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Axial Spondyloarthritis

Axial spondyloarthritis (axSpA) is a long-term (chronic) form of arthritis that causes significant pain in the lower back and/or buttocks that lasts for over three months. It is an umbrella term for ankylosing spondylitis (AS), where the changes to the spine and joints can be seen on x-ray, and non-radiographic axSpA (nr-axSpA), where x-ray changes are not present but there are symptoms. Nr-axSpA is the earlier form of the condition which can in some cases can progress into AS.1,2

Who is affected by axial spondyloarthritis/ankylosing spondylitis?

Onset of axSpA is commonly late teens and early twenties, with the average age of onset being 24. It affects men and women, with men generally experiencing a more progressive form of the disease and women experiencing a longer diagnostic delay.1-3

What are the symptoms of axial spondyloarthritis/ankylosing   spondylitis?4

The symptoms of axSpA can vary, but usually involve back pain and stiffness. Further symptoms include:

  • Pain and swelling in other parts of the body - caused by inflammation of the joints and inflammation where a tendon joins a bone (enthesitis)
  • Extreme tiredness
  • Irritated, scaly patches of inflamed skin (psoriasis)
  • Swollen fingers and toes (dactylitis)
  • Eye pain, redness and sensitivity to light (uveitis)
  • Bowel conditions

How is axial spondyloarthritis/ankylosing spondylitis diagnosed?1,2,4

Most back pain isn't caused by axSpA. However, the symptoms, especially in the early stages, can be very similar to more common back problems. AxSpA is normally diagnosed by a rheumatologist.

There is no specific test to confirm a diagnosis of axSpA and so it involves piecing together information from different sources, including:

  • The history of the condition (including if there is pain during the second half of the night)
  • A physical examination
  • Blood tests, which may show inflammation or the presence of the HLA-B27 gene for which most people with axSpA test positive
  • X-rays, in the case of AS
  • MRI, in the case of nr-axSpA

How is axial spondyloarthritis/ankylosing spondylitis treated?4

There is not yet a cure, however patients can relieve the pain, swelling and other associated symptoms with the use of medicines, and exercise and physiotherapy programmes.

The main types of medicines used to treat axSpA/AS are as follows:

  • Analgesic drugs (painkillers)
  • Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
  • Disease Modifying Antirheumatic Drugs (DMARDs)
  • Biological therapies

1. NHS Choices: Ankylosing spondylitis. https://www.nhs.uk/conditions/ankylosing-spondylitis/ (last accessed November 2020)

2. National Axial Spondyloarthritis Society 2020. https://nass.co.uk/about-as/what-is-as/ (last accessed November 2020)

3. Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky. T. Rusman & R. F. van Vollenhoven & I. E. van der Horst-Bruinsma. Current Rheumatology Reports (2018).

4.  What are the symptoms of ankylosing spondylitis (AS)? Ankylosing spondylitis. What treatments are there for ankylosing spondylitis (AS)? Arthritis Research UK. https://www.versusarthritis.org/about-arthritis/conditions/ankylosing-spondylitis/  (last accessed November 2020)