Comorbidities of Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2020 | Last updated: January 2021

While spondyloarthritis (SpA) can have a variety of associated symptoms, there are also comorbidities that can occur with SpA. It’s important to differentiate between symptoms of SpA and comorbidities that are separate.

What is a comorbidity?

Comorbidity is a term used when there are two or more diseases or conditions occurring at the same in a person.1 These are often chronic or long-term conditions, not things like a cold. Comorbid conditions can also be called “coexisting” conditions.

People with diagnoses on the SpA spectrum often have comorbidities alongside their SpA diagnoses. Comorbidities can be associated with worse physical functioning, so appropriate treatment is important in order to minimize any negative effects.2

Symptoms versus comorbidities

There can be a variety of symptoms of different types of SpA, so it’s important to differentiate between symptoms and actual conditions. This can be difficult, since things like inflammatory occurrences can be features of SpA, but also separate diseases like inflammatory bowel disease (IBD).3 If you have any symptoms that could be a sign of another disorder, talk with your doctor about your symptoms so they can do an exam and run any necessary tests. Having accurate diagnoses are important so that the right treatment plan can be developed.

Common comorbidities that occur with SpA

While there can be a wide range of comorbidities with SpA, there are some that are more common than others. These include:

Being aware of the more common comorbidities can help you identify them earlier and thus get earlier treatment.

Peripheral arthritis

Peripheral arthritis typically affects the larger joints of the arms or legs, and can include the elbows, wrists, knees, and ankles.4 The pain can move from one joint to another, and if not treated, can be long-term.


Uveitis is a type of eye inflammation. It affects the middle layer of tissue in the eye wall, which is called the uvea.5 Uveitis results in eye redness, pain, dark floating spots in vision, light sensitivity, and blurry vision.5 Causes of uveitis include infection, injury, autoimmune disease, or inflammatory disease. If uveitis is not treated, it can cause permanent vision loss.

Inflammatory bowel disease (IBD)

Inflammatory bowel disease (IBD) is a general term that includes both Crohn’s disease and ulcerative colitis (UC). The hallmark of IBD is inflammation of the gastrointestinal (GI) tract.6 When this inflammation is long-term, it can damage the GI tract. Symptoms of IBD can include persistent diarrhea, stomach pain, rectal bleeding, weight loss, and fatigue. While the exact cause of IBD is not known, it is associated with malfunctions of the immune system. IBD is typically treated with medications.


Psoriasis is a skin disorder. It is associated with the immune system and it causes raised, red, scaly patches on the skin.7 It can appear anywhere on the body, but typically occurs on the elbows, knees, and scalp.7 For some people, psoriasis can be itchy, burn, or even sting. It is not known what exactly causes psoriasis but genetics and the immune system have been associated with its development.7 There are various treatments for it, including topical treatments, light therapy, and medications. Treatment can vary, depending on how severe the psoriasis is.


Osteoporosis is a condition where the density and quality of bones is impaired. The word “osteoporosis” literally means “porous bone.”8 Bones are constantly going through a process of breaking down and remodeling. In people with osteoporosis, bone loss happens faster than growth of new bone, causing bones to become weak and porous. This puts people at risk for fracture, especially of the spine and hip.8 It can also cause loss of height, back pain, and a curved spine. Treatment can involve lifestyle changes and medication.

Spinal cord injury

A spinal cord injury is when damage occurs to any part of the spinal cord or the nerves at the end of the spinal canal, called the cauda equina.9 This kind of injury typically causes permanent changes in strength and sensation, and may affect other functions below the area of injury.9 While spinal cord injury itself is not a common comorbidity, as SpA progresses on the AxSpA spectrum, more severe SpA can increase the risk of spinal cord injury.10 This is because the vertebral column has become weakened from the chronic inflammation and associated changes.10 In addition, spinal fusion increases the risk of fracture from minor trauma due to the spines lack of ability to bend normally.

Cardiovascular risk

Chronic inflammation like that in SpA can increase the risk of developing early coronary artery disease.11 Chronic inflammation can also make blood thicker, increasing the risk of cardiovascular diseases and heart problems.11 There is a higher incidence of cardiovascular disease (CVD) among people with SpA; CVD is the leading cause of mortality in those with SpA.12 There is also a higher rate of risk factors for CVD, such as smoking and obesity, in people with SpA. Knowing risk factors for CVD and cardiovascular health can help you reduce your risk for cardiovascular problems.

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