25th February 2025

Signs and symptoms of spondyloarthropathies

These include:

• Inflammatory back pain with features of:
  • Chronic or recurrent pain >3 months
  • Morning stiffness relieved with exercise and NSAIDs
  • Pain at night
  • Buttock pain
  • Reduction in spinal mobility due to fusion 
• Synovitis, usually affecting the asymmetric larger joints in the lower limbs (hips and knees)
• Enthesitis, most commonly causing Achilles tendonitis and plantar fasciitis 
  • In AS this can occur at the costochondral joints with pain and reduced chest expansion
• Dactylitis, with swelling of fingers and toes

AS classically has more axial features, and the other spondyloarthropathies have more peripheral features.

PsA in particular, has a number of different patterns; alongside spine-predominant, enthesopathic-predominant, and asymmetric arthritis are also:

• Symmetrical polyarthritis
• DIPJ (distal interphalangeal joint)-predominant disease 
• Arthritis mutilans in 5% with erosive arthropathy of the hands (‘telescope fingers’)

Other features are:

• Systemic fatigue, weight loss, low-grade fever, anaemia
• Non-musculoskeletal features (Table 1)

Table 1 Non-musculoskeletal features of spondyloarthritides

* The classic triad of post-infection arthritis, urethritis and conjunctivitis (‘Reiter’s syndrome’) is only seen in a minority.

General complications can include osteoporosis, fractures, nerve root entrapment and renal involvement from NSAID use.