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Spondyloarthritis
It is a type of arthritis that attacks the spine and, in some people, the joints of the arms and legs.
It can also involve the skin, intestines and eyes. The main symptom (what you feel) in most patients is low back pain. This occurs most often in axial spondyloarthritis.
In a minority of patients, the major symptom is pain and swelling in the arms and legs. This type is known as peripheral spondyloarthritis.
Many people with axial spondyloarthritis progress to having some degree of spinal fusion, known as ankylosing spondylitis.
Diseases & Conditions
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis/Reiter’s syndrome
Enteropathic arthritis
Undifferentiated: Patients with features of more than one disease who do not fit in the defined categories above
AS is a chronic, systemic, inflammatory disease of the joints and ligaments of the spine. Other joints may be involved.
This typically results in pain and stiffness in the spine.
The disease may be mild to severe. The bones of the spine may fuse over time, causing a rigid spine.
Early diagnosis and treatment may help control the symptoms and reduce debility and deformity.
The onset is typically in late adolescence to early adulthood. It is rare for AS to begin after age 45. Ankylosing spondylitis tends to start in the teens and 20s and strikes males two to three times more often than females.
Family members of affected people are at higher risk, depending partly on whether they inherited the HLA-B27 gene.
The incidence is 1 in 1000 persons. About 90% of people with AS have the HLA B27 gene.
The cause of AS is unknown, although there appears to be some genetic component. AS is associated with the HLA B27 gene, but it is unclear why. The gene is seen in about 8% of normal Caucasians. There are no known infectious or environmental causes. The gut organisms may play a role in causing the disease.
Early on, there is pain and stiffness in the buttocks and low back due to sacroiliac joint involvement.
Over time, the symptoms can progress up the spine to involve the low back, chest and neck. Ultimately, the bones may fuse together, causing a limited range of motion of the spine and limiting one’s mobility.
Shoulders, hips and sometimes other joints may be involved.
AS may affect tendons and ligaments. For example, the heel may be involved with Achilles.
Tendonitis and plantar fasciitis.
Since it is a systemic disease, patients can get fever and fatigue, eye or bowel inflammation, and Rarely, there can be heart or lung involvement.
AS is typically non-life-threatening.
Usually, it is a slowly progressive disease. Most people are able to work and function normally.
How is ankylosing spondylitis (AS) diagnosed?
The diagnosis is typically suspected by the doctor based on the signs and symptoms. The doctor will take a thorough history and do a physical examination.
X-rays, especially those of the sacroiliac joints and spine, can be confirmatory.
If X-rays do not show enough changes, but the symptoms are highly suspicious, your doctor might order magnetic resonance imaging, or MRI, which shows these joints better and can pick up early involvement before an X-ray scan.
The HLA B27 gene may be checked by a blood test, but its presence or absence does not ultimately confirm or reject the diagnosis.
At this time, there is no known curative treatment.
The goals of treatment are to reduce pain and stiffness, slow progression of the disease, prevent deformity, maintain posture and preserve function.
Exercise programs are an essential part of the treatment.
Patients may be referred for a formal physical therapy program. Patients with AS are given daily exercises for stretching and strengthening, deep breathing exercises and posture exercises to avoid stooping and slumping. Most recommended are exercises that promote spinal extension and mobility.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are traditionally used to control symptoms. There are many drug treatment options. The first lines of treatment are the NSAIDs, such as naproxen, ibuprofen, meloxicam or indomethacin. No one NSAID is superior to another. Given in the correct dose and duration, these drugs give great relief for most patients.
Steroids, such as cortisone or prednisone, are rarely used, except for with injections to a tendon or joint. Sometimes, medications that are normally used for rheumatoid arthritis, such as sulfasalazine or methotrexate, may be used. These appear to be less helpful for spine disease.
Frequent exercise is essential to maintain joint and heart health.
If you smoke, try to quit. Smoking aggravates spondyloarthritis and can speed up the rate of spinal fusion.
TNF alpha-blockers (a newer class of drugs known as biologics) are very effective in treating both the spinal and peripheral joint symptoms of spondyloarthritis. TNF alpha-blockers that the FDA has approved for use in patients with ankylosing spondylitis are:
infliximab (Remicade), which is given intravenously (by IV infusion) every 6-8 weeks at a dose of 5 mg/kg;
etanercept (Enbrel), given by an injection of 50 mg under the skin once weekly;
adalimumab (Humira), injected at a dose of 40 mg every other week under the skin;
Golimumab (Simponi), injected at a dose of 50 mg once a month under the skin.
However, anti-TNF treatment is expensive and not without side effects, including an increased risk for serious infection. Biologics can cause patients with latent tuberculosis (no symptoms) to develop an active infection.
Therefore, you and your doctor should weigh the benefits and risks when considering treatment with biologics. Those with arthritis in the knees, ankles, elbows, wrists, hands and feet should try DMARD therapy before anti-TNF treatment.
These drugs may not only help symptoms but also slow the progression of the disease. They are only given as IV’s in the doctor’s office or by self-administered shots at home.
Surgical options are limited. 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.
Other problems can occur in patients with spondyloarthritis.
Osteoporosis, which occurs in up to half of patients with ankylosing spondylitis, especially in those whose spine is fused. Osteoporosis can raise the risk of a spinal fracture.
Inflammation of part of the eye called uveitis, which occurs in about 40% of those with spondyloarthritis. Symptoms of uveitis include redness and pain in the eye. Steroid eye drops most often are effective, though severe cases may need other treatments from an ophthalmologist.
Inflammation of the aortic valve in the heart, which can occur over time in patients with spondylitis.
Psoriasis, a patchy skin disease, which, if severe will need treatment by a dermatologist
Intestinal inflammation, which may be so severe that it requires treatment by a gastroenterologist.
RAJESH KUMAR AGGARWAL5 October 2023Dr. Himanshu Aggarwal is very humble and experience doctor in his field.Vinay Gupta4 October 2023Really an eminent doctor..His diagnosis helped me a lot, ..May God bless him...Ritik Singh.22 September 2023Dr. Himanshu Aggarwal (Rhemutologist)is good in nature. he gives enough time to patient to satisfaction, and clear all the quarries of the patient.Vishesh Singla22 September 2023I visited Dr himanshu aggarwal for my relative's arthritis nd within few weeks she start getting relief.. Thanks to himYogendra Singh13 September 2023डॉक्टर हिमांशु अग्रवाल जी मैक्स अस्पताल में जो हड्डी ज्वाइंट का इलाज करते हैं मेरा भी इलाज किया और मैं अपने को शत प्रतिशत ठीक महसूस करता हूं डाक्टर साहब जी को कोटि कोटि प्रणाम करता हूंJai Rawat29 August 2023Excellent Doctor, Great humanitarian Dr Himanshu Aggarwal listens very patiently & gives sufficient time to say his problem.He studies the patient and disease meticulously.He is very cheerful and gentle in his behavior.I think he is best rheumatologist in Dehi,Ghaziabad NCR.Hikmat Bahadur Aidei13 August 2023He is god for us.Ran Singh Chauhan10 August 2023First of Thankyou very very much Dr for given to valuable tratement to my disease ankylosing spondylitis.. I suffering from last five years ankylosing spondylitis and I started tratement to dr last six months before. After tratement my body pain or stiffness are ok and I sleep on bed easily.... .Yashas Bhatt27 July 2023Dr Himanshu is very humble, Knowledgable and understanding doctor. I have went to him for my mothers treatment. At first when my mother went for her check up we thought it's gonna take a lot of time for my mother to get better as she was unable to walk and was on wheel chair, but when she got consultation from him and he made us understand what's the cause of it and started my mothers treatment and within a few days my mother started getting better and now she is able to walk also. Excellent doctor for Arthritis related diseases.Saurabh Agrawal21 July 2023I met Dr Aggarwal with my mother in law on 12th Aug 2022 on Friday. Her age is 78 years and 4 months and she is suffering from Rheumatoid Arthritis, Ankylosing Spondylitis , Asthma and Diabeties. But we went to Dr Aggarwal for the treatment of RA and AS. Personality and Characteristics: Dr is very young, smart, dynamic, humble, polite and very down to earth. Listening : His listen, every single problem shared by me and my Mother in law. She gave ample amount of time and understand the history. Diagnosed: He had seen all the past 5 years reports, Prescriptions which we were carrying at least for 10-15 mins . He did not ask us to do all the tests again those my last Dr conducted just 15 days back. He considered all tests and reports. Treatment: He had given some injections initially with oral tabs and ask to come weekly then by monthly after wards once it is required. Initial first or second week the pain and swelling of my mother in law had declined like anything. My in law started moving with the help of stick before that she was not able to move from the bed. This is the first line of faith developed in my and in law mind . You dnt believe it now almost 1 year completed and my mother in law is walking without stick easily. Her medications are limited and orally only. I again insist you to meet the Dr Aggarwal if you are or near one or dear one suffering from joint pain. Thank you Dr Aggarwal!