Axial Spondyloarthritis

Axial spondyloarthritis (axSpA) is a progressive subtype of inflammatory rheumatoid arthritis that mainly affects areas where ligaments and tendons attach to bone (entheses) in the spine and pelvic (sacroiliac) joints and which causes chronic lower back, hip, and buttock pain. There are two subtypes of axial spondyloarthritis: 1) non-radiographic axial spondyloarthritis (nr-axSpA), which means that the joint damage cannot be seen on X-ray, and 2) ankylosing spondylitis (AS), when the joint damage can be seen on X-ray. Axial spondyloarthritis starts early in life and occurs in both men and women, usually between the teenage years and thirties, and appears more often in individuals with a family history of the disease, or who are of Alaskan and Siberian Eskimo, Native American, or Scandinavian Lapp ancestry.

There are several alternative names for axial spondyloarthritis, including ankylosing spondylitis, AS, axSpA, Axial SPA, non-radiographic axial spondyloarthritis, and spondyloarthropathy.

Axial spondyloarthritis is an autoimmune disorder, meaning that the body’s immune system attacks the normal cells in the areas of hip, spine, and pelvic bones where tendons and ligaments attach (entheses), usually after being triggered by a bacterial or viral infection. Researchers further believe that axial spondylarthritis has a genetic cause, as individuals with the disease are also carriers of the HLA B27 genetic marker and it has been determined that the disease is 90% inheritable. Additional factors that can contribute to developing axial spondyloarthritis include exposure to smoking, pollution, toxins, and infections, joint injuries, intestinal biome imbalances, and bowel inflammation.

The primary symptom of axial spondylarthritis is chronic (three months or more) back pain due to inflammation of the joints of the spine that began before the age of 45, is worse at night, improves with exercise, and worsens with rest. Additional symptoms of axial spondylarthritis include fatigue, buttock pain on both sides, limited spinal flexibility, arthritis in one or more joints of the hands, legs, arms, or feet, inflammation of areas where ligaments attach to bone (enthesitis), psoriasis, eye inflammation (uveitis), and inflammatory bowel disease, and more rarely, pain and swelling in the arms and legs (peripheral spondyloarthritis).

Treatments for axial spondyloarthritis focus on relieving pain and stiffness as well as decreasing joint swelling and inflammation, maintaining range of motion and flexibility, and prevention of joint damage and deformity and include medications, physical and occupational therapy, lifestyle modifications, and, in severe cases, surgery. Medications – Medications for axial spondyloarthritis include non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ibuprofen, meloxicam, or indomethacin, to reduce pain and swelling, biologics, such as TNF alpha blockers; infliximab (Remicade), entanercept (Enbrel), adalimumab (Humira), certolizumab (Cimzia), golimumab (Simponi), and IL-17 blockers, such as secukinumab (Simponi), disease-modifying antirheumatic drugs (sulfasalazine ) to relieve symptoms and prevent joint damage, and corticosteroids to reduce inflammation. Physical therapy and regular exercise – Physical therapy and regular exercise are recommended for patients with axial spondyloarthritis to help improve extension of the spine and mobility, to preserve range of motion, to strengthen the neck and back, to maintain flexibility, and for improving posture. Swimming is a recommended exercise due to its low impact on joints. Lifestyle adjustments – Individuals with axial spondylarthritis can benefit from lifestyle modifications, such as always maintaining good posture, sleeping on their back on a firm mattress, stopping smoking, using assistive devices as recommended by an occupational therapist for workplace accommodations, avoiding lifting or sitting too long, taking frequent breaks, eating a healthy diet, applying hot and cold treatments as needed, massage and relaxation techniques, acupuncture, and focusing on emotional wellness when dealing with a chronic disease.

There are several online, local, national, and international support groups for axial spondyloarthritis, including the following: Arthritis Foundation - https://www.arthritis.org/diseases/spondyloarthritis National Axial Spondyloarthritis Society - https://nass.co.uk/ Spondyloarthritis Association of America - https://spondylitis.org/

While the outcomes (prognosis) for axial spondyloarthritis can depend on the individual, the disease is progressive, and many patients will experience fatigue, pain, and stiffness that can be steady or come and go. As the disease progresses, some individuals’ joints or spine may become fused, leading to a lack of flexibility and reduced mobility. Due to newer treatments, most patients with axial spondyloarthritis are able to maintain a productive life with a normal lifespan.

Complications of axial spondyloarthritis may include osteoporosis (thinning of the bone), psoriasis (patchy skin disease), uveitis (eye inflammation), intestinal inflammation, inflammation of the aortic heart valve, spinal fractures, and spinal fusion (ankylosing spondylitis).

If you experience any of the symptoms of axial spondyloarthritis, such as chronic (three months or more) back pain due to inflammation of the joints of the spine that began before the age of 45, which is worse at night, improves with exercise, and worsens with rest, contact your doctor as soon as possible.

There is no way of preventing axial spondyoarthritis; however, the disease can be managed with treatments to help prevent as much joint damage and fusion as possible. Quitting smoking can help reduce the rate of progression of osteoporosis and spinal fusion in axial spondyloathritis.