What Is Axial Spondyloarthritis?

Axial spondyloarthritis (axSpA) is a form of inflammatory arthritis that causes chronic pain in the lower back and axial joints (spine, chest, and pelvis). This progressive condition can cause severe pain along with stiffness and fatigue. Getting an early diagnosis and beginning treatment is key to managing axSpA.

This article discusses the symptoms, causes, diagnosis, and treatment for axSpA.

Types of Axial Spondyloarthritis 

The two types of axial spondyloarthritis are:

• Ankylosing spondylitis (AS): A form of arthritis that causes inflammation in the spine. The first symptom is typically chronic back pain (for three months or longer). Imaging tests can detect any damage to the bones and joints caused by AS-related inflammation.
• Non-radiographic axial spondyloarthritis (nr-axSpA): A form of arthritis that is diagnosed when a person has ankylosing spondylitis symptoms, but imaging tests are not able to detect damage to the bones or joints. Up to 40% of people with nr-axSpA progress to a diagnosis of ankylosing spondylitis.

Axial Spondyloarthritis Symptoms

Axial spondyloarthritis symptoms are caused by autoimmune responses in the body that cause inflammation in the spine and joints.

As the condition progresses, symptoms may come and go and may vary in intensity. Symptoms typically worsen after periods of inactivity, such as sleeping and resting.

Back pain is the first and most predominant symptom of axSpA. If your back pain is related to axial spondyloarthritis, it may be:

• Chronic (lasting three or more months)
• Intermittent
• Feels worse at night
• Improves with activity, such as exercise and stretching 
• Is relieved with nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen) and Aleve (naproxen) 
• Occurs with pain in the glutes/buttocks
• Makes day-to-day life difficult due to limited flexibility
• Experienced before the age of 45 

Aside from back pain, other common symptoms of axSpA include: 

• Enthesitis (inflammation where ligaments and tendons connect with bone)
• Eye inflammation (uveitis) 
• Fatigue 
• Heel pain 
• Digestive issues
• Joint pain in peripheral joints, such as the hands, feet, arms, and legs
• Limited mobility
• Psoriasis (skin disease causing red, itchy, and scaly patches)
• Trouble sleeping

Men and women with axSpA may experience different symptoms. Women tend to have more peripheral pain in the neck, shoulders, hips, and other joints than men.

Causes and Risk Factors

Researchers are continuing to explore the causes of axial spondyloarthritis. Though a specific cause has not yet been identified, there are certain risk factors that can increase your chances of developing axSpA.

These risk factors include: 

• Family history: Some people who carry the HLA-B27 gene are at a greater risk of developing axial spondyloarthritis. 
• Gender: Previously thought of as a “man’s disease,” experts now know that women and men both develop the condition at equal rates. Women tend to get a later diagnosis and are often misdiagnosed with another condition, such as fibromyalgia, a condition causing widespread pain, before being accurately diagnosed with axSpA.
• Environment: Though not fully understood why, certain factors may increase your risk of developing axSpA. These include infections, injury to affected joints, changes to the microbiome in your colon, and exposure to pollutants and toxins in the environment.
• Lifestyle: While smoking does not cause axial spondyloarthritis, it can worsen the severity and progression of the disease. Several studies found that smoking is associated with early-onset axSpA and a decreased quality of life. Making healthy lifestyle choices, such as eating a balanced diet, exercising regularly, and not smoking, can help relieve symptoms of axSpA.

Diagnosis

If you suspect you have axial spondyloarthritis, schedule a visit with your healthcare provider or a rheumatologist, a doctor who specializes in joint-related conditions. Early diagnosis can ensure you receive timely and effective treatment and improve your long-term outcomes.

To reach a diagnosis of axial spondyloarthritis, your healthcare provider will begin with a review of your medical history, risk factors, such as family history and other autoimmune conditions, and ask about the symptoms you are experiencing. They will do a physical examination to look for joint inflammation in your spine, pelvis, and hips.

Your healthcare provider may also assess your mobility and flexibility by asking you to move your body in certain ways. These movements may include reaching for your toes, lifting up your leg, and putting your chin to your chest.

They may also perform a neurological evaluation to assess your motor and sensory functions, such as your muscle strength and reflexes. 

Lab work and imaging tests are important steps in giving an accurate diagnosis of axSpA. Blood tests will look for:

• Inflammation markers: Blood tests may detect erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, and plasma viscosity (PV) levels. All of these are common markers for inflammation and may indicate the presence of axial spondyloarthritis.
• Genetics: Axial spondyloarthritis may be a genetic disease. Blood tests can determine if you carry the HLA-B27 gene that is associated with axSpA. Carrying the gene does not necessarily mean you have the condition, but it may be a sign you have it.

Blood tests alone cannot provide enough evidence to diagnose axial spondyloarthritis, so you may also undergo some imaging tests. These tests will look for evidence that axSpA has affected your spine and joints. Tests can include:

• X-ray: X-rays can spot bone damage in your spine and sacroiliac joint. Bone damage is only visible in people with ankylosing spondylitis.
• Computed tomography (CT) scan: CT scans are used to detect structural changes in the body, particularly around the spine, to look for bone erosion or new bone formation/fusion.
• Magnetic resonance imaging (MRI): An MRI is effective at detecting inflammation in the soft tissues around the spine and sacroiliac joint in the early stages of the disease, before any damage to the joints or bones has occurred.

Treatment

There is no cure for axial spondyloarthritis, but treatments can help manage symptoms and slow the progression of the disease.

Depending on the severity of your symptoms, your healthcare provider may recommend certain types of medication, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter or prescription NSAIDs, such as ibuprofen and naproxen, are effective at relieving pain and reducing inflammation. 
• Corticosteroids: When joint inflammation and pain are not widespread, corticosteroid injections placed into the affected joints may provide immediate and ongoing relief. 
• Disease-modifying antirheumatic drugs (DMARDs): These medications help provide symptom relief and protect against further joint damage. Your healthcare provider may prescribe traditional DMARDs, such as Trexall or Otrexup (methotrexate), or biologics, such as TNF inhibitors or interleukin (IL) inhibitors.

Another way to help relieve axSpA symptoms is with exercise.

When you’re in pain, exercising may be the last thing you want to do. However, most people with axSpA find relief from their back pain with movement and gentle stretching. Finding an exercise program and sticking to it can help you build muscle and maintain a healthy weight, which protects the joints from extra pressure and stress.

Flexibility exercises and stretching can help preserve your mobility and joint function. 

If axSpA has caused significant damage to your spine that limits your mobility or causes debilitating pain, your healthcare provider may recommend surgery. The affected joints will be replaced with a prosthetic to restore function and mobility and provide pain relief.

Coping 

Living with axial spondyloarthritis means experiencing a variety of symptoms that can have a tremendous impact on your life. Living with chronic pain is hard, and finding ways to cope can go a long way in helping you live life to the fullest.

Though your pain may not fully disappear, there are measures you can take to alleviate the pain and find ways to cope, including: 

• Stay active: It’s important to stay as active as possible. Many people with axSpA find relief from their pain after movement. Getting regular exercise, even a walk around the block a couple times a day, can help keep your joints mobile, avoid stiffness, and maintain your range of motion. Exercise is also a great way to boost your mood, and the endorphins released during exercise can help reduce pain.
• Prioritize your emotional well-being: Living with chronic pain takes a toll not only on your physical health, but on your mental and emotional health too. Stress can worsen inflammation and chronic pain, so finding ways to manage stress is important. Meditation, yoga, and breathing techniques can help you calm your mind, body, and spirit.
• Find a support group: You may find it comforting to talk with others who know what it’s like to live with axSpA. Online communities and in-person groups can help you connect with others to share your experiences, ways to cope, and treatment protocols. Being part of an understanding, compassionate community can go a long way in helping you feel less alone with your disease. 
• Lifestyle changes: Making healthy lifestyle choices can help reduce your pain and improve your overall health and well-being. Eat a nutritious, balanced diet, get plenty of exercise, and sleep well. Limit your consumption of alcohol, and if you smoke, make a plan to quit. 

Summary

Axial spondyloarthritis is a condition affecting the spine, chest, and pelvic joints. It can lead to severe back pain as well as other symptoms. Diagnosis is often delayed, so it's important to meet with your healthcare provider if you are experiencing pain and other related symptoms. Treatment options such as medication, surgery, and lifestyle changes can help.

A Word From Verywell 

Living with axial spondyloarthritis can impact every aspect of your life, from your work life to your family life, your sleep, and your emotional and physical well-being. With an accurate diagnosis and proper treatment, it is possible to live a full, happy life with axSpA. Following your treatment plan and making healthy lifestyle choices can help reduce your pain and slow the progression of the disease.