What is Axial Spondyloarthritis?

Spondyloarthritis is a broad term that describes inflammatory conditions involving the joints and places where ligaments or tendons attach to bone, eventually causing arthritis.1 Most of the time, spondyloarthritis mainly affects the spine, although it can affect the hands, feet, arms, and legs.1 Axial spondyloarthritis, or AxSpA, is a type of spondyloarthritis that affects mainly the spine and pelvic joints.2,3

Unlike other kinds of arthritis, AxSpA does not destroy cartilage or cause bone spurs or resorption. One of the hallmarks of the condition is new bone formation.3 This new bone formation causes bone fusion and hardening of the sacroiliac (SI) joints and areas of the spine.3 The SI joints can also become inflamed and damaged due to erosions. The SI joints are in your pelvis, and when these are inflamed or something is wrong, a person usually feels pain in the lower back or buttocks.

What are the symptoms of AxSpA?

There are two main ways symptoms can present. One is inflammation, which can also result in stiffness or pain, usually in the spine or back. In AxSpA, the SI joints are often affected. This can cause pelvic, hip, or lower back pain.3

The other main symptom is changes in bone formation. This causes spinal deformities and shoulders or hips that don’t work properly.2

AxSpA can cause significant fatigue, with about 66 percent of people with AxSpA reporting fatigue and impaired sleep quality.3

What causes AxSpA?

While there is no one cause for AxSpA, there is a strong genetic component to the condition, and with spondyloarthritis as a whole. There are at least 30 genes that are linked to spondyloarthritis, with the main gene being HLA-B27.1

How is AxSpA diagnosed?

Diagnosing AxSpA involves a variety of things. During a physical exam, the doctor should ask you about any pain you’re having, along with any other symptoms. Knowing symptom patterns is a big part of diagnosing AxSpA, especially given conditions that often occur with AxSpA, which include psoriasis, cardiovascular disease, osteoporosis, and depression.3

A patient’s medical history is typically examined to find out which symptoms are present and how long they’ve been occurring. This information and a physical exam can help the doctor decide on next steps. Blood tests or imaging tests may be ordered. Blood tests can include those for C-reactive protein, sedimentation rate, or HLA-B27.3,4

How is AxSpA treated?

Treatment for AxSpA is still evolving, but there are a variety of possible treatments for the condition, including drug and non-drug treatments.

Regular exercise, good posture, avoiding smoking cigarettes, and various lifestyle adjustments can be helpful for some people living with AxSpA.3

Nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs) can help control pain and increase physical range of motion.3

Tumor necrosis factor alpha (TNF-alpha) blockers are biologic drugs that have been effective in arthritis of the spine and joints, and have been shown to improve quality of life in those with AxSpA.3

Other biologic drugs have been used for ankylosing spondylitis (AS), but more information is needed for use in people living with AxSpA.

Different kinds of treatment can have various side effects, so each treatment might not be the best choice for different people. Together, you and your doctor will work as a team to find the right treatments for your situation at any given time to address any discomfort and improve quality of life.

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Written by: Jaime Rochelle Herndon | Last reviewed: May 2020