Early diagnosis and treatment can significantly improve your quality of life.
Non-radiographic axial spondyloarthritis (nr-axSpA), is a type of inflammatory arthritis that primarily affects the spine. It falls under the umbrella of spondyloarthritis, a category of arthritis diseases that affect the spine.
Chronic back pain is the hallmark symptom of nr-axSpA, but it’s a bit different than other types of back pain. The onset of pain is often gradual and occurs in people under 45 years of age, and the occurrence of the pain is often worse in the morning and better after exercise. People with nr-axSpA may experience pain and inflammation in other parts of their body as well. Learn more about the symptoms of nr-axSpA.
Tests That Diagnose nr-axSpA
The diagnostic process for nr-axSpA doesn’t stop at X-rays and symptom checks. To diagnose nr-axSpA, doctors will often look at a variety of other factors and conduct more tests, such as:
- Medical history
- Physical exam
- Blood tests: There’s no one blood test that can diagnose nr-axSpA, but doctors may do a test to look for a certain gene called the HLA-B27 gene, which is found in many people with spondyloarthritis.
- Imaging tests: This includes X-rays and MRIs (magnetic resonance imaging). The “nr” in nr-axSpA stands for “non-radiographic,” which means there’s no damage visible on X-rays.
For some people, it may take months or years for a doctor to be confident in a diagnosis of nr-axSpA. Once nr-axSpA is diagnosed, the goals of treatment are to relieve symptoms, maintain function, and prevent complications. Treatment can also help minimize the risk other conditions that are associated with nr-axSpA, such as psoriasis or inflammatory bowel disease (IBD).
The first line of treatment is often non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy. If that doesn’t work, other medicines, such as disease-modifying antirheumatic drugs (DMARDs) or biologics, may be prescribed. Learn more about how nr-axSpA is treated here.
Maggie Cadet, MD, is a board-certified rheumatologist in New York. She specializes in autoimmune diseases, arthritis, and health conditions that disproportionately affect women and minorities.
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Many patients who have longstanding back pain
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may be sent to a rheumatologist to get a workup
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for inflammatory back pain because
there are other symptoms
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that can accompany the back pain.
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These patients may also have radiographic studies
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that do not show any extra X-ray changes.
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When an individual is diagnosed with
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many specialists may be involved
in the diagnostic workup.
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They may first go see their internist
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when they're having back pain initially.
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If the back pain does not improve with physical therapy,
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rest, or medications,
then a rheumatologist
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may get involved to do more diagnostic workup
and gene testing.
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For the diagnosis of non-radiographic
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a clinical history is key.
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Next, a physical exam will be performed to look for
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the spine mobility and any other types of joint inflammation
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that can be involved, as well as eye involvement
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or GI involvement.
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Tests is also important, so a rheumatologist may order
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a blood test looking for inflammatory markers
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and they will also obtain a genetic marker
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as well called HLA-B27.
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Radiographic testing is also critical to see
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if there are any changes on X-rays.
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If there are no radiographic changes on an X-ray,
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then the rheumatologist may order an MRI,
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which will detect early inflammatory changes
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on the diagnostic imaging.
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First-line treatment may include non-steroidal
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to treat the underlying inflammation.
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If the person does not respond
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to a non-steroidal anti-inflammatory drug,
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then another medication called a biologic,
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which focuses on certain chemicals
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which cause inflammation, can also be used.
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Sometimes these drugs are used as injections
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to help treat the inflammation.
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If individuals do not treat their
non-radiographic axial spondyloarthritis,
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there may be complications in the future,
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which may include progression of spinal inflammation,
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causing bone fusion and restricted mobility.
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Many of my patients do have concerns
that when they're diagnosed
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with non-radiographic axial spondyloarthritis
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that they will not be able to lead a highly functional life.
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That is not true.
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As long as they get treated early,
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and engage in healthy lifestyle habits,
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and keep moving with exercise,
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they can lead highly functional lives.
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- Diagnosis and differential diagnosis of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. UpToDate. Accessed on August 11, 2020.
- Overview of the clinical manifestations and classification of spondyloarthritis. UpToDate. Accessed on August 11, 2020.
- Slobodin G, Eshed I. Non-Radiographic Axial Spondyloarthritis. Isr Med Assoc J. 2015. Accessed on August 11, 2020.
- Robinson PC, Sengupta R, Siebert S. Non-Radiographic Axial Spondyloarthritis (nr-axSpA): Advances in Classification, Imaging and Therapy. Rheumatol Ther. Accessed on August 11, 2020.