Table of ContentsView AllTable of ContentsDiagnosisMRI vs. X-RayHow Does an MRI Work?What to ExpectFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Diagnosis
MRI vs. X-Ray
How Does an MRI Work?
What to Expect
Frequently Asked Questions
Axial spondyloarthritis(axSpA) is a type ofinflammatory arthritisaffecting the spine andsacroiliac (SI) jointslinking the pelvis to the spine. The condition primarily causes back pain and stiffness, but because back pain is a symptom of numerous conditions, an axSpA diagnosis can take many years.
Magnetic resonance imaging(MRI) can find active inflammation early to aid in an axSpA diagnosis and monitor for structural changes that lead to spine fusion.Unfortunately, MRI is not always the first imaging choice, and not all medical providers recognize early bone and joint changes in axSpA.
This article covers how axSpA is diagnosed, challenges in diagnosis, the benefits of MRI for diagnosis and monitoring, and more.
ER Productions Limited / Getty Images
Diagnosing Axial Spondyloarthritis
There are two subsets of axSpA—non-radiographic axSpA(nr-axSpA) andankylosing spondylitis(AS). Nr-axSpA causes inflammation of the spine and other joints throughout the body, but there is radiographic (X-ray) evidence of joint or bone damage.
AS will cause inflammation that will lead to bone and joint damage, and that damage will be evident on X-rays and MRIs of the spine. Nr-axSpA is sometimes a precursor to AS.
The disease is more common in families. For example, your risk for axSpA increases if you have a first-degree relative (parent, sibling, or child) with the condition.The presence of a genetic marker calledhuman leukocyte antigen B27(HLA-B27) also increases the risk of developing axSpA. HLA-B27 is believed to run in families.
Testing Methods
AxSpA can be a challenging diagnosis to make. No single test can confirm the condition. Instead, a healthcare provider will rely on your medical and family histories, a physical exam, blood work, and imaging tests to confirm a diagnosis.
Medical and Family History
The first step in determining whether a person has axSpA is to review their medical and family history. Back pain in axSpA is inflammatory rather than mechanical.
Mechanical back pain results from various events, such as heavy and improper lifting, injury, or uncomfortable sleep posture.In contrast, inflammatory back is persistent, lasts three or more months, worsens with inactivity, and improves withnonsteroidal anti-inflammatory drugs(NSAIDs) and movement.
Causes of Back Pain and Treatment Options
Additional symptoms of axSpA are:
Researchers believe the HLA-B27 gene is inherited.Let your healthcare provider know if axial spondylitis or other autoimmune diseases run in your family.
Physical Examination
The physical exam for axial spondyloarthritis looks for physical and neurological symptoms.
For the physical examination, the healthcare provider will want you to bend your back and pelvis in different directions to check for pain and stiffness and see if your range of motion has been affected.
For the neurological exam, the healthcare provider will want to assess sensory and motor function, reflexes, and muscle strength. They will also want to know if you are experiencing neurological symptoms, such as nerve pain, numbness, muscle spasms, and bowel and bladder dysfunction.
Neurological symptoms are more common in long-standing axSpA but might affect some people early in the disease process.
Blood Work
Blood work for diagnosing axSpA includes inflammatory marker testing, blood tests to rule out other conditions, and genetic testing to see if you carry the HLA-B27 gene. While blood work alone cannot confirm axSpA, it can help the healthcare provider make sense of your symptoms.
The healthcare provider may request the following blood work if they suspect axSpA:
Imaging
Different imaging studies can help a healthcare provider make a diagnosis of axSPA, includingconventional radiology(X-rays), MRI,computed tomography(CT), and ultrasound.
X-rays are generally the standard for diagnosing axial spondyloarthritis, but MRI, CT, and ultrasound might be more reliable for evaluating joints and soft tissues in the spine.
A healthcare provider might also rely on X-rays and MRIs to track disease progression or to look for structural changes in the spine and SI joints.
Challenges of Diagnosing AxSpA
AxSpA can be a challenge to diagnose because the condition develops slowly. Symptoms of axSpA might resemble those of other spondyloarthritis conditions, includingpsoriatic arthritis. Also, no single test can help a healthcare provider confirm the cause of your symptoms.
A 2021Rheumatologyreview of studies found the average diagnostic delay for axSpA was 6.7 years.These delays appeared to be prevalent worldwide and occurred in both high-income and middle-income countries.
Factors linked to these delays included individual factors (low education levels, younger age at the start of symptoms, and absence of non-joint symptoms) and disease presentation.
Conditions That Mimic Axial SpondyloarthritisIn its early stages, axSpA causes symptoms similar to other spondyloarthritis types, including psoriatic arthritis. Also, early axSpA joint and bone damage cannot be seen on X-rays, and it might be misdiagnosed as mechanical back pain.Additional conditions that might mimic axspA include:FibromyalgiaRheumatoid arthritisReactive arthritisEnteropathic arthritisDiffuse idiopathic skeletal hyperostosis
Conditions That Mimic Axial Spondyloarthritis
In its early stages, axSpA causes symptoms similar to other spondyloarthritis types, including psoriatic arthritis. Also, early axSpA joint and bone damage cannot be seen on X-rays, and it might be misdiagnosed as mechanical back pain.Additional conditions that might mimic axspA include:FibromyalgiaRheumatoid arthritisReactive arthritisEnteropathic arthritisDiffuse idiopathic skeletal hyperostosis
In its early stages, axSpA causes symptoms similar to other spondyloarthritis types, including psoriatic arthritis. Also, early axSpA joint and bone damage cannot be seen on X-rays, and it might be misdiagnosed as mechanical back pain.
Additional conditions that might mimic axspA include:
MRI vs. X-Ray: Which Is Better?
An MRI takes multiple images across different body areas with the help of a magnetic field and computer-generated radio waves to create images of tissues throughout the body.
An X-ray produces a single flat image using ionizing radiation. For multiple images, the X-ray technician must set the machine to change positions for different angles and body areas.
Imaging studies are crucial to diagnosing axSpA. Inflammation in axSpA might eventually damage the spine and SI joints. X-rays can check for joint and bone changes, but early signs cannot be seen on X-rays. To look for early radiographic signs, MRI might be more reliable.
An MRI can offer more detailed images of bones and soft tissues and reveal evidence of axSpA earlier in the disease process.
X-Rays in the Diagnosis and Treatment of Ankylosing Spondylitis
An MRI machine is a large, tube-shaped machine that creates a magnetic field that transmits radio waves from the scanner to produce weak signals that create cross-sectional images.Images are often three-dimensional (3D).
MRI is non-invasive but can produce detailed images of nearly every internal body structure. No radiation is produced during the MRI. In contrast, X-rays use ionizing radiation to produce images. MRI scans can provide your healthcare provider with details to diagnose a condition, plan its treatment, and monitor it.
If you have axSpA, your healthcare provider might request an MRI to look for active inflammation of the spine and SI joints, new bone formation in the spine or SI joints, erosive bone damage, disc problems (especially at the lower spine), and fusing of the facet joints.
Erosive bone damagerefers to bone loss from a disease process. Thefacet jointsare located at the top and bottom of each vertebra (each small bone of the spinal column). They connect thevertebrae(all the bones of the spinal column) and allow for spinal movement.
Radiographic signs of axSpA, such as active inflammation and new bone formation, can be found early on MRIs, and MRIs can be helpful in the diagnosis process.MRI can also track disease progression and help your healthcare provider catch problems early when treatment plan changes are more helpful.
What Is an MRI With Contrast?
What to Expect When Getting an MRI
You will be placed inside a large magnetic tube to obtain MRI scans. You must remain still during the imaging process to avoid blurring the images. You might be given intravenous (IV, within a vein)contrastbefore or during the MRI to help body protons align with the magnetic field. The faster the alignment, the better the imaging.
Side effects after an MRI are rare, although some people could experience a reaction to the contrast dye.If you experience areaction to the dye, such as itching, swelling, or breathing troubles, reach your healthcare provider immediately.
If you feel the symptoms of the reaction might be life-threatening or severe, call 911 or head to your local emergency room. You should also inform your healthcare provider if you notice any pain, redness, or swelling at the IV site that continues after you get home.
If you are concerned about changes to your spine or other joint damage from axSpA, ask your healthcare provider about getting an MRI. Because MRI procedures are expensive, you should check with your insurance company to see what they cover and what yourout-of-pocket costsmight be.
Summary
Axial spondyloarthritis is a lifelong progressive disease that gets worse with time. It is diagnosed based on medical and family history, physical examination, blood work, and imaging. Imaging is the most helpful tool for diagnosing the condition.
Diagnostic imaging tools used in axSpA include X-rays, CTs, ultrasounds, and MRIs. MRI scans can detect active inflammation and bone formation very early in the process. MRI can also monitor the progression of axSpa in the spine and SI joints and look for fusing or facet joint and disc problems.
A Word From Verywell
Axial spondyloarthritis is a progressive disease you will need to live with for the rest of your life. While there is no cure, it is treatable and manageable.
For most people, living with axSpA means having periods of flare-ups (increased symptoms) and remission (little or no symptoms). For others, it could mean a severe disease that leads to spinal fusion, joint damage, breathing troubles, and neurological problems.
It is vital to see a rheumatologist (a doctor specializing in arthritis conditions) who can help you manage axSpA and to follow your treatment plan. This is the best way to improve your outlook and keep you moving and enjoying life.
Frequently Asked QuestionsIn early axial spondyloarthritis, MRIs can help detect signs of active inflammation and early bone and joint damage in the spine and SI joints. As the disease progresses, MRI scans might look for new bone formation, bone erosion, and changes to the facet joints and spinal discs.Learn MoreWhat Tests Can Diagnose Axial Spondyloarthritis?MRI is very sensitive for detecting inflammation. It can be a helpful tool for diagnosing axial spondyloarthritis and other inflammatory joint diseases early.Learn More5 Signs of InflammationMost healthcare providers utilize X-rays as the first tool in diagnosing axSpA. They usually use MRI if they suspect axSpA.If spondyloarthritis conditions run in your family or you have another autoimmune arthritis, let your healthcare provider know. These circumstances might prompt them to utilize MRI in their diagnostic process.If you have already been diagnosed with axSpA and have concerns about bone and joint changes to your spine or SI joints, let your healthcare provider know that you would like an MRI done. You should also reach out to your insurance company regarding your out-of-pocket costs.Learn MoreSpondyloarthropathy Conditions
In early axial spondyloarthritis, MRIs can help detect signs of active inflammation and early bone and joint damage in the spine and SI joints. As the disease progresses, MRI scans might look for new bone formation, bone erosion, and changes to the facet joints and spinal discs.Learn MoreWhat Tests Can Diagnose Axial Spondyloarthritis?
In early axial spondyloarthritis, MRIs can help detect signs of active inflammation and early bone and joint damage in the spine and SI joints. As the disease progresses, MRI scans might look for new bone formation, bone erosion, and changes to the facet joints and spinal discs.
Learn MoreWhat Tests Can Diagnose Axial Spondyloarthritis?
MRI is very sensitive for detecting inflammation. It can be a helpful tool for diagnosing axial spondyloarthritis and other inflammatory joint diseases early.Learn More5 Signs of Inflammation
MRI is very sensitive for detecting inflammation. It can be a helpful tool for diagnosing axial spondyloarthritis and other inflammatory joint diseases early.
Learn More5 Signs of Inflammation
Most healthcare providers utilize X-rays as the first tool in diagnosing axSpA. They usually use MRI if they suspect axSpA.If spondyloarthritis conditions run in your family or you have another autoimmune arthritis, let your healthcare provider know. These circumstances might prompt them to utilize MRI in their diagnostic process.If you have already been diagnosed with axSpA and have concerns about bone and joint changes to your spine or SI joints, let your healthcare provider know that you would like an MRI done. You should also reach out to your insurance company regarding your out-of-pocket costs.Learn MoreSpondyloarthropathy Conditions
Most healthcare providers utilize X-rays as the first tool in diagnosing axSpA. They usually use MRI if they suspect axSpA.If spondyloarthritis conditions run in your family or you have another autoimmune arthritis, let your healthcare provider know. These circumstances might prompt them to utilize MRI in their diagnostic process.If you have already been diagnosed with axSpA and have concerns about bone and joint changes to your spine or SI joints, let your healthcare provider know that you would like an MRI done. You should also reach out to your insurance company regarding your out-of-pocket costs.
Most healthcare providers utilize X-rays as the first tool in diagnosing axSpA. They usually use MRI if they suspect axSpA.
If spondyloarthritis conditions run in your family or you have another autoimmune arthritis, let your healthcare provider know. These circumstances might prompt them to utilize MRI in their diagnostic process.
If you have already been diagnosed with axSpA and have concerns about bone and joint changes to your spine or SI joints, let your healthcare provider know that you would like an MRI done. You should also reach out to your insurance company regarding your out-of-pocket costs.
Learn MoreSpondyloarthropathy Conditions
14 SourcesVerywell 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.Laloo F, Herregods N, Jaremko JL, et al.MRI of the axial skeleton in spondyloarthritis: the many faces of new bone formation.Insights Imaging. 2019;10(1):67. doi:10.1186/s13244-019-0752-4Protopopov M, Poddubnyy D.Radiographic progression in non-radiographic axial spondyloarthritis.Expert Rev Clin Immunol. 2018;14(6):525-533. doi:10.1080/1744666X.2018.1477591Spondylitis Association of America.Most common symptoms.Magrey MN, Danve AS, Ermann J, Walsh JA.Recognizing axial spondyloarthritis: a guide for primary care.Mayo Clin Proc. 2020;95(11):2499-2508. doi:10.1016/j.mayocp.2020.02.007Spondylitis Association of America.Inflammatory vs. mechanical back pain.Costantino F, Breban M, Garchon HJ.Genetics and functional genomics of spondyloarthritis.Front Immunol. 2018;9:2933. Published 2018 Dec 18. doi:10.3389/fimmu.2018.02933Nissen MJ, Möller B, Ciurea A, et al.Site-specific resolution of enthesitis in patients with axial spondyloarthritis treated with tumor necrosis factor inhibitors.Arthritis Res Ther. 2021;23(1):165. doi:10.1186/s13075-021-02534-7Berdal G, Halvorsen S, van der Heijde D, Mowe M, Dagfinrud H.Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study.Arthritis Res Ther. 2012;14(1):R19. doi:10.1186/ar3699Caetano AP, Mascarenhas VV, Machado PM. Axial spondyloarthritis: mimics and pitfalls of imaging assessment.Front Med(Lausanne). 2021;8:658538. doi:10.3389/fmed.2021.658538Gensler L. Spondylitis Association of America.Blood work in ankylosing spondylitis.Kenyon M, Maguire S, Rueda Pujol A, O’Shea F, McManus R.The genetic backbone of ankylosing spondylitis: how knowledge of genetic susceptibility informs our understanding and management of disease.Rheumatol Int. 2022;42(12):2085-2095. doi:10.1007/s00296-022-05174-5KhmelinskiiN, Regel A, Baraliakos X.The role of imaging in diagnosing axial spondyloarthritis.Front Med (Lausanne). 2018;5:106. doi:10.3389/fmed.2018.00106Zhao SS, Pittam B, Harrison NL, Ahmed AE, Goodson NJ, Hughes DM.Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis.Rheumatology (Oxford). 2021;60(4):1620-1628. doi:10.1093/rheumatology/keaa807National Institute of Biomedical Imaging and Bioengineering.Magnetic resonance imaging (MRI).
14 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.Laloo F, Herregods N, Jaremko JL, et al.MRI of the axial skeleton in spondyloarthritis: the many faces of new bone formation.Insights Imaging. 2019;10(1):67. doi:10.1186/s13244-019-0752-4Protopopov M, Poddubnyy D.Radiographic progression in non-radiographic axial spondyloarthritis.Expert Rev Clin Immunol. 2018;14(6):525-533. doi:10.1080/1744666X.2018.1477591Spondylitis Association of America.Most common symptoms.Magrey MN, Danve AS, Ermann J, Walsh JA.Recognizing axial spondyloarthritis: a guide for primary care.Mayo Clin Proc. 2020;95(11):2499-2508. doi:10.1016/j.mayocp.2020.02.007Spondylitis Association of America.Inflammatory vs. mechanical back pain.Costantino F, Breban M, Garchon HJ.Genetics and functional genomics of spondyloarthritis.Front Immunol. 2018;9:2933. Published 2018 Dec 18. doi:10.3389/fimmu.2018.02933Nissen MJ, Möller B, Ciurea A, et al.Site-specific resolution of enthesitis in patients with axial spondyloarthritis treated with tumor necrosis factor inhibitors.Arthritis Res Ther. 2021;23(1):165. doi:10.1186/s13075-021-02534-7Berdal G, Halvorsen S, van der Heijde D, Mowe M, Dagfinrud H.Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study.Arthritis Res Ther. 2012;14(1):R19. doi:10.1186/ar3699Caetano AP, Mascarenhas VV, Machado PM. Axial spondyloarthritis: mimics and pitfalls of imaging assessment.Front Med(Lausanne). 2021;8:658538. doi:10.3389/fmed.2021.658538Gensler L. Spondylitis Association of America.Blood work in ankylosing spondylitis.Kenyon M, Maguire S, Rueda Pujol A, O’Shea F, McManus R.The genetic backbone of ankylosing spondylitis: how knowledge of genetic susceptibility informs our understanding and management of disease.Rheumatol Int. 2022;42(12):2085-2095. doi:10.1007/s00296-022-05174-5KhmelinskiiN, Regel A, Baraliakos X.The role of imaging in diagnosing axial spondyloarthritis.Front Med (Lausanne). 2018;5:106. doi:10.3389/fmed.2018.00106Zhao SS, Pittam B, Harrison NL, Ahmed AE, Goodson NJ, Hughes DM.Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis.Rheumatology (Oxford). 2021;60(4):1620-1628. doi:10.1093/rheumatology/keaa807National Institute of Biomedical Imaging and Bioengineering.Magnetic resonance imaging (MRI).
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.
Laloo F, Herregods N, Jaremko JL, et al.MRI of the axial skeleton in spondyloarthritis: the many faces of new bone formation.Insights Imaging. 2019;10(1):67. doi:10.1186/s13244-019-0752-4Protopopov M, Poddubnyy D.Radiographic progression in non-radiographic axial spondyloarthritis.Expert Rev Clin Immunol. 2018;14(6):525-533. doi:10.1080/1744666X.2018.1477591Spondylitis Association of America.Most common symptoms.Magrey MN, Danve AS, Ermann J, Walsh JA.Recognizing axial spondyloarthritis: a guide for primary care.Mayo Clin Proc. 2020;95(11):2499-2508. doi:10.1016/j.mayocp.2020.02.007Spondylitis Association of America.Inflammatory vs. mechanical back pain.Costantino F, Breban M, Garchon HJ.Genetics and functional genomics of spondyloarthritis.Front Immunol. 2018;9:2933. Published 2018 Dec 18. doi:10.3389/fimmu.2018.02933Nissen MJ, Möller B, Ciurea A, et al.Site-specific resolution of enthesitis in patients with axial spondyloarthritis treated with tumor necrosis factor inhibitors.Arthritis Res Ther. 2021;23(1):165. doi:10.1186/s13075-021-02534-7Berdal G, Halvorsen S, van der Heijde D, Mowe M, Dagfinrud H.Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study.Arthritis Res Ther. 2012;14(1):R19. doi:10.1186/ar3699Caetano AP, Mascarenhas VV, Machado PM. Axial spondyloarthritis: mimics and pitfalls of imaging assessment.Front Med(Lausanne). 2021;8:658538. doi:10.3389/fmed.2021.658538Gensler L. Spondylitis Association of America.Blood work in ankylosing spondylitis.Kenyon M, Maguire S, Rueda Pujol A, O’Shea F, McManus R.The genetic backbone of ankylosing spondylitis: how knowledge of genetic susceptibility informs our understanding and management of disease.Rheumatol Int. 2022;42(12):2085-2095. doi:10.1007/s00296-022-05174-5KhmelinskiiN, Regel A, Baraliakos X.The role of imaging in diagnosing axial spondyloarthritis.Front Med (Lausanne). 2018;5:106. doi:10.3389/fmed.2018.00106Zhao SS, Pittam B, Harrison NL, Ahmed AE, Goodson NJ, Hughes DM.Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis.Rheumatology (Oxford). 2021;60(4):1620-1628. doi:10.1093/rheumatology/keaa807National Institute of Biomedical Imaging and Bioengineering.Magnetic resonance imaging (MRI).
Laloo F, Herregods N, Jaremko JL, et al.MRI of the axial skeleton in spondyloarthritis: the many faces of new bone formation.Insights Imaging. 2019;10(1):67. doi:10.1186/s13244-019-0752-4
Protopopov M, Poddubnyy D.Radiographic progression in non-radiographic axial spondyloarthritis.Expert Rev Clin Immunol. 2018;14(6):525-533. doi:10.1080/1744666X.2018.1477591
Spondylitis Association of America.Most common symptoms.
Magrey MN, Danve AS, Ermann J, Walsh JA.Recognizing axial spondyloarthritis: a guide for primary care.Mayo Clin Proc. 2020;95(11):2499-2508. doi:10.1016/j.mayocp.2020.02.007
Spondylitis Association of America.Inflammatory vs. mechanical back pain.
Costantino F, Breban M, Garchon HJ.Genetics and functional genomics of spondyloarthritis.Front Immunol. 2018;9:2933. Published 2018 Dec 18. doi:10.3389/fimmu.2018.02933
Nissen MJ, Möller B, Ciurea A, et al.Site-specific resolution of enthesitis in patients with axial spondyloarthritis treated with tumor necrosis factor inhibitors.Arthritis Res Ther. 2021;23(1):165. doi:10.1186/s13075-021-02534-7
Berdal G, Halvorsen S, van der Heijde D, Mowe M, Dagfinrud H.Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study.Arthritis Res Ther. 2012;14(1):R19. doi:10.1186/ar3699
Caetano AP, Mascarenhas VV, Machado PM. Axial spondyloarthritis: mimics and pitfalls of imaging assessment.Front Med(Lausanne). 2021;8:658538. doi:10.3389/fmed.2021.658538
Gensler L. Spondylitis Association of America.Blood work in ankylosing spondylitis.
Kenyon M, Maguire S, Rueda Pujol A, O’Shea F, McManus R.The genetic backbone of ankylosing spondylitis: how knowledge of genetic susceptibility informs our understanding and management of disease.Rheumatol Int. 2022;42(12):2085-2095. doi:10.1007/s00296-022-05174-5
KhmelinskiiN, Regel A, Baraliakos X.The role of imaging in diagnosing axial spondyloarthritis.Front Med (Lausanne). 2018;5:106. doi:10.3389/fmed.2018.00106
Zhao SS, Pittam B, Harrison NL, Ahmed AE, Goodson NJ, Hughes DM.Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis.Rheumatology (Oxford). 2021;60(4):1620-1628. doi:10.1093/rheumatology/keaa807
National Institute of Biomedical Imaging and Bioengineering.Magnetic resonance imaging (MRI).
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