Spondyloarthritis Heidelberg

When joints, tendons and spine hurt

The spondyloarthritides (SpA) are a group of diseases in which, besides the joints, the tendons and the spine are frequently affected. They are associated with the genetic marker HLA-B27.

A distinction is made between peripheral involvement (affecting joints and tendons) and axial involvement (affecting the spine).

Doctor showing a patient information on a tablet

Forms of spondyloarthritis

The spondyloarthritides can be divided into several forms:

Ankylosing spondylitis (Bechterew’s disease):

advanced inflammatory disease of the spine, the late form of axial spondyloarthritis, in which spinal mobility is markedly reduced by stiffening of the spine

Psoriatic arthritis:

inflammatory changes of joints, tendons or spine occurring together with psoriasis

Enteropathic spondyloarthritis:

inflammatory changes of joints, tendons or spine occurring together with inflammatory bowel disease (Crohn’s disease, ulcerative colitis)

Reactive arthritis:

inflammation of a joint, usually a larger one (knee/ankle), about three weeks after a bowel or urinary tract infection

Inflammatory back pain

The hallmark of axial spondyloarthritis – spondyloarthritis with spinal involvement – is inflammatory back pain.
Inflammatory back pain is characterised as follows:

  • chronic, usually deep-seated back pain lasting more than three months
  • onset before the age of 45
  • gradual onset
  • improvement with movement
  • no improvement with rest
  • pain at night
Doctor and patient going through a medical history form

History taking in spondyloarthritis

As with all rheumatic diseases, taking the medical history is a key element in diagnosing spondyloarthritis.
We ask about the character of the pain (inflammatory pain: pain at rest? at night? worst in the morning? morning stiffness?). We also look and ask for the following symptoms that can occur with spondyloarthritis:

  • psoriasis in the patient or a close relative
  • inflammatory bowel disease (Crohn’s disease, ulcerative colitis) in the patient or a close relative
  • chronic, usually deep-seated back pain at rest (see inflammatory back pain)
  • painful joint swelling
  • frequent tendon inflammation (enthesitis)
  • dactylitis (sausage-like swelling of an entire finger or toe, hence “sausage finger”/“sausage toe”)
  • deep eye inflammation (uveitis)
Doctor examining a patient’s back

Diagnosing spondyloarthritis

Physical examination

The physical examination focuses on the joints and the spine, and we also look for skin or nail changes (“oil-drop” or pitted nails) that can indicate psoriasis.

Laboratory tests

The rheumatologist always looks at the inflammatory markers (ESR, CRP). HLA-B27 is an important genetic marker that can point to spondyloarthritis. General internal medicine laboratory values are also taken into account, particularly before a treatment decision.

Ultrasound and radiological diagnostics
Joint ultrasound can detect joint effusion, synovitis (inflammation of the joint lining) and tendinitis. A special technique (power Doppler) makes increased blood flow in the synovial membrane – and thus inflammation – visible in our practice.

Conventional X-rays are used to assess bony changes. Inflammatory changes can also be visualised by MRI.

HLA-B27

HLA-B27 is a genetic marker on the white blood cells (leukocytes) associated with the spondyloarthritis group of diseases. A positive HLA-B27 result does not necessarily mean that a patient has spondyloarthritis, however, since around 8% of the healthy population is HLA-B27 positive.

Doctor listening to a patient’s chest with a stethoscope

Treating spondyloarthritis

Treatment depends on the symptoms. Anti-inflammatory painkillers (NSAIDs, e.g. ibuprofen) can relieve pain and inflammation. Besides cortisone (glucocorticoids), used mainly for joint inflammation, sulfasalazine (e.g. in reactive arthritis) or methotrexate may be used. Where tendons or the spine are involved, cortisone and NSAIDs are often not sufficient, so in severe cases – particularly with spinal involvement – biologics are used (e.g. infliximab, adalimumab, certolizumab, golimumab, secukinumab, ustekinumab).

In addition to drug treatment, physiotherapy is extremely important, especially with spinal involvement, to maintain mobility. Patients should exercise regularly on their own. Joining a self-help group (in Germany the Deutsche Vereinigung Morbus Bechterew, DVMB) is recommended, as local groups offer weekly land and water exercise sessions.

Do you have further questions or need a diagnostic work-up? You are welcome to make an appointment at the Centre for Rheumatology Heidelberg.

Back to all services

All services

Make an appointment

Contact
+49 6221 9832980

For patients with statutory health insurance

Dear patient,

Despite our best efforts we have not been granted a statutory health insurance licence. Patients with statutory health insurance (GKV) can therefore only be seen in our practice as self-paying patients. A rheumatological work-up is best arranged in consultation and cooperation with your general practitioner. For cost reasons, the necessary laboratory diagnostics should, for example, be ordered through your GP, who is also welcome to contact one of our physicians in advance. A list of the required rheumatological laboratory values is available from the practice on request. The cost of an initial rheumatological consultation as a self-paying patient is between 150 and 200 euros. We do our best to offer every patient an appointment at short notice, particularly in the case of acute illness, joint swelling or elevated inflammatory markers. We see ourselves as a “signpost” for statutory-insured patients: once a rheumatic disease has been confirmed, we help you find a path within the statutory health care system and stay in close contact with your treating doctors.
We are happy to answer further questions by phone.

If you are interested in an examination, please send an e-mail to rheumatologie-hd@atos.de with the subject line “Laborwerte Kassenpatient” so that we can send you the laboratory sheet.