Understanding the Different Forms of Spondylitis
This article explores the various types of spondylitis, including ankylosing, enteropathic, reactive, psoriatic, juvenile, and undifferentiated forms. It explains symptoms, causes, and classification systems, helping readers understand this complex condition. Whether affecting the spine or peripheral joints, recognizing these types can aid in early diagnosis and effective management.
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Spondylitis, often referred to as spondyloarthritis (SpA), is a type of inflammatory joint disease primarily affecting the spine. Caused by degenerative changes like bone spurs and disc deterioration, it can limit spinal mobility and irritate nearby nerves. Many individuals experience mild symptoms or none at all, especially with age. Roughly 85% of adults over 60 show signs of spondylitis. The condition varies from mild to severe, with several classification systems describing its types.
The traditional system recognizes six main types: ankylosing spondylitis, enteropathic arthritis, reactive arthritis, juvenile spondyloarthritis, undifferentiated spondyloarthritis, and psoriatic arthritis.
According to the Spondylitis Association of America, spondylitis classifications include:
Ankylosing spondylitis: Characterized by inflammation of the spine and pelvis, it often causes inflammatory back pain before age 45. Symptoms improve with movement, and stiffness persists after rest. Progressive inflammation can lead to new bone growth, fusing spine sections and causing immobility. It may also affect hips, shoulders, heels, ribs, and other joints.
Enteropathic arthritis: Linked to inflammatory bowel diseases such as Crohn’s and ulcerative colitis, this type causes back inflammation and joint pain, often accompanied by digestive symptoms like abdominal pain, diarrhea, blood in stool, and weight loss. It affects both the spine and peripheral joints.
Reactive arthritis: Triggered by infections in the urinary or gastrointestinal tract, this form causes pain and inflammation of mucous membranes, joints, skin, eyes, and genitals. It usually lasts 3 to 12 months but can recur and become chronic.
Psoriatic arthritis: Seen in about 30% of psoriasis patients, it affects finger joints, nails, and sometimes the spine. Nail changes like pitting and crumbling may occur, with some cases experiencing spinal fusion similar to ankylosing spondylitis.
Undifferentiated spondyloarthritis: Symptoms overlap with other types, but don’t fit into specific categories. It can include heel pain, iritis, or knee swelling, often mistaken for other conditions, and may progress into a clearer form of spondylitis.
Juvenile spondyloarthritis: Developing in children and teens, it features enthesitis—pain where tendons meet bones—and peripheral joint inflammation, especially in lower limbs.
The newer classification divides spondylitis into axial and peripheral types. Axial spondyloarthritis involves the spine and pelvis, with x-ray changes found in radiographic cases, and can be nonradiographic. Peripheral spondyloarthritis affects joints outside the spine, such as the feet, ankles, knees, shoulders, elbows, wrists, and hands.
