Axial spondyloarthritis

Axial spondyloarthritis is an inflammatory arthritis that mainly affects your spine. The two main types of axial spondyloarthritis are known as ankylosing spondylitis (AS) and psoriatic arthritis.

Inflammation occurs around your spine where the ligaments or tendons attach to the bone. It often starts at the bottom of the spine in the pelvis joints but can happen anywhere in the spine. Over time, repeated inflammation can lead to further bone formation and the individual vertebrae in your spine may fuse together.

It is a very rare condition affecting only one in 200 people, but it is extremely important that it gets diagnosed quickly.

What causes axial spondyloarthritis?

Axial spondyloarthritis is what we call an autoinflammatory condition, which means that your body’s inflammatory system is mistakenly targeting and attacking its own tissues.

It is linked to the genes we inherit, although that does not mean that you will definitely pass it on to your children.

However, people with a parent, sibling or child with axial spondyloarthritis, ulcerative colitis, Crohn’s disease or uveitis are statistically more likely to develop axial spondyloarthritis.

What are the symptoms of axial spondyloarthritis?

Most people with axial spondyloarthritis will experience some of these symptoms:

• Your symptoms started before you were 45 years old.
• You have lower back and/or buttock pain that came on gradually and has lasted more than 3 months.
• Your symptoms are worse in the early morning.
• You have stiffness in your back lasting longer than 30 minutes in the morning.
• You wake in the early hours of the morning with back pain and/or stiffness.
• Your pain improves with activity and not with rest.
• Your pain improves with anti-inflammatories such as Ibuprofen or Naproxen.
• You have problems with your tendons such as the Achilles tendon (at the back of the ankle), plantarfasciitis (sole of foot pain) or tennis elbow (tendons at the elbow).
• You experience fatigue or tiredness.

If you have been previously diagnosed with ulcerative colitis, Crohn’s disease or acute uveitis, you are also statistically more likely to develop axial spondyloarthritis.

How is axial spondyloarthritis diagnosed?

Make an appointment to see your GP and discuss your symptoms.

Investigations for axial spondyloarthritis normally start with assessment of symptoms and an examination, then blood testing, an x-ray or magnetic resonance imaging (MRI) scan and referral to a specialist rheumatologist to evaluate the results.

It is important for the rheumatologist to make the diagnosis and begin treatment as soon as possible.

What are the treatment options for axial spondyloarthritis?

Your treatment will be tailored to your individual diagnosis as well as other lifestyle factors but will typically include medications to reduce inflammation, relieve pain or to alter the condition itself.

A programme of exercises can also help to maintain mobility and strength in the spine and affected joints. Physiotherapy and other manual therapies are also options.

Surgery is uncommon but might be used if, for example, your hip joints are badly affected.

What is the prognosis (outlook) for axial spondyloarthritis?

There is currently no cure for axial spondyloarthritis, but modern treatment techniques enable many patients to return to full function and many others to manage their symptoms with minimal impact on their lives.”