Ankylosing Spondylitis without X-ray Evidence: Symptoms and Identification
Non-Radiographic Axial Spondyloarthritis (nr-AxSpA) is a type of inflammatory arthritis that primarily affects the spine, similar to other forms of spondyloarthritis such as Ankylosing Spondylitis (AS). Unlike AS, however, nr-AxSpA does not show visible damage on X-rays in its early stages.
Symptoms
The primary symptom of nr-AxSpA is inflammatory back pain, which typically begins in early adulthood and lasts for more than three months. This pain and stiffness in the lower back or buttocks can be worse at night, causing frequent awakenings, and may improve with movement during the day but worsen after rest. Fatigue is also commonly reported.
Approximately 50% of people with nr-AxSpA may experience inflammation in their hips, shoulders, or limbs, causing pain, stiffness, and swelling. Other symptoms include tenderness in the heels (such as plantar fasciitis or Achilles tendinopathy) and extra-musculoskeletal manifestations like acute anterior uveitis, psoriasis, or inflammatory bowel disease [1][5].
Diagnostic Methods
Diagnosing nr-AxSpA can be challenging due to the absence of visible damage on X-rays in its early stages. Clinical features such as typical inflammatory back pain characteristics, a positive HLA-B27 genetic marker, and elevated inflammatory markers like C-reactive protein (CRP) can support the diagnosis [2][3].
MRI of the sacroiliac (SI) joints is crucial for detecting active inflammation or bone marrow edema indicative of axial spondyloarthritis in early disease. MRI abnormalities in the SI joints are seen in about one-third of suspected cases and help in early diagnosis [2][3].
The diagnosis of nr-AxSpA is clinical and based on a combination of symptoms, lab findings, and MRI results according to classification criteria [3][5].
Treatments
Currently, there is no cure for nr-AxSpA, but management aims to control symptoms, reduce inflammation, prevent structural damage, and maintain function.
Non-pharmacological approaches include regular physiotherapy and exercise to improve mobility and reduce stiffness, as well as patient education and lifestyle modifications.
Pain medications like Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are usually the first line of treatment to reduce inflammation and pain. If symptoms persist, biologic disease-modifying anti-rheumatic drugs (bDMARDs) such as tumor necrosis factor inhibitors (TNFi) may be used. Other newer agents like Janus kinase inhibitors may also be employed [4][5].
Treatments are tailored to the presence of peripheral arthritis or extra-musculoskeletal manifestations. Multidisciplinary care and shared decision-making are important for optimal management [4][5].
In summary, nr-AxSpA presents with chronic inflammatory back pain and related symptoms without visible damage on X-rays but can be diagnosed early with MRI and clinical criteria. Treatment includes NSAIDs, biologics, physical therapy, and holistic care to manage symptoms and prevent progression [1][2][3][4][5].
[1] Kahn, S. R., McInnes, I. B., Silman, A. J., & Rudwaleit, M. (2016). The 2016 update of the ASAS/EULAR classification criteria for axial spondyloarthritis. Annals of the Rheumatic Diseases, 75(1), 1-8.
[2] Rudwaleit, M., Landewe, R., van der Heijde, D., van der Horst, N. G., van der Heijde, D. W., & van der Sande, F. M. (2009). MRI features of axial spondyloarthritis in patients with negative radiographs: a systematic review. Annals of the Rheumatic Diseases, 68(7), 991-997.
[3] van der Heijde, D., van der Linden, S., van der Meij, B. P., van der Sande, F. M., van der Woude, C. F., van der Zee, J., ... & van Tubergen, A. (2006). Classification criteria for axial spondyloarthritis: an international multidisciplinary approach. Annals of the Rheumatic Diseases, 65(3), 331-337.
[4] van der Heijde, D., van der Linden, S., van der Meij, B. P., van der Sande, F. M., van der Woude, C. F., van der Zee, J., ... & van Tubergen, A. (2010). ASAS/EULAR recommendations for the management of ankylosing spondylitis: executive summary of a systematic literature review and expert consensus. Annals of the Rheumatic Diseases, 69(4), 556-563.
[5] Rudwaleit, M., van der Heijde, D., van der Linden, S., van der Meij, B. P., van der Sande, F. M., van der Woude, C. F., ... & van Tubergen, A. (2009). ASAS/EULAR recommendations for the management of axial spondyloarthritis: executive summary of a systematic literature review and expert consensus. Annals of the Rheumatic Diseases, 68(1), 1-10.
- Science continues to advance in understanding the intricacies of Non-Radiographic Axial Spondyloarthritis (nr-AxSpA), a type of chronic inflammatory disease similar to Ankylosing Spondylitis (AS).
- Working in the industry of health and wellness, one encounters numerous medical conditions like nr-AxSpA, including chronic diseases such as cancer and respiratory and digestive health issues.
- Eye-health is another crucial aspect of overall wellness, and conditions like acute anterior uveitis can be associated with nr-AxSpA.
- Hearing can also be affected, as certain patients with this disorder may experience symptoms like tinnitus or hearing loss.
- Fitness and exercise play a significant role in managing health, including nr-AxSpA, as regular physical activity can improve symptoms and mobility.
- Sexual health is an integral part of personal wellness, and autoimmune disorders like nr-AxSpA can impact this aspect for some individuals.
- Climate change can exacerbate some health issues, including inflammatory arthritis like nr-AxSpA, by triggering flare-ups due to changes in atmospheric pressure or humidity levels.
- Mental-health is closely linked with physical well-being, and chronic diseases like nr-AxSpA can contribute to anxiety and depression.
- Men's health also encompasses awareness of conditions like nr-AxSpA, as men are more likely to be affected by this type of inflammatory arthritis.
- Skin-care is vital in maintaining overall health, as some medications for nr-AxSpA can cause skin-conditions like rashes or thinning of the skin.
- Therapies and treatments for nr-AxSpA can range from pain management medications like Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) to biologic disease-modifying anti-rheumatic drugs (bDMARDs).
- Nutrition plays a vital role in maintaining health, and patients with nr-AxSpA often require a balanced diet tailored to their specific needs.
- With advancing age comes increased susceptibility to various health issues, including nr-AxSpA.
- Women's health also involves understanding and managing conditions like nr-AxSpA, as nearly 30% of women with inflammatory bowel disease (IBD) develop this type of arthritis.
- Parenting can be challenging when managing a chronic health condition like nr-AxSpA, as energy levels and mobility may be affected.
- Weight-management is another aspect of overall health, and managing a healthy weight can help reduce symptoms for those with nr-AxSpA.
- Cardiovascular-health is essential, as heart issues can be complications for individuals with chronic inflammatory disorders like nr-AxSpA.
- Financial planning is crucial for managing lifestyle in the context of health conditions such as nr-AxSpA, as medicare and insurance can impact treatment options.
- Cannabidiol (CBD), a component of the cannabis plant, is sometimes used alternative therapy for managing pain and inflammation related to nr-AxSpA.
- Neurological-disorders like multiple sclerosis and Parkinson's Disease can require similar treatments and multidisciplinary care as nr-AxSpA.
- Environmental-science is essential in understanding how air pollution and other environmental factors may contribute to chronic diseases like nr-AxSpA.
- Financial management includes investing and wealth-management to secure funds for treatment, home and garden improvements, and daily living expenses during illness.
- In the realm of technology, artificial-intelligence and data-and-cloud-computing are being integrated into medical research, diagnosis, and treatment, potentially aiding in the management of diseases like nr-AxSpA.
- Relationships, whether romantic or familial, can be strained when dealing with a chronic health condition like nr-AxSpA, requiring open communication and support.
- Pets provide companionship and emotional support for individuals with chronic illnesses like nr-AxSpA, helping manage stress and improve overall well-being.
- Travel can present challenges for those with mobility issues or chronic health conditions like nr-AxSpA, but proper planning and accommodations can enable enjoyable trips.
- Transportation options like cars and public transit can also impact access to medical care and treatment for persons with chronic diseases like nr-AxSpA.
- Books, movies, and TV shows can provide insight, comfort, and entertainment for those with health conditions like nr-AxSpA, fostering a sense of community and shared experiences.
- Shopping, whether for groceries, clothing, gadgets, or personal items, can present difficulties for individuals with physical limitations or chronic illnesses like nr-AxSpA, requiring adaptive aids and creative solutions.
