Axial Spondyloathritis (Axial SpA), which encompasses Ankylosing Spondylitis (AS) and nonradiographic axial spondyloarthritis, is a chronic inflammatory arthritis involving the spine and sacro-iliac joints. Diagnosis can be difficult and often takes 8.5 years, so delaying treatment. Early treatment usually has a better outcome.
Axial SpA is often associated with other musculoskeletal features including; arthritis of peripheral joints , Enthesitis such as Achilles Tendinitis and Plantar Fasciitis, inflammation of entire fingers(Dactylitis) and other features such as inflammation of the eyes (uveitis), psoriasis and inflammatory bowel disease (IBD) such as Crohn’s Disease or Ulcerative Collitis.
Approximately one in 200 hundred people suffer with it equally affecting men and women. The main presenting symptom is back pain and stiffness and buttock pain. As well as the above features, sufferers may complain of fatigue, low spirits and functional impairment affecting work and leisure pursuits.
Inflammatory back pain is chronic back pain beginning under the age of 45 years and lasting at least 3months with at least 4 of the following features:
Age of onset less than 40,
Improvement with exercise,
No improvement with rest,
Pain at night which improves with moving
Those patients with inflammatory back pain who are diagnosed with Axial SpA will also be found to have some of the above non-musculoskeletal symptoms such as Inflammatory Bowel Disease, psoriasis etc. They will usually respond well to non-steroidal anti-inflammatories. They may have increased levels of C-reactive protein, a positive HLA-B27 test and family history of axial SpA, psoriasis and IBD. There is no one test to confirm the diagnosis but blood test results may contribute towards a positive diagnosis. X rays and MRI’s may show spinal fusion and spinal changes
Regular exercise and stretching can help to maintain flexibility and posture and helps with management of pain. Those with spinal fusion should not be manipulated in case of spinal fracture. Patients should be encouraged to stop smoking as it reduces the effectiveness of the treatment.
Non-steroidal anti-inflammatories are usually the first course of treatment to reduce pain and stiffness and may reduce the worsening of structural damage. However, their long term use can have cardiovascular, renal and gastro-intestinal side-effects. Some patients have benefitted from the use of biological disease-modifying ant-rheumatic drugs such as tumour necrosis factor inhibitors. These can only be prescribed by rheumatologists.
Those who are suffering with inflammatory back pain should seek help from a GP or osteopath to help identify whether they maybe suffering from Axial SpA.