If left untreated, this inflammatory arthritis can progress or lead to complications.
Living with back pain can be very limiting. You may avoid activities you used to love, or you may have a hard time carrying out basic, everyday activities. Because back pain is so common, many people just try to “push through” the pain—but seeking treatment can drastically improve your quality of life.
Furthermore, if you have an inflammatory cause of back pain like non-radiographic axial spondyloarthritis (nr-axSpA), treatment is crucial. Untreated, this inflammatory arthritis that affects the spine can progress or lead to complications. In fact, nr-axSpA can be an early-stage ankylosing spondylitis, which is when the spine can fuse together and become immobile.
The Goals of Treatment
Of course, the primary goals of treatment for nr-axSpA are to reduce symptoms and maintain function. Chronic back pain is the hallmark symptom of nr-axSpA, but people may also experience pain and inflammation in other parts of their body as well. Learn more about the symptoms of nr-axSpA.
Additionally, a major goal of nr-axSpA treatment is to prevent complications. This includes preventing the fusing of the vertebrae (which may be seen in ankylosing spondylitis), as well as related autoimmune diseases, such as psoriasis and inflammatory bowel disease (IBD).
How nr-axSpA Is Treated
There are many treatment options available for nr-axSpA. The type of treatment that’s right for you is based on the characteristics and severity of the disease.
The first line of treatment is often non-steroidal anti-inflammatory drugs (NSAIDs) and other forms of therapy, such as:
- Physical therapy, which may include posture training, range of motion exercises, stretching, recreational activities, and hydrotherapy.
- Patient education and counseling on how to manage the condition in everyday life (e.g., how to quit smoking).
- Mental health support and treatment
If NSAIDs don’t work, doctors may consider other medicines called disease-modifying antirheumatic drugs (DMARDs) or biologics. Common medicines used for the treatment of nr-axSpA include:
- Tumor necrosis factor (TNF) inhibitors: These are a type of biologic medication that blocks the action of an inflammatory cytokine in the immune system to help relieve pain and inflammation.
- Interleukin-17 (IL-17) inhibitors: These are a type of biologic that interleukin-17 (IL-17), which are cytokines that regulate the immune response.
If you have questions about treatment options and what plan of action is right for you, talk to your doctor.
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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The goal of treatment for an individual
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with non-radiographic spondyloarthritis
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is to help ease inflammation in the spine,
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as well as the pelvic and hip area.
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If this is not treated early, there is a possibility
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of progression where there's bone fusion
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and restricted mobility.
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The first line of treatment for non-radiographic
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are a class of drugs called non-steroidal
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and this will help with inflammation.
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To help with the back pain and stiffness,
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physical therapy is also recommended for patients
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to help with mobility.
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It should be used also as first-line with medications.
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If an individual does not respond to NSAIDs
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or physical therapy, then the rheumatologist may elect
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to go to the second class of drug,
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which may be called biologic therapies.
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These biologics target a certain chemical,
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which can cause inflammation.
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There are TNF inhibitors and other biologics
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that can be used as injections or infusions,
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which can help with the inflammation.
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If a patient has other symptoms,
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such as psoriatic arthritis, psoriasis,
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eye inflammation, or GI symptoms,
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some of these biologics can also be used.
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For patients with GI symptoms,
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there must be caution using non-steroidal
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I encourage anyone having longstanding back pain
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to seek help from a rheumatologist or another physician
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to determine what kind of back pain they're having
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and do diagnostic testing.
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That way, a diagnosis of non-radiographic
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may be made and treatment may be instituted early.
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- Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. 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.