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Spondyloarthropathies

Alexander R. Kim, MD
Jake Van Weezep, DO
Taran W. Silva, DO

American Family Physician. 2026;114(3):262-270.

Author Disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Spondyloarthropathies are a group of inflammatory syndromes that includes ankylosing spondylitis, reactive arthritis, inflammatory bowel disease–associated arthritis, psoriatic arthritis, and undifferentiated spondyloarthropathy. Each subtype can present with axial and peripheral symptoms. These syndromes share genetic predisposition and clinical findings, including inflammatory back pain, peripheral arthritis, dactylitis, and enthesitis. Additional clinical features include ocular disease, mucocutaneous lesions, and inflammatory bowel disease. Diagnosis is made primarily through history and physical examination findings, but radiography and testing for the HLA-B27 gene are also performed. Treatment depends on the specific subtype and typically involves a multimodal approach, including nonsteroidal anti-inflammatory drugs, physical therapy, and biologic therapy (eg, tumor necrosis factor inhibitors). The goal of the family physician is to recognize early signs and symptoms and initiate appropriate treatment to optimize quality of life and minimize disease progression.

Spondyloarthropathies are a group of inflammatory syndromes that share genetic predisposition and clinical presentations.1 The traditional subtypes include ankylosing spondylitis, reactive arthritis, inflammatory bowel disease (IBD)–associated arthritis, psoriatic arthritis, and undifferentiated spondyloarthropathies 1,2 (Table 11,3–6). Clinical characteristics include low back pain, peripheral arthritis, enthesitis (inflammation of tendonous or ligamentous attachments to bone), and dactylitis (inflammation of an entire digit).1 Extra-musculoskeletal manifestations include ocular disease, mucocutaneous lesions, and IBD.7

SORT: KEY RECOMMENDATIONS FOR PRACTICE

RecommendationEvidence ratingComments
Patients with suspected spondyloarthropathy should be tested for the HLA-B27 gene.10CDisease-oriented outcomes based on expert opinion and consensus guidelines
Plain radiography should be obtained for patients with sus pected spondyloarthropathy to evaluate for sacroiliitis.10,12CDisease-oriented outcomes based on expert opinion and consensus guidelines
Nonsteroidal anti-inflammatory drugs and physical therapy are the first-line treatments for symptomatic patients with axial spondyloarthropathy.26,27AModerate- to high-quality evidence based on meta-analysis
Tumor necrosis factor inhibitors should be considered first-line treatment in patients with arthritis associated with irritable bowel disease.38CDisease-oriented outcomes based on expert opinion and consensus guidelines

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

TABLE 1. Spondyloarthropathy Subtypes

Factor Ankylosing spondylitis Reactive arthritis IBD–associated arthritis Psoriatic arthritis
Demographic Age < 45 years

More common in men		 Age 20–40 years

More common in men		 Can occur at any age

Affects males and females equally		 Age 35–45 years

Affects men and women equally
Characteristic clinical features Inflammatory back pain

Sacroiliitis		 Preceding infection

Urethritis, conjunctivitis, arthritis

Diarrhea		 Signs or symptoms of IBD Psoriatic skin lesions

Nail pitting

Uveitis
Arthritis pattern Asymmetrical, lower limbs Asymmetrical, lower limbs Asymmetrical, lower limbs Asymmetrical, any joint
Dactylitis Uncommon Common Uncommon Common
Enthesitis Common Common Uncommon Common
HLA-B27 association 90% 80% 30% 50%
First-line management NSAIDs

Physical therapy		 Antibiotics for preceding infection, if warranted, followed by observation

NSAIDs

Intra-articular corticosteroid injections		 Tumor necrosis factor, anti-interleukin-17, or Janus kinase inhibitors Topical steroids (for psoriasis)

NSAIDs

Intra-articular corticosteroid injections

IBD = inflammatory bowel disease; NSAIDs = nonsteroidal anti-inflammatory drugs.

Information from references 1 and 3 – 6.

ALEXANDER R. KIM, MD, CAQSM, is an assistant professor of family medicine at the Uniformed Services University, Bethesda, Maryland, and a family medicine residency and sports medicine fellowship faculty physician at David Grant Medical Center, Fairfield, California.

JAKE VAN WEEZEP, DO, is an assistant professor of family medicine at the Uniformed Services University, Bethesda, and a family medicine residency faculty physician at David Grant Medical Center, Fairfield.

TARAN W. SILVA, DO, is an assistant professor of family medicine at the Uniformed Services University, Bethesda, and a family medicine residency faculty physician at David Grant Medical Center, Fairfield.

Address correspondence to Alexander R. Kim, MD, at alexander.r.kim.mil@health.mil.

Author Disclosure: No relevant financial relationships.

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