Axial Spondyloarthritis

What is axial spondyloarthritis?

Axial spondyloarthritis (axSpA) is a type of arthritis that affects the joints in your axial skeleton (chest, spine and pelvis). People with axSpA often have back pain before the age of 45 and may even have stiffness and pain as teens or young adults. This pain can be severe and debilitating.

AxSpA is a type of spondyloarthritis, which is a group of inflammatory arthritis conditions that cause joint pain and other symptoms. Inflammatory indicates an unregulated or overactive immune system. This causes joint or soft tissue swelling and damage.

Spondyloarthritis is different from other types of arthritis because it can affect other body systems in addition to your joints. If you have axSpA, you might experience eye inflammation, diarrhea or other problems that seem unrelated to joint pain.

Who might get axial spondyloarthritis?

Anyone can get axSpA, but it’s rare. This condition affects about 1% of people in the world. It usually occurs in people younger than 40, often starting during your teens or 20s. It occurs equally in people assigned male at birth and people assigned female at birth.

How does axial spondyloarthritis affect my body?

Over time, untreated axSpA can cause the bones of your spine to fuse together. The name for this fusion is ankylosis, and it can cause osteoporosis in your spine. This can lead to a breakdown of the bones in your spine and raise the risk of a spinal fracture (broken bone in your spine).

What causes axial spondyloarthritis?

AxSpA often runs in families. Most people with axSpA have a gene called HLA-B27. However, some people get axSpA who don’t have this gene or a family history of the condition. And many people with the HLA-B27 gene don’t get axSpA.

What are the symptoms of axial spondyloarthritis?

The most common symptom of axSpA is back pain that’s:

• Chronic (lasting three months or longer).
• Not caused by an injury or mechanical problem, such as a slipped disk or muscle spasm.

If you have axSpA, your back pain may also:

• Feel better when you exercise or move around.
• Get worse at night or during rest.
• Occur with back stiffness, especially in the morning.
• Spread to your hips or buttocks.

The inflammation from axSpA can also affect other systems in your body. For example, people with axSpA may also experience:

• Digestive problems, such as diarrhea.
• Fatigue.
• Enthesitis (swelling, calcification and bone spurs).
• Dactylitis (inflammation of fingers or toes).
• Psoriasis.
• Uveitis (inflammation of the eye).

How is axial spondyloarthritis diagnosed?

When you see your provider about your back pain, they’ll check your vital signs and perform a physical exam. These two things give your provider some general information about your health. Your provider may also perform blood tests to look for the HLA-B27 gene and C-reactive protein, which is a sign of inflammation in your body.

Your provider may also recommend imaging tests to view the bones in your axial skeleton. These tests may include:

• X-ray: Spinal X-rays can show axSpA or other bone problems.
• MRI: These highly detailed images may show spine problems sooner than X-rays.

Healthcare providers diagnose axSpA if you have back pain and other symptoms of axSpA, even if an imaging test doesn’t show inflammation. If you have symptoms of axSpA but no visible inflammation in the spine, your provider may diagnose non-radiographic axSpA. Non-radiographic means that it can’t be seen on an imaging test like an X-ray or MRI.

Some cases of non-radiographic axSpA can get worse over time, eventually showing up on an X-ray or MRI. But in many cases, non-radiographic axSpA never reaches the point of being visible on imaging tests.

How is axial spondyloarthritis treated?

There’s no cure for axSpA. But treatment can help you get relief from symptoms and improve your quality of life. Your treatment may include:

• Nonsteroidal anti-inflammatory drugs: These over-the-counter (OTC) medications, known as NSAIDS, can relieve pain and decrease inflammation. The most common types are aspirin, ibuprofen and naproxen sodium.
• Physical therapy: Your provider may refer you to a physical therapist, who guides you through special exercises designed for your needs. Physical therapy can help relieve pain and increase your flexibility and strength.
• Steroid injections: Corticosteroids are medicines that fight pain and inflammation. If you have a specific area of pain or swelling, steroid injections may help.
• Disease-modifying anti-rheumatic drugs (DMARDs): DMARDs may be an option if other treatments haven’t worked well for you. DMARDs reduce pain and joint swelling. They may also help prevent future joint damage.
• Biologics: These medications are a type of DMARD. They help control inflammation by targeting your immune system. Although biologics can be effective, they have potential side effects, such as a higher risk of infections.

How can I prevent axial spondyloarthritis?

There’s no known way to prevent axial spondyloarthritis, and it’s not caused by back injuries.

How do I know if I’m at risk?

If you have a parent or sibling with axSpA, you have a higher risk of getting this condition. However, having a family history or the HLA-B27 gene doesn’t mean you’ll get axSpA.

What is the outlook for people with axial spondyloarthritis?

There’s no cure for axSpA. If you have axSpA, your symptoms may come and go, or you might feel them all the time. People with this condition can live long, full lives. Work with your provider so you can manage symptoms and stay as healthy as possible.

How do I take care of myself?

There are a few things you can do to boost your health and manage axSpA symptoms:

• See your provider regularly and attend physical therapy if it’s part of your care plan.
• Take your medications as prescribed.
• Don’t smoke. If you do smoke, get help quitting. Smoking can make axSpA worse by raising inflammation and decreasing your bone health.
• Get regular exercise, such as walking. Exercise can help you keep your bones and joints healthy. It can help slow the progression of axSpA and increase flexibility in your spine.
• Eat a healthy diet with plenty of fruits and vegetables, which can help fight inflammation.

When should I see my healthcare provider?

Contact your provider if you notice:

• Unwanted side effects from your treatment.
• Your symptoms are getting worse.
• No improvement from your current treatment.

What is the difference between axial spondyloarthritis and ankylosing spondylitis?

Ankylosing spondylitis is a type of axSpA. Ankylosing spondylitis mainly affects the sacroiliac joints, which are the joints that connect the lower part of your spine to your hips. But AxSpA can also affect your chest or other areas of your spine.

Other types of spondyloarthritis include:

• Peripheral spondyloarthritis, which usually affects your arms and legs.
• Psoriatic arthritis, a form of arthritis linked to the skin condition psoriasis.
• Reactive arthritis, a rare type of arthritis caused by a bacterial infection.
• Inflammatory bowel disease (IBD)-associated arthritis, common in people with Crohn’s disease or ulcerative colitis.

A note from Cleveland Clinic

Living with axSpA can be challenging, but many people lead long, healthy lives with this condition. You can manage the condition by seeing your provider regularly and taking care of your overall health. Consider joining a support group for people with axSpA and spondyloarthritis. These groups can help you connect with others who understand how you’re feeling and the unique challenges you face.