Axial spondyloarthritis (axSpA) is an umbrella term for inflammatory arthritis that affect the spine. 'Axial' and 'Spondylo' refer to  inflammation of the joints in the spine, chest and sacroiliac (hip) joints and ‘arthritis’ means joint disease. People with axSpA can have inflammation of other joints. 

What is the difference between axial spondyloarthritis and ankylosing spondylitis (AS)?

New classifications of axial spondyloarthritis has expanded to include radiographic axSpA and non-radiographic axSpA (nr-axSpA). Radiographic axSpA, also known as ankylosing spondylitis (AS) shows damage to the spinal and sacroilliac joints on x-rays. People in earlier stages of the disease may not have evidence of radiographic changes, but share the same symptoms and signs, family history and genetic factors. People with nr-axSpA may develop AS in the future. 

People with axSpA  and their healthcare providers may still use AS to describe the condition. However, as more is learnt about the disease, more people are using axSpA to describe AS.

Symptoms of axSpA and nr-axSpA may include inflammation of:

• The spine and sacroiliac joints (joints that connect the base of your spine to your pelvis), as felt as pain and stiffness in the buttocks, back and/or neck.
• The joints in the legs and arms, causing pain, stiffness and swelling.
• the tendons (strong cords that connect bones to each other) and ligaments (which connect bones to each other), often at the back of the heel or underneath the foot.
• The eyes, skin and other parts of the body.

People with nr-axSpA may develop axSpA in the future. Where inflammation can be seen on x-rays.

Both axSpA and nr-axSpA are seronegative and are associated with a gene called HLA-B27.

What does seronegative mean?

Seronegative means ‘absent from the blood’. Having a type of arthritis that is seronegative means that your body does not produce rheumatoid factor (RF). RF is a type of antibody that your body makes when you have rheumatoid arthritis (RA). Although uncommon, RF can be found in people who do not have RA. Rheumatoid factor is found by doing a blood test. Cases of arthritis that test negative for rheumatoid factor can be called seronegative arthritis.

What causes it?

It is not known what causes axSpA. You have higher risk of axSpA if you have a history of it in your family. The HLA-B27 gene is linked to axSpA. Although it is possible to have the gene and not develop axSpA.

What is HLA-B27?

HLA-B27 is a gene that is linked to the development of axSpA. Your doctor will take a blood test to determine whether you have the HLA-B27 gene. Not everyone who has the gene will develop axSpA. It is also possible that some people will not have the gene and develop axSpA. The presence of the HLA-B27 gene amongst different population groups varies. This means that some racial groups are more likely to have the HLA-B27 gene than others, though they may still develop axSpA.

How is axSpA diagnosed?

Your doctor will diagnose you with axSpA from your symptoms, a physical examination and blood tests to measure levels of inflammation.  Your doctor will also order imaging tests of your spine and pelvis. If you doctors suspects you have axSpA they will refer you to a rheumatologist, a doctor who specialises in arthritis. Read out resource on how axSpA is diagnosed 

What will happen to me?

With the right treatment most people with axSpA can live full and active lives. Newer treatments mean that axSpA can be well controlled and the risk of permanent stiffness in the back or neck due is low. Starting proper treatment as early as possible is important to help prevent complications.

What treatments are there for axSpA?

Your rheumatologist will tailor your treatment to your symptoms and how severe you condition is. There is no way of predicting exactly which treatment will work best for you. Your doctor may need to trial several different treatments before finding the one that is right for you. Your treatment may include:

• Physiotherapy exercises, to keep the spine flexible and improve posture
• Medicines, such as:
  • Analgesics (pain-relievers, such as paracetamol)
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroid medicines or injections
  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biological DMARDs.

What can I do?

• See a rheumatologist. A rheumatologist can diagnose your disease and make sure you get the right treatment. If you have axSpA and have not seen a rheumatologist, ask your doctor to consider referring you.
• Learn about your condition and play an active role in your treatment. Not all information you read or hear will be trustworthy so always talk to your doctor or healthcare team about treatments you are thinking about trying. Self-management courses aim to help you develop skills to be actively involved in your healthcare. Contact your Arthritis Office for details of these courses.
• Learn ways to manage pain.
• Stay active. It is important to do regular sports and activities for general fitness and wellbeing. Read more about physical activity or ask your physiotherapist for help.
• Acknowledge your feelings and seek support. As there is no cure for axSpA, it can affect many parts of your life. It is natural to feel scared, frustrated, sad and sometimes angry. Be aware of these feelings and get help if they start affecting your daily life.