We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Below we will list the departments and units that form part of Vall d’Hebron Hospital and the main diseases that we treat. We will also make recommendations based on advice backed up by scientific evidence that has been shown to be effective in guaranteeing well-being and quality of life.
We will guide you from your first visit to the centre, allowing you to find all the departments and make the most of our facilities. Whatever the reason for your visit, we will explain how to get about the hospital.
Spondyloarthritis is the name of a group of diseases whose common element is inflammation of the axial skeleton (especially the spine), although it can also affect the peripheral joints (hands, feet, knees, etc.). The following diseases are included in this group: axial spondyloarthritis (or ankylosing spondylitis, in its more advanced stage), psoriatic arthritis, arthritis related to inflammatory intestinal disease, reactive arthritis, and a subgroup of juvenile idiopathic arthritis.
The most common symptom is pain in the lower back or buttocks (inflammatory lumbar pain). This pain is characterised by worsening with rest and improving with exercise. It is associated with prolonged morning stiffness, can wake patients up in the night, and it improves with anti-inflammatory medications. It can also affect the peripheral joints; this is most common in psoriatic arthritis, which can manifest as pain and inflammation in the knuckles, wrists, feet, and other joints.
Spondyloarthritis also affects what we call the enthesis, where a tendon inserts into a bone. The most commonly affected entheses are the Achilles tendon and the epicondyles (elbows), although any tendon insertion can be affected.
Finally, these diseases also present with manifestations outside the joints, and these may be the only visible presentation of the illness. These include inflammation of the eye (uveitis), inflammatory intestinal disease (ulcerative colitis or Crohn's disease), or inflammation of the skin (psoriasis). In fact, 30% of patients with psoriasis have psoriatic arthritis and the skin lesions tend to predict the joint disease.
Spondyloarthritis can affect anyone, although it usually presents between adolescence and 50 years of age. Axial spondyloarthritis usually manifests before the age of 40, while psoriatic arthritis can start later (between 30 and 50 years of age). These affect women and men equally, even though axial spondyloarthritis is slightly more prevalent in men.
It is quite common for people who have one of these illnesses to have family members with the same disease or another spondyloarthritic condition. That is why it was decided these be grouped together, thinking that they share a common aetiology. Thus, genetics is the main cause of these diseases, with several genes identified; the most prominent is HLA-B27, which can be detected in the laboratory, making diagnosis easier. Other causes, like infectious aetiologies, have been investigated, since in many cases the disease is preceded by an infection that acts as a trigger.
The diagnosis of the disease is done in a comprehensive way, considering the symptoms the patient complains of, the physical examination, the analytical results, and the imaging (X-ray, ultrasound, MRI) results. It's important to consider that there is no one analysis or other test that can diagnose these diseases by itself; it will always require a specialist in rheumatology to perform a medical evaluation of the situation as a whole.
Since the symptoms they present can be confused with very common conditions (lower back pain) and there is no specific test that can diagnose them unequivocally, it's common for a diagnosis to take up to 10 years. It is routine for patients to visit multiple professionals and specialists (traumatologists, physical therapists, osteopaths, primary care physicians, etc.) before receiving a diagnosis.
One of the treatment pillars for spondyloarthritis is exercise and physical therapy that targets the joints. The main pharmacological options are anti-inflammatory agents, and in case these do not control the illness, the so-called disease modifying drugs (DMDs) will then be used. Within the DMDs, we use conventional DMDs, like methotrexate and sulfasalazine, and more recently we have begun using biological and synthetic DMDs, which represent an important advance in the treatment of these diseases.
Unfortunately, there is no particular action we know of that can prevent the appearance of spondyloarthritis.Nevertheless, tobacco use is one of the most important factors involved in these diseases and their progression, so avoiding tobacco is recommended. In the case of psoriatic arthritis, the fact that the skin disease often precedes the joint disease offers us a window of opportunity to identify it early and avoid its progression. Biomarkers to be able to identify it before it appears are being researched.
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