Axial Spondyloarthritis

Also known as: Ankylosing spondylitis, AS, axSpA

Inflammatory arthritis of the spine and sacroiliac joints, typically starting before age 45 with back pain that improves with movement.

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How it works · Axial spondyloarthritis

A flexible spine

Vertebrae are separated by discs and held together by ligaments, letting the back bend and twist.

What it is

Axial spondyloarthritis inflames the sacroiliac joints, the spine and the points where ligaments attach to bone. When X-rays show established changes it is called ankylosing spondylitis. It is strongly linked to the HLA-B27 gene and can also affect the eyes, gut and skin.

Symptoms

Back or buttock pain for three months or more that is worse after rest and better with exercise. Morning stiffness, waking in the second half of the night with pain, heel pain and episodes of a painful red eye (uveitis).

How it’s diagnosed

Your doctor looks at the pattern of back pain, examines spine movement and orders HLA-B27, CRP and imaging. MRI of the sacroiliac joints can show inflammation years before X-rays change.

Treatment

NSAIDs and a daily exercise program come first. If symptoms persist, TNF or IL-17 inhibitors are very effective, and JAK inhibitors are another option. Methotrexate does not help the spine.

Living with it

Daily stretching, posture work and swimming keep the spine flexible. Not smoking matters, since smoking speeds up spinal fusion. Seek same-day care for a painful, red, light-sensitive eye.

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