Spondyloarthritis (SpA) is a family of inflammatory rheumatic diseases that primarily affect the spine and, in some cases, other joints and organs. Peripheral and undifferentiated spondyloarthritis are two subtypes that do not fit neatly into the other categories of spondyloarthritis, such as ankylosing spondylitis or psoriatic arthritis.
What is Peripheral and Undifferentiated Spondyloarthritis?
Peripheral Spondyloarthritis
Peripheral spondyloarthritis primarily affects the joints outside the spine, including the arms and legs (peripheral joints), entheses (sites where tendons or ligaments attach to bone), and sometimes the skin, eyes, and intestines. Commonly affected joints include the knees, ankles, and feet.
Undifferentiated Spondyloarthritis
Undifferentiated spondyloarthritis refers to cases where the disease does not fully meet the criteria for any specific type of spondyloarthritis but still exhibits some characteristic features. This type often includes symptoms that overlap with other forms of SpA, making it challenging to categorise precisely.
Symptoms of Peripheral and Undifferentiated Spondyloarthritis
The symptoms of peripheral and undifferentiated spondyloarthritis can vary widely but typically include:
Joint Pain and Swelling
- Peripheral Joint Pain – Pain and swelling in joints outside the spine, such as the knees, ankles, and wrists.
- Asymmetrical Involvement – Often affects one side of the body more than the other.
Enthesitis
- Inflammation at Entheses – Pain and tenderness at the sites where tendons or ligaments attach to bone, commonly the Achilles tendon or plantar fascia.
Dactylitis
- Sausage Digits – Swelling of an entire finger or toe, giving it a sausage-like appearance.
Back Pain
- Axial Involvement – In some cases, mild to moderate lower back pain may occur.
Extra-Articular Manifestations
- Skin – Psoriasis-like skin rashes may develop.
- Eyes – Uveitis, an inflammation of the eye, causing redness and pain.
- Gut – Inflammatory bowel diseases symptoms, such as diarrhoea and abdominal pain.
Causes and Risk Factors
The exact causes of peripheral and undifferentiated spondyloarthritis are not fully understood, but several factors can increase the risk of developing these conditions:
Genetic Factors
- HLA-B27 Gene – A significant genetic marker associated with spondyloarthritis. Not everyone with the HLA-B27 gene will develop SpA, but it increases the risk.
Environmental Triggers
- Infections – Certain bacterial infections can trigger the onset of spondyloarthritis in genetically predisposed individuals.
Immune System Dysfunction
- Autoimmunity – The body’s immune system mistakenly attacks its tissues, leading to inflammation.
Diagnosis for Peripheral and Undifferentiated Spondyloarthritis
Diagnosing peripheral and undifferentiated spondyloarthritis involves a combination of medical history, physical examination, and diagnostic tests:
Medical History
- Symptom Inquiry – Your doctor will ask about your symptoms, their onset, duration, and any potential triggers, as well as your family history of spondyloarthritis or related conditions.
Physical Examination
- Joint and Enthesis Assessment – Examining the affected joints and entheses for signs of inflammation, tenderness, and reduced range of motion.
Laboratory Tests
- Blood Tests – To check for markers of inflammation (e.g., C-reactive protein, erythrocyte sedimentation rate) and the presence of the HLA-B27 gene.
Imaging Tests
- X-Rays – To detect joint damage or enthesitis.
- MRI or Ultrasound – To provide detailed images of the joints and entheses, helping to identify inflammation that may not be visible on X-rays.
Peripheral and Undifferentiated Spondyloarthritis Treatment Options
The goal of treating peripheral and undifferentiated spondyloarthritis is to reduce pain, and inflammation and prevent further joint damage. Treatment options include:
Medications
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – To reduce pain and inflammation.
- Corticosteroids – Oral or injectable steroids to provide rapid relief of severe inflammation and pain.
- Disease-Modifying Antirheumatic Drugs (DMARDs) – Such as methotrexate or sulfasalazine to control inflammation and prevent joint damage.
- Biologic Therapies – TNF inhibitors (e.g., etanercept, adalimumab) or IL-17 inhibitors (e.g., secukinumab) for patients who do not respond to traditional DMARDs.
Physical Therapy
- Exercise – Engaging in regular, low-impact exercises to maintain joint flexibility and strength.
- Joint Protection – Learning techniques to protect the joints during daily activities to prevent further injury.
Lifestyle Modifications
- Healthy Diet – Maintaining a balanced diet to support overall health and reduce inflammation.
- Weight Management – Achieving and maintaining a healthy weight to reduce stress on the joints.
Managing and Preventing Peripheral and Undifferentiated Spondyloarthritis
Managing and preventing peripheral and undifferentiated spondyloarthritis involves a combination of medical treatment, lifestyle changes, and self-care strategies. Here are some tips:
- Take medications as prescribed by your doctor to control inflammation and prevent flare-ups.
- Engage in regular, low-impact exercises such as swimming, walking, or yoga to maintain joint function and overall health.
- Eating a balanced diet rich in fruits, vegetables, and whole grains supports overall health and potentially reduces inflammation.
- Achieving and maintaining a healthy weight reduces joint stress and lowers the risk of spondyloarthritis flare-ups.
- Practising stress-reduction techniques such as meditation, deep breathing exercises, and mindfulness to help manage symptoms.
- Regular visits to your healthcare provider to monitor the progression of the disease, adjust treatment as needed, and manage any complications.
Peripheral and undifferentiated spondyloarthritis are forms of arthritis that can cause significant pain and discomfort. However, with the right knowledge, treatment, and management strategies, individuals can effectively manage their symptoms, reduce inflammation, and maintain an active and fulfilling life. If you suspect you have spondyloarthritis, it’s important to seek medical advice early to manage symptoms and prevent joint damage. By staying informed, adhering to treatment plans, and making healthy lifestyle choices, you can take control of your condition and live well with spondyloarthritis.
