Axial Spondyloarthritis: Early Symptoms You Shouldn't Ignore

What is Axial Spondyloarthritis?

Axial spondyloarthritis (axial SpA) is a chronic inflammatory condition that affects the spine and sacroiliac joints, leading to pain and stiffness primarily in the lower back. It is classified into two main types:

• Ankylosing spondylitis (AS), where joint damage and changes can be seen on X-rays, and
• Non-radiographic Axial Spondyloarthritis (nr-axial SpA), which shows inflammation but no visible damage on X-rays.

Despite its classification, both forms can cause significant discomfort and impact quality of life. Early recognition of axial SpA symptoms is crucial for timely diagnosis and treatment, which can prevent long-term damage and improve patient outcomes.

Why Early Diagnosis is Important

Delays in diagnosing axial spondyloarthritis are common, often because early symptoms are mistaken for other types of back pain or musculoskeletal issues. However, unlike mechanical back pain that may result from injury or posture, axial SpA is an inflammatory condition that requires specific treatments.

On average, it can take up to eight years for someone with axial spondyloarthritis to be accurately diagnosed. This delay can lead to progression of the disease, causing irreversible joint damage, reduced mobility, and a higher risk of complications like spinal fusion (where bones in the spine grow together).

Understanding the early signs of axial SpA can empower patients to seek appropriate medical attention sooner and start treatments that will help control inflammation and preserve joint function.

Early Symptoms You Shouldn't Ignore

Axial spondyloarthritis presents with a range of symptoms, many of which can be subtle or develop gradually. Below are some early warning signs you should not ignore.

1. Chronic Lower Back Pain

Persistent back pain, especially in the lower back or buttock area, is a hallmark symptom of axial SpA. What sets this apart from typical back pain is that it tends to:

• Last for more than three months,
• Feel worse after periods of rest, especially in the morning, and
• Improve with physical activity or movement.

This inflammatory back pain is often mistaken for mechanical back pain, but the key difference is that rest doesn’t alleviate it—it actually makes it worse. If your back pain fits this pattern, especially if it has been ongoing for months or years, you should speak to your GP or rheumatologist.

2. Morning Stiffness

Morning stiffness is another critical indicator of axial SpA. Many patients report feeling stiff and immobile when they first wake up, with the stiffness lasting for 30 minutes or more. This stiffness tends to ease as the day progresses and with movement.

If you regularly feel as though your body is "frozen" or stiff after sleeping or sitting for long periods, it could be a sign of inflammation in the spine or sacroiliac joints, both of which are affected in axial spondyloarthritis.

3. Pain in Other Joints (Peripheral Arthritis)

Although axial spondyloarthritis primarily affects the spine, it can also cause inflammation in other joints, such as the hips, shoulders, and knees. This is referred to as peripheral arthritis. If you’re experiencing joint pain and swelling, particularly in combination with back pain, it may be related to axial SpA.

4. Fatigue

Fatigue is a common but often overlooked symptom of axial spondyloarthritis. Chronic inflammation can trigger fatigue, and in some cases, this can be severe. Many patients report feeling drained of energy, even if they’ve had enough rest. Fatigue can negatively impact quality of life and make it difficult to carry out daily activities.

5. Inflammation in the Eyes (Uveitis)

Another early symptom of axial SpA that people may not associate with back pain is eye inflammation, also known as uveitis or iritis. This condition causes redness, pain, sensitivity to light, and blurry vision. Uveitis is more common in people with axial SpA and can recur over time if left untreated. If you experience any eye symptoms in combination with back pain, it is important to see a healthcare professional.

6. Alternating Buttock Pain

Pain that switches from one side of the buttocks to the other can be a sign of inflammation in the sacroiliac joints, which are located at the base of the spine. This is one of the key areas affected by axial spondyloarthritis. If you have unexplained, recurrent buttock pain that alternates sides, you should mention this to your doctor.

7. Family History of Axial Spondyloarthritis

If you have a family history of axial spondyloarthritis, ankylosing spondylitis, or other forms of spondyloarthritis, you may be at a higher risk for developing the condition. The genetic marker HLA-B27 is strongly associated with axial SpA, though not everyone with this gene will develop the disease. If you experience any of the above symptoms and have a family history of the disease, this should prompt further investigation.

When to See a Doctor

If you are experiencing chronic back pain that doesn’t improve with rest, or any combination of the symptoms mentioned above, it’s important to see a healthcare professional as soon as possible. The earlier axial spondyloarthritis is diagnosed, the better the chances of controlling the disease and preventing long-term damage.

Your GP may refer you to a rheumatologist, a specialist in inflammatory diseases, for further testing, which may include:

• Blood tests to check for inflammation markers and the presence of the HLA-B27 gene,
• Imaging tests like X-rays or MRIs to detect inflammation or joint damage.

Conclusion

Axial spondyloarthritis is a potentially debilitating condition that can significantly impact your quality of life. However, with early detection and proper treatment, the disease can be managed, and many people with axial SpA can lead full, active lives.

If you recognize any of the early symptoms mentioned above in yourself or a loved one, don’t ignore them. Speak with your healthcare provider to discuss your concerns and start the path toward a diagnosis and treatment plan that can help manage the disease.

References

• National Health Service (NHS). Axial Spondyloarthritis. https://www.nhs.uk/conditions/ankylosing-spondylitis/.
• Sieper, J., & Poddubnyy, D. (2017). Axial spondyloarthritis. The Lancet, 390(10089), 73-84. doi:10.1016/S0140-6736(16)31591-4.
• Rudwaleit, M., van der Heijde, D., Landewé, R., et al. (2009). The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis. Annals of the Rheumatic Diseases, 68(6), 777-783. doi:10.1136/ard.2008.101055.
• British Society for Rheumatology. Axial Spondyloarthritis Guidelines.