Axial spondyloarthritis (axSpA) mostly affects the spine. It can cause damage visible on X-ray (ankylosing spondylitis) or damage that doesn’t show up on X-rays (nonradiographic axSpA).
 

What Is It?

Axial spondyloarthritis (axSpA) is a type of arthritis. It mostly causes pain and swelling in the spine and the joints that connect the bottom of the spine to the pelvis (sacroiliac joint). Other joints can be affected as well. It is a systemic disease, which means it may affect other body parts and organs. The disease tends to run in families. 
There are two types of axSpA:

• Radiographic axSpA (also called ankylosing spondylitis or AS) includes damage to the sacroiliac joints and spine that can be seen on X-rays.

• Nonradiographic axSpA (nr-axSpA) does not include damage you can see on X-rays but it may show up on magnetic resonance images (MRIs).

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The disease can occur at any age, but typically begins between ages 20 and 40. AS is more common in men than in women. However, nr-axSpA may be just as common in women as in men. It is less common among African Americans than people of other racial backgrounds.

 

What Are The Symptoms?

Low back, buttocks and hip pain are usually the first symptoms. Children, however, may have pain in the hips, knees or heels before the back. 

Symptoms of axSpA include:

• Pain in the low back, buttocks and hips that develops slowly over weeks or months.

• Pain, swelling, redness and warmth in the toes, heels, ankles, knees, rib cage, upper spine, shoulders and neck. 

• Stiffness when first waking up or after long periods of rest.

• Back pain during the night or early morning. 

• Fatigue.

• Appetite loss. 

 

What Are The Health Effects?

Joints:   Over time, the joints and bones of the spine may grow together (fuse). This usually happens at the base of the spine first. This causes the back to become stiff and hard to move. The rib cage may also fuse, making chest expansion difficult. 

Eyes: Chronic eye inflammation (uveitis) causes dryness, pain, redness, sensitivity to light and vision problems. The white part of the eye may also get inflamed and red (called scleritis).

Digestive Tract: Inflammation may cause abdominal pain and diarrhea.

Heart: Though uncommon, inflammation may affect the largest artery that leads to the heart (aorta). People with axSpA also have an increased risk for heart attack and stroke.
 
Lungs: Complications affecting the lungs are rare. Inflammation may cause shortness of breath and impaired lung function.

 

How Is It Diagnosed?

The most common symptom of axSpA, which often affects the joints where the spine meets the pelvis, is pain in the lower back, buttocks and hips.

 

It can also affect shoulders, knees, toes and fingers, as well as the eyes and gastrointestinal tract, and symptoms often begin in the teen and young adult years.

 

No single test can detect axSpA. It may involve a physical exam, blood and imaging tests and the doctor’s judgment.

Other signs of axSpA might include:

• Symptoms that come on gradually.

• Pain that lasts at least three months.

• Nighttime pain and morning stiffness.

• Less pain with movement.

• Blood tests that indicate bodywide inflammation.

• A positive HLA-B27 gene test and X-rays or MRIs showing changes in the pelvic joints may also point to axSpA but don’t confirm it.

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What Are The Treatment Options?

There is no cure for axial spondyloarthritis but treating it quickly and aggressively can.

• Ease back pain and help maintain your posture

• Prevent joint damage

• Help you maintain mobility and quality of life

Symptoms vary widely.

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Treatment may include activities and medications:

• Exercise, which is essential for pain relief and range of motion in your neck and back.

• Posture training.

• Nonsteroidal anti-inflammatory drugs (or NSAIDS), commonly used for axSpA, include over-the-counter or prescription medications.

• Corticosteroid (steroid) shots may ease joint pain and swelling but are not used in the spine.

• Biologics tamp down inflammation that drives the disease. Biologics used for axSpA include tumor necrosis factor (or TNF) blockers and interleukin-17 (or IL-17) blockers, but not everyone with axSpA needs these powerful drugs.

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Steps you can take to relieve symptoms include:

• Regular, low-impact physical activity, such as walking

• Quitting smoking, which can worsen disease and make some medications less effective

• Hot and cold therapy

• Relaxation, such as deep breathing and mindful meditation.