Axial spondyloarthropathy (axSpA) is a type of inflammatory arthritis that primarily affects the spine and sacroiliac joints, leading to stiffness, pain, and potentially disability if left untreated. Despite its impact on millions of people worldwide, awareness about axSpA remains low and many people are not formally diagnosed or there is a significant delay to diagnosis. This page delves into the symptoms of axSpA to help raise awareness and encourage early detection and treatment.

 

 

What is Axial Spondyloarthropathy?

Axial spondyloarthropathy is a chronic inflammatory condition that primarily affects the axial skeleton, including the spine and sacroiliac joints (the joints that link the pelvis onto the spine). It belongs to a group of conditions known as spondyloarthritis (SpA), which also includes other forms of arthritis like psoriatic arthritis, reactive arthritis and arthritis linked to inflammatory bowel diseases, including Crohn’s disease or ulcerative colitis. The symptoms often start in people at a young age, in their teens or twenties but there can be a significant delay to these symptoms being recognised as significant and not due to sporting injuries or biomechanical back pain.

Key symptoms to be aware of

Chronic Lower Back Pain

One of the hallmark symptoms of axSpA is chronic lower back pain that persists for more than three months, often worsening with rest and improving with physical activity. This pain is typically felt in the lower back or buttocks and can also cause alternating buttock pain and regular waking at night due to pain symptoms.

Morning Stiffness

People with axSpA often experience stiffness in the spine and sacroiliac joints, particularly in the mornings or after periods of inactivity. This stiffness can last for several hours and typically improves with movement and exercise.

Reduced Mobility

As axSpA progresses, individuals may notice a decrease in spinal mobility, which can lead to difficulty bending, twisting, or turning. This reduced mobility can significantly impact daily activities and quality of life.

Back pain

Fatigue

Chronic inflammation associated with axSpA can cause fatigue, which may be debilitating for some individuals. Fatigue can affect both physical and mental well-being, making it challenging to carry out routine tasks.

Eye Inflammation

In some cases, axSpA can be associated with inflammation of the eyes, known as anterior uveitis or iritis. Symptoms may include eye redness, pain, sensitivity to light, and blurred vision. Prompt treatment is essential to prevent complications and preserve vision.

Enthesitis

Enthesitis refers to inflammation at the sites where tendons or ligaments attach to the bones. It commonly affects areas such as the heels, bottoms of the feet (plantar fascia), and the Achilles tendons, leading to pain, swelling, and tenderness.

Link with other conditions

Inflammatory back pain and axSpA can be linked and co-exist with other related conditions, such as psoriasis, reactive arthritis or inflammatory bowel disease, including Crohn’s disease or ulcerative colitis.

Back pain

The Importance of early diagnosis and treatment

Early diagnosis and treatment of axSpA are crucial for managing symptoms, preventing structural damage to the spine, and preserving overall function and quality of life. However, axSpA is often underdiagnosed or misdiagnosed due to overlapping symptoms with other conditions like mechanical back pain or fibromyalgia.

If you experience persistent lower back pain, morning stiffness, buttock pain, or any other symptoms mentioned above, it is essential to consult a Rheumatologist, with a clinical interest in axSpA. Diagnosis typically involves a combination of medical history, physical examination, imaging tests (such as X-rays and MRI), and blood tests to assess inflammatory markers.

Acknowledgements

Author: Dr Dobrina Hull MA (Oxon), BMBCh, FRCP, PhD

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