Table of ContentsView AllTable of ContentsNon-Radiographic Axial Spondyloarthritis SymptomsWhat Is the Cause of Non-Radiographic Axial Spondyloarthritis?Diagnosing Non-Radiographic Axial SpondyloarthritisNon-Radiographic Axial Spondyloarthritis Treatment
Table of ContentsView All
View All
Table of Contents
Non-Radiographic Axial Spondyloarthritis Symptoms
What Is the Cause of Non-Radiographic Axial Spondyloarthritis?
Diagnosing Non-Radiographic Axial Spondyloarthritis
Non-Radiographic Axial Spondyloarthritis Treatment
Non-radiographicaxial spondyloarthritis(nr-AxSpA) is a type of inflammatory arthritis that falls under a category of diseases calledspondyloarthritis(SpA). Spondyloarthritis conditions have a common and very specific symptom that affects all people with spondyloarthritis conditions—inflammation of the spine.
Axial spondyloarthritis (AxSpA)affects the axial joints. Non-radiographic means that while there are symptoms, standard X-rays do not show visible damage. Axial relates to the spine, chest, and hip bones. Spondyloarthritis means it affects the joints and theentheses, tissues between bone and ligament or tendons.
Paul Bradbury / Getty Images
Back pain is a hallmark symptom of nr-AxSpA. Back pain is distinguishable based on when it occurs, how long it lasts, the age of when the back pain starts, and what it takes to treat it.
Inflammation from nr-AxSpA also causes inflammation throughout the body, including:
Ankylosing Spondylitis
Many people with nr-AxSpA eventually developankylosing spondylitis(AS), an inflammatory type of arthritis that mostly affects the spine and large joints.One 2015 population-based study shows that in as early as five years 6% of people with nr-AxSpA develop AS, 17% after 10 years, and 26% after 15 years.
Researchers now recognize that people with earlier stages of AS do not have radiological changes, but have similar symptoms, risk factors, and family history.
People with nr-AxSpA who eventually become disabled are later confirmed as having AS, but those early stages of AS are considered nr-AxSpA. Of course, some people with nr-AxSpA and AxSpA never go on to develop AS. Others live with AxSpA for many years—even decades—before developing AS.
Axial Spondyloarthritis and Ankylosing Spondylitis
A specific cause of nr-AxSpA is difficult to pinpoint as most people with this condition may go undiagnosed for many years.
What researchers know about nr-AxSpA is that it is anautoimmune disease. This means that the immune system thinks the body is being attacked. As a result, it produces inflammation to protect itself, damaging healthy tissue in the process.
While researchers don’t know exactly why the immune system overreacts in nr-AxSpA, or spondyloarthritis in general, they believe there is a genetic component. For example, people with all types of spondyloarthritis carry the immune gene variant calledHLA-B27more frequently than other people.
Causes of Back Pain and Treatment Options
No single test can make a definitive diagnosis of non-radiographic axial spondyloarthritis, so healthcare providers look at clinical symptoms, blood work, and imaging to make a diagnosis.
Your healthcare provider will order blood work that measures inflammation in the body. This may includeC-reactive protein (CRP)anderythrocyte sedimentation rate (ESR)testing. While these tests cannot show exactly where inflammation is occurring, healthcare providers factor in blood test results when determining a diagnosis.
Your healthcare provider will also do blood work to see if you have the HLA-B27 gene, which is present in 83% of people with axial spondyloarthritis.However, HLA-B27 is not enough to confirm a diagnosis because the majority of people with this gene do not go on to develop the condition. This gene is absent in certain groups of people who also develop Ax-SpA.
Healthcare providers can also usemagnetic resonance imaging (MRI)to confirm a diagnosis of nr-AxSpA. MRIs can show inflammation in the SI joints long before the disease progresses enough to see bone fusions on an X-ray.
Even if inflammation isn’t evident on MRIs and blood work is inconclusive, a healthcare provider can make a diagnosis and prescribe treatments if symptoms and other clinical characteristics and/or testing results meet the clinical criteria of the Assessment of Spondyloarthritis International Society, and there is no other explanation for the symptoms.
What Is Peripheral Spondyloarthritis?
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At this point, your healthcare provider’s focus on nr-AxSpAtreatmentis addressing symptoms such as pain and stiffness.Non-steroidal anti-inflammatory drugs (NSAIDs)and physical therapy are effective in this regard.
When these treatments fail,tumor necrosis factor (TNF) inhibitorsandbiologic drugsare a next line treatment. These drugs target specific inflammation-promoting molecules.
TNF Inhibitors
In March 2019, the U.S. Food and Drug Administration (FDA) approved Cimzia (certolizumab pegol) injection, a TNF inhibitor, specifically for the treatment of nr-AxSpA.Previously, it had only been FDA-approved for Crohn’s disease, rheumatoid arthritis, ankylosing spondylitis, and plaque psoriasis.
Biologics
In a human-based trial, patients treated with Taltz experienced at least 40% improvement or reduction in at least three crucial areas they struggled with, including pain, function, and inflammation.
Compared to those on placebo, more participants achieved relief: 31% of those treated every two weeks and 30% treated every four weeks. Those treated for 16 weeks had comparable results.
Cosentyx (secukinumab) has also been approved for nr-AxSpA treatment. It is a biologic traditionally used to treatinflammatory arthritisconditions and targets the same pro-inflammatory molecule as Taltz.
A 2019 study found that 42.2% of people with nr-axSpA taking Cosentyx showed significant improvement in disease signs and symptoms through the sixtienth week and for many, improvement continued at 52 weeks.
It’s important for those who think they can benefit from these options to talk to their healthcare provider to learn more. Both biologics are injected under the skin, and a healthcare provider can explain what that means, how to reduce side effects, and walk you through the steps to address any fears or concerns.
Other Options
Intra-articular corticosteroid injectionscan treat local inflammation. However, oral corticosteroids have not been helpful in treating nr-AxSpA.
Disease-modifying anti-rheumatic drugs (DMARDs)usually are not recommended for people with AxSpA without peripheral arthritis (affecting joints outside the spine) or AS due to their lack of effectiveness in treating these conditions.
Summary
Non-radiographic axial spondyloarthritis (nr-AxSpA) is a type of inflammatory arthritis of the spine. Back pain is a distinguishing symptom of nr-AxSpA; when it occurs, how long it lasts, the age of onset, and the effectiveness of treatment methods signal nr-AxSpA. Diagnosis is based on blood work and MRI imaging. Most people respond well to treatment, which includes medication and physical therapy.
7 Sources
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Bedaiwi M, Sari I, Thavaneswaran A, et. Al.Fatigue in ankylosing spondylitis and nonradiographic axial spondyloarthritis: analysis from a longitudinal observation cohort. J Rheumatol. 2015 Dec;42(12):2354-60. doi:10.3899/jrheum.150463Best Practice Journal.Diagnosis and management of axial spondyloarthritis in primary care.Wang R, Gabriel SE, Ward MM.Progression of nonradiographic axial spondyloarthritis to ankylosing spondylitis: A population-based cohort study.Arthritis Rheumatol. 2016 Jun;68(6):1415-21. doi:10.1002/art.39542Londono J, Santos AM, Peña P, et al.Analysis of HLA-B15 and HLA-B27 in spondyloarthritis with peripheral and axial clinical patterns. BMJ Open. 2015;5(11):e009092. doi:10.1136/bmjopen-2015-009092U.S. Food & Drug Administration.FDA approves treatment for patients with a type of inflammatory arthritis.Deodhar A, Blanco R, Dokoupilova E, et. al. Secukinumab150 mg significantly improved signs and symptoms of non-radiographic axial spondyloarthritis: results from a phase 3 double-blind, randomized, placebo-controlled study[abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10).UpToDate.Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics).
Bedaiwi M, Sari I, Thavaneswaran A, et. Al.Fatigue in ankylosing spondylitis and nonradiographic axial spondyloarthritis: analysis from a longitudinal observation cohort. J Rheumatol. 2015 Dec;42(12):2354-60. doi:10.3899/jrheum.150463
Best Practice Journal.Diagnosis and management of axial spondyloarthritis in primary care.
Wang R, Gabriel SE, Ward MM.Progression of nonradiographic axial spondyloarthritis to ankylosing spondylitis: A population-based cohort study.Arthritis Rheumatol. 2016 Jun;68(6):1415-21. doi:10.1002/art.39542
Londono J, Santos AM, Peña P, et al.Analysis of HLA-B15 and HLA-B27 in spondyloarthritis with peripheral and axial clinical patterns. BMJ Open. 2015;5(11):e009092. doi:10.1136/bmjopen-2015-009092
U.S. Food & Drug Administration.FDA approves treatment for patients with a type of inflammatory arthritis.
Deodhar A, Blanco R, Dokoupilova E, et. al. Secukinumab150 mg significantly improved signs and symptoms of non-radiographic axial spondyloarthritis: results from a phase 3 double-blind, randomized, placebo-controlled study[abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10).
UpToDate.Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics).
Bakland G, Alsing R, Singh K, et al.Assessment of spondyloarthritis international society criteria for axial spondyloarthritis in chronic back pain patients with a high prevalence of HLA-B27.Arthritis Care Res.(Hoboken). 2013 Mar;65(3):448-53. doi:10.1002/acr.21804
Furer V, Stark M, Matz H, et al.Prevalence of non-radiographic axial spondyloarthritis in psoriatic arthritis – a single center observational study [abstract].Arthritis Rheumatol.2016; 68 (suppl 10)
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