Myths and Misconceptions About Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: September 2022

When you are first diagnosed with axial spondyloarthritis (axSpA), you may not understand much about it. Learning about the condition and being able to tell fact from fiction can help empower you to make informed decisions about your health.

Myth: If there is no damage to your sacroiliac joint (SI) on X-rays, you do not have axSpA

X-rays do not have to show SI joint damage to indicate an axSpA diagnosis. There are 2 main types of axSpA:1

  • Radiographic (r-axSpA) – Inflammation and bone damage are visible on X-rays. This type of axSpA is most commonly called ankylosing spondylitis (AS). AS causes chronic inflammation in the joints, which can lead to joint damage over time.
  • Non-radiographic (nr-axSpA) – Inflammation and bone damage are not visible on X-rays.

Many people can have severe pain and stiffness from axSpA but not have visible damage on X-rays. Also, some people with X-ray evidence of damage to the SI joint do not have pain or stiffness. These people might find out they have axSpA or AS after getting an X-ray for something else.2

Myth: AxSpA and AS mainly occur in men

In the past, axSpA and AS were thought to impact 2 to 3 times more men than women. New research suggests this may not be true.3

Men tend to have more changes that show up on X-rays when compared to women. Because of this, men are diagnosed more often. But this does not necessarily mean men get axSpA more often. Also, women may not have the same positive response to treatment for axSpA compared to men. More studies are needed to look at differences related to sex.3

Myth: AxSpA and AS always progress to a fused spine

The progression of axSpA varies widely from person to person. Some people experience a fast progression, while others have a mild or slower progression. While the disease is long-term (chronic), it may not always cause significant joint damage.1,2

As the condition progresses, it can cause joints in the spine to fix or fuse. This often leads to a loss of mobility or a curved posture. Complete fusion of the spine is sometimes called “bamboo spine” because of its appearance on an X-ray.1,2

However, some people with axSpA will never experience fused joints in their spine. Early and effective treatment may help prevent or slow joint damage.2

Myth: AxSpA and AS only affect the spine

AS primarily affects the spine, but it can also affect other parts of the body. The sacroiliac (SI) joints are the areas where the pelvis meets the base of the spine. This is often where people feel pain and stiffness first.1,2

Many other areas of the body also may be affected, including:1,2

  • Neck
  • Hips
  • Shoulders
  • Heels
  • Toes
  • Ribs or chest
  • Knees
  • Jaw
  • Wrists
  • Fingers

Myth: There are no treatments for axSpaA and AS

There is not yet a cure for AS, but there are ways to treat the disease and its symptoms. Treatment options often include prescription drugs, physical therapy, and exercise.1,2

Some people with AS may find that treatment stops the progression of their disease and results in milder symptoms (remission). Others may continue to have periods of worsening symptoms (flares).1,2

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