Axial Spondyloarthritis Symptoms

Reviewed by: HU Medical Review Board | Last reviewed: January 2023

Chronic, long-term back pain is one of the most commonly reported health problems in the United States. Not surprisingly, back pain is also the most reported symptom by people living with axial spondyloarthritis (axSpA). Other symptoms may occur with axSpA as well, which can lead to delays in diagnosing the condition.1

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There are 2 types of axSpA:2

  • Radiographic (r-axSpA) – Diagnosed based on signs that are visible in X-rays of your spine. You may not have symptoms when you are first diagnosed. R-axSpA is better known as ankylosing spondylitis, or AS.
  • Non-radiographic (nr-axSpA) – Inflammation and bone damage are not visible on X-rays, but you have symptoms.

Primary symptoms of axSpA

In people who do have symptoms of axSpA, the most common symptoms are pain, lack of flexibility in the spine, and other symptoms that may be related to inflammation.


Nearly everyone with axSpA first reports spinal pain, usually in their low back. This pain typically begins before age 45. Spinal pain in people with axSpA also may:1

  • Be worse with rest and better with movement or exercise
  • Wake you up in the middle of the night
  • Start gradually, unlike a sudden injury
  • Cause morning stiffness that lasts longer than 30 minutes
  • Include hip or buttock pain

Spinal flexibility problems

Your spine is made with cushion-like discs that act as shock absorbers between the bones of your spine (vertebrae). These discs allow your spine to twist and bend. In people with axSpA, inflammation and bone damage often occurs in the spine. This damage can cause pain, stiffness, and loss of flexibility. Decreased spinal flexibility is most common with AS.1

Other symptoms

Spinal pain and flexibility problems are not the only symptoms of axSpA. Other symptoms may include:1

  • Heel, shoulder, hip, foot, or other joint pain
  • Sausage-shaped swelling of the toes or fingers, called “sausage digits” (dactylitis)
  • Fatigue
  • Nausea or diarrhea
  • Eye inflammation (uveitis)
  • Changes in skin or nails linked to psoriasis
  • Depression and anxiety

Symptom severity

While back pain and stiffness occur in most people with axSpA, the severity of symptoms varies greatly. Doctors often think of axSpA as a spectrum. This means there are no specific symptoms that are always linked to axSpA. Also, it means that some people with axSpa can have mild symptoms, while others can be disabled by their symptoms.1

In people whose axSpA progresses, fusion of the spine may occur. This means their bones join together, causing the spine to be inflexible. Doctors may refer to this as “bamboo spine” because bone fusion on an X-ray looks like a reed of bamboo. Spinal fusion changes the shape of the spine. This often leads to a curved or “hunched” appearance.1

The joints where the hips meet the spine are called the sacroiliac (SI) joints. The SI joints are often affected by axSpA. They, too, may be sites of fusion.1

Gender differences in symptoms

In the past, doctors thought that AS occurred in about 2 to 3 men for every 1 woman with the condition. They now realize that, although men are diagnosed with AS more often than women, the disease may not be more common in men.3

This is because men often have more changes that are visible on an X-ray than women do. But women do not have fewer symptoms than men. Rather, women often have symptoms in addition to or instead of back pain. The overall effects of axSpA are generally worse for women than they are for men.3

Diagnosing axSpA

Because of the vast differences in the ways people experience axSpA, many people have to wait a long time to get a proper diagnosis. Knowing the signs and symptoms can help you get the diagnosis you need. Talk to your doctor if you have any symptoms of axSpA. The outcomes of the disease may be better if it is treated early.1

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