Axial spondyloarthritis

If you’ve recently been told you have axial spondyloarthritis, also called axSpA, you might be feeling uncertain about what this diagnosis means. Axial spondyloarthritis is an autoimmune inflammatory disease continuum that begins with inflammation causing stiffness in the joints and tissue of the spine and/or joints that link the pelvis and lower spine (sacroiliac joints). 

Everyone with axial spondyloarthritis experiences some form of back pain, though how often and how severe that pain is can vary from person to person. While axial spondyloarthritis is a lifelong condition, learning about it is the first step to managing it well and protecting your overall wellbeing.

Axial spondyloarthritis is part of a family of inflammatory conditions known as spondyloarthropathies. These include psoriatic arthritis, enteropathic arthritis, and reactive arthritis. These conditions often share symptoms and may be linked to a gene called HLA-B27.

The most common symptom is back pain, especially in the lower back and buttocks, often worse in the morning or after being inactive. This pain usually gets better with movement or a warm shower.

You might also experience:

• Stiffness in the spine, hips or pelvis
• Fatigue (ongoing tiredness not relieved by rest)
• Pain and swelling in other joints, such as the knees, ankles, or heels
• Changes in posture over time
• Eye inflammation (redness, pain or blurred vision)

Axial spondyloarthritis symptoms can also include inflammation where tendons and ligaments attach to bones (enthesitis).

Your health professional will look at your symptoms, family history, and may order blood tests, imaging like MRI or X-ray, and check for the presence of the HLA-B27 gene. Diagnosis can sometimes take time, especially if your X-rays don’t yet show any joint changes.

If you have symptoms but no visible joint damage on scans, your condition may be called non-radiographic axial spondyloarthritis (nr-axSpA). If changes eventually appear on X-rays, this becomes radiographic axial spondyloarthritis, also known as ankylosing spondylitis (AS).

In AS, inflammation can lead to the vertebrae in your spine fusing together, creating a more rigid spine and reducing flexibility.

While there is no cure for axial spondyloarthritis, there’s a lot you can do to manage symptoms and protect your joints.

Early diagnosis and starting treatment as soon as possible can help slow progression. Medications can reduce inflammation and manage pain, but non-medical approaches are just as important.

Keeping your body moving is one of the best things you can do. Regular stretching and strengthening exercises help maintain spinal flexibility and reduce stiffness. Listening to your body and resting when you need to is also important.

Staying connected with your whānau and reaching out for support when things feel tough can help protect your emotional wellbeing too.

Axial spondyloarthritis is a long-term condition, but effective treatments are available that can help manage inflammation, reduce pain, and protect joints.

Your treatment plan will depend on your symptoms, test results, and how the condition is affecting your day-to-day life. You may be referred to a rheumatologist who will guide your medical care.

Medicines commonly used for axSpA include non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and relieve pain, biologics to target specific parts of your immune system and can help slow the condition’s progress, and corticosteroids are sometimes used to manage flares or specific areas of inflammation.

You might need regular blood tests to check how your body is responding to medication and to monitor any side effects. Some treatments can take time to work, and it might take a few tries to find the right one for you.

It’s okay to ask questions. Staying informed and working closely with your healthcare team is an important part of living well with axial spondyloarthritis.

• Back pain is the most common symptom, but severity varies from person to person
• Early diagnosis and good management can slow progression and protect your joints
• While there is no cure, there’s a lot you can do to manage symptoms and protect your joints
• Your treatment will depend on your symptoms, test results, and how the condition is affecting your day-to-day life