Ask an expert: What is axial spondyloarthritis?

Despite the fact that many readers won’t have heard of it, axial spondyloarthritis is an extremely common condition which affects millions of people every year. It can cause great pain and discomfort in different parts of the body if not taken care of. Luckily, Professor Hasan Tahir, one of London’s top rheumatologists has shared his expertise on this condition.

What is axial spondyloarthritis?

Formerly known as ankylosing spondylitis, axial spondyloarthritis (or axial SpA) is a type of inflammatory arthritis that affects the spine, particularly the lower part, as well as the pelvis. The symptoms of this condition vary both in terms of severity and affected areas. Axial SpA may also affect peripheral joints, tendons and ligaments. Some people hardly notice symptoms, while in some cases pain and stiffness can cause great discomfort and difficulty performing everyday tasks.

Is axial spondyloarthritis an autoimmune disease?

Axial SpA is both an autoimmune and chronic disease, however, thanks to modern treatment options, most patients are able to live an active life. It is also unlikely to cause severe disability later in life.

Who does this condition typically affect?

Most axial SpA patients are diagnosed before the age of thirty-five. Early diagnosis means patients can start treatment sooner, although this can be difficult because of the prevalence of back pain for people of all ages in modern society.

How does it occur?

The exact cause of axial SpA is unknown, but there is a considerable amount of evidence which suggests genetics could be a factor. There is no cure for this condition at the moment but it can be managed with anti-inflammatory, pain-relieving drugs, physical therapy, biological medication and exercise.

What are the symptoms?

Inflammatory back pain (IBP) is a term used to describe the most common symptoms of axial SpA. IBP commonly occurs in the early stages of axial SpA and usually continues as the condition develops. Symptoms of IBP include:

• gradually worsening pain in the lower back or buttocks and stiffness lasting over three months
• severe pain during sleep which wakes you up
• lower spine stiffness when waking up which usually improves with movement and exercise during the day although may worsen after long periods of rest
• severe tiredness

Which other areas of the body does it affect?

As well as the spine, axial SpA can affect joints, bones and tendons in other areas of the body. Roughly half of all axial SpA patients experience inflammation in the peripheral joints of the limbs, especially those involving larger joints such as the hips or shoulders.

Peripheral arthritis can also occur due to axial SpA which can lead to pain, stiffness and sometimes swelling of the joint. These symptoms are usually worse in the mornings and can result in dactylitis (inflammation of a whole finger or toe). Inflammation of the area where ligaments and tendons meet the bone, or enthesitis, is also a common symptom of axial SpA. This can lead to the heels (plantar fascitis) or soles of the feet feeling tender during long periods of walking or when taking your first steps in the morning.

Enthesitis also commonly causes inflammation in the Achilles tendon (Achilies tendinopathy), which causes pain at the back of the heel. Enthesitis can also affect the elbows (tennis elbow or golfer’s elbow) and the front of the knees (patellar tendinopathy).

How is axial SpA treated?

While there is no cure for axial SpA, most patients are able to successfully manage the condition without it having too much of a detrimental effect on their quality of life. With a combination of medicine, exercise, physiotherapy and lifestyle changes the condition can be managed well. In some cases, motional and/or psychological wellbeing strategies may also be required.

The majority of axial SpA patients do not require surgery. Biological drugs are a type of medication that targets the cells in the immune system that are responsible for the inflammation in a specific area of the body. This medication is usually offered to patients with high levels of pain and stiffness who don’t respond to or can’t tolerate non-steroidal anti-inflammatory drugs (NSAIDs).

Exercise is considered to be an essential part of axial SpA treatment, as it has been proven to help patients at all stages. It can improve your cardiovascular health, flexibility, strength, posture and sleep, therefore improving your overall quality of life. Although pain and stiffness may worsen at different times, the fitter and more flexible you are, the better you'll be able to manage sudden flare-ups.

If these symptoms sound familiar to you, you may be suffering from axial SpA. Visit Professor Tahir’s profile to book an appointment with him and receive his expert advice.