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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.
Digestive System, General Hospital
This test is performed to check if there are alterations in the motility (movements) of the stomach and the small intestine when fasting and after eating.
The gastrointestinal manometry allows us to detect changes in the movement of the oesophagus, as well as making sure the oesophageal sphincter opens and closes properly to allow food to pass properly from mouth to stomach. It is also useful for assessing the condition of the inner oesophageal sphincter and making sure it closes properly in people who suffer from acidity, heart burn, retrosternal pain or repetitive pneumonia. It also allows us to check the results of some treatments, surgical or otherwise, that affect stomach motility.
Firstly, a thin tube is inserted through the mouth that connects to a device that records the movements, a.k.a. motility, of the small intestine. We then check the device is placed properly using an x-ray.
During the test, patients should be lying down on a bed and given a light meal that they can easily swallow.
This test lasts an average of 6 hours.
Once the test is done, the professional interprets the results in order to define or discard a diagnosis.
The process of placing the probe is uncomfortable and can cause nausea, which disappears when the probe is in the right position.
Endoscopy with endoscopic capsule is used to study the intestines. In order to perform this exploration, patients must swallow a small capsule that travels naturally through the gut. As it makes its way down, this capsule collects images that are studied later.
To do this test, sensors are placed in the abdomen of the patient along with a belt with a recorder with a battery. The patient then takes the capsule with some water. The study will last 8 hours, during which the person having the test done cannot perform any activities that involve stretching, abrupt physical exertion, bending or carry out any physical activity.
The capsule comes out with the patient’s stool, but the images it has taken are saved on the recorder that the patient is wearing on a belt.
The patient must inform the doctor of all medication he/she is taking, in order to make any necessary adjustments. Also remember to follow the instructions of the professionals relating to what solids and liquids to consume before and after the test.
During the procedure, patients cannot go near areas with strong electromagnetic fields, such as amateur radio equipment or magnetic resonance imaging.
Once the endoscopy with capsule is done, patients must check their stools to make sure the capsule has been expelled properly.
Fibrocolonoscopy, or colonoscopy is an exploration that is performed to examine the large or small intestine or, if necessary, the final part of the small intestine.
If you are a diabetic patient, check with your doctor to find out about the medication guidelines you should follow.
The duration of this test is usually no longer than 30 minutes, as long as no therapeutic treatments are performed.
The aim of the intestinal biopsy is to obtain a surface fragment of the mucus of the small intestine to analyse it under a microscope. This sample helps us to determine if the patient has any disease or health problem, as well as showing us how the patient is progressing.
To take the sample, a very thin catheter is inserted through the patient's mouth to the area being explored. Then the person undergoing the test must change position until the doctor makes sure that the capsule is properly placed using x rays.
When the position of the capsule is correct, a syringe is used to collect a sample, what we call a "biopsy".
Sometimes, it is necessary to move the catheter to make sure the capsule is properly placed, which does not hurt, but can cause irritation to the throat or a feeling of nausea.
The risks involved are minimal. There may be complications, such as perforation, bleeding or difficulty in removing the capsule, though these are very rare.
Gastroenteritis is an infection that causes diarrhoea, an increase in loose stools. It is normally accompanied by vomiting, fever and stomach ache.
Every time the child passes diarrhoea or vomits they lose fluids and they need to replace them orally (by drinking). To achieve this, electrolyte solutions can be used.
If the child is vomiting, they will need to drink the solution bit by bit (one teaspoon every 5 minutes). If they are not vomiting, increase the amount gradually.
When they are not vomiting, offer them small amounts of food. Never force them to eat and make sure they drink plenty of fluids between meals.
The child should not be fasting. Offer them food without forcing them to eat. Infants with gastroenteritis normally lose some of their appetite. If they are breastfeeding, the number of feeds should be increased. Milk bottles should continue to be given in the normal doses, they should not be diluted.
A dry diet is not necessary, soft foods can be eaten if preferred. The foods that tend to be tolerated better are cereals (rice and wheat), potatoes, bread, lean meat, vegetables, fish, yoghurt and fruit. Avoid foods that are difficult to digest, with lots of fat and sugar.
To recover lost fluids, do not use homemade solutions or commercial drinks. Solutions prepared specifically for rehydration are recommended.
Do not administer medications for vomiting or diarrhoea without consulting a paediatrician.
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