While most of us are familiar with osteoarthritis and rheumatoid arthritis, there are other, lesser-known forms of arthritis, like axial spondyloarthritis.
Axial spondyloarthritis is a form of inflammatory arthritis that mostly causes severe back pain. According to the NHS, it affects one in 200 UK adults. Though, experts suspect many more people may be living undiagnosed with the condition.
Although there’s currently no cure for this condition, it can usually be managed with a combination of treatment and lifestyle changes. While living with axial spondyloarthritis can be incredibly challenging, most people can still lead an active life.
Here, we’ll take a closer look at axial spondyloarthritis, covering everything from symptoms, causes, and diagnosis to ways to live well with the condition.
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What is axial spondyloarthritis?
Axial spondyloarthritis is a form of inflammatory arthritis. It was previously known as axial spondylitis and often causes back pain due to swelling in the spine and the joints that connect the bottom of the spine to the pelvis (the sacroiliac joint). However, other joints can also be affected.
There are two types of axial spondyloarthritis…
- Ankylosing spondylitis, also known as radiographic axial spondyloarthritis, causes damage to the sacroiliac joints and spine, which can be detected on X-rays.
- Nonradiographic axial spondyloarthritis causes damage that may not be visible on X-rays but may appear on MRI scans.
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What are the symptoms of axial spondyloarthritis?
The most common symptom of axial spondyloarthritis is back pain. According to the NHS, this pain is typically…
- Gradual, causing pain and stiffness that starts in the lower back or buttocks and usually lasts more than three months
Nightly pain, which may cause you to wake up
- Associated with stiffness in the lower back when you first wake up, and tends to improve with movement during the day, but worsens after periods of rest
- Linked with fatigue
Axial spondyloarthritis can also affect joints other than the spine. Around 50% of people with the condition have inflammation in their arms or legs – most commonly in the hip or shoulder joints, causing pain, stiffness, and sometimes swelling.
Some people also experience tenderness in their heel or sole, known as plantar fasciitis, or pain in the back of the heel, called Achilles tendinopathy.
If left unchecked, axial spondyloarthritis can cause bones in the spine to fuse, making them less flexible and increasing the risk of certain health complications. We’ll cover some of these below.
Note: If you experience any of these symptoms, it’s important to speak to your GP immediately.
Potential complications of axial spondyloarthritis
Axial spondyloarthritis and mental health
Research shows that axial spondyloarthritis can significantly impact mental health – largely due to physical symptoms like pain, immobility, and long-term effects of the condition.
In this study, 57% of people with axial spondyloarthritis reported experiencing psychological distress as a result of their symptoms. And another study found that people with axial spondyloarthritis had a 51% greater risk of depression, compared to those without the condition.
Axial spondyloarthritis and eye health
According to the NHS, around one quarter of people with axial spondyloarthritis develop uveitis – a condition caused by inflammation in the front of the eye between the cornea and the lens. Symptoms can include redness, sensitivity to light, and painful, gritty eyes.
Axial spondyloarthritis and osteoporosis
People with axial spondyloarthritis have a higher risk of developing osteoporosis due to higher inflammation levels and reduced flexibility. This risk is further increased by lifestyle factors such as smoking, lack of exercise, and excessive alcohol intake.
Axial spondyloarthritis and heart health
The inflammation caused by axial spondyloarthritis is believed to increase the risk of heart and circulation problems in 2-10% of people diagnosed with the condition.
Axial spondyloarthritis and breathing issues
Some people with axial spondyloarthritis may experience tightness or stiffness around their rib cage, upper back, and chest caused by inflammation of the muscles or rib joints. These symptoms are often made worse by sneezing or taking deep breaths.
What causes axial spondyloarthritis, and are there any risk factors?
The exact cause of axial spondyloarthritis is currently unclear. However, research suggests that genes play a role, as the condition tends to run in families. Specifically, a gene called HLA B27 is present in more than 85% of people with axial spondyloarthritis.
However, it’s important to note that carrying the HLA B27 gene doesn’t necessarily mean you have axial spondyloarthritis or will go on to develop it. Around 15% of people with axial spondyloarthritis don’t have the gene.
Certain other health conditions, including psoriasis, uveitis (a type of eye inflammation), and inflammatory bowel diseases, like Crohn’s or ulcerative colitis, also increase your risk of developing axial spondyloarthritis. For example, research suggests that around one in 14 people with axial spondyloarthritis has inflammatory bowel disease.
While axial spondyloarthritis can occur at any age, with the average age of onset being 26. According to research, the condition is generally more common in men than women (although nonradiographic axial spondyloarthritis is just as common in women as in men).
How is axial spondyloarthritis diagnosed?
If left untreated, axial spondyloarthritis can increase the risk of health complications. So, it’s important to speak to your GP if you’re experiencing symptoms. They’ll be able to assess your joint pain and will refer you to a specialist (rheumatologist) if they suspect you have axial spondyloarthritis.
There’s no single test used to diagnose axial spondyloarthritis. Instead, a rheumatologist will usually ask you about your symptoms, medical history, examine your joints, and perform certain tests.
This often includes blood tests to check for inflammation and the HLA B27 gene, as well as X-rays and MRI scans to look for changes like extra bone growth, inflammation, or fusing bones.
If you’re diagnosed with axial spondyloarthritis, you’ll continue under the care of the rheumatology department. For more information on treatment for axial spondyloarthritis, head over to the NHS website.
How is axial spondyloarthritis treated?
There’s currently no cure for axial spondyloarthritis. However, the condition can often be managed with a combination of medication, exercise, and other lifestyle changes.
According to the NHS, establishing a treatment plan and looking after your health is essential for reducing the long-term effects of axial spondyloarthritis.
Medication
A range of medications is used to treat axial spondyloarthritis. This includes steroids, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and disease-modifying anti-rheumatic drugs (DMARDs), which can help reduce inflammation.
You can read more about medication for axial spondyloarthritis on the NHS website.
Exercise
Exercise has been found to help patients with axial spondyloarthritis at all stages, so it’s a key part of treatment.
Staying active benefits everything from your heart health to flexibility, posture, sleep, and mental health and can significantly improve quality of life. While there’ll be times when pain and stiffness make exercising more difficult, experts say that being physically fit and more flexible can help make flare-ups more manageable and improve axial spondyloarthritis.
According to the NHS, exercise such as swimming, yoga, Pilates, and resistance training can be particularly beneficial. Introducing regular stretching into your routine is also recommended.
If you’re yet to find a form of exercise that you enjoy, head over to our fitness and exercise section. Alternatively, you can ask your GP to refer you to a physiotherapy team if you’d like further guidance on exercising with axial spondyloarthritis. The National Axial Spondyloarthritis Society also offers regular exercise sessions tailor-made for people with axial spondyloarthritis.
Surgery
According to the NHS, most people with axial spondyloarthritis don’t need surgery. However, if joint inflammation causes significant damage, surgery, such as joint replacement, may be considered.
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5 tips for living with axial spondyloarthritis
Living with a long-term health condition can be challenging. However, several things can help. We’ll cover some ideas below.
1. Eat a healthy, balanced diet
Eating a balanced diet is beneficial for general wellbeing, and research suggests it can help manage symptoms of axial spondyloarthritis.
One reason for this is that eating well is key to maintaining a healthy weight, and research shows that being overweight or obese places strain on joints. Other research has found that diet may play a role in the severity of arthritis symptoms and slow its progress.
While there’s no specific axial spondyloarthritis diet, experts advise basing it around whole, unprocessed foods. Anti-inflammatory foods, such as fish, nuts, seeds, and wholegrains, can be particularly effective for reducing inflammation associated with the condition. If you’re not sure what this looks like, the Mediterranean diet is a great place to start.
For further guidance, you might like to read our article: 7 diet tips for people living with arthritis.
2. Take steps to stop smoking
We all know that smoking is bad for our health in general, but research shows that it can worsen axial spondyloarthritis symptoms.
This study linked smoking with earlier disease onset, more damage and inflammation, poorer function, and reduced quality of life in people with axial spondyloarthritis. Another study found that smokers with axial spondyloarthritis report more severe symptoms and poorer health than non-smokers.
As a result, stopping smoking is one of the best things you can do for your health. Check out our article, 7 tips for quitting smoking, for support with this.
3. Practise relaxation techniques
Introducing relaxation techniques into your daily routine, such as deep breathing and mindfulness, can help manage pain and the impact of axial spondyloarthritis on your mental health.
Check out our article, 9 simple stress-relieving activities, for more ideas.
4. Try to moderate your alcohol intake
There’s some evidence to suggest that drinking alcohol may exacerbate axial spondyloarthritis symptoms. For example, this study identified a potential link between alcohol and the progression of spinal damage in people with axial spondyloarthritis.
As a result, it can be helpful to moderate your intake. The NHS advises those with axial spondyloarthritis to stick to the national recommendations of drinking no more than 14 units of alcohol per week.
For help reducing your alcohol intake, have a read of our articles: 13 affordable and tasty alcohol-free drinks and 10 tips to stay alcohol-free beyond dry January.
5. Prioritise good-quality sleep
Fatigue is a common symptom of axial spondyloarthritis and one that many people find most difficult to live with. People with the condition often have trouble getting to sleep and experience disturbed sleep due to pain, leaving them feeling tired and low in energy.
Take this study, which found that 53% of people with axial spondyloarthritis experienced poor sleep.
Research has also revealed that the relationship between arthritis pain and poor sleep is two-way. Just as arthritis pain can make it difficult to sleep well, a lack of sleep has been found to exacerbate pain by interrupting the body’s ability to rest and recover. So, prioritising good-quality sleep is one of the best things you can do.
If you’re currently struggling, you might like to read our article: 9 tips for sleeping better with arthritis. Or, head over to our sleep and fatigue section.
Final thoughts…
Axial spondyloarthritis can be painful and distressing to live with – often significantly affecting quality of life. However, while there’s currently no cure, the good news is that, with the right approach, most people with axial spondyloarthritis can manage their symptoms and lead active lives.
For further reading, head over to our bone health section. Here, you’ll find information on everything from keeping your knees healthy to other forms of arthritis.
Do you have any experience with axial spondyloarthritis? Are there any other tips you’d like to share? We’d be interested to hear from you in the comments below.
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