Spondyloarthropathy

What is Spondyloarthropathy?

Spondyloarthropathy is a family of inflammatory joint diseases that mainly affect the spine and the large joints close to it, including the sacroiliac joints where the spine meets the pelvis. Unlike ordinary wear-and-tear back pain, this is driven by inflammation, so the pain often behaves differently.

The group includes several types. Ankylosing spondylitis is the most recognised, where long-standing inflammation can lead to fusion of the spine over time. Others include reactive arthritis after an infection, psoriatic arthritis linked to psoriasis, and the arthritis that can come with inflammatory bowel disease.

The HLA-B27 gene raises the risk but does not directly cause the condition. A hallmark is inflammatory back pain: it tends to be worse with rest and in the early morning, comes with stiffness, and eases with movement rather than with rest.

Symptoms

• Back and buttock pain that is worse at night and in the early morning
• Stiffness on waking that improves as the day goes on
• Pain that eases with activity rather than rest
• Pain and swelling in larger joints such as the hips or knees
• Reduced flexibility of the spine over time
• Fatigue during active flares

How We Treat It

This condition usually needs shared care: a rheumatologist manages the underlying inflammation with medication, and our role is to control the pain and keep you moving. When a specific joint such as a sacroiliac joint is the main pain generator during a flare, we use image-guided steroid injections to settle the local inflammation and restore function.

Where pain from the sacroiliac or facet joints persists after injections give good but temporary relief, radiofrequency ablation can interrupt the pain signal for longer-lasting comfort. We combine these procedures with an exercise programme focused on mobility and posture, because keeping the spine moving is one of the most important parts of managing inflammatory spine disease.