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Finding the Right Treatment for Axial Spondyloarthritis

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Understanding Non-Radiographic Axial Spondyloarthritis

Medically Reviewed By Nancy Carteron, M.D., FACR

Non-radiographic axial spondyloarthritis can be hard to pronounce, let alone figure out what the words mean. However, once you understand what it is, you will have a better idea of what to talk about with your doctor.


To start, “spondyloarthritis” refers to a chronic, immune-related joint inflammation. “Axial” means the inflamed joints are mainly in the spine and pelvis. 

There is also a form of spondyloarthritis that mainly affects joints outside the spine. The name for it is peripheral spondyloarthritis. Examples include psoriatic arthritis and arthritis due to inflammatory bowel disease (IBD).

It is possible to have symptoms both in and outside the spine. If so, doctors base it on whichever form is most bothersome.

Understanding non-radiographic axial spondyloarthritis

Doctors divide axial spondyloarthritis into two types:

  • Radiographic: Inflammation has damaged joints in the spine or pelvis, and doctors can see this damage on X-rays (radiographs). The damage may cause vertebrae in the spine to fuse. This is called ankylosis. So, another name for this type is ankylosing spondylitis.
  • Non-radiographic: Inflammation affects joints in the spine or pelvis, but doctors do not yet see apparent damage on X-rays. Doctors may be able to see signs of inflammation with other imaging exams, such as an MRI scan.

However, the difference is not always apparent. Doctors tend to think of the two types as ends of a spectrum.

On one end, there is little or no visible joint damage. This is non-radiographic axial spondyloarthritis (nr-axSpA). On the other end, there is apparent damage. This is radiographic axial spondyloarthritis (also called ankylosing spondylitis or AS).

Everyone who has AS had nr-axSpA at one time. However, not everyone who has the nr-axSpA will progress to ankylosing spondylitis. Those who progress to ankylosing spondylitis can do so at different rates — taking years to decades. 

In addition, symptoms can vary from mild to severe for either type. In fact, symptoms do not depend on the amount of joint damage. Pain and disability are similar for both types. As a result, doctors treat them in similar ways.

Diagnosing non-radiographic axial spondyloarthritis

Diagnosing nr-axSpA can be challenging. Doctors look for one of the following:

  • lower back pain and stiffness that has lasted for at least 3 months and gets better with activity but not with rest
  • limited motion in the lower back
  • limited ability to expand your chest

If you have one or more of these, doctors will usually recommend X-rays of the lower back. They are looking for changes in the sacroiliac (SI) joints. There is an SI joint on both sides of the body where the pelvis meets the spine.

If doctors cannot see changes on an X-ray, they may recommend an MRI Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  scan. This imaging exam can show signs of inflammation in the spine and SI joints that X-rays cannot. 

Doctors may also recommend an HLA-B27 lab test. This gene marker is present in most people who have nr-axSpA or AS. Your doctor may also consider testing for inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

Prioritizing your well-being with non-radiographic axial spondyloarthritis

Nr-axSpA and AS usually start before age 45. The average age when symptoms start is 28 years.

Inflammation from these conditions increases the risk of heart and blood vessel problems. Treating nr-axSpA and AS can improve quality of life. Because the symptoms are the same for nr-axSpA and AS, the approach to treating them is, too. 

First-line treatment is usually a nonsteroidal anti-inflammatory drug (NSAID) and physical therapy. However, not everyone may respond to this approach. 

In this case, doctors usually prescribe a biologic drug. Biologics treat nr-axSpA by slowing disease progression, improving function, and relieving symptoms.

2023 study Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  states that JAK inhibitors may help improve quality of life and work function for people with nr-axSpA. 

There are also several self-care habits Trusted Source National Institute of Arthritis and Musculoskeletal and Skin Diseases Governmental authority Go to source  you can consider to improve your well-being with nr-axSpA, including: 

  • managing stress
  • quitting smoking if you smoke
  • practicing good posture with the help of a physical therapist
  • eating a nutritious diet as recommended by a doctor to help maintain your target body weight
  • exercising to promote spine mobility after approval from your doctor
  • tending to your mental health with the help of counselors or support groups

Your medical team can work with you to develop a care plan that meets your needs.

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Medical Reviewer: Nancy Carteron, M.D., FACR
Last Review Date: 2024 Jan 5
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