And it could be what’s causing your unexplained back pain.
There’s a good chance you’ve probably never heard of axial spondyloarthritis (axSpA), commonly known as inflammatory arthritis of the spine. And that’s okay—most people haven’t. But just because you’re unfamiliar with the name doesn’t make living with axSpA any less painful, or even make the journey to relief any less real. These conditions are beasts that, once caught, can be tamed.
WHAT IS AXIAL SPONDYLOARTHRITIS (axSpA)?
AxSpA is an inflammatory arthritis of the spine that is made up of two underdiagnosed conditions: non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). What causes the inflammation is unknown, but when inflammation occurs within the spinal joints and vertebrae, it causes chronic lower back pain, stiffness, fatigue, and reduced mobility. If left untreated, axSpA can cause irreversible damage, and in some cases, fusion of spinal joints and vertebrae.
It’s important to know that axSpA also affects men and women differently. AS is more likely to affect men, whereas nr-axSpA is more likely to affect women. Men with AS are more likely to experience symptoms in the back and spine, whereas women with AS are more likely to experience pain in the hips, neck, and knees. But that doesn’t mean men won’t develop nr-axSpA and women won’t develop AS. They do. And living with it can be a monster pain.
WHAT ARE THE SYMPTOMS OF AXIAL SPONDYLOARTHRITIS (AxSpA)?
AxSpA is a type of inflammatory arthritis of the spine that can often cause stiffness, fatigue, and reduced mobility. While these symptoms may first appear in the lower back, they often affect other parts of the body, including the hips, shoulders, knees, heels, buttocks, and thighs. But as the disease progresses, pain and stiffness may even reach the neck.
HERE’S HOW axSpA ATTACKS THE BODY
Fatigue and trouble sleeping
Pain, stiffness, and reduced mobility in the lower back that worsens in the morning or at night
Pain that affects other areas of the body, including the hips, shoulders, knees, heels, buttocks, thighs, and neck
HOW IS AXIAL SPONDYLOARTHRITIS (axSpA) DIAGNOSED?
AxSpA is difficult to diagnose, and many people live with it for years before they’re officially diagnosed by a rheumatologist. A rheumatologist will typically look at how inflammation is not only affecting the parts of the body that are in pain, but also at how that inflammation is affecting the entire body. To make a diagnosis, a rheumatologist will look at a patient's history and may perform a variety of tests including physical exams, imaging, and lab tests.
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NR-AXSPA & AS
WHAT ARE THE DIFFERENCES BETWEEN NR-AXSPA AND AS?
Both conditions have similar symptoms of back pain, fatigue, and reduced activity. The main difference is that spinal fusion or damage from ankylosing spondylitis (AS) will appear on an X-ray, while with non-radiographic axial spondyloarthritis (nr-axSpA), no definitive damage will appear.
Can you say that for me?
Their names are a mouthful, and their acronyms can be even more confusing. Don’t you want to know what these words even mean? Let's break it down.
may not appear on imaging techniques, like X-rays
a type of arthritis that attacks the spine
the abnormal stiffening and immobility of a joint due to fusion of the bones
the inflammation of the spine, or vertebrae
Non-radiographic Axial Spondyloarthritis (nr-axSpA)
Damage may not appear on X-ray, but may appear on an MRI
nr-axSpA patients are more likely to be female (50–60%)
nr-axSpA may be considered an early form of AS in some patients
Ankylosing Spondylitis (AS)
Joint damage and spinal fusion
Damage will appear on X-rays
AS patients are more likely to be male
At one time, it was believed that men were more likely than women to develop AS and nr-axSpA. But because symptoms may be different and not commonly looked for in women, the ratio of men to women may not be as high as once thought.
Even though damage caused by nr-axSpA may not appear on an X-ray, people with this condition are still at risk of long-term damage. In fact, up to 50% of nr-axSpA cases are at risk of progressing to AS, which may cause irreversible spinal fusion.
AXSPA IS A MONSTER THAT CAN BE DIFFICULT TO DIAGNOSE
It’s not uncommon for axSpA to be misdiagnosed or mistaken for other conditions. Many people with axSpA are thought to have rheumatoid arthritis (RA) or fibromyalgia. One reason for this is that the symptoms of axSpA are so similar to those of many other conditions.
AXSPA versus RA and fibromyalgia
AxSpA and related conditions affect approximately 1.7 million people in the United States
<45(often in the mid-20s)
Usual age of onset
Primarily affects joints in the spine and lower back, but can also affect the neck, hips, shoulders, thighs, and heels
Affects approximately 1.5 million people in the United States
Usual age of onset
Primarily affects joints in the arms, hands, legs, and feet
Affects approximately 4 million people in the United States
Usual age of onset
Can affect many different areas of the body
Find a Rheumatologist. BOOK AN APPOINTMENT NOW.
A rheumatologist will understand the types of tests needed to properly diagnose nr‑axSpA and AS. Your quiz results, and knowledge of your family history, could help your rheumatologist discover what’s causing your pain. Download this Family Conversation Starter, and find a local rheumatologist who may help.