Spinal Issues and Axial Spondyloarthritis

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

Symptoms associated with spondyloarthritis (SpA) and conditions on the AxSpA spectrum can vary. While some are obviously central to the condition, others may seem unrelated at first. Knowing the range of possible symptoms can help you in letting your health care provider know about any new symptoms. It can also help in getting you appropriate treatment sooner, rather than waiting until they worsen.

Not everyone will have every symptom, and the frequency and severity of symptoms can vary at different points along the AxSpA spectrum, especially as the condition progresses. Some symptoms may not appear until the condition is more severe. Awareness of symptoms can help you get treatment earlier, which can help relieve discomfort or pain and improve quality of life.

Stooped posture is typically an end-stage symptom. This means it is usually associated with more severe SpA, like ankylosing spondylitis (AS). Although it may not always be fixable, there are things you can do to help relieve discomfort.

What is kyphosis, also called stooped posture?

Stooped posture is posture that is hunched over or curved, with rounded shoulders. Some postural changes are normal with age because of osteoporosis, changes in muscle mass, or changes in intervertebral discs.1

Arthritis can make bones and discs more rigid or curved, causing stooped posture.1

Why stooped posture occurs

People with any condition on the AxSpA spectrum face challenges with posture. This is because of the inflammation that often occurs and the pain or discomfort associated with it. There is a tendency to bend over when the spinal pain happens, and this puts more strain on the spine.2

As SpA progresses, radiographic axial spondyloarthritis (r-AxSpA)/ankylosing spondylitis (AS) is further along on the AxSpA spectrum. For some people with advanced AS, the inflammation that is part of the condition can cause new bone formation in the spine.3 This new bone formation can cause areas of the spine to fuse and become immobile. If the spine fuses in such a way that it is not upright, this can contribute to stooped posture. However, good postural habits may help influence the pattern of fusion and potential outcomes.2

Figure 1. A normal spine versus a fused spine due to progressed AxSpA

A normal spine next to a spine that has lost normal curvature due to bone formation between the vertebrae, showing progression of axial spondyloarthritis.

How stooped posture is treated

Exercise can be beneficial to people at any point on the AxSpA spectrum. It can help you maintain good posture, help with flexibility, and even help with pain.2 Practicing proper posture techniques when possible can also help reduce the risk of stooped posture and help you feel better.2

The treatment for SpA at any point along the AxSpA spectrum includes the goals of reducing pain and stiffness and maintaining posture, along with slowing progression of disease. This can include working with a physical therapist or occupational therapist, medications, and a healthy diet. The specific treatment plan details can vary among individuals depending on what medications have been shown to be effective.

Medications used to treat AS can include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologic drugs like TNF (tumor necrosis factor) inhibitors.4 These medications can help reduce inflammation and pain, helping you keep a more upright postural position.

If you’re concerned about postural changes or developing stooped posture, talk with your doctor about ways to reduce the risk of becoming hunched over. The best treatment is prevention, and there are things you can do to help reduce the risk and encourage good posture.

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