Axial spondyloarthritis (axSpA) or ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints . It’s part of the broader family of spondyloarthritis diseases, which also includes conditions like psoriatic arthritis and reactive arthritis.
Classification
Axial spondyloarthritis is typically divided into two subtypes:
- Radiographic Axial Spondyloarthritis (Ankylosing Spondylitis or AS): This form shows clear evidence of inflammation and damage on X-rays, particularly in the sacroiliac joints and spine.
- Non-Radiographic Axial Spondyloarthritis (nr-axSpA): This form does not show such damage on X-rays, but inflammation can be detected through MRI scans and clinical symptoms.
Symptoms
- Chronic Back Pain: Persistent pain and stiffness in the lower back and buttocks, which often improves with exercise but not with rest.
- Morning Stiffness: Stiffness that lasts for more than 30 minutes after waking up.
- Improvement with Exercise: Symptoms tend to improve with physical activity.
- Alternating Buttock Pain: Pain can switch from one side to the other.
- Peripheral Joint Pain: Involvement of joints outside the spine, such as hips, shoulders, and knees.
- Enthesitis: Inflammation at the sites where tendons and ligaments attach to bone.
- Fatigue: A common symptom due to chronic inflammation and pain.
Causes and Risk Factors
- Genetics: The HLA-B27 gene is strongly associated with axSpA.
- Environmental Factors: Infections and other environmental triggers may play a role in susceptible individuals.
Diagnosis
- Medical History and Physical Examination: Evaluation of symptoms, family history, and physical signs of inflammation.
- Imaging Tests: MRI and X-rays to detect inflammation and structural damage.
- Laboratory Tests: Blood tests to check for inflammation markers (like C-reactive protein) and the presence of the HLA-B27 gene.
Treatment
- Medications:
- NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): First-line treatment to reduce pain and inflammation.
- Biologics (TNF inhibitors, IL-17 inhibitors): Used for patients who do not respond to NSAIDs.
- DMARDs (Disease-Modifying Antirheumatic Drugs): Occasionally used, especially if there is peripheral joint involvement.
- Physical Therapy: Exercise programs to maintain flexibility and posture.
- Lifestyle Changes: Regular exercise, maintaining a healthy weight, and avoiding smoking.
- Surgery: Rarely needed, but might be considered in severe cases of joint damage.
Management
- Regular Monitoring: Regular visits to a rheumatologist to monitor disease activity and treatment effectiveness.
- Patient Education: Understanding the disease, treatment options, and the importance of physical activity.
- Support Systems: Counseling and support groups for coping with chronic illness.
Prognosis
The course of axSpA varies. Early diagnosis and appropriate treatment can manage symptoms effectively and prevent or slow disease progression, significantly improving quality of life.
