Axial spondyloarthritis (axSpA) is a long-term rheumatic condition marked by inflammation in the sacroiliac joints, spine, and entheses (where tendons or ligaments attach to bone). Affecting as much as 1.4% of the adult population in the United States, axSpA can lead to a decreased quality of life, higher mortality rates, and significant health care expenses. This condition imposes a substantial burden, not only on the individuals living with it but also on their caregivers and the broader health care system.
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What is Axial Spondyloarthritis?
Axial spondyloarthritis (axSpA) is a form of arthritis that primarily impacts the joints within the axial skeleton, including those in the chest, spine, and pelvis. This condition often begins with back pain that can start before the age of 45, with some people experiencing pain and stiffness as early as their teens or young adulthood. The associated pain is frequently intense and can be severely limiting.
AxSpA belongs to the spondyloarthritis family—a group of inflammatory arthritis conditions marked by joint pain and other related symptoms. The inflammation characteristic of spondyloarthritis stems from an immune system that is either overactive or poorly regulated, leading to swelling and tissue damage around the joints or soft tissue.
What sets spondyloarthritis apart from other forms of arthritis is its potential to impact various body systems beyond the joints. If you have axSpA, you might also experience issues like eye inflammation, gastrointestinal symptoms (like diarrhea), or other health concerns that may not initially seem related to joint pain.
Causes of Axial Spondyloarthritis
he exact cause of axSpA remains uncertain. Researchers suggest that individuals with certain genetic predispositions, particularly those carrying the HLA-B27 gene, may develop axSpA when exposed to specific triggers like viruses, bacteria, or other environmental factors. However, it’s important to note that the majority of people with the HLA-B27 gene never go on to develop axSpA.
Symptoms
Axial spondyloarthritis (axSpA) often begins with discomfort in the lower back, hips, and buttocks. In children, however, initial symptoms may present as pain in the hips, knees, or heels before affecting the back. Common symptoms of axSpA include:
- Persistent pain in the lower back, hips, and buttocks that gradually worsens over weeks or months.
- Swelling, tenderness, redness, and warmth in areas such as the toes, heels, ankles, knees, rib cage, upper spine, shoulders, and neck.
- Morning stiffness or stiffness after prolonged inactivity.
- Back pain, particularly during nighttime or early morning hours.
- General fatigue and low energy levels.
- Reduced appetite.
Diagnosis Process of Axial Spondyloarthritis
When you visit your healthcare provider for back pain, they’ll start by checking your vital signs and conducting a physical examination. This helps give your provider a general overview of your health. They may also order blood tests to check for the HLA-B27 gene and measure levels of C-reactive protein, a marker of inflammation in the body.
Additionally, your provider might suggest imaging tests to get a closer look at the bones in your axial skeleton. These imaging tests could include:
- X-ray: An X-ray of the spine can reveal signs of axial spondyloarthritis (axSpA) or other bone-related conditions.
- MRI: MRI scans provide highly detailed images, often detecting spinal issues earlier than X-rays.
To diagnose axSpA, healthcare providers look for specific symptoms of the condition along with back pain, even if imaging doesn’t show inflammation. If you have symptoms consistent with axSpA but no visible inflammation on imaging tests, your provider may diagnose non-radiographic axSpA. “Non-radiographic” simply means that the inflammation isn’t visible on tests like X-rays or MRIs.
In some cases, non-radiographic axSpA can progress and become detectable on X-ray or MRI. However, many people with non-radiographic axSpA do not reach a stage where their condition becomes visible on these imaging tests.
Treatment
While there’s no cure for axSpA (axial spondyloarthritis), treatment focuses on:
- Reducing pain and stiffness in the back and other affected areas.
- Supporting spinal alignment.
- Preventing damage to joints and organs.
- Maintaining joint function and mobility.
- Enhancing overall quality of life.
Early, proactive treatment is essential to reduce long-term complications and protect joints from damage. A comprehensive approach usually involves medications, non-drug therapies, healthy lifestyle choices, and, in rare cases, surgery.
Medications
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are the primary drugs for managing axSpA, providing pain relief and reducing inflammation. Over-the-counter options include ibuprofen (Advil) and naproxen (Aleve), while prescription NSAIDs include indomethacin, diclofenac, and celecoxib.
- Analgesics: In addition to NSAIDs, doctors may recommend acetaminophen (Tylenol) for additional pain relief.
- Disease-Modifying Antirheumatic Drugs (DMARDs): Conventional DMARDs are generally not used for axSpA that affects only the back. However, sulfasalazine may be prescribed for involvement of joints outside the spine and pelvis.
- Biologics: A specialized form of DMARD, biologics target specific proteins in the immune system to control inflammation. For axSpA, TNF inhibitors and IL-17 inhibitors are particularly effective. Biologics are administered by self-injection or infusion under medical supervision.
- Corticosteroids: Though rarely used for spinal inflammation in axSpA, corticosteroids can provide rapid relief when injected into a specific joint, such as a knee or shoulder.
Exercise
Regular physical activity is essential in axSpA management. It helps reduce stiffness and maintain flexibility in the back and neck. Activities like walking, swimming, yoga, and tai chi improve flexibility and posture while strengthening the core and leg muscles. Consulting with a physical therapist can help create a well-rounded exercise program.
Physical Therapy and Assistive Devices
A physical therapist can guide you through exercises to strengthen and stretch muscles, promoting mobility and easing pain. Occupational therapists may suggest assistive devices and techniques to protect joints and simplify daily activities.
Surgery
Surgery is rarely necessary for axSpA. However, joint replacement may be beneficial for those with severe pain or significant joint damage. In some cases, surgery may also help correct a spine that has become severely bent.
Self-Care Tips for Axial Spondyloarthritis (axSpA)
- Nourish with Anti-Inflammatory Foods
While there isn’t a specific diet for axSpA, adopting an anti-inflammatory approach can be beneficial. The Mediterranean diet, rich in anti-inflammatory foods, is a great option. Focus on eating fatty fish, fresh fruits, leafy vegetables, whole grains, and extra virgin olive oil. Aim to limit your intake of red meat, added sugars, and processed foods to support overall wellness.
- Quit Smoking for Better Health
Smoking can worsen axSpA symptoms and increase the rate of joint damage, besides making breathing more difficult. Consider seeking guidance from your healthcare provider to explore strategies for quitting, as doing so can improve both your condition and your overall health.
- Prioritize Good Posture
Practicing good posture is key to managing pain and stiffness in axSpA. Keep your computer monitor at eye level, sit with your feet firmly on the ground, and try to avoid cramped or bent positions. Alternating between sitting and standing and using supportive cushions can make a difference. Remember to watch for “text neck” if you’re frequently on your phone.
- Incorporate Stretching
Gentle stretching exercises, especially following a warm bath or shower, can help reduce stiffness and ease discomfort. Develop a routine of stretches that feel good and gradually increase your flexibility over time.
- Pace Your Activities
On challenging days, take things slowly. Balance activity with regular short breaks to help manage fatigue and prevent overexertion. Listen to your body, and give yourself permission to rest as needed.
FAQ
- What is Axial Spondyloarthritis?
A: Axial Spondyloarthritis (AxSpA) is a type of inflammatory arthritis that primarily affects the spine and sacroiliac joints, causing pain and stiffness. It can lead to chronic back pain and reduced flexibility over time.
- What causes Axial Spondyloarthritis?
A: The exact cause is unknown, but a combination of genetic factors (like the HLA-B27 gene) and environmental factors may increase the risk of developing AxSpA.
- What are the symptoms of Axial Spondyloarthritis?
A: Symptoms include chronic lower back pain, stiffness, especially in the morning or after periods of inactivity, fatigue, and in some cases, inflammation in other areas like the eyes or intestines.
- How is Axial Spondyloarthritis diagnosed?
A: Diagnosis usually involves a combination of medical history, physical examination, blood tests (such as for HLA-B27), and imaging tests like X-rays or MRI to detect joint inflammation.
- What treatments are available for Axial Spondyloarthritis?
A: Treatments focus on managing symptoms and preventing progression and may include anti-inflammatory medications, physical therapy, and, in some cases, biologic drugs to reduce inflammation.
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