Spondyloarthritis
associated with inflammatory bowel disease (also called enteropathic
spondylarthropathy) : The arthritis occurs in men
and women equally and at any age (young to middle age). It affects both
sides of the body equally and mainly affects the spinal joints and not
the hands, knees and none spinal joints. There is a gradual development
of symptoms.
Juvenile
spondyloarthropathy : Occurs in children with arthritis,
more often in boys and almost always starts in the ankles, feet, knees,
hips and other non-spinal joints.
Undifferentiated
spondyloarthropathy : This is the diagnosis given to a
person who has symptoms that do not precisely fit into the other categories.
So a person with knee swelling and a family member affected with ankylosing
spondylitis would fit into this category.
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Why
are these diseases linked ?
The members
of the family are genetically linked. All the members are linked
to the gene HLA B27. Some of the features of a spondyloarthropathy are
:
The joints
in the pelvis (sacroiliac joints) and the spine are affected
The ligaments
and tendons attaching muscle to bone become inflamed
Bacteria
found in the gut are thought to be the common trigger to these diseases.
A person
with one condition within the spondyloarthropathy family, could develop
another condition within the family. For example, about 60% of people
with undifferentiated spondyloarthropathy develop a mild form of ankylosing
spondylitis.
If
I am told I have one diagnosis by one doctor and then am told by another
doctor that I have a different diagnosis, what does that mean ?
A lot of
people are told at different points in time new names for their condition. For
example a person with ankylosing spondylitis may develop psoriasis. It
is very difficult to define if this is ankylosing spondylitis with psoriasis
or psoriatic spondylarthropathy . However, in terms of treatment
it doesn't make a great deal of difference as treatment options remain
the same. Many of the drugs and treatments are not specific to one condition
but work on inflammation in general. This means they can be used no
matter what the diagnosis.
The problem
is that at presentation it can be very hard to define which member of
the Spondyloarthropathy family a person has and often a person progress
from one type of spondyloarthropathy to another type. For example a
person may have undifferentiated spondyloarthropathy and develop ankylosing
spondylitis. Therefore, the diagnosis can naturally change with time.
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Why
is there difficulty telling the different family members apart ?
There is
no chemical or antibody produced by people with spondyloarthropathy
that can be measured and used as a diagnostic test. Instead the
type of damage done to the bones and tissues of the body is used to
distinguish one condition from another. However, looking at damage
after it has happened means it can be many years before a full diagnosis
can be made. A person who is ultimately going to get psoriatic
spondyloarthropathy may go to their doctor with arthritis symptoms and
be told they have undifferentiated spondyloarthropathy. The disease
may then become worse and they develop symptoms that can be categorized
as ankylosing spondylitis and then develop psoriasis which means their
doctor will say it is psoriatic spondyloarthropathy. This has been
the same disease all the time, but with 3 different names. A bit
like a chain, there is overlap between the conditions and one can evolve
into another. The diagnosis in the past was not wrong, but was
how the disease looked at that point in time.
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