Prognosis: What Happens to People with Axial Spondyloarthritis

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

Axial spondyloarthritis (axSpA) is a type of chronic, inflammatory arthritis that mainly affects the spine. It usually begins in a person's 20s or 30s with persistent lower back pain and stiffness. This pain is caused by inflammation of the sacroiliac (SI) joints, which are the joints between the pelvic bones and spine. People with axSpA also can feel pain in other parts of the body.1

How does axial spondyloarthritis progress?

There is no single predictable path for people with axSpA. Some people will get worse over time and have more symptoms. Other people will have periods of feeling better (remission). Doctors do not know why people progress differently.1,2

AxSpA may cause a wide range of pain and disability. But it is usually described as 1 of 2 types. The 2 main types of axSpA are:1

  • Non-radiographic axSpA (nr-axSpA) – People who do not have inflammation in the SI joints or the bones of the spine (vertebrae) that shows on X-ray imaging are diagnosed with nr-axSpA. Magnetic resonance imaging (MRI) tests are often needed to detect changes in the SI joints in these cases. Many people with nr-axSpA never show evidence of the disease on X-rays.
  • Radiographic axSpA (r-axSpA, or ankylosing spondylitis) – Some people have inflammation that shows on X-ray right away. These people are typically described as having ankylosing spondylitis (AS). Others with nr-axSpA develop changes in their SI joints over time that begin to be seen on X-rays.

Bony fusion is the most severe progression of AS. This happens when the bones in the spine start to grow together. This makes it harder for people to move and can cause the spine to lose its normal curvature.1,2

People who have axSpA for a long time or whose spine is fused are at increased risk of spinal fractures if they fall or have a car accident. If you have a fall and fracture your spine, watch out for new tingling or weakness in your arms and legs. This could be a sign of nerve damage.1

Long-term remission of axSpA can occur, but it is unlikely without treatment.2

Determining your prognosis

Your doctor may be unable to predict the exact course of your axSpA. But there may be some indicators of whether you will have a more severe form of the disease.1,2

For example, if you develop axSpA at a younger age, it is more likely that the symptoms will progress more quickly. This is especially true for children and teenagers.3

Other factors that increase the risk of poor outcomes include:3

  • Joint involvement beyond the SI joints
  • Non-steroidal anti-inflammatory drugs (NSAIDs) not controlling pain
  • Smoking
  • Increased blood inflammatory markers
  • Having other inflammatory conditions, like psoriasis or inflammatory bowel disease (IBD)

There also are some differences between men and women with axSpA. But while doctors used to think that axSpA was simply more common in men, new research has revealed that the truth is a bit more complex:4

  • Women with axSpA often have a longer delay before they are diagnosed.
  • Women with axSpA may not respond as well to biologic treatments as men.
  • Men have a higher chance of developing AS, but the disease (even if it does not show up on an X-ray) can be just as bad for women.

Living with axial spondyloarthritis

Physical activity and stretching can help you feel better and do the things you want to do for a longer time.1

Many people with AS can continue working after they start to have symptoms. If you are struggling to keep up with your current job duties, seeing a physical or occupational therapist might help. About 1 in 3 people change to less physically demanding jobs if their symptoms progress.1,5

There is some evidence that some NSAIDs may slow the progression of the disease in some people. However, the evidence is not clear. Talk to your doctor about the axSpA treatment that is right for you.6

People with nr-axSpA and AS usually have the same life expectancy as people in the general population. But people with more severe forms of the disease or who develop complications may not live as long.7

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