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Finding the Right Treatment for Axial Spondyloarthritis

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Why Non-Radiographic Axial Spondyloarthritis Can Be Misdiagnosed

Medically Reviewed By Stella Bard, MD

Back pain is a common symptom of a type of arthritis called non-radiographic axial spondyloarthritis (nr-axSpA). However, it often takes years for people with nr-axSpA to get an accurate diagnosis.

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Non-radiographic axial spondyloarthritis (nr-axSpA) symptoms begin in the lower back. When you experience lower back pain, you may assume you did something to strain it, such as lifting something heavy. This is what’s known as mechanical back pain. As with any medical condition, getting a proper diagnosis is the first step to finding the right treatment.

Nr-axSpA is a type of inflammatory back pain that is less common. Signs of inflammatory back pain caused by nr-axSpA can include:

  • gradual worsening of pain
  • pain that lasts longer than 3 months
  • consistent pain that starts before you are 45 years of age
  • pain that improves with activity and worsens with rest, such as first thing in the morning

Nr-axSpA testing and diagnosis

Axial spondyloarthritis (axSpA) Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source is an inflammatory condition that affects your spine and the joints that connect your spine and pelvis.

Some people have the type known as radiographic axial spondyloarthritis (r-axSpA), also known as ankylosing spondylitis. With r-axSpA, you can see visible changes in your sacroiliac joints between the bottom of your spine and pelvis on an X-ray.

However, with nr-axSpA an X-ray does not show any changes in those joints. People with nr-axSpA may still experience significant lower back pain and stiffness, but there is no apparent damage on the X-ray.

An MRI can reveal signs of inflammation in the sacroiliac joints that are not visible on X-rays for many people with nr-axSpA. In some cases, an MRI may not show signs of the condition.

Athletes or a person in postpartum may show inflammation of the sacroiliac joints that isn’t caused by nr-axSpA.  So, while an MRI can help diagnose nr-axSpA, it doesn’t always provide a definitive answer.

Doctors can recommend a blood test for medical conditions to determine a specific diagnosis. However, this isn’t the case for nr-axSpA. Blood tests, such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), may indicate the presence of inflammation within the body. Still, they don’t specify that it’s due to nr-axSpA.

Blood tests can also be done to check for a gene strongly associated with nr-axSpA called HLA-B27. However, many people can also have this gene but not have nr-axSpA. Knowing if someone has this gene is essential when determining a diagnosis.

Nr-axSpA can affect other parts of your body

Nr-axSpA is thought to be an autoimmune disease in which an overactive immune system attacks healthy tissues. This can cause inflammation in your body beyond your spine and pelvis. You may notice:

  • arthritis in smaller joints, such as hands, hips, ankles, and knees
  • enthesitis, or pain where your bone attaches to a tendon or ligament, in areas such as your knees or heels
  • swelling in your fingers or toes
  • uveitis, or inflammation of your eye

Nr-axSpA may overlap with other autoimmune diseases. You may experience gastrointestinal issues associated with inflammatory bowel disease or an itchy skin rash from psoriasis.

It may not be apparent that these varied symptoms are all linked to nr-axSpa. For example, you may see a dermatologist for your rash or an eye doctor for your painful eye with no mention of your back pain. This can lead to delays in diagnosis.

Takeaway

Due to the complexities of nr-axSpA, it may take time before you are referred to a rheumatologist, a doctor who specializes in inflammatory disorders of the joints, muscles, and bones.

A rheumatologist will ask you about your medical and family histories and perform a physical exam. You can expect your doctor to order blood work and imaging tests to reach an official diagnosis.

Although there is no cure for nr-axSpA, several treatments are available. Medications, physical therapy, and lifestyle modifications can help relieve symptoms and improve your quality of life.

The medical community’s understanding of nr-axSpA continues to improve. As knowledge grows, earlier diagnosis and treatment initiation will follow.

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Medical Reviewer: Stella Bard, MD
Last Review Date: 2024 Jan 18
View All Finding the Right Treatment for Axial Spondyloarthritis Articles
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