What Are Risk Factors for Axial Spondyloarthritis?

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

Axial spondyloarthritis (AxSpA) is an inflammatory form of arthritis that causes back and sacroiliac (SI) joint pain. When diagnosed with any condition, it’s natural to wonder what causes it, what the risk factors are, and wonder how it occurs in people. Sometimes definitive risk factors are unknown and more research needs to be done; sometimes risk factors can vary and interact with heredity or environment.

Risk factors for a condition are things that increase a person’s chance, or likelihood, of developing a condition. Having one or even many risk factors doesn’t always mean you’ll definitely get the condition, but it may make it more likely you’ll develop it. Some people only have one risk factor and have a condition, while others may have many risk factors and not have it.

Being aware of risk factors can be helpful in trying to get a diagnosis or in talking with a health care provider about your symptoms.

Age and AxSpA

While age is not necessarily a risk factor per se, AxSpA, particularly ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-AxSpA) are usually diagnosed between the ages of 20 and 30 years old.1

That being said, AxSpA can be diagnosed at a variety of ages, especially if the diagnosis is unclear to health care professionals.

Heredity as a risk factor

Heredity is a large risk factor for AxSpA. Different kinds of spondyloarthritis are associated with certain genes. For AS, approximately 30 genes relate to its development.2 One gene in particular, human leukocyte antigen B27 (HLA-B27), is especially associated with AS/r-AxSpA.2

There are several other conditions that are also associated with the HLA-B27 gene and having a family history of any of these conditions also increases risk for AxSpA. These conditions include psoriasis, ulcerative colitis and Crohn’s disease.

If you have the gene HLA-B27, it does not mean you will develop AxSpA for certain. It merely means you may be at higher risk of developing the condition than someone without the gene.

There are other biologic factors that may play a role in AxSpA, like autoantibodies to the cluster of differentiation 74 (CD74) receptor and the HLA-B40 gene, but more research needs to be done.3 If you or a family member has AxSpA, talk with your doctor about any genetic testing that should be done. This may also help to guide treatment.

Smoking and AxSpA risk

If you have AxSpA, AS, or spondylitis, smoking is the most important risk factor for developing more severe disease.1 This means that smoking can make a patient’s AxSpA symptoms worse. The good news is that this is a risk factor that can be minimized. If you smoke cigarettes, talk with your doctor about how to quit. They can help you make a plan to reduce or quit smoking and provide you with outlets for support on your quitting journey.

Risk factors are not definitive and if you’re worried about your risk or a loved one’s risk of developing AxSpA, talk with your doctor. The doctor will be able to go over your family history and all known risk factors for AxSpA to give you a better understanding of your risk factors and staying as healthy as possible.

By providing your email address, you are agreeing to our privacy policy.