5 answers about axial spondyloarthritis

The axial skeleton includes the bones of the head, neck, back and chest, or the bones that form the body’s vertical axis. Axial spondyloarthritis (AxSpA) is a type of inflammatory arthritis that affects the joints of the axial skeleton, most often the joints between the vertebrae of the spinal column. It can also affect the joints that connect the spine to the pelvis (called the sacroiliac joints).

What are the symptoms of axial spondyloarthritis?

In adults, pain and stiffness in the lower back, hips, and buttocks are the most common symptoms. These symptoms typically get worse at night, after rest, and after sleep—a person with axial spondyloarthritis will often experience pain and stiffness in the morning, and they will often see an improvement in symptoms after moving around or exercising. It’s also common for people with this condition to experience a type of eye inflammation called acute iritis.

Symptom onset

Symptoms will typically begin before a person is 45 years old. Axial spondyloarthritis can affect children, and pain in the hips, knees, and heels of the feet can be symptoms of childhood axial spondyloarthritis.

Disease progression

Symptoms typically begin with pain in the joints between the spine and pelvis. Over time, pain spreads to the rest of the spine, the joints between the spine and the ribs, and sometimes, other parts of the body, such as the shoulders, arms, legs, hands, and feet. As more damage occurs, vertebrae can fuse together, limiting a person’s mobility and putting a person at risk for spinal fractures.

How does axial spondyloarthritis damage the joints?

Pain and stiffness are the result of inflammation. Inflammation is a response by the body’s immune system. Under normal circumstances, inflammation helps protect the body against infections and injuries, breaking down and clearing away damaged and diseased cells. Some disorders cause a constant state of inflammation that damages healthy tissues. With inflammatory arthritis, the inflammation and damage occur in the joint tissues.

How is axial spondyloarthritis diagnosed?

There is no single test used to diagnose axial spondyloarthritis. A diagnosis is made using a combination of medical history, physical examination, blood tests, and imaging tests that look for damage to the spine or pelvis. A diagnosis is typically made by a rheumatologist, a medical doctor that specializes in inflammatory disorders.

What causes axial spondyloarthritis?

The exact causes of axial spondyloarthritis are not fully understood. It is believed to be caused by a combination of genetics and environmental factors. Research has associated several gene variants with the condition. It’s thought that these genes put a person at risk for axial spondyloarthritis, and an environmental factor—such as an injury or infection—cause the disease to become active. Cigarette smoking is a known environmental factor, and is associated with more severe pain, symptoms, and progression.

What is the treatment for axial spondyloarthritis?

Treatment for axial spondyloarthritis will vary from person to person. There is no cure for the condition, and treatment focuses on relieving pain and stiffness, controlling disease activity, and maintaining strength and mobility in the joints. Treatment will vary from person to person, but may include pain-relieving medications, anti-inflammatory medications, disease-modifying antirheumatic drugs (DMARDs), biologics, regular exercise, and physical therapy.

A treatment plan will also need to take into account coexisting health conditions. Axial spondyloarthritis can occur alongside other inflammatory disorders, such as psoriasis and inflammatory bowel disease. It is also associated with high blood pressure, unhealthy cholesterol levels, and obesity.