Spondyloarthritis: Types, Symptoms & Treatment

Spondyloarthritis sounds like something you’d need a spell book to pronounce, but it’s really a family of
inflammatory arthritis conditions that mainly target the spine, hips, and other joints. Instead of the
“wear-and-tear” arthritis many people get with age, spondyloarthritis (often shortened to SpA) is driven by
inflammation from your immune system. That means it can show up earlier in life, cause stiff, painful mornings,
and sometimes bring along uninvited guests like eye inflammation, gut issues, and skin problems.

Understanding what spondyloarthritis is, the different types, symptoms, and treatment options can make this
complex condition feel a lot less mysterious. Think of this guide as your friendly, plain-English roadmap through
the world of SpAno medical degree required.

What is spondyloarthritis?

Spondyloarthritis is a group of chronic inflammatory rheumatic diseases that share common features:
inflammation in the spine and joints, changes where tendons and ligaments attach to bone, and a tendency to run
in families. These conditions are more common than many people realize and often begin in teens, 20s, or 30s.

Doctors usually divide spondyloarthritis into two big umbrellas:

Axial spondyloarthritis (axSpA) – Mainly affects the spine, sacroiliac (SI) joints in the
pelvis, and hips.
Peripheral spondyloarthritis – Primarily affects joints and soft tissues in the arms and legs,
such as knees, ankles, heels, and toes.

Spondyloarthritis can also cause inflammation outside the joints, especially in the eyes, skin, and digestive
tract. That’s why some people discover they have SpA only after an eye doctor, dermatologist, or GI specialist
notices a pattern and sends them to a rheumatologist.

Types of spondyloarthritis

“Spondyloarthritis” isn’t one single disease. It’s more like a family reunion with several related but distinct
members.

Axial spondyloarthritis and ankylosing spondylitis

Axial spondyloarthritis is the term doctors use when the main action is happening along the spine
and sacroiliac joints. It comes in two main forms:

Non-radiographic axial spondyloarthritis (nr-axSpA) – Symptoms and inflammation are present,
but damage doesn’t yet show up on standard X-rays. MRI or lab tests often help confirm the diagnosis.
Ankylosing spondylitis (AS) – Sometimes called radiographic axial spondyloarthritis, because
structural changes in the spine and SI joints do show up on X-rays. Over time, bones in the spine may fuse,
leading to reduced flexibility and a more stooped posture in some people.

Axial spondyloarthritis often starts in young adulthood with persistent, inflammatory back pain and morning
stiffness that actually gets better when you move arounda key clue that sets it apart from mechanical
back pain due to muscle strain or disc issues.

Peripheral spondyloarthritis

Peripheral spondyloarthritis focuses more on the joints and soft tissues of the limbs rather than
the spine. People may notice:

Swollen, painful knees, ankles, or feet
Pain where tendons attach to bone, like the Achilles tendon or bottom of the heel
“Sausage” fingers or toes (dactylitis), where an entire digit looks swollen

Peripheral SpA can exist on its own, but it also overlaps with other named conditions in the spondyloarthritis
family.

Psoriatic arthritis

Psoriatic arthritis (PsA) is linked to psoriasis, a chronic skin condition that causes red,
scaly patches. In PsA, joints and entheses (where tendons and ligaments attach) get inflamed. Some people also
have back or SI joint involvement that looks similar to axial spondyloarthritis. Others mainly have swollen
fingers or toes, nail changes (like pitting or separation), or knee and ankle arthritis.

Reactive, enteropathic, and undifferentiated spondyloarthritis

Reactive arthritis – Inflammation that occurs after an infection, often in the gut or
genitourinary tract. Symptoms can include arthritis, eye inflammation, and urinary or genital symptoms.
Enteropathic spondyloarthritis – Associated with inflammatory bowel diseases such as Crohn’s
disease and ulcerative colitis. People may have spinal pain, peripheral arthritis, or both.
Undifferentiated spondyloarthritis – When someone clearly has features of SpA, but doesn’t fit
neatly into any one subtype (yet). Over time, the picture may become more specific.

Common symptoms of spondyloarthritis

Symptoms can vary widely from person to person, which is one reason diagnosis is sometimes delayed. Still, there
are some classic patterns.

Inflammatory back pain and stiffness

Back or buttock pain that lasts longer than three months
Pain and stiffness worse in the morning or after rest
Improvement with movement, stretching, or exercise
Night pain that may wake you up, especially in the second half of the night

If “I wake up feeling like a rusty robot, but loosen up once I move” sounds familiar, inflammatory back pain could
be on the radar.

Peripheral joint pain and swelling

Many people with spondyloarthritis develop arthritis in joints outside the spine, especially:

Knees and ankles
Hips
Shoulders
Small joints of the hands and feet

The arthritis is usually asymmetricmeaning it doesn’t necessarily show up in the same joint on both sides of the
body.

Enthesitis and dactylitis

Two very SpA-specific features are:

Enthesitis – Inflammation where tendons and ligaments meet bone. Common spots include the
Achilles tendon, the bottom of the heel (plantar fascia), and the spots where ribs attach to the chest.
Dactylitis – Diffuse swelling of an entire finger or toe, often described as a “sausage digit.”

Extra-articular symptoms

Spondyloarthritis doesn’t always stay in the joints. It can also involve:

Eyes – Recurrent episodes of eye inflammation (most often anterior uveitis), with pain, redness,
and light sensitivity. This is a “see an eye doctor now” symptom.
Skin – Psoriasis plaques, nail changes, or rashes linked to inflammatory bowel disease.
Gut – Abdominal pain, diarrhea, or blood in the stool in people with Crohn’s disease or
ulcerative colitis.
General symptoms – Fatigue, low-grade fevers, and weight loss in active disease.

Causes and risk factors

The exact cause of spondyloarthritis isn’t fully understood, but researchers know it involves a mix of genetics,
immune system changes, and environmental triggers.

Genetics – Many people with SpA carry a gene called HLA-B27. Not everyone with
this gene gets the disease, and not everyone with SpA has the gene, but it’s a strong risk factor in many
populations.
Family history – Having a close relative with ankylosing spondylitis, psoriatic arthritis, or
other forms of SpA increases your risk.
Age and sex – Symptoms often start before age 45. Some subtypes, like ankylosing spondylitis,
are more common in males, though women certainly get them too and may be underdiagnosed.
Infections and environment – Certain gut or genitourinary infections have been linked to
reactive arthritis. Microbiome changes and smoking may also influence disease severity.

How spondyloarthritis is diagnosed

There’s no single “spondyloarthritis test.” Instead, doctors gather clues from your symptoms, physical exam,
imaging, and blood work. A rheumatologist (a specialist in joint and autoimmune diseases) usually leads the
diagnostic process.

Key clinical clues

Inflammatory back pain beginning before age 45
Morning stiffness lasting 30 minutes or more
Arthritis in the hips, knees, ankles, or small joints of the feet
History of enthesitis, especially at the heel or bottom of the foot
Eye inflammation (uveitis), psoriasis, or inflammatory bowel disease
Family history of spondyloarthritis or related conditions

Imaging tests

Imaging helps confirm inflammation and structural changes:

X-rays – Can show structural damage in the sacroiliac joints and spine, such as erosions,
sclerosis, or bone fusion. These changes take time to appear.
MRI – More sensitive than X-rays for early inflammation, especially in the SI joints. MRI can
detect bone marrow edema and other early changes before damage becomes permanent.

Laboratory tests

Blood tests can support the diagnosis but don’t prove or rule out spondyloarthritis on their own.

HLA-B27 – A genetic marker that increases risk, especially in axial forms. Many people with
axSpA test positive, but not all.
Inflammatory markers – C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may be
elevated, especially during flares. However, they can also be normal in some patients with active disease.

Your doctor may also use classification criteria developed by international expert groups to help categorize your
type of SpA, especially in clinical trials or research studies.

Treatment options for spondyloarthritis

There’s no cure yet, but the good news is that modern treatments can dramatically reduce symptoms, control
inflammation, and protect your joints and spine. A typical treatment plan combines lifestyle changes, physical
therapy, and medications.

Lifestyle strategies and self-care

Stay active – Regular movement is one of the best therapies for axial SpA. Walking, swimming,
cycling, and low-impact exercise help maintain posture, flexibility, and strength.
Stretching and posture exercises – Daily stretching for the spine, hips, and shoulders can help
counter stiffness. Many rheumatology teams refer patients to physical therapists who specialize in SpA.
Quit smoking – Smoking has been linked with worse disease activity and more structural damage in
some forms of spondyloarthritis.
Sleep and stress management – Good sleep hygiene, stress reduction techniques, and mental health
support make it easier to handle chronic pain and fatigue.
Heat and cold – Warm showers, heating pads, or cold packs can temporarily ease stiffness and
pain in specific areas.

Medications

Medication choices depend on your type of spondyloarthritis, where inflammation is happening, and how severe your
symptoms are.

NSAIDs (nonsteroidal anti-inflammatory drugs) – Drugs like naproxen, ibuprofen, and
prescription-strength NSAIDs are usually first-line treatment. They reduce pain and inflammation and can make a
huge difference for many people with axial SpA.
Biologic therapies – If NSAIDs aren’t enough, biologic medications are often the next step.
These target specific immune pathways:
- TNF inhibitors – Block tumor necrosis factor (TNF), a key inflammatory molecule. They are
  widely used in axSpA, ankylosing spondylitis, psoriatic arthritis, and enteropathic SpA.
- IL-17 inhibitors – Target interleukin-17, another cytokine involved in inflammation.
  Several IL-17 blockers are FDA-approved for axial and peripheral forms of SpA, especially in ankylosing
  spondylitis and PsA.
- JAK inhibitors – Oral medications that interfere with Janus kinase (JAK) signaling in the
  immune system. These are newer options being used in some forms of axial and peripheral SpA.
Conventional DMARDs – Drugs like sulfasalazine or methotrexate can help with peripheral joint
inflammation, especially in psoriatic arthritis. However, they’re generally not effective for spine-only
disease.
Corticosteroids – Short courses by mouth or targeted injections into a particularly angry joint
or tendon can calm flares. Long-term high-dose steroid use is usually avoided because of side effects.
Pain relievers – Acetaminophen, topical treatments, and other supportive medications may be
added to the regimen, always under medical guidance.

Because these medications affect your immune system, regular lab monitoring and follow-up appointments are key.
Your rheumatologist will help balance benefits and risks based on your health history and treatment goals.

Procedures and surgery

Most people with spondyloarthritis never need surgery. But in advanced or severe cases, it may help:

Hip or knee replacement for joints that are severely damaged and painful
Spine surgery in rare cases of extreme deformity, fractures, or nerve compression

These decisions are highly individualized and made with both rheumatologists and orthopedic surgeons.

Living well with spondyloarthritis

Spondyloarthritis can reshape your daily routine, but it doesn’t have to steal your life. Many people continue
working, exercising, and enjoying family and hobbies with the right treatment plan.

Build a care team – A rheumatologist, primary care provider, physical therapist, and sometimes
ophthalmologist, dermatologist, or gastroenterologist may all be part of your support system.
Ask about work and school accommodations – Ergonomic chairs, standing desks, and flexible
schedules can make a big difference.
Prioritize mental health – Chronic pain and fatigue can increase the risk of anxiety and
depression. Counseling, support groups, or online communities can help you feel less alone.
Track your symptoms – Keeping notes on pain levels, stiffness, sleep, and flares helps you and
your doctor judge whether treatments are working.

The overall goal is not just fewer symptoms on paper, but a life where you can do more of what matters to youwith
less pain, stiffness, and worry.

Real-life experiences: What living with spondyloarthritis can feel like

Medical definitions and treatment algorithms are important, but they don’t fully capture the day-to-day reality of
living with spondyloarthritis. While everyone’s experience is different, common themes show up again and again in
patient stories.

Imagine someone like Alex, a 29-year-old software developer who started waking up with tight,
aching lower back pain. At first, Alex blamed their office chair, long commutes, and a few intense gym sessions.
But instead of easing up, the stiffness got worseespecially in the morning. It took hot showers and a good hour
of moving around before their back began to loosen. Oddly enough, going for a walk or doing yoga helped far more
than “resting.”

Over time, Alex noticed heel pain that made those first steps out of bed feel like walking on rocks. Then came an
episode of a painfully red, light-sensitive eye, which an eye doctor labeled “uveitis.” Once a rheumatologist put
the pieces together and diagnosed axial spondyloarthritis, Alex felt a mix of relief (finally, an explanation!) and
anxiety (what does this mean long-term?).

Treatment started with NSAIDs and a tailored exercise program. Within weeks, mornings became less brutal. But
long days at a desk still caused a slow, creeping stiffness. So Alex worked with their employer to get an
adjustable desk and scheduled short movement breaks throughout the day. Instead of powering through pain, they
built “micro-stretches” into their routine, like a private, standing yoga class between emails.

After a while, flares became more frequent, and MRI imaging showed ongoing inflammation in the sacroiliac joints.
That’s when Alex and their rheumatologist decided to add a biologic (a TNF or IL-17 inhibitor, for example). The
change didn’t happen overnight, but over a couple of months the baseline level of pain dropped noticeably. Alex
still had the occasional flareespecially after viruses, big life stress, or overdoing it physicallybut the lows
weren’t as low, and the recovery was faster.

Then there’s someone like Maria, a 42-year-old teacher with psoriasis who started having painful,
swollen fingers and toes. At first, she thought she’d just “overused” her hands grading papers and setting up her
classroom. But the swelling wasn’t just in the jointsit involved entire digits, giving them that classic
“sausage” look. A rheumatologist diagnosed psoriatic arthritis with features of peripheral spondyloarthritis.

Maria’s journey involved trial and error with medications. A conventional DMARD helped some, but not enough. A
biologic that targeted both her skin and joints made a bigger difference. One unexpected benefit: she could write
on the board again without constantly switching markers between hands to give her fingers a break.

Many people with spondyloarthritis describe an emotional arc too: confusion and self-doubt at the beginning (“Is
this in my head?”), frustration at delays in getting a diagnosis, and then cautious optimism as treatments start
working. They learn to notice early warning signs of a flaremaybe extra fatigue, subtle eye irritation, or a
familiar pattern of stiffnessand respond sooner rather than later.

There are also practical life skills that people with SpA become surprisingly good at:

Choosing travel seats that allow for stretching and walking breaks (aisle seats, we see you).
Packing heat wraps or small pillows to support the lower back on long car rides.
Negotiating plans with friends so activities are more “walk and talk” instead of “sit for four hours without
moving.”
Saying “no” (or “not this time”) when the body clearly needs rest, then saying “yes” to movement when joints
feel too stiff to stay still.

A big part of living with spondyloarthritis is learning your personal “sweet spot” between activity and rest,
between pushing your limits and protecting your joints. For many, the combination of modern medications,
supportive healthcare providers, and smart lifestyle adjustments turns SpA from an overwhelming diagnosis into
something real but manageablea part of life, not the whole story.

Conclusion

Spondyloarthritis is a complex, chronic inflammatory condition that can affect the spine, joints of the limbs,
and even the eyes, skin, and gut. Understanding the different typesaxial, peripheral, psoriatic, reactive,
enteropathicand recognizing hallmark symptoms like inflammatory back pain, enthesitis, and dactylitis can speed
up diagnosis and treatment.

While there’s no cure yet, a combination of movement, physical therapy, and powerful modern medications (from
NSAIDs to biologics and JAK inhibitors) can significantly reduce symptoms and protect long-term joint health.
Partnering closely with a rheumatologist and building a lifestyle that supports your bodya bit more stretching
here, a bit less sitting therecan help you live a full, active life with spondyloarthritis.