Non-radiographic axial spondyloarthritis or nr-axSpA and non-radiographic ankylosing spondylitis/AS are related. However, non-radiographic axial spondyloarthritis can present AS symptoms with active inflammation of the spine and sacroiliac/SI joints, causing back and hip pain but does not reveal joint damage on X-rays or MRIs. Injury Medical Chiropractic and Functional Medicine Clinic can explain what it means to have non-radiographic axial spondyloarthritis, how it can be managed, and what to do to prevent it from turning into ankylosing spondylitis.

Non-Radiographic Axial Spondyloarthritis

Non-radiographic axial spondyloarthritis means there are early AS symptoms but have not developed enough joint inflammation or damage to show up on an X-ray or other form of imaging. Early evidence of joint inflammation includes blurring of the joint edges and localized regions of joint erosion. It can be difficult for physicians to see these subtle changes on an x-ray.

Ankylosing Spondylitis

• Ankylosing spondylitis, or AS, is a form of inflammatory arthritis that affects joints in the spine and elsewhere.
• It is a chronic, inflammatory, autoimmune disease.
• Medical research is still ongoing to determine the exact cause, but a genetic component is believed to be contributing factor.
• Around 85% of individuals with ankylosing spondylitis have inherited the HLA-B27 gene, which is associated with multiple autoimmune conditions.
• In the early stages, individuals will present lower back pain around the sacroiliac joints or the joints that connect the spine to the pelvis.
• Later stages have more obvious X-ray findings, like the fusing of the sacroiliac joints and the lower spine that takes place over time.
• Joint inflammation can progress, causing permanent joint damage and spine rigidity.
• Most individuals with the condition can manage their symptoms with NSAIDs, chiropractic care, physical and massage therapy, and range of motion exercises.

Stage 1

• There is no evidence of spinal inflammation on x-rays.
• MRI provides more detailed images of bones and may reveal bone marrow edema or accumulation of fluid in the structures of the spinal bones and joints.
• Individuals with non-radiographic axial spondyloarthritis, you are here.

Stage 2

• There is visible inflammation of the spinal joints on the x-ray.
• The sacroiliac joints between the spine and the pelvis are the most affected.

Stage 3

• Chronic inflammation of the joints has caused bone loss and permanent joint damage, resulting in spine rigidity.

Symptoms of Non-Radiographic Axial Spondyloarthritis

There are differences between back pain associated with muscle strain and arthritis. Back pain symptoms include:

• Starts to present before age 40.
• It has a gradual onset and can go unnoticed for years.
• Improves with movement or activity.
• Eases up throughout the day.
• Starts up in the evening when resting.

Other symptoms include:

• Joint stiffness
• Swollen fingers
• Heel pain
• Bilateral buttock discomfort and pain

Slowing Progression

Progression from non-radiographic axial spondyloarthritis to ankylosing spondylitis occurs in 10% – 20% of individuals over a two-year period. Progression factors include genetics, gender, degree of joint damage, and level of inflammatory markers at the time of diagnosis.

• Early diagnosis and treatment can slow the progression before significant joint damage with anti-inflammatory therapy, rheumatological therapy, and targeted exercise.
• Work with a specialist like an orthopedic spine specialist and rheumatologist that understands the disorder and is up to date on the most recent treatment modalities.
• A rheumatologist will perform diagnostic tests, including spine X-rays, genetic blood work, and serum inflammatory markers.
• Individuals with non-radiographic axial spondyloarthritis should expect to have serial X-rays to gauge the progression of the disease.
• Staying healthy and active is recommended to slow the progression of nr-AxSpA and AS.
• Recent medical advances and lifestyle adjustments can slow the progression in most cases.

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References

Six tips for living well with ankylosing spondylitis. Available at www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/in-depth/6-tips-for-living-well-with-ankylosing-spondylitis/art-20478753. Accessed 11/07/2022.

Ankylosing spondylitis. Mayo Clinic. Available at www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808. Accessed 11/05/2022.

D. J. Pradeep, A. Keat, K. Gaffney, Predicting outcome in ankylosing spondylitis, Rheumatology, Volume 47, Issue 7, July 2008, Pages 942–945, doi.org/10.1093/rheumatology/ken195

Kucyba?a, Iwona, et al. “Radiologic approach to axial spondyloarthritis: where are we now and where are we heading?.” Rheumatology international vol. 38,10 (2018): 1753-1762. doi:10.1007/s00296-018-4130-1

Michelena, Xabier, López-Medina, Clementina, and Helena Marzo-Ortega. “Non-radiographic versus radiographic axSpA: what’s in a name?”.” National Center for Biotechnology Information. October 14, 2020. doi.org/10.1093/rheumatology/keaa422

Swift D. Ankylosing spondylitis: disease progression varies widely. Medpage Today. Accessed 11/05/2022.Available at www.medpagetoday.com/rheumatology/arthritis/49096