Spondyloarthritis is classified according to affected areas, symptoms, and specific subgroups:

1. By course:
   • Axial spondyloarthritis: Primary involvement of the spine and sacroiliac joints.
   • Peripheral spondyloarthritis: Involvement of peripheral joints and tendon attachments.
2. By specific form:
   • Ankylosing spondylitis: Chronic inflammatory disease of the spine with possible stiffening.
   • Psoriatic arthritis: Joint inflammation associated with psoriasis.
   • Reactive arthritis: Result of an infection, e.g., of the gastrointestinal tract or urinary tract.
   • Enteropathic arthritis: Association with chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.

The causes of spondyloarthritis are complex and include genetic, immunological, and environmental factors:

• Genetic predisposition:
  • Strongly associated with the genetic marker HLA-B27.
• Immunological factors:
  • Dysregulation of the immune system leading to chronic inflammation.
• Infections:
  • Reactive arthritis following bacterial infections (e.g., by Salmonella or Chlamydia).
• Mechanical factors:
  • Microtraumas or chronic stress can exacerbate inflammation.

The symptoms vary depending on the form and progression of the disease, but typically include:

- **Pain:**

- Deep-seated back pain, especially at night or at rest.

- Pain in the sacroiliac joints radiating to the buttocks.

- **Morning stiffness:**

- Stiffness of the spine that improves with movement.

- **Inflammatory changes:**

- Swelling, redness, and pain in peripheral joints.

- **Enthesitis:**

- Pain and swelling at tendon attachments, e.g., at the Achilles tendon.

- **Systemic symptoms:**

- Fatigue, fever, and weight loss.

- **Accompanying symptoms:**

- Inflammation of the eyes (uveitis), skin changes, or intestinal inflammation.

The diagnosis is based on a combination of medical history, clinical examinations, and imaging techniques:

• Medical History:
  • Duration and course of symptoms, family history, and comorbidities.
• Physical Examination:
  • Tests to assess the mobility of the spine and sacroiliac joint (e.g., Mennell's sign).
  • Palpation of inflamed joints and tendon insertions.
• Imaging:
  • X-ray: Detection of changes in the sacroiliac joints or spine.
  • MRI: Early detection of inflammation in the sacroiliac joints or soft tissues.
• Laboratory Tests:
  • HLA-B27 test for genetic clarification.
  • Inflammatory markers such as CRP and ESR.

Conservative Therapy

The treatment of spondyloarthritis aims to relieve pain, control inflammation, and improve mobility:

• Medication Therapy:
  • NSAIDs: First choice for relieving pain and inflammation.
  • Biologics: TNF-alpha inhibitors or IL-17 inhibitors in severe cases.
  • Corticosteroids: Short-term for acute inflammation.
• Physiotherapy:
  • Exercises to improve spinal mobility and strengthen back muscles.
  • Posture training to prevent misalignments.
• Pain Management:
  • Heat or cold applications as needed.

Surgical Therapy

Surgeries are rarely required but may be necessary in advanced cases:

• Joint Replacement: In severe osteoarthritis of peripheral joints.
• Spinal Correction: To treat severe misalignments.

The following measures are suitable for preventing or alleviating symptoms of spondyloarthritis:

1. Regular exercise: Promoting mobility and strengthening muscles through targeted exercises.
2. Quitting smoking: Reducing the risk of inflammatory processes.
3. Stress management: Reducing psychological stress that can exacerbate inflammation.
4. Ergonomic posture: Avoiding incorrect strain in everyday life.
5. Regular check-ups: Early treatment of inflammatory flare-ups through medical care.