Table of ContentsView AllTable of ContentsSpondyloarthropathiesAnkylosing SpondylitisNon-Radiographic Axial SpondyloarthritisAnkylosing Spondylitis and nrAxSpAMultiple Diagnoses
Table of ContentsView All
View All
Table of Contents
Spondyloarthropathies
Ankylosing Spondylitis
Non-Radiographic Axial Spondyloarthritis
Ankylosing Spondylitis and nrAxSpA
Multiple Diagnoses
Spondyloarthritis(also calledspondyloarthropathy) refers to a family of inflammatory rheumatological conditions that can affect the joints, including the joints of the spine, as well as other bodily systems.Axial spondyloarthritiscan be considered a subset of spondyloarthritis. This type primarily affects the axial joints, which are those found in the spine, chest, and pelvis.Ankylosing spondylitisis generally considered a specific and severe subset of axial spondyloarthritis.Verywell / JR BeeSpondyloarthropathiesSpondyloarthropathiesare the broadest definition of the disorder. They are a group of related inflammatory illnesses with some overlapping characteristics in terms of symptoms and genetic links. Overall, these related conditions are believed to affect up to 2% of the population.Some of these symptoms and characteristics include:Inflammation in the spine and pelvis bonesInflammation of peripheral jointsInflammation of part of the eye (uveitis)Inflammation where ligaments and tendons connect to bones (enthesitis)Inflammation of the bowelSkin lesionsAssociation with the genetic factor HLA-B27The subsets of spondyloarthritis were once classified according to their associated condition. These conditions and groupings included:Psoriatic spondyloarthritis, in people with psoriatic arthritisEnteropathic spondyloarthritis, in people with inflammatory bowel disease (IBD)Reactive arthritis, associated with a urinary tract infection, digestive tract infection, or elsewhere in the bodyUndifferentiated spondyloarthritis, with initially unclear patterns of symptomsAnkylosing spondylitis, a common form that affects the joints in your spineHealthcare providers now place these variations into two main groupings:One is calledaxial, or axial-predominant, spondyloarthritis.The other is calledperipheral, or peripheral-predominant, spondyloarthritis.These names more accurately describe the way that symptoms sometimes overlap between the types.Axial vs. Peripheral SpondyloarthritisThese two main divisions of spondyloarthropathies are based on the parts of your body that are most affected.In peripheral spondyloarthritis, people have pain and other symptoms that affect joints such as the knees, fingers, or toes.In axial spondyloarthritis, the arthritis symptoms affect the axial joints. These joints are found in the spine, chest, and the sacroiliac joint (hip bone).Keep in mind that the difference in symptoms and effects between peripheral and axial types of spondyloarthritis are not always that clear cut. Some people with axial spondyloarthritis have problems with one or more of their peripheral joints as well.Regardless of type,diagnosisof all spondyloarthropathies requires a physical exam, a conversation about your symptoms, and usually imaging and lab tests. There is also quite a bit of overlap in terms of the ways these different forms of spondyloarthropathy are treated.Ankylosing SpondylitisAnkylosing spondylitis(AS) is a term that many people with the condition, and healthcare providers who care for them, still use. The term “spondylitis” simply means “inflammation of the vertebrae,” the small bones that make up your spine.Ankylosing spondylitis is considered an advanced or severe form of axial spondyloarthritis.People with ankylosing spondylitis experienceinflammatory back pain. This pain may arise with other symptoms that include:Limited movement of the spineInflammation where ligaments and tendons connect to bonesPain or redness in one eye (uveitis)Some people with ankylosing spondylitis experience severe impacts and mobility challenges that mayinterfere with being able to work.Historically,X-rayswere an important part of diagnosing the condition. When viewed with X-ray images, there are visible signs of substantial inflammation of the sacroiliac joints (termedsacroiliitis). These are the joints where the lower part of the spine (the sacrum) connects to the pelvis.Because the diagnosis has relied on imaging, it gave rise to another set of terms used to describe the disorder and its progression.These terms are called:Radiographic axial spondyloarthritis(rAxSpA), which is strongly linked with an AS diagnosis; sometimes the terms have been used interchangeablyNon- or pre-radiographic axial spondyloarthritis(nrAxSpA)Ankylosing Spondylitis Doctor Discussion GuideGet our printable guide for your next doctor’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.Non-Radiographic Axial SpondyloarthritisMagnetic resonance imaging (MRI) began to be used more commonly in the 1980s. Because of the way it works, MRI can pick up more detail than conventional X-rays, revealing more information about what is going on.Practitioners began to notice that although some people had many of the symptoms of ankylosing spondylitis, changes in chronic inflammation couldn’t be seen on X-ray. However, those peopledidhave inflammation of the sacroiliac joint that could be seen with an MRI scan.In other words, these people had inflammation and inflammatory changes that weren’t as severe or advanced as those of people already diagnosed with ankylosing spondylitis. These people were eventually categorized as nrAxSpA.What to Expect During an MRIAnkylosing Spondylitis and nrAxSpAResearchers and clinicians still aren’t sure about the relationship between the non-radiographic and radiographic forms of axial spondyloarthritis, or how it defines ankylosing spondylitis.In fact, a recent study of 2,080 people with axial spondyloarthritis, who were identified as either nrAxSpA or having a variant of rAxSpA, found that the current differentiation offers limited benefit in terms of understanding how well treatment will work and what kind of outcomes can be predicted.Some people diagnosed with nrAxSpA go on to later develop the symptoms of classic ankylosing spondylitis that’s considered rAxSpA. The inflammation of the sacroiliac joint becomes severe enough to be viewed on an X-ray, with their sacroiliitis defined as radiographic later on.Yet this may not always happen. One study reviewed the progression in 94 people who were diagnosed six years earlier with axial spondyloarthritis and found 83% of them showed no changes in their sacroiliac joints during that time.Seven people progressed from non-radiographic to rAxSpA during that time, but nine people actually changed from radiographic to nrAxSpA.Researchers still aren’t sure how common progression is. However, the broader understanding of progression in some people who first have non-radiographic axial spondyloarthritis (nrAxSpA) has underscored the need for early detection.Your gender assigned at birth may be a contributing factor to any progression to ankylosing spondylitis, with more females diagnosed with nrAxSpA forms than with ankylosing spondylitis.People with nrAxSpA tend to have a shorter length of disease and lower levels of inflammatory markers. They also tend to have less severe disease. There may be genetic differences, too, but researchers are still working to understand that.Currently, thetreatmentof the two conditions is very similar. It may include:Physical therapyExerciseOver-the-counter pain medicationsPrescription treatmentsMultiple DiagnosesYou’re not likely to have both non-radiographic axial spondyloarthritis and another form of spondyloarthropathy. Currently, researchers are generally categorizing other classic forms of spondyloarthropathies as kinds ofperipheralspondyloarthropathy.For example, you might be told you have peripheral spondyloarthritis with psoriasis, peripheral spondyloarthritis with inflammatory bowel disease, or peripheral spondyloarthritis from a preceding infection (reactive arthritis).People with these conditions are generally not considered in the axial spondyloarthritis group. However, they still do sometimes have symptoms involving the axial joints.It’s often helpful to understand the basic terminology that professionals use to discuss your disease. Don’t hesitate to ask your healthcare provider to explain if you don’t understand it. Keep in mind that the treatment can overlap among the different types of the condition, and the words are less important than knowing what’s going on in your body and how to manage your symptoms.10 Unusual Symptoms of Ankylosing Spondylitis
Spondyloarthritis(also calledspondyloarthropathy) refers to a family of inflammatory rheumatological conditions that can affect the joints, including the joints of the spine, as well as other bodily systems.
Axial spondyloarthritiscan be considered a subset of spondyloarthritis. This type primarily affects the axial joints, which are those found in the spine, chest, and pelvis.
Ankylosing spondylitisis generally considered a specific and severe subset of axial spondyloarthritis.
Verywell / JR Bee
Spondyloarthropathiesare the broadest definition of the disorder. They are a group of related inflammatory illnesses with some overlapping characteristics in terms of symptoms and genetic links. Overall, these related conditions are believed to affect up to 2% of the population.
Some of these symptoms and characteristics include:
The subsets of spondyloarthritis were once classified according to their associated condition. These conditions and groupings included:
Healthcare providers now place these variations into two main groupings:
These names more accurately describe the way that symptoms sometimes overlap between the types.
Axial vs. Peripheral Spondyloarthritis
These two main divisions of spondyloarthropathies are based on the parts of your body that are most affected.
In peripheral spondyloarthritis, people have pain and other symptoms that affect joints such as the knees, fingers, or toes.
In axial spondyloarthritis, the arthritis symptoms affect the axial joints. These joints are found in the spine, chest, and the sacroiliac joint (hip bone).
Keep in mind that the difference in symptoms and effects between peripheral and axial types of spondyloarthritis are not always that clear cut. Some people with axial spondyloarthritis have problems with one or more of their peripheral joints as well.
Regardless of type,diagnosisof all spondyloarthropathies requires a physical exam, a conversation about your symptoms, and usually imaging and lab tests. There is also quite a bit of overlap in terms of the ways these different forms of spondyloarthropathy are treated.
Ankylosing spondylitis(AS) is a term that many people with the condition, and healthcare providers who care for them, still use. The term “spondylitis” simply means “inflammation of the vertebrae,” the small bones that make up your spine.
Ankylosing spondylitis is considered an advanced or severe form of axial spondyloarthritis.
People with ankylosing spondylitis experienceinflammatory back pain. This pain may arise with other symptoms that include:
Some people with ankylosing spondylitis experience severe impacts and mobility challenges that mayinterfere with being able to work.
Historically,X-rayswere an important part of diagnosing the condition. When viewed with X-ray images, there are visible signs of substantial inflammation of the sacroiliac joints (termedsacroiliitis). These are the joints where the lower part of the spine (the sacrum) connects to the pelvis.
Because the diagnosis has relied on imaging, it gave rise to another set of terms used to describe the disorder and its progression.
These terms are called:
Ankylosing Spondylitis Doctor Discussion GuideGet our printable guide for your next doctor’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
Download PDF
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Magnetic resonance imaging (MRI) began to be used more commonly in the 1980s. Because of the way it works, MRI can pick up more detail than conventional X-rays, revealing more information about what is going on.
Practitioners began to notice that although some people had many of the symptoms of ankylosing spondylitis, changes in chronic inflammation couldn’t be seen on X-ray. However, those peopledidhave inflammation of the sacroiliac joint that could be seen with an MRI scan.
In other words, these people had inflammation and inflammatory changes that weren’t as severe or advanced as those of people already diagnosed with ankylosing spondylitis. These people were eventually categorized as nrAxSpA.
What to Expect During an MRI
Researchers and clinicians still aren’t sure about the relationship between the non-radiographic and radiographic forms of axial spondyloarthritis, or how it defines ankylosing spondylitis.
In fact, a recent study of 2,080 people with axial spondyloarthritis, who were identified as either nrAxSpA or having a variant of rAxSpA, found that the current differentiation offers limited benefit in terms of understanding how well treatment will work and what kind of outcomes can be predicted.
Some people diagnosed with nrAxSpA go on to later develop the symptoms of classic ankylosing spondylitis that’s considered rAxSpA. The inflammation of the sacroiliac joint becomes severe enough to be viewed on an X-ray, with their sacroiliitis defined as radiographic later on.
Yet this may not always happen. One study reviewed the progression in 94 people who were diagnosed six years earlier with axial spondyloarthritis and found 83% of them showed no changes in their sacroiliac joints during that time.
Seven people progressed from non-radiographic to rAxSpA during that time, but nine people actually changed from radiographic to nrAxSpA.
Researchers still aren’t sure how common progression is. However, the broader understanding of progression in some people who first have non-radiographic axial spondyloarthritis (nrAxSpA) has underscored the need for early detection.
Your gender assigned at birth may be a contributing factor to any progression to ankylosing spondylitis, with more females diagnosed with nrAxSpA forms than with ankylosing spondylitis.
People with nrAxSpA tend to have a shorter length of disease and lower levels of inflammatory markers. They also tend to have less severe disease. There may be genetic differences, too, but researchers are still working to understand that.
Currently, thetreatmentof the two conditions is very similar. It may include:
You’re not likely to have both non-radiographic axial spondyloarthritis and another form of spondyloarthropathy. Currently, researchers are generally categorizing other classic forms of spondyloarthropathies as kinds ofperipheralspondyloarthropathy.
For example, you might be told you have peripheral spondyloarthritis with psoriasis, peripheral spondyloarthritis with inflammatory bowel disease, or peripheral spondyloarthritis from a preceding infection (reactive arthritis).
People with these conditions are generally not considered in the axial spondyloarthritis group. However, they still do sometimes have symptoms involving the axial joints.
It’s often helpful to understand the basic terminology that professionals use to discuss your disease. Don’t hesitate to ask your healthcare provider to explain if you don’t understand it. Keep in mind that the treatment can overlap among the different types of the condition, and the words are less important than knowing what’s going on in your body and how to manage your symptoms.
10 Unusual Symptoms of Ankylosing Spondylitis
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Baraliako X, Braun J.Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences?RMD Open. 2015;1(Suppl 1):e000053. doi:10.1136/rmdopen-2015-000053
Mease PJ.Suspecting and diagnosing the patient with spondyloarthritis and what to expect from therapy.Rheum Dis Clin North Am. 2022 May;48(2):507-521. doi:10.1016/j.rdc.2022.02.008
Carli L, Calabresi E, Governato G, Braun J.One year in review 2018: axial spondyloarthritis.Clin Exp Rheumatol. 2019 Nov-Dec;37(6):889-898.
Benavent D, Navarro-Compán V.Understanding the paradigm of non-radiographic axial spondyloarthritis.Clin Rheumatol2021;40:501–512. doi: 10.1007/s10067-020-05423-7
Taurog JD, Chhabra A, Colbert RA.Ankylosing spondylitis and axial spondyloarthritis.N Engl J Med. 2016;374(26):2563-74. doi: 10.1056/NEJMra1406182
Slobodin G, Sagiv M, Khreish T, Croitoru S, Shouval A, Eshed I.Facet joint disease in patients with axial spondyloarthritis: A retrospective computed tomography study.Semin Arthritis Rheum. 2022;55:151991. doi: 10.1016/j.semarthrit.2022.151991
Ciurea A, Kissling S, Bürki K, Baraliakos X, de Hooge M, Hebeisen M, et al.Current differentiation between radiographic and non-radiographic axial spondyloarthritis is of limited benefit for prediction of important clinical outcomes: data from a large, prospective, observational cohort.RMD Open. 2022 Feb;8(1):e002067. doi: 10.1136/rmdopen-2021-002067
Fernández-Carballido C, Tornero C, Castro-Villegas MC, et al.No radiographic sacroiliitis progression was observed in patients with early spondyloarthritis at 6 years: results of the Esperanza multicentric prospective cohort.RMD Open. 2020 Sep;6(2):e001345. doi:10.1136/rmdopen-2020-001345
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