1987, and has a private practice since 2001. He combines his professional work with teaching, being associate professor of medicine at the University of Alcalá professor since 1988. He has Former President of the Spanish Society of Rheumatology.

In his more than 34 years of experience in the treatment of rheumatic diseases, it has treated more than 200,000 patients.

*Translated with Google translator. We apologize for any imperfection

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