Chronic back pain is a hallmark symptom of this type of arthritis.
When you think of arthritis, you may automatically picture someone holding a wrist or ankle. What many people don’t know is that arthritis comes in many forms, and can affect any joint in the body—not just the hands or feet.
Non-radiographic axial spondyloarthritis (nr-AxSpA), is one type of inflammatory arthritis that primarily affects the spine. It falls under an umbrella of arthritis diseases that affect the spine, called spondyloarthritis.
The Signs of nr-axSpA
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.
The “nr” in nr-axSpA stands for “non-radiographic,” which is what differentiates it from another type of arthritis that affects the spine, called ankylosing spondylitis. Non-radiographic is just a fancy way of saying there’s no damage visible on X-rays. In patients with ankylosing spondylitis, however, damage to the bone is visible on X-rays. Technically, nr-axSpA can be an early-stage ankylosing spondylitis.
Diagnosing + Treating nr-axSpA
There’s no one test that diagnoses nr-axSpA. To diagnose nr-axSpA, doctors will often look at a variety of factors and tests, such as:
- Evidence of inflammation of the sacroiliac (SI) joints on magnetic resonance imaging (MRI)
- Symptoms, such as chronic back pain and stiffness
- Age (nr-axSpA often presents before age 45)
- Blood tests (many people with nr-axSpA carry a gene called HLA-B27)
Once nr-axSpA is diagnosed, the goals of treatment are to:
- Relieve symptoms
- Maintain function and quality of life
- Prevent complications
- 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.
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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Axial spondyloarthritis is part of a group of inflammatory disorders
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called the spondyloarthropathies.
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There is a form which affects the spine, the axial part,
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which can also include the chest, the ribs,
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and also the hips and pelvis.
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Many of my patients wonder what is the difference
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between non-radiographic spondyloarthritis
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and ankylosing spondylitis.
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Although they both experience symptoms of low back pain
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there are no changes seen
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on the X-ray with non-radiographic spondyloarthritis.
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In ankylosing spondylitis, there are changes
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of inflammation that are seen on X-rays,
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and sometimes the bone can fuse.
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Many of my patients come in for low back pain.
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This is one of the hallmark symptoms for both
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and ankylosing spondylitis.
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This kind of back pain is different from mechanical pain
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because the pain is felt worse at night or early morning,
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accompanied by stiffness, but the pain does not get better
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with rest or inactivity.
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In fact, the pain does improve with exercise and activity.
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There's no specific test to really diagnose
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However, a clinical history is important,
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as well as some blood tests and also diagnostic imaging
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to see if there are changes that occur in the spine.
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One test that the rheumatologist will do is a measurement
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of the inflammation marker ESR and CRP.
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Another thing the rheumatologist may check for is
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a gene called HLA-B27 gene
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that is seen with many of the spondyloarthritis.
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There are treatments for non-radiographic spondyloarthritis,
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which is similar to ankylosing spondylitis treatment.
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Usually the first line of therapy
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is non-steroidal anti-inflammatory drugs, or NSAIDs.
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These medications can include ibuprofen, naproxen,
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and other anti-inflammatory agents.
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Sometimes you can add or switch these anti-inflammatory agents.
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If the person does not respond to this medication,
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then the next line of therapy may be something
called a biologic,
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which focuses on treatment of certain chemicals
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that can cause inflammation.
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Physical therapy can also be done to help with back mobility,
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as well as occupational therapy.
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Patients diagnosed with non-radiographic
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can lead normal lives and functional lives.
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It is important for them to know
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that if they are diagnosed with this,
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despite having any changes on X-rays,
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they can be treated with medications, physical therapy,
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as well as exercise, and weight loss.
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They can lead 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.