Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, which are located at the base of the spine where it connects to the pelvis. As a systemic condition, axSpA can also impact other joints and organs throughout the body. It’s known to have a familial tendency. There are two main classifications of axSpA:
- Ankylosing Spondylitis (AS): Also referred to as radiographic axSpA, AS is characterized by visible damage to the sacroiliac joints and spine that can be detected through X-rays.
- Non-radiographic axial Spondyloarthritis (nr-axSpA): In nr-axSpA, the damage may not be apparent on X-rays but can be identified using Magnetic Resonance Imaging (MRI).
AxSpA can manifest at any age, but it commonly begins between 20 and 40 years old. Ankylosing spondylitis is more prevalent in men, while non-radiographic axSpA is observed with similar frequency in both women and men. It’s also noted to be less common in African Americans compared to other racial groups.
Pinpointing the Causes of Axial Spondyloarthritis
The precise cause of axSpA remains elusive. Current research suggests that genetic predisposition plays a role, where individuals with specific genes might develop axSpA upon exposure to environmental triggers such as viruses, bacteria, or other unknown factors. The HLA-B27 gene is frequently found in people with axSpA; however, the majority of individuals carrying this gene do not develop the condition.
Recognizing Axial Spondyloarthritis Symptoms
The initial symptoms of axSpA often involve pain in the lower back, buttocks, and hips. In children, pain might initially present in the hips, knees, or heels before affecting the back.
Common symptoms of axSpA include:
- Gradual onset of pain in the lower back, buttocks, and hips, developing progressively over weeks or months.
- Pain, swelling, redness, and warmth in various joints such as toes, heels, ankles, knees, rib cage, upper spine, shoulders, and neck.
- Stiffness, particularly upon waking up in the morning or after periods of inactivity.
- Nocturnal back pain or pain in the early morning hours.
- Persistent fatigue.
- Loss of appetite.
Health Implications of Untreated Axial Spondyloarthritis
Joints: Over time, axSpA can lead to the fusion of spinal joints and bones. This fusion typically begins at the base of the spine, resulting in stiffness and limited back mobility. Fusion of the rib cage can also occur, restricting chest expansion and breathing capacity.
Eyes: Chronic eye inflammation (uveitis) is a potential complication, causing symptoms like dryness, pain, redness, light sensitivity, and visual disturbances. Inflammation of the white part of the eye (scleritis) can also occur, leading to redness and discomfort.
Digestive Tract: Inflammation in the digestive system can result in abdominal pain and diarrhea.
Heart: Although less common, axSpA can affect the aorta, the body’s largest artery. Individuals with axSpA also have an elevated risk of heart attack and stroke.
Lungs: Lung complications are rare but possible. Inflammation can lead to shortness of breath and impaired lung function.
The Process of Axial Spondyloarthritis Diagnosis
Early diagnosis is crucial for effective management of axSpA. While a primary care physician might initially assess joint pain, a rheumatologist, a specialist in arthritis, should be consulted if axSpA is suspected. There isn’t a single definitive test for axSpA diagnosis. Diagnosis involves a comprehensive approach including medical history review, physical examination, and various tests to exclude other causes of back and hip pain.
- Medical History: The doctor will inquire about symptoms, their onset, patterns of occurrence, existing medical conditions, medications, and family history of arthritis.
- Physical Examination: This involves checking for tenderness, swelling, and pain in the spine, pelvis, and hips. The doctor will assess joint movement and may examine the eyes for signs of inflammation.
- Blood Tests: Testing for the HLA-B27 gene may be conducted. While the presence of this gene doesn’t confirm axSpA, it supports the diagnosis. Other blood tests can detect general inflammation in the body.
- Imaging Tests: X-rays, ultrasound, MRI, or CT scans of the pelvis and spine may be ordered to identify structural damage indicative of axSpA, especially in cases of non-radiographic axial spondyloarthritis where X-rays might not show conclusive evidence initially. MRI is particularly valuable in early Axial Spondyloarthritis Diagnosis, often detecting inflammation before changes are visible on X-rays.
Managing Axial Spondyloarthritis: Treatment Approaches
Currently, there is no cure for axSpA. However, treatment strategies aim to:
- Alleviate pain and stiffness in the back and affected joints.
- Maintain spinal alignment.
- Prevent joint and organ damage progression.
- Preserve joint function and mobility.
- Enhance overall quality of life.
Early and aggressive treatment is essential to minimize long-term complications and joint damage. A comprehensive treatment plan typically includes medication, non-pharmacological therapies, healthy lifestyle adjustments, and in rare cases, surgery.
Medications are a cornerstone of axSpA management to control inflammation and pain.
Exercise: Regular physical activity is vital for managing axSpA. It helps prevent stiffness and maintain range of motion in the neck and back. Activities like walking, swimming, yoga, and tai chi can improve flexibility and posture. Strengthening core and leg muscles is also important. Consulting a physical therapist can help create a personalized exercise plan.
Physical Therapy and Assistive Devices: A physical therapist can guide you on muscle strengthening and stretching exercises to maintain mobility and reduce pain. Occupational therapists can recommend assistive devices and strategies to protect joints and simplify daily tasks.
Surgery: Surgery is rarely needed for axSpA. However, joint replacement surgery can be beneficial for individuals with severe pain or joint damage. Surgical intervention may also be considered to correct severe spinal deformities.
Self-Care Strategies for Axial Spondyloarthritis
Adopt a Healthy Diet: While there’s no specific axSpA diet, an anti-inflammatory diet, such as the Mediterranean diet, may be beneficial. Focus on consuming fatty fish, fruits, vegetables, whole grains, and extra virgin olive oil. Limit red meat, sugar, and processed foods.
Avoid Smoking: Smoking negatively impacts overall health and can accelerate axSpA disease activity and joint damage. It also impairs respiratory function. Seek medical advice for smoking cessation strategies.
Maintain Good Posture: Proper posture can help reduce pain and stiffness. Adjust computer monitor and desk height for optimal screen viewing at eye level. Keep feet firmly planted on the ground. Avoid prolonged cramped or bent positions. Alternate between standing and sitting, and use lumbar support cushions. Be mindful of “texting neck” from excessive cellphone use.
Incorporate Stretching: Regular stretching exercises, especially after warm baths or showers, can ease pain and relieve stiffness.
Pace Activities: On days with increased symptoms, pace your activities and take frequent short breaks to manage fatigue effectively.
By understanding axial spondyloarthritis diagnosis, symptoms, and management strategies, individuals can take proactive steps towards managing their condition and improving their quality of life. Early diagnosis and a comprehensive treatment approach are key to living well with axSpA.
