What Is Peripheral Spondyloarthritis?
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Medically reviewed by Stella Bard, MD
Spondyloarthritis is a group of inflammatory arthritis that is broken down into two subcategories: axial spondyloarthritis and peripheral spondyloarthritis.
Symptoms of axial spondyloarthritis affect the spine and sacroiliac (pelvic) joints. The symptoms of peripheral spondyloarthritis predominately affect the upper and lower limbs but can also include symptoms in the spine and sacroiliac joints. In addition, peripheral spondyloarthritis includes conditions like psoriatic arthritis, reactive arthritis, and enteropathic arthritis.
This article will cover peripheral spondyloarthritis symptoms, causes, and treatments. It will also discuss coping with the condition and outlook after diagnosis.
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Peripheral Spondyloarthritis Symptoms
Peripheral spondyloarthritis symptoms are primarily located outside of the spine. The joints and areas that often have symptoms include:
Hands
Wrists
Shoulders
Elbows
Knees
Ankles
Feet
Inflammation of the finger or toe tendons (dactylitis) and inflammation where the tendons and ligaments attach to the bone (enthesitis) are commonly found in those with peripheral spondyloarthritis.
People with peripheral spondyloarthritis have arthritis symptoms, including pain, swelling, and stiffness in the affected area. Their symptoms will vary based on the severity of the condition and the affected regions.
Symptoms can present in other areas of the body too. When they affect these areas, the symptoms and conditions that present are:
Eyes: Iritis (inflammation of the iris of the eye)
Skin: Psoriasis
Causes
Researchers do not know what causes peripheral spondyloarthritis, but it is suspected to have a genetic and environmental component.
According to a 2020 study, 27% to 47% of people with peripheral spondyloarthritis had the HLA-B27 gene. If someone has the HLA-B27 gene, it does not mean they will have peripheral spondyloarthritis. It has only been identified as an association with the development of the condition.
A type of peripheral spondyloarthritis called reactive arthritis develops after a urinary tract infection or infectious diarrhea.
People with inflammatory bowel disease can develop peripheral spondyloarthritis, leading researchers to believe there are links between these conditions.
Despite all the information, there is still not enough known about peripheral spondyloarthritis to determine the exact cause of the condition.
Infections That Lead to Reactive Arthritis
Reactive arthritis can develop after someone has an infection caused by certain bacteria. The bacteria that have been identified are:
Shigella
Yersinia
If someone has one of these infections, it does not mean they will develop reactive arthritis. It is thought to be an interaction between the HLA-B27 gene and the infection that causes the condition to surface.
Diagnosis
There is no specific tool or test to diagnose peripheral spondyloarthritis definitively. A healthcare provider will review the person's past and current medical history and perform a physical exam. They may look at the joints to evaluate inflammation and look for signs of other conditions like psoriasis.
Blood tests can be used to determine if the HLA-B27 gene is present and to look for signs of inflammation. In addition, imaging tests like ultrasounds and magnetic resonance imaging (MRI) can look for inflammation around joints.
Treatment
Peripheral spondyloarthritis treatment is typically focused on medication management. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first medication class used. Often they will be prescribed along with other medicines like glucocorticoids.
Other commonly prescribed medications are disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate or Azulfidine (sulfasalazine). Another class of prescribed medications is tumor necrosis factor (TNF) inhibitors. For example, Humira (adalimumab) is a TNF inhibitor that is effective in people with peripheral spondyloarthritis.
Peripheral spondyloarthritis is a complex condition that should be followed by a healthcare provider who specializes in the condition. This type of healthcare provider would be a rheumatologist. Do not hesitate to ask your primary healthcare provider for a rheumatology referral to get a proper diagnosis and treatment.
Summary
Peripheral spondyloarthritis is a chronic, arthritic condition that is an umbrella term for several sub-conditions like reactive arthritis and psoriatic arthritis. Symptoms include pain, stiffness, and inflammation that can happen in joints except for the spine.
Diagnosis involves a physical exam, blood tests, and diagnostic imaging. A healthcare provider will typically treat the condition with various medications that have been shown to effectively treat symptoms.
Frequently Asked Questions
Is peripheral spondyloarthritis an autoimmune disease?
Yes, peripheral spondyloarthritis is an autoimmune disease. This means the body's immune system is attacking healthy cells and tissue causing the condition to develop.
