Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily affects the spine and the sacroiliac joints, which connect the base of the spine to the pelvis. It is part of a group of diseases known as spondyloarthropathies and can significantly impact mobility and quality of life. Unlike other types of arthritis, axSpA mainly targets the axial skeleton—the central part of the body, including the spine.

Types of Axial Spondyloarthritis

AxSpA is broadly classified into two subtypes:

1. Radiographic axSpA (Ankylosing Spondylitis - AS): In this form, damage to the sacroiliac joints can be seen on X-rays.

2. Non-radiographic axSpA: Here, patients show clinical symptoms of the disease, but joint damage is not visible on standard X-rays. However, inflammation may be detected via MRI.

Both types share similar symptoms and are often managed using the same treatment approaches.

Common Symptoms

Symptoms typically begin in early adulthood, often before the age of 45. The following are the most common signs:

  • Chronic back pain and stiffness, particularly in the lower back and buttocks

  • Pain that improves with exercise but worsens with rest

  • Morning stiffness lasting more than 30 minutes

  • Fatigue

  • Alternating buttock pain

  • Reduced flexibility or range of motion in the spine

  • Inflammation in other joints, such as hips, shoulders, or knees

  • Enthesitis, or inflammation where tendons attach to bones

  • Uveitis (eye inflammation)

Symptoms tend to fluctuate, with periods of flares and remission.

What Causes AxSpA?

The exact cause of axSpA remains unclear, but it involves an abnormal immune response that causes inflammation. Several factors are believed to contribute:

  • Genetics: The HLA-B27 gene is present in over 90% of people with ankylosing spondylitis but not everyone with this gene will develop axSpA.

  • Immune dysregulation: An overactive immune system targets the joints and spine.

  • Environmental triggers: Certain infections may initiate or worsen the disease in genetically predisposed individuals.

Risk Factors

Some individuals may be more susceptible to axSpA:

  • Family history of spondyloarthritis

  • Testing positive for the HLA-B27 gene

  • Early onset of chronic back pain

  • Male gender (although non-radiographic axSpA affects both genders equally)

Diagnosis

Diagnosing axSpA can be challenging due to the lack of visible joint damage in early stages. It often involves a combination of:

  • Medical history and symptom review

  • Physical examination

  • Blood tests, including HLA-B27

  • Imaging tests:

    • X-rays (to detect structural damage)

    • MRI (to identify inflammation before damage is visible)

Early diagnosis is crucial to prevent long-term spinal damage.

Treatment Options

There is no cure for axSpA, but treatments aim to control inflammation, relieve symptoms, and maintain mobility.

Medications

  • NSAIDs (Nonsteroidal anti-inflammatory drugs): First-line treatment for pain and stiffness

  • TNF inhibitors and IL-17 inhibitors: Biologic drugs that reduce inflammation by targeting specific immune system pathways

  • DMARDs (Disease-modifying antirheumatic drugs): Occasionally used if peripheral joints are involved

  • Corticosteroids: For short-term inflammation relief

Physical Therapy

Exercise and physical therapy are vital components of axSpA management. Benefits include:

  • Improved posture and spinal mobility

  • Pain relief and muscle strengthening

  • Enhanced flexibility and endurance

Lifestyle Modifications

  • Maintain a regular exercise routine

  • Practice good posture

  • Stop smoking

  • Ensure adequate sleep and stress management

Complications

Without proper treatment, axSpA can lead to severe complications:

  • Spinal fusion: Bones of the spine can fuse, reducing flexibility

  • Restricted chest expansion: Due to involvement of rib joints

  • Eye inflammation: Such as uveitis, which may cause vision loss if untreated

  • Cardiovascular issues: Increased risk of heart disease

Living With AxSpA

Managing axSpA requires a long-term, holistic approach. Partnering with a rheumatologist, maintaining physical activity, and staying informed are key to improving quality of life.

Support groups and mental health counseling can also be helpful in dealing with the emotional aspects of living with a chronic condition.