What Is Axial Spondyloarthritis?

The main symptom of axSpA is low back pain, which may gradually worsen over time. The pain may eventually spread to your:

• arms
• hands
• legs
• feet
• ribcage
• shoulders

According to a 2018 research review, females with axSpA are more likely to experience worsening symptoms in their neck and middle back.

Aside from joint pain in your spine, you may also experience:

• joint stiffness, which may be worse at night and when you first wake up in the morning
• difficulty sleeping at night
• fatigue
• loss of appetite

Like with other inflammatory conditions, axSpA symptoms may come and go. These are known as “flares.” But for some people, the symptoms may be constant.

It’s possible for axSpA to start during childhood. Symptoms are slightly different in this age group. While adults often experience back pain as a first sign of this arthritis, children might first experience pelvic and lower extremity pain.

The exact cause of axSpA is unknown. However, this type of arthritis may be hereditary.

For this reason, a doctor may run genetic blood testing to see if you carry a known related gene called HLA-B27. It’s important to note that not everyone with this gene has axSpA.

Experts also think that axSpA may be due to a combination of genetics and exposures to certain triggers, such as viruses.

Risk factors for axSpA may include:

• having other family members with arthritis of the spine
• carrying the HLA-B27 gene
• having exposure to environmental triggers, such as viruses and bacteria
• having other inflammatory conditions, such as psoriatic arthritis

axSpA typically develops in early to mid-adulthood, around the ages of 20–40 years.

A doctor may diagnose axSpA using a combination of:

• a physical exam
• blood testing
• an evaluation of your symptom history

A primary care physician may refer you to a specialist called a rheumatologist for further testing and treatment.

Imaging tests of your spine are also critical for diagnosing this type of arthritis. These include MRI and X-ray imaging. Such imaging tests can also help your doctor determine what type of axSpA you may have: radiographic or non-radiographic.

Also called ankylosing spondylitis (AS), radiographic axSpA means that joint damage in your spine and pelvic areas is visible on an X-ray. While the damage may still exist in non-radiographic axSpA, the difference is that it’s only detectable via MRI.

As with other types of arthritis, axSpA treatment aims to help increase your mobility while slowing disease progression. Early treatment may also help you preserve your joints and prevent damage to your internal organs.

You’ll likely need a combination of treatments and strategies, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs help alleviate pain and inflammation in your spine and other affected joints. According to a 2018 review, people with spondyloarthritis tend to respond well to NSAIDs.
• Over-the-counter pain relievers: When appropriate, a doctor may recommend buying acetaminophen, aspirin, or ibuprofen, which are available over the counter.
• Corticosteroid injections: Steroid injections may help reduce inflammation and relieve inflammatory symptoms in affected joints.
• Disease-modifying antirheumatic drugs (DMARDs): A doctor may recommend DMARDs if your axSpA doesn’t respond to other treatments. You can receive DMARDs, such as biologics and tumor necrosis factor inhibitors, via injection.
• Mobility exercises: Regular exercise can help reduce inflammation and pain while also increasing heart, muscle, and joint strength and function. This may be regular exercise on your own at home or under the guidance of a physical therapist.

There’s no cure for axSpA yet, which makes early diagnosis and treatment critical.

Without treatment, axSpA may worsen joint damage in the spine and pelvic areas. It may also lead to complications, such as:

• spinal fusion
• eye inflammation (uveitis)
• inflammation in your digestive tract
• breathing problems
• heart attack
• stroke

Surgery is rarely necessary for axSpA. However, in severe cases, a doctor may recommend joint replacement surgery to help improve mobility.

Consider the following commonly asked questions about axSpA, which you may wish to discuss further with a doctor.

What is the difference between axial spondyloarthritis and ankylosing spondylitis?

AS is a subtype of axSpA. With AS, your condition may progress to causing spinal fusions, in which your spinal bones grow together.

Also, unlike non-radiographic axSpA, doctors can detect AS on an X-ray.

What does an axial spondyloarthritis flare feel like?

Low back pain is the primary symptom of an axSpA flare. You might also experience joint stiffness and overall fatigue. More advanced cases of axSpA may cause joint problems that extend to your arms and legs.

What conditions are associated with axial spondyloarthritis?

Conditions with links to axSpA include other types of arthritis, such as reactive arthritis or psoriatic arthritis. It’s also associated with other autoimmune conditions, including inflammatory bowel disease.

Common axSpA comorbidities include osteoporosis and cardiovascular disease.

AxSpA is a type of inflammatory arthritis that affects your spine. Low back pain is one of the first symptoms in males, while females may first experience symptoms in their neck or middle back. Symptoms may progress over time.

Because axSpA can affect your whole body, it’s important to contact a doctor if you have persistent low back pain along with other symptoms or risk factors. Early treatment reduces your risk of later complications.