Understanding the Types of Spondylitis

All types of spondylitis cause pain and inflammation (swelling and redness). The most common symptom is lower back pain. Other signs and symptoms may depend on the kind of spondylitis you have.

symptoms of spondylitis

Common symptoms of spondylitis include:

• fatigue
• muscle pain
• eye inflammation
• joint pain
• back pain
• swelling in the arms and legs

According to the Spondylitis Association of America, there two main ways to categorize spondylitis. In the older, more traditional way, there are six different types. A newer system breaks all spondylitis diagnoses into one of two categories.

Traditional types of spondylitis

The six traditional forms of spondylitis include:

1. Ankylosing spondylitis

Ankylosing spondylitisis the most common type. It usually affects the spine, lower back, and hip joints.

Symptoms of ankylosing spondylitis include:

• lower back pain
• hip joint pain
• stiffness
• swelling

2. Enteropathic arthritis (EnA)

This type of spondylitis is characterized by pain and inflammation in the intestines. You may have back and joint pain.

Other symptoms include:

• stomach pain
• chronic diarrhea
• weight loss
• blood in bowel movements

3. Psoriatic arthritis (PsA)

This type of spondylitis causes back pain and stiffness. It’s associated with psoriasis of the skin. Psoriatic arthritis mostly causes pain and swelling in smaller joints, like in the fingers and toes.

Symptoms include:

• pain and swelling in the hands, fingers, and feet
• skin rash (psoriasis flare-up)
• dactylitis (toe or finger swells between joints, sometimes called “sausage fingers”)

4. Reactive arthritis/Reiter’s syndrome (ReA)

ReA is a type of spondylitis that usually occurs after a bacterial infection. It could be due to a sexually transmitted infection, such as chlamydia, or a gastrointestinal infection from food contaminated with Salmonella.

ReA may cause pain and inflammation in the peripheral joints (like the knees and ankles), spine, and sacroiliac joints. These are located on each side of your lower spine.

You may experience:

• joint pain and swelling
• skin rash
• eye inflammation
• bladder and genital pain and inflammation

5. Juvenile spondylitis (JSpA)

JSpA is a type of arthritis that occurs in children and teenagers. This kind of arthritis usually affects the leg joints. One leg may be affected more than another.

JSpA can look like other kinds of spondylitis. The main symptoms are pain and inflammation around the joints and in the spine.

This type of spondylitis affects areas where the muscles, ligaments, and tendons are attached to bone.

6. Undifferentiated spondylitis

This type of spondylitis is called undifferentiated because it doesn’t meet the criteria for a diagnosis of ankylosing spondylitis or related disease.

If you have undifferentiated spondylitis, you’ll likely not have the usual symptoms of back pain, skin rash, or digestive problems. Instead, you may have:

• inflammatory back pain
• buttock pain
• enthesitis (heel pain)
• peripheral arthritis
• dactylitis
• fatigue
• eye inflammation

A new way to classify spondylitis diagnosis

A newer way to classify the types of spondylitis is based on where it happens in the body. This system has two main types of spondylitis. Some people with spondylitis will have both types.

7. Axial spondylitis

These are types of spondylitis that cause symptoms in the back and groin or hip area. This group is further divided into spondylitis that causes bone and joint changes that can be seen on an X-ray or scan and those that can’t.

Axial spondylitis types may include:

• ankylosing spondylitis
• reactive arthritis
• enteropathic arthritis
• undifferentiated spondylitis
• psoriatic arthritis

8. Peripheral spondylitis

This group covers types of spondylitis that cause symptoms in the arms and legs. Common affected areas include joints in the:

• knees
• ankles
• feet
• hands
• wrists
• elbows
• shoulders

Types of spondylitis disease that fit into this category are:

• psoriatic arthritis
• enteropathic arthritis
• reactive arthritis
• undifferentiated arthritis

Doctors don’t fully know the causes of spondylitis diseases. Medical research shows that some types, like ankylosing spondylitis, may be genetic. This means you’re more likely to develop it if someone else in your family has it.

There are up to 30 genes that are linked to ankylosing spondylitis. Some of these genes may also cause other types of spondylitis.

Other possible causes of spondylitis include bacterial infections. You may have a higher risk for types like enteropathic arthritis and reactive spondylitis if you have an intestine, bladder, or genital infection.

You may be more likely to develop enteropathic arthritis if you have other inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis.

Up to 20 percent of people with IBD also have enteropathic arthritis. It’s more common in teens and younger adults.

Unmanaged stress may trigger or worsen some types of spondylitis. An older survey of people with ankylosing spondylitis found 80 percent said stress caused their symptoms.

Your doctor will perform a physical exam and discuss your medical history to find out whether you have spondylitis. You may also need tests and scans to confirm a diagnosis, such as:

• blood test to check for inflammation and signs of infection
• X-ray of your hip and pelvis
• MRI scan of your back, hip, and pelvis
• genetic testing

Keep a symptom journal, and note when you have symptom flare-ups. This may help your doctor diagnose your spondylitis.

Finding the best doctor for spondylitis

Different types of spondylitis may need different kinds of treatments. Some doctors may have specialized training and experience in treating a specific type of spondylitis, but not others. There are several ways to find a qualified specialist:

• Ask your primary care doctor to refer you to a joint or arthritis specialist who’s experienced in treating the type of spondylitis you have.
• Check information websites like the Spondylitis Association of America and the Arthritis Foundation. They have lists of doctors who treat spondylitis in your area.
• Join a local spondylitis support group to find out which doctors people recommend.

Treatment for spondylitis usually targets pain and inflammation. Bringing down inflammation (swelling) in the spine, joints, and body may help stop or reduce symptoms.

Your doctor may recommend the following:

• NSAIDs like aspirin, ibuprofen, or naproxen
• disease-modifying antirheumatic drugs (DMARDs)
• tumor necrosis alpha (TNF-alpha) blockers
• steroid injections
• steroid eye drops
• physical therapy, like the gym and water exercises
• surgery for the back or hip

what you can do at home

Home remedies to help soothe symptoms include:

• over-the-counter pain-relief medications
• support bandages and braces
• home massages
• warm baths
• infrared sauna
• balanced diet
• daily exercise
• smoking cessation
• avoidance of alcohol

Some types of spondylitis, like reactive arthritis, last for about 3 to 12 months. You may have a risk for it reoccurring if you have this type of spondylitis. Some people with spondylitis can get other kinds of arthritis.

If you have ankylosing spondylitis, you may have symptom flare-ups. Complications of ankylosing spondylitis include the spine becoming fused over time. This happens when new bone grows and makes the spine less flexible.

A rare complication of spondylitis affects the heart. The inflammation can spread to the heart and lead to serious heart disease, including:

• inflammation of the aorta and aortic valve
• cardiomyopathy
• coronary artery disease
• heart conduction problems

Spondylitis is an umbrella term for several similar kinds of arthritis diseases. It commonly affects the back, but you can have a number of associated symptoms, like eye inflammation or small joint pain, before the onset of back pain.

Tell your doctor immediately if you have any symptoms, or if your symptoms get worse. Treating spondylitis early can help reduce symptoms and avoid other health complications.