Spondyloarthritis refers to several inflammatory arthritis conditions that affect the sites in the body where tendons and ligaments attach to bones. The subtype called axial spondyloarthritis (AxSpA) causes inflammation in the pelvis, spine, or both, which leads to back pain.
AxSpA affects 1.4% of people in the United States, according to the American College of Rheumatology (ACR). The condition usually develops in people aged 17–45 years, but it can start at a younger age as well.
There are two main types of AxSpA. Radiographic AxSpA, also known as ankylosing spondylitis (AS), involves damage and fusion of the joints that connect the lowest part of the spine to the pelvis. The other type, non-radiographic AxSpA, does not involve this damage and fusion.
Keep reading to learn more about the symptoms and diagnosis of AxSpA, as well as treatment and complementary practices.
AxSpA causes low back pain, because it primarily produces inflammation in the spine and in the joints that link the spine to the pelvis.
A person with the condition may experience morning stiffness that gets better with exercise but not with rest. Many people with the condition develop some degree of spinal fusion as the condition progresses.
Individuals who have AxSpA may have comorbidities, which are conditions that can co-occur with another primary condition. These comorbidities may include:
- inflammation of the eye, which causes redness and pain
- psoriasis, which is a skin condition causing white scales, as well as patches of skin that are a different color from a person’s usual skin tone
- inflammatory bowel disease (IBD), which is a long-term inflammation of the intestinal tract that can cause abdominal pain, diarrhea, and weight loss
- heart and blood vessel diseases
- sleep apnea, which is a condition where the breathing stops and restarts during sleep
- osteoporosis, which occurs when the bones weaken and become prone to fractures
- pain and swelling in the joints of the arms, hands, feet, or legs
In making a diagnosis, doctors may use the following:
- a physical exam
- a medical history
- MRI scans
- blood tests
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However, another 2019 study notes that the predictive value of elevated CRP in the general population is not known.
There is currently no cure for AxSpA. However, there are various treatments that can help reduce symptoms, prevent deformities, and enable people to continue carrying out their everyday activities.
Medication options include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These can decrease pain and inflammation. Examples include ibuprofen (Motrin) and naproxen (Aleve).
- Acetaminophen (Tylenol): A doctor may suggest this medication for pain relief if an individual cannot take NSAIDs. However, acetaminophen will not reduce inflammation.
- Corticosteroids: If the joint swelling is not widespread, a doctor may recommend an injection containing one of these drugs. Doctors do not prescribe corticosteroids taken by mouth to a person with AxSpA, because the high dose necessary to alleviate symptoms would produce a number of side effects.
- Disease-modifying antirheumatic drugs (DMARDs): These medications prevent joint damage and reduce symptoms. They may include conventional DMARDs, such as sulfasalazine (Azulfidine) and methotrexate (Trexall).
- Biologics: When conventional DMARDs prove ineffective, doctors may prescribe a type of DMARDs called biologics. These include interleukin inhibitors, such as secukinumab (Cosentyx), and tumor necrosis factor-alpha blockers, such as infliximab (Remicade). Biologics are more costly, and they can increase the risk of infection.
Sometimes, doctors may recommend hip or knee replacement to improve function.
In addition, if a person’s spine is severely bent forward, surgery can help straighten it. However, this surgery is rarely performed, because it is complex and only available at a few medical centers.
A physical therapist can create an individualized exercise program to:
- maintain or increase range of motion
- boost muscle strength
- maintain flexibility
- improve posture
An exercise program may include aerobic activity and deep breathing techniques that help maintain flexibility in the rib cage and chest.
Swimming is another beneficial way of exercising, as it helps keep the neck, shoulders, hips, and spine supple.
Making some lifestyle changes may help ease the AxSpA symptoms. The changes include quitting smoking and eating a balanced diet rich in fruits, vegetables, fish, and healthy fats, such as olive oil.
People may also benefit from the following:
A person may wish to consider various therapies, such as:
- Acupuncture: Acupuncturists insert thin needles into the skin to stimulate the central nervous system, which in turn releases certain biochemicals believed to ease pain and promote healing.
- Massage: This therapy involves manipulating soft tissues of the body. It can help reduce stress, alleviate pain, and improve joint function.
- Hot and cold therapy: This therapy works by using heat to reduce stiffness and boost blood flow, and applying cold to decrease swelling.
Self-care practices can make a difference to the condition. Examples include:
- maintaining proper posture to reduce back and neck pain
- joining a support group or getting counseling to acquire or improve coping skills
- using relaxation techniques, such as guided imagery, to decrease muscle tension
- pacing activities — for example, by taking breaks during the day — to protect joints
AxSpA causes inflammation of the spine and the joints in the pelvis that connect to the spine. The condition results in low back pain and stiffness and can sometimes lead to fusion of the bones in this area.
A person with AxSpA may also experience fatigue and symptoms of IBD.
Various medications, such as NSAIDs, may help reduce pain and inflammation. Other beneficial measures include exercising regularly, quitting smoking, and following a diet rich in anti-inflammatory foods.