Joint pain resolved in a professional manner.
AS or axial-Spondyloarthritis: a modern name for an age-old condition
A new name:
Ankylosing Spondylitis (or AS) has a new name now – ‘axial Spondyloarthritis’ (usually shortened to ax-SpA). This term reflects a spectrum of disease that includes:
- Radiographic axSpA: where inflammation is visible on X-rays (formerly called AS)
- Non-radiographic axSpA: where inflammation is only visible on MRI
This update recognises that serious symptoms and disability can occur even without X-ray changes.
What is it?
It is an important inflammatory condition primarily affecting the back and sacroiliac joints. It usually starts during the late teens or twenties. The average age of onset is 26. It is thought to affect 1 person in 200 and occurs more frequently in men (2:1).
What are the symptoms?
Most people experience a recurrent severe low aching back pain and severe stiffness worse in the second half of the night and early morning. Some people find they get similar symptoms in the middle back and neck.
It is frequently severe enough to wake you and some people have to get out of bed to stretch as they are so uncomfortable.
The very severe symptoms usually last 1-3 hours and are very much better with movement, stretching, a hot shower and improve as the day goes on. The pain and stiffness is very much worse with rest e.g. sitting in a car for an hour.
Some people also have swollen, painful and stiff joints, some have Psoriasis, some have had episodes of eye inflammation called Iritis (another name for this is Uveitis), some have Crohn’s disease or Ulcerative Colitis (inflammation of the bowel) and some have recurrent Achilles tendinitis or plantar fasciitis, severe tennis or golfer’s elbow or costochondritis.
Fatigue can be profound.
How is it diagnosed?
If you experience severe backpain and stiffness which is much worse in the morning, better with movement and better as the day goes on this is often described as “inflammatory back pain”.
If you have inflammatory back pain and if either you or members of your family have a diagnosis of inflamed joints, Psoriasis, Crohn’s disease or Ulcerative Colitis or someone in your family has ax-SpA, then it is wise to seek the advice of a Rheumatologist as it is quite possible you have ax-SpA.
This is quite different from back pain due to osteoarthritis, disc problems in the back, muscle spasm, ‘sciatica’ etc. These conditions usually get worse with activity and often get worse as the day goes on.
If it is likely you have ax-SpA, your Rheumatologist would usually request blood tests and a very specific MRI scan of your back and your sacroiliac joints (SIJs) – these are the joints where the spine and pelvis meet at the bottom of your back and are often inflamed with ax-SpA (people often describe the inflammation in these joints as ‘buttock pain’).
If inflammation is seen on the MRI scan when someone has the symptoms of inflammatory back pain etc. (see above) they will usually have ax-SpA.
How is it treated?
About 70% of patients with ax-SpA do very well with a combination of a drug such as Naproxen (a long acting anti-inflammatory medication or NSAID) and daily stretching exercises.
Therefore, it is important for anyone with this diagnosis to see a specialist AS physiotherapist for advice about daily stretching exercises.
Also, it is a good idea to look at the NASS website (National Axial Spondyloarthritis Society) as they have a lot of very useful information on the site including exercises to do in the gym etc.
For those whose ax-SpA (or AS) is not well controlled with the combination of daily stretching exercises and Naproxen there are many other more intensive medications available. These are called Biologic Therapies. These would need to be provided by your Rheumatologist (they cannot be prescribed by anyone other than a specialist) and there are national guidelines (called NICE guidelines) that need to be followed
Additional Tips for Living Well with axSpA
– Avoid smoking: it worsens outcomes and progression.
– Maintain a healthy weight and stay physically active.
– Monitor posture and core strength with professional support.
– Attend regular rheumatology reviews.
Final Thoughts
Axial Spondyloarthritis can be a challenging condition, especially due to diagnostic delays. But with early recognition, proper treatment, and the right support, people with axSpA can lead full and active lives.
*Sources: NICE NG65, British Society for Spondyloarthritis (BRITSpA), BMJ Best Practice, National Axial Spondyloarthritis Society (NASS)*
