Ankylosing Spondylitis Vs Undifferentiated Spondyloarthropathy - Exploring the Differences

Introduction

Spondyloarthritis refers to a group of heterogeneous rheumatic inflammatory disorders that are characterized by similar inflammatory signs and symptoms along with genetic characteristics. Ankylosing spondylitis and undifferentiated spondyloarthropathy are the subtypes of the spondyloarthritis group of inflammatory diseases.

Ankylosing spondylitis is the most common type of spondyloarthritis. It is an autoimmune-mediated inflammatory chronic disease characterized by severe joint pain and tenderness in the spine that is long-lasting and, in advanced cases, may lead to joint fusion.

Undifferentiated spondyloarthropathy encompasses the clinical features that are typical of a spondyloarthritis group of inflammatory diseases, but the patients suffering from this disorder do not sufficiently fulfill the definitive diagnostic criteria for any of the established diagnostic inflammatory diseases in the group.

What Are the Causes of Ankylosing Spondylitis?

It is an autoimmune disorder caused by the interaction of several factors that, include:

• Genetic Factors - The patients have been reported to have a genetic mutation in the gene human leukocyte antigen-B. This mutated gene produces a defective protein called HLA-B27 that raises the risk of developing the disorder.

• Immunological Factors - Autoimmune-mediated diseases like Crohn’s disease, ulcerative colitis, anterior uveitis, and psoriatic arthritis increase the risk of developing the condition in individuals suffering from those diseases.

• Microbial Factors - Encountering the microbial infection acts as a triggering factor for the host’s immunity system.

• Endocrinal Disturbances - Lower levels of vitamin D and sex hormones increase the risk of susceptibility of individuals to ankylosing spondylitis.

Ankylosing spondylitis is one of the most common types of spondyloarthropathy. The prevalence is higher in Caucasians. Males are more commonly affected than females.

What Are the Clinical Symptoms of Ankylosing Spondylitis?

The early clinical features of ankylosing spondylitis include:

1. The lower back stiffness and pain might radiate to the hips.

2. The pain is initially mild, which might worsen with time.

3. Pain is usually aggravated during the morning hours or after long inactive periods.

4. The pain usually occurs in episodes.

5. Extreme fatigue.

6. Pain in the neck.

7. Joint pain and tenderness.

8. Pain in the abdomen.

9. Nausea and vomiting.

10. Unexplained weight loss.

11. Breathlessness.

12. Pain, swelling, and stiffness in other parts of the body may also occur.

13. Inflammation and arthritis at the point where the tendon joins the bone.

14. The most commonly affected areas of the body include:

• The joint between the spine and pelvic bone.

• Lower back vertebrae.

• Points where the tendons are connected to the bones.

• Cartilage is present between the chest bone and ribs.

• Joints of the shoulders and hips.

How Is Ankylosing Spondylitis Diagnosed?

The following diagnostic tests can be carried out to confirm the diagnosis of the disease.

• Magnetic Resonance Imaging: They can be used to detect spinal pathologies that cannot be detected on conventional X-rays.

• Spinal X-Rays: They are carried out to look for swelling in the spinal bone.

• Hematological Tests: Blood tests can be carried out to detect the presence of the mutated gene human leukocyte antigen-B.

What Are the Serious Complications of Ankylosing Spondylitis?

Ankylosing spondylitis may affect other parts of the body, including the spine. It can lead to serious complications, including:

• Fractures of the spine.

• Osteoporosis (a condition where the bones become brittle due to loss of mineral content).

• Fusion of the vertebrae is known as spondylodesis.

• Heart diseases.

• Inflammation in the eyes, such as iritis or uveitis.

• Sensitivity to light.

• Kyphosis (forward bending of the spine).

• Chest pain and infection.

• Kidney diseases.

• Inflammation in the jaws.

How to Treat and Manage Ankylosing Spondylitis?

There is no definite cure for the disease. The treatment is aimed at reducing the symptoms of the condition and preventing the complications of the disease.

The management of the condition includes:

• Physical Exercise: The pain is aggravated if the individual becomes inactive. Therefore, it is very crucial to do some amount of physical activity to stop the progression of the disorder. The doctor recommended physical exercises that are safe to perform should be done by the individual.

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These anti-inflammatory drugs are given to relieve pain, swelling, and inflammation at the affected site.

• Anti-Rheumatic Drugs: Newer drugs are disease-modifying and are called biologics. These include interleukin inhibitors and tumor necrosis factors that are used to reduce the inflammatory reaction by altering or modifying the host’s immune system.

• Corticosteroid Injections: They can be given to reduce the inflammation and tenderness in the joint.

• Surgery: Joint replacement surgery may be required in specific individuals to repair severely damaged joints.

• Lifestyle Modifications: Eating a well-balanced diet, maintaining the proper weight, and cessation of smoking and alcohol are some of the measures that can be taken to stop the progression of the disease.

When Should the Patient Seek Medical Advice?

The patient should seek medical advice if the symptoms of ankylosing spondylitis are persistent and worsen with the passage of time. If there is rigidity in the spine, chest pain, and vision problems, the patient should immediately visit a doctor for further intervention.

How Is Undifferentiated Spondyloarthropathy Different From Ankylosing Spondylitis?

Undifferentiated spondyloarthropathy is chiefly characterized by the following:

• An inflammatory lower back pain, arthritic changes mainly involving the large joints in the lower extremities, and enthesitis (inflammation of the points where the tendons are connected to the bone surface).

• Females are more commonly affected by ankylosing spondylitis.

• A higher tendency for human leukocyte antigen B-negative patients to be affected than the cases of ankylosing spondylitis.

What Are the Causes of Undifferentiated Spondyloarthropathy?

• The disease is caused by a number of risk factors, including hereditary, microbial, and immune-mediated diseases.

• Intestinal inflammation has also been associated with the onset of arthritic changes in the joints in some patients.

• Human leukocyte antigen B-negative patients have a higher tendency to get affected by the condition.

What Are the Symptoms of Undifferentiated Spondyloarthropathy?

• Usually, the only symptom experienced by the patient having undifferentiated spondyloarthropathy is pain and tenderness in the spine.

Other Symptoms May Be:

• Chronic lower back pain may radiate to the hip region.

• General rigidity in the body.

• Diarrhea in some patients.

• Inflammation of the intestines.

• Pain in the heels.

• The onset of pain is usually in the 3rd to 4th decade of life.

• Females are more commonly involved as compared to males.

• Rash on the skin.

• Fever.

• Fatigue.

• Inflammation in the eyes.

• Inflammation in the urinary tract.

How to Diagnose Undifferentiated Spondyloarthropathy?

This condition can be easily mistaken for other rheumatic diseases in the group.

• Expert Advice - An expert doctor who has complete knowledge of rheumatologic diseases should be consulted.

• Physical Examination - A thorough physical examination should be conducted.

• Ileocolonoscopy - Since intestinal inflammation is common, therefore it is necessary to perform an ileocolonoscopy.

• Digestive Infections - This should be ruled out.

• Antibody Tests - These can be performed to look for immune responses.

• Test for the HLA-B27 Gene - This test is taken to rule out cases of ankylosing spondylitis.

What Is the Treatment of Undifferentiated Spondyloarthropathy?

The management of the disease includes:

• Drug Therapy - Nonsteroidal anti-inflammatory drugs or Corticosteroids are mainly given to reduce pain and inflammation.

• Heat Therapy - To relieve stiffness in the joints.

• Ice Packs - To relieve pain and swelling.

• Massage Therapy - To improve blood circulation.

• Weight Loss - The weight should be under control.

• Surgery - In very few cases, it is recommended.

Conclusion

Both conditions worsen with the passage of time. The symptoms such as pain and joint stiffness interfere with the day-to-day activities of an individual and may lead to depression. Hence, early diagnosis and management of the disease are crucial to prevent the disease from progressing. Physical exercise with lifestyle modifications and drug therapy can help to alleviate pain.