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Undifferentiated Spondyloarthropathies

When a person has a variety of symptoms that cannot be classified as a specific rheumatoid disorder, they are said to have undifferentiated spondyloarthropathies.

Some doctors don't recognize this as a formal diagnosis. Some view it as related to ankylosing spondylitis, psoriatic arthritis, spondylitis associated with inflammatory bowel or Crohn's disease and reactive arthritis.

Because the symptoms tend to be general, a person may be mistakenly diagnosed as being anxious or depressed or having fibromyalgia.

Sometimes the only symptom that persons with undifferentiated spondyloarthropathies have is pain. Other symptoms that persons with undifferentiated spondyloarthropathies experience include:

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• Long-standing, on-going low back pain that comes on gradually (commonly radiating from the buttocks) before the age of 45
• General stiffness of the body that is worse on waking and gets better with exercise
• A history of swelling in the feet and hands, especially heel pain.
• A general lack of abdominal symptoms, although up to a third of patients have short episodes of diarrhea or have more than two bowel movements a day.
• Inflammation of the intestines that can only be shown by doing an ileocolonscopy. The symptoms may resemble inflammatory bowel disease or a bacterial inflection. With continued monitoring, there appears to be a strong relationship between intestinal and joint inflammation.
• Joint pain that affects both small and large joints, mainly in the legs and feet. However, this joint pain may affect one side of the body more than it does the other.
• Inflammation of the eye
• A bumpy red rash that often occurs with a fever and joint pains that come and go
• Symptoms affecting the urinary tract and genitals

As in reactive arthritis, many people with undifferentiated spondyloarthropathies have the HLA-B27 genetic marker, which suggests there is an inherited element of this disease. Studies of families show a pattern of mild intestinal inflammation or Crohn's disease.

Some findings suggest that intestinal inflammation may trigger the other rheumatic symptoms such as joint pain in this condition. A virus, bacteria or germ may also cause it.

The nature of the symptoms of undifferentiated spondyloarthropathies makes it easy to mistake for other conditions. It is not as common as other types of rheumatoid diseases. Having a trained doctor with expertise in rheumatic conditions is important for an accurate diagnosis and appropriate treatment.

Not all physicians are aware of how common this problem is, especially among women. Considering it is often overlooked makes it even more essential to do the homework for yourself.

A doctor will do a physical examination and review the patient's symptoms. He or she will do tests to exclude digestive infections. Other tests that a doctor may order to confirm a diagnosis of undifferentiated spondyloarthropathies include:

• An ileocolonscopy to see if there is inflammation in the intestines
• Blood tests for a variety of factors including antibodies or immune system responses
• A test for the HLA-B27 gene. This test helps rule out ankylosing spondylitis. More than 95% of people with ankylosing spondylitis have that gene while many fewer people with undifferentiated spondyloarthropathy do. (Having the gene doesn't necessarily mean that an individual will develop ankylosing spondylitis.)
• X-rays may show erosion of the joints in the hands and feet or the hip. These may resemble the joint damage that is often seen with rheumatoid arthritis

Undifferentiated spondyloarthropathies, like its related rheumatic disorders, is a chronic condition that requires the active participation of the patient as well as the doctor to manage.

Treatment may include:

• Drugs. These range from over-the-counter nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen to stronger pain-relieving drugs to corticosteroids. Other drugs that may be prescribed are similar to those used to manage the symptoms of ankylosing spondylitis, including tumor-necrosis factor alpha blocker
• Heat for stiffness, including hot baths and warm showers
• Ice for swelling
• Exercise
• Ultrasound
• Gentle massage therapy
• Electrical stimulators for pain (TENS or TNS units)
• Losing weight to lessen stress on joints
• Improving posture
• Surgery, in some cases.