Symptoms of Axial Spondyloarthritis

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

The symptoms of spondyloarthritis (SpA) can vary because there are different kinds of SpA, and it is also a progressive condition. Because SpA is a spectrum, your symptoms may change over time as your condition progresses. You may notice a worsening of certain symptoms, or they may come and go. Depending on what treatment you receive, you may experience symptoms or side effects from the treatments.

What are the symptoms of axial spondyloarthritis?

Axial spondyloarthritis usually presents in two main ways: inflammation and bone destruction.1 Depending on the severity of your condition, the bone destruction may not be apparent yet, so not having this symptom does not mean you don’t have SpA.

The inflammation usually causes pain and stiffness, particularly of the spine. In some types of SpA, the arms or legs may become stiff or painful, as in peripheral SpA.2 Sometimes fingers and toes can become inflamed, giving a “sausage-like” appearance.2

The bone destruction may cause fusing of parts of the spine, deformities of the spine, and reduced functioning of the shoulders and hips.1 This is often seen in the more progressive forms of SpA. When this bone destruction is visible on tests like x-rays, it is then called radiographic axial spondyloarthritis (r-AxSpA), or ankylosing spondylitis (AS).

If blood tests are done, a person with SpA may test positive for HLA-B27, a gene variant that is involved in controlling immune responses.2 However, there is no one gene that determines whether or not a person will have SpA. There are other genetic variants that have been associated with disease response and severity.

Other symptoms of SpA

Symptoms of SpA can vary, depending on what kind of SpA you have. Even among people who have the same kind of SpA, you might not have the exact same symptoms. Symptoms that are not related to a joint are called extra-articular symptoms, and can be characteristic of other kinds of SpA, like the inflammatory bowel disease symptoms in enteropathic arthritis (EnA).3

Other symptoms of SpA can include:2

  • Chronic low back pain
  • Fatigue/exhaustion
  • Heel pain
  • Tendonitis, commonly around the elbows or knees
  • Episodes of eye inflammation (uveitis)
  • Changes in skin and nails associated with psoriasis
  • Back pain and/or stiffness, especially at night and improving with activity
  • Painful swelling of joints
  • Abdominal pain or diarrhea

Things to consider

Men and women can have different presenting symptoms of SpA. Women tend to have more extra-articular symptoms than men, especially inflammatory bowel disease-related symptoms and psoriasis; and men were more likely to have uveitis than women.4 Because women often have other symptoms than joint-related ones, this might also explain the longer delay in diagnosis they have.

Some people have a variety of symptoms that don’t fit into any one category of SpA. This doesn’t mean that SpA is not a possibility. Undifferentiated spondyloarthritis (USpA) have symptoms that may overlap among SpA categories and may not have any back pain.

Being aware of the symptoms you experience can be helpful to both you and your health care team. If you notice any changes in the severity or frequency of symptoms, or if you have any new symptoms, talk with your doctor. A thorough physical examination and medical history, bloodwork, and imaging studies can be helpful in finding the cause of symptoms and providing you with an accurate diagnosis in order to get the appropriate treatment.

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