Non-radiographic Axial Spondyloarthritis

Non-radiographic axial spondyloarthritis (nr-axSpA) is a rare type of arthritis that causes pain and stiffness in the spine and joints. Sometimes it causes inflammation in other parts of the body too. 

Nr-axSpA falls under a family of conditions called spondyloarthritis. It’s very similar to ankylosing spondylitis, which is in this family too. (That’s why you’ll notice several articles about ankylosing spondylitis linked below.) 

Since this condition has a pretty long name, let’s break down what it means:

• Non-radiographic means that there are no signs or changes seen on “radiograph” (or X-ray). 

• Axial refers to the way it affects the center area of the body, like the spine and pelvis. 

• Spondyloarthritis means inflammation of the spine and joints. 

So, nr-axSpA is a condition that causes inflammation in the spine and joints with no X-ray changes. More specifically, X-rays of the sacroiliac (SI) joints in the pelvis are normal.

Nr-axSpA affects about 1.2 million people in the U.S. (slightly more women than men), and it typically begins before age 45. It’s a chronic condition, but it is treatable.

Ankylosing Spondylitis: Your GoodRx Guide

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Causes

Nr-axSpA is an autoimmune condition. The immune system helps protect against things that don’t belong in the body, like infections. The “auto” in autoimmune means “self,” so an autoimmune condition is when the body mistakes itself for something foreign. The result is too much inflammation. 

So, why does the immune system get confused in the first place? Experts aren’t exactly sure, but they do know that a few different things play a role:

• Genetics: People’s genes (DNA inherited from birth parents) can increase their risk for nr-axSpA. The gene that leads to the highest risk is called HLA-B27. 

• The environment: Something from the environment — like an infection or tobacco smoking — can trigger the immune system, leading to nr-axSpA.

• Risk factors: Certain things — like a personal history of inflammatory bowel disease, psoriasis, or psoriatic arthritis — increase the chances of developing nr-axSpA.

What Causes Ankylosing Spondylitis? A Look Into this Rare Autoimmune Arthritis

Written by Samantha C. Shapiro, MD

Symptoms

One of the hallmark symptoms of nr-axSpA includes inflammatory back pain. This is a special kind of back pain that typically starts before age 45, is present when you wake up in the morning, and improves with exercise. It’s always a symptom of nr-axSpA.

People with nr-axSpA may also experience other symptoms, such as:

• Fatigue

• Stiffness

• Decreased flexibility of the spine

• Tender, swollen joints

• Inflammation inside of the eye (iritis)

• Painful swelling of an entire finger or toe (dactylitis)

• Pain where tendons attach to bones, like the back of the heel (enthesitis)

• Pain with deep inhales (costochondritis)

Every person with nr-axSpA has their own set of symptoms. Inflammatory back pain is always present, but other symptoms vary.

What Are the Symptoms of Ankylosing Spondylitis?

Written by Samantha C. Shapiro, MD

Diagnosis

Nr-axSpA is a clinical diagnosis, which means there is no single test that can diagnose it. The diagnosis is typically made by a rheumatologist (a provider that specializes in autoimmune and arthritis conditions). Rheumatologists use clues from the following sources to determine if someone has nr-axSpA:

• Symptoms

• Personal medical history

• Family medical history

• Physical examination

• Blood tests, like showing the presence of the HLA-B27 gene

• Imaging tests, like MRI of the SI joints or spine

Since there is no single test for nr-axSpA, delays in diagnosis are common. So, if you have symptoms of nr-axSpA, talk to your healthcare provider to determine the next best steps.

Ankylosing Spondylitis Testing: How Healthcare Providers Make the Diagnosis

Written by Samantha C. Shapiro, MD

Treatment

Treatment of nr-axSpA includes both medications and non-medications. The goal is to improve symptoms and protect the body from further damage down the line.

Medications

In nr-axSpA, the immune system behaves like a broken faucet, causing a flood of inflammation throughout the body. Nr-axSpA medications turn off this faucet. 

Certain medications are FDA-approved for nr-axSpA. These include: 

• Cimzia

• Taltz

• Cosentyx

However, rheumatologists frequently use medications approved to treat ankylosing spondylitis (like Humira and Xeljanz) to treat nr-axSpA, too, since it’s in the same family of conditions.

Non-medications

Self-care goes hand in hand with medication when it comes to feeling your best with nr-axSpA. This includes things like:

• Physical therapy

• Exercise and stretches

• Stress management

• Eating a healthy diet

• Getting enough sleep

• Quitting smoking

An Overview of Ankylosing Spondylitis Treatment

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Living with non-radiographic axial spondyloarthritis

Nr-axSpA is a treatable condition, and there’s a lot you can do to make the day to day a little easier: 

1. Get a diagnosis. If you’re concerned about nr-axSpA, speak up. The sooner you’re diagnosed, the sooner you can start to feel better.

2. Work with your provider. They can help you find the medication or combination of medications that improve your symptoms. There is no one-size-fits-all approach, since every person with nr-axSpA responds to treatment differently. 

3. Practice self-care. Exercise when you are able to. Sleep. Limit stress.

4. Be patient with yourself. It takes time to adapt to a new health condition, and it takes time for treatments to work.

5. Ask for support. Whether it’s family, friends, or a local support group, you don’t have to go through this alone.

9 Self-care Tips to Help With Ankylosing Spondylitis

Written by Samantha C. Shapiro, MD

Frequently asked questions