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Axial Spondyloarthritis.

Predominately a chronic inflammatory disease of axial involvement, Axial Spondyloarthritis (Axial SpA) refers to the axial skeleton or spine. It involves:

  • Ankylosing Spondylitis (AS)
  • Non-radiographic axial SpA (absence of plain radiographic changes)

It is characterised by spinal pain and progression of spinal stiffness and limited spinal mobility. Commonly involving back pain, neck pain can present early in the disease, though inflammatory back pain is often felt deep, around the buttock and sacroiliac region and sometimes refers down the back of the legs. It can also affect hips, shoulders, and other body joints outside of the spine. It initially is noticed in late adolescence and usually affects young adults between 20-30 years of age. Other clinical manifestations can develop outside of the joints of the body and can involve the eyes, lungs, heart, gastrointestinal tract, and other systems and effects on the body. 

Axial Spondyloarthritis features:

  • Inflammatory back pain
  • Arthritis
  • Enthesitis (heel)
  • Uveitis
  • Dactylitis
  • Psoriasis
  • Crohn’s disease/ulcerative colitis
  • Good response to NSAIDs
  • Family history of SpA
  • HLA-B21
  • Elevated CRP

Criteria for Inflammatory Back Pain includes:

  • Age of onset < 40 years old
  • Insidious onset
  • Improvement with exercise
  • No improvement with rest
  • Waking during the night (usually second half)
  • Morning stiffness
  • Pain at night with improvement upon rising
  • Alternating buttock pain
  • Positive response to non-steroidal anti-inflammatory drugs

Causes of Axial Spondyloarthritis

The definitive cause of Axial SpA remains unknown, although a triggering infection, mechanical stress and disruption of the external barrier causes immune and inflammatory mechanisms to respond, which are thought to be involved. It is an autoimmune disease, so the immune system is overactive and effects the body’s healthy tissues and creates increased inflammation.

Axial SpA is a disease process that begins at the entheses and involves an immune system mechanism and pathway that when activated leads to chronic inflammatory disease including Axial SpA. This is followed by characteristic bone loss (erosion) and new bone formation – a clinical manifestation of the disease.

How is a Diagnosis made?

Diagnosis is made by a Rheumatologist. Diagnosis of Axial SpA is a major challenge as it is generally made by careful consideration of several criteria. Reasoning and combining clinical criteria of inflammatory back pain, enthesitis or arthritis with clinical features and history, thorough physical examination, testing and observation, laboratory (blood) testing, and radiological findings provides a diagnosis. 

Early identification is critical along with referral to a rheumatologist if Axial SpA is suspect.

Treatment for Axial Spondyloarthritis

Although there is no cure, and the course of progression of the disease variable, Axial SpA can be managed in many ways. Treating the disease early can be effective in relieving symptoms and possibly preventing progression and further long- term problems. 

Every individual is different, and everyone’s symptoms, severity and progression of the disease is different. Your doctors will work with you to develop and refer you for a treatment plan specific to you. Improving movement patterns, Education, Exercise, Diet, Sleep and relevant lifestyle modification combined with medication is the gold standard.

The aims of treatment are to:

  • Reduce pain, stiffness and fatigue
  • Limit spine and joint damage as much as possible
  • Control other skin or body problems
  • Improve mobility of spine and joints, flexibility and strength 
  • Improve cardiovascular health
  • Improve inflammatory markers
  • Improve function and quality of life

The treatment of Axial SpA can broadly be divided into two types of management categories:

  • Pharmacological or medication
  • Physiotherapy 

Pharmacological or medication management to treat the disease as well as treat the co-existent conditions (such as psoriasis, uveitis) is critical and prescribed, managed, and reviewed by the treating Rheumatologist.

Allied Health play an important role in Axial SpA and Physiotherapists and Exercise Physiologists play an integral role in ongoing therapy. A tailored treatment plan involving specific exercises, education and advice can assist with treatment aims. Physiotherapy is the best known non-surgical therapeutic way of treating AS by improving flexibility and physical strength. 

At Move For Better Health, we pride ourselves on our collaborative approach to treatment to ensure you can be the best you. We have a multidisciplinary approach to management regularly liaising with other health professionals involved in your care.

At our Malvern and Magill locations, we have Physiotherapy, Exercise Physiology, Clinical Psychology (with specialisation in sleep dysfunction), Podiatry and Dietetics. Being able to provide you with the recommendations of gold standard care for axial spondyloarthritis, please get in touch to discuss your treatment options with one of our friendly staff. You can:

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