Axial Spondyloarthritis (also known as axSpA or axial SpA) is one of a group of inflammatory rheumatic diseases known as Spondyloarthritis that share clinical and genetic features. AxSpA is a progressive chronic inflammatory disease that primarily affects the spine and the sacroiliac (SI) joints that connect the lower spine to the pelvis.This results in pain and stiffness in the lower back, hips and buttocks. It can also affect other joints in the body, as well as tendons and ligaments. It causes inflammation and can lead to chronic pain, and impairments in mobility.

axSpA has 2 forms:

Non-radiographic axSpA
There are symptoms and inflammation can occur. But damage to the sacroiliac joints (SIJ) is not visible on X-Ray. MROs can help diagnose nr-axSpA

Radiographic axSpA (r-axSpA)
Sometimes known as ankylosing spondylitis (AS) or Morbus Bechterew. Damage to the spine or SIJ is visible on X-ray. This doesn’t usually occur until a number of years after first symptoms. Over time, AS can cause some of the vertebrae to fuse together, which makes your spine less flexible and can make it difficult to straighten the back and neck;in some severe cases this can lead to astooped posture, known as kyphosis.

AxSpA affects both men and women equally

Affects both men and women equally. It used to be thought that three times as many men as women had the disease. This was based on a diagnosis of the disease using x-ray. Men are more likely than women to experience changes to the bones and fusion, and thus they were being picked up using x-ray.
Over time MRI’s were developed which could identify inflammation. Women are more likely than men to experience inflammation rather than fusion

Typical symptoms of axial SpA (AS) include:

  • Slow or gradual onset of back pain and stiffness over weeks or months, rather than hours or days
  • Early-morning stiffness and pain, wearing off or reducing during the day with exercise
  • Persistence for more than 3 months
  • Feeling better after exercise and worse after rest
  • Weight loss, especially in the early stages
  • Fatigue or tiredness
  • Feeling feverish and experiencing night sweats

What Happens?

It’s a painful, progressive form of inflammatory arthritis. It mainly affects the spine but can also affect other joints, tendons and ligaments.
Other areas such as the eyes and bowel can also sometimes be involved.

  • Inflammation occurs at the site where ligaments or tendons attach to the bone. This is known as enthesis
  • The inflammation is followed by some wearing away of the bone at the site of the attachment. This is known as enthesopathy
  • As the inflammation reduces, healing takes place and new bone develops. Movement becomes restricted when bone replaces the elastic tissue of ligaments or tendons
  • Repetition of this inflammatory process leads to further bone formation and the individual bones which make up your backbone (vertebrae) can fuse together

AxSpa places a huge physical impact and psychological stress on patients which can disrupt every aspect of their life and its quality including mobility, sleep, work and relationships. It is a poorly understood disease that causes patients to worry for their future.

How do I know I have AS?

Do you have:

  • Back pain caused by inflammatory arthritis?
  • Gradual onset of pain?
  • Persistent pain in the lower back, buttocks and/or hips longer than 3 months?
  • Pain/stiffness in the back and /or hips worse with immobility, especially night and early morning?
  • Back pain and stiffness tend to ease with physical activity and exercise?
  • Tiredness and fatigue?
  • Inflammation of the eyes (ie. iritis or uveitis)?

Unfortunately, about half of the people with AxSpA wait five or more years for a diagnosis. Careful consideration of the above questions and discussions with your family doctor can help speed up the diagnosis and prevent irreversible damage that can result from this progressive, painful, and infectious disease.

There is a strong association of a patient testing positive for HLA B27 which is a marker of AxSpA. Ask your doctor to run this test.
However, we caution that many people who are diagnosed with AxSpA test negative for HLA B27.
If you answer yes to many of the above you may have inflammatory back pain, we encourage you to request a referral to a rheumatologist. Early diagnosis and treatment regimen is paramount to managing your condition and improving outcomes.