Axial Spondyloarthritis (axSpA) is a chronic inflammatory disease that includes radiographic (Ankylosing Spondylitis or AS) and non-radiographic forms (nr-axSpA). It is a chronic inflammatory disease of the spine and sacroiliac joints called Morbus Bechterew in some European countries. It can cause chronic pain, structural damage and paralysis.
Axial Spondyloarthritis is an umbrella term that includes:
Ankylosing Spondylitis (AS) where changes to the sacroiliac joints or the spine can be seen on x-ray
Non-radiographic Axial Spondyloarthritis where x-ray changes are not present but inflammation is visible on a MRI scan or you have symptoms
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 (as opposed to coming on in short attacks)
- Feeling better after exercise and worse after rest
- Weight loss, especially in the early stages
- Fatigue or tiredness
- Feeling feverish and experiencing night sweats
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.