What Is Non-Radiographic Axial Spondyloarthritis? Causes, Symptoms, and Treatment

What is non-radiographic axial spondyloarthritis?

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

Nr-axSpA falls under a family of conditions called spondyloarthritis. It’s very similar to ankylosing spondylitis, which is also in this family. (That’s why you’ll notice helpful 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 a “radiograph” (or X-ray). 

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

• Spondyloarthritis means inflammation of your spine and joints. 

So, nr-axSpA is a condition that causes inflammation in your spine and joints without showing up on an X-ray. More specifically, X-rays of the sacroiliac (SI) joints in your pelvis look normal.

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

Ankylosing Spondylitis: Your GoodRx Guide

Written by Mandy Armitage, MD

Non-radiographic axial spondyloarthritis causes

Non-radiographic axial spondyloarthritis (nr-axSpA) is an autoimmune condition. The immune system helps protect against things that don’t belong in your body, like infections. The word “auto” means “self.” So, an autoimmune condition is when your 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: A person’s genes (DNA passed down from their birth parents) can increase the risk of nr-axSpA. The gene that leads to the highest risk is called HLA-B27. 

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

• Immune system dysfunction: Having other autoimmune conditions, like inflammatory bowel disease, psoriasis, or psoriatic arthritis, may increase your risk of developing nr-axSpA.

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

Written by Samantha C. Shapiro, MD

Non-radiographic axial spondyloarthritis symptoms

One of the hallmark symptoms of non-radiographic axial spondyloarthritis (nr-axSpA) is inflammatory back pain. This is a special kind of back pain that typically starts before age 45. It’s often worse when you wake up in the morning and it gets better with exercise. 

Other symptoms experienced with nr-axSpA may include:

• Fatigue

• Stiffness

• Decreased flexibility in your spine

• Tender, swollen joints

• Inflammation inside of your eye (iritis)

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

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

• Chest pain with deep inhales (costochondritis)

Each 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

Non-radiographic axial spondyloarthritis diagnosis

Non-radiographic axial spondyloarthritis (nr-axSpA) is a clinical diagnosis. This means there isn’t a single test that can diagnose it. A rheumatologist usually makes the diagnosis. A rheumatologist is a healthcare professional who 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 testing for the presence of the HLA-B27 gene

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

Because there isn’t a single test for nr-axSpA, delays in diagnosis are common. If you have symptoms of nr-axSpA, talk to your primary care provider. They can help you determine the next best steps for getting a diagnosis.

Ankylosing Spondylitis Testing: How Healthcare Providers Make the Diagnosis

Written by Samantha C. Shapiro, MD

Non-radiographic axial spondyloarthritis treatment

Treatment for non-radiographic axial spondyloarthritis (nr-axSpA) includes both medications and non-medication approaches. The goal is to improve symptoms and protect your body from long-term damage.

Medications

In nr-axSpA, your immune system behaves like a broken faucet, causing a flood of inflammation throughout your body. Medications help “turn off” this faucet and lower inflammation. 

Medications that are FDA-approved for nr-axSpA include: 

• Cimzia

• Taltz

• Cosentyx

However, rheumatologists frequently use medications approved to treat ankylosing spondylitis, like Humira and Xeljanz, to treat nr-axSpA.

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

Written by Samantha C. Shapiro, MD

Living with non-radiographic axial spondyloarthritis

Non-radiographic axial spondyloarthritis (nr-axSpA) is a treatable condition. There’s a lot you can do to make daily life 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 treatment and feel better.

2. Work with your healthcare team. They can help you find the medication or combination of medications that improve your symptoms. There’s no one-size-fits-all approach. Each person with nr-axSpA responds to treatment differently. 

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

4. Be patient with yourself. It takes time to adapt to a new health condition. It also 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

Non-radiographic axial spondyloarthritis prognosis

Non-radiographic axial spondyloarthritis (nr-axSpA) isn’t fatal. But it’s a life-long condition that progresses at different rates for different people. 

Some people with nr-axSpA have mild symptoms that remain relatively stable over time. Others have a more progressive disease that can lead to limited spinal mobility, chronic pain, and organ damage. 

Experts don’t yet have a way to predict how the disease will progress for each person. But they know that the following factors can increase the risk of faster progression: 

• Being male

• Having high inflammatory markers on blood tests

• Having a strong family history of the condition

It’s unclear whether treatment prevents progression of disease. More data is needed to know for sure. But some studies show that medication may prevent progressive changes in the spine.