Understanding Axial Spondyloarthritis (Inflamed Spine):Causes,Treatments, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on June 10, 2024
Axial spondyloarthritis (axSpA) is a chronic inflammatory condition primarily affecting the spine and sacroiliac joints, causing pain and stiffness. This condition encompasses both non-radiographic axial spondyloarthritis and ankylosing spondylitis, with the latter often resulting in visible damage on X-rays. Understanding and addressing axSpA is crucial as it can significantly impact a person's mobility, quality of life, and overall health.
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Early diagnosis and treatment are essential to manage symptoms, reduce inflammation, and prevent long-term complications. Effective management of axSpA often includes a combination of medication, physical therapy, and lifestyle modifications, which can help maintain function and improve the quality of life for those affected by this condition (Sieper et al., 2015; Poddubnyy et al., 2017).
What is Axial Spondyloarthritis?
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily affects the spine and the sacroiliac joints, where the lower spine connects to the pelvis. It can cause significant pain, stiffness, and reduced mobility. AxSpA is an umbrella term that includes both non-radiographic axial spondyloarthritis (nr-axSpA), where changes are not visible on X-rays, and ankylosing spondylitis (AS), where such changes are evident.
AxSpA differs from other types of inflammatory arthritis, such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), in its primary location and pattern of joint involvement. While RA often affects the small joints of the hands and feet, axSpA mainly impacts the spine and sacroiliac joints. PsA can affect both skin and joints but typically involves peripheral joints more than the axial skeleton (Sieper et al., 2015).
AxSpA is relatively common, affecting about 0.5% to 1.4% of the population worldwide. It often begins in late adolescence or early adulthood and is more common in men than in women (Reveille et al., 2012).
Common causes and risk factors of Axial Spondyloarthritis
The exact cause of axSpA is unknown, but it is believed to result from a combination of genetic, environmental, and immune system factors.
Genetic Predisposition
A strong genetic component is associated with axSpA, particularly the presence of the HLA-B27 gene. Approximately 90% of individuals with ankylosing spondylitis possess this gene, although not everyone with HLA-B27 will develop the disease (Rudwaleit et al., 2009).
Environmental Triggers and Infections
Environmental factors, including certain bacterial infections, might trigger axSpA in genetically predisposed individuals. Studies suggest that infections with bacteria such as Klebsiella may play a role in disease onset and progression (Rosenbaum & Asquith, 2018).
Immune System Dysfunction
AxSpA involves a dysregulated immune response, where the body's immune system mistakenly attacks healthy tissues in the spine and sacroiliac joints. This inappropriate immune reaction leads to chronic inflammation and subsequent pain and stiffness (Sieper et al., 2015).
Signs and symptoms of Axial Spondyloarthritis
General signs to look out for
Axial spondyloarthritis (axSpA) presents with various signs and symptoms, often beginning with chronic pain and stiffness in the lower back and buttocks. These symptoms typically improve with exercise but not with rest and are often worse in the morning or after periods of inactivity.
Specific symptoms
Chronic Back Pain: Persistent pain lasting for more than three months, often radiating to the buttocks or thighs.
Morning Stiffness: Stiffness in the spine and sacroiliac joints, especially upon waking.
Fatigue: General tiredness and lack of energy.
Limited Spinal Mobility: Reduced ability to move the spine, which may worsen over time.
When to seek medical attention
Individuals experiencing chronic back pain and stiffness, especially if it improves with exercise and worsens with rest, should seek medical attention. Early diagnosis and treatment are crucial in managing symptoms and preventing complications (Sieper et al., 2015).
Prevention of Axial Spondyloarthritis
Strategies for managing and reducing flare-ups
While axSpA cannot be entirely prevented, managing and reducing flare-ups is possible through:
Medication Compliance: Following prescribed treatments can help control inflammation and pain.
Regular Exercise: Engaging in physical activities to maintain mobility and reduce stiffness.
Importance of maintaining a healthy lifestyle
A healthy lifestyle, including a balanced diet and regular physical activity, can improve overall health and manage symptoms.
Exercise routines
Exercises tailored for individuals with axSpA, such as swimming, yoga, and stretching routines, can help maintain flexibility and strength (Skargren et al., 1998).
Tips for avoiding common triggers
Avoiding smoking and managing stress can help reduce the frequency and severity of flare-ups.
Diagnosis procedures and tests of Axial Spondyloarthritis
Diagnosing axSpA involves a combination of patient history, physical examinations, imaging studies, and laboratory tests.
Role of imaging studies
X-rays: Used to detect structural changes in the spine and sacroiliac joints.
MRIs: Helpful in identifying early inflammatory changes before they are visible on X-rays (Braun et al., 2009).
Laboratory tests
Genetic Testing for HLA-B27: The presence of the HLA-B27 gene is a significant risk factor.
Blood Tests: Inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can indicate inflammation.
Physical examinations and patient history
A thorough physical examination and detailed patient history are essential in diagnosing axSpA, as symptoms and their patterns provide critical diagnostic clues.
Treatment options for Axial Spondyloarthritis
Treatment for axSpA aims to relieve symptoms, improve function, and prevent complications.
Medication and pain management
NSAIDs: Non-steroidal anti-inflammatory drugs are the first line of treatment to reduce pain and inflammation.
DMARDs: Disease-modifying anti-rheumatic drugs can be used in certain cases.
Biologics: Tumor necrosis factor (TNF) inhibitors and interleukin-17 (IL-17) inhibitors are effective in reducing inflammation (van der Heijde et al., 2017).
Physical therapy and exercise programs
Regular physical therapy and exercise programs tailored to individual needs can improve mobility and reduce pain.
Rest and activity modification
Balancing rest and activity, and avoiding prolonged periods of inactivity, can help manage symptoms.
Alternative treatments
Acupuncture: May provide pain relief for some individuals.
Massage: Can help reduce muscle tension and pain (Lauche et al., 2013).
Effectiveness and role of physiotherapy in managing and treating Axial Spondyloarthritis
Physiotherapy plays a crucial role in managing and treating axial spondyloarthritis (axSpA). It helps reduce pain, improve spinal mobility, and enhance the overall quality of life for individuals with this condition. Regular physiotherapy can prevent the progression of spinal stiffness and maintain functional independence.
Specific Physiotherapy Techniques
Manual Therapy: Techniques such as spinal mobilization and manipulation can help alleviate pain and improve joint function.
Exercise Programs: Tailored exercise routines, including stretching, strengthening, and aerobic exercises, are essential. These exercises help maintain flexibility, strengthen the muscles supporting the spine, and improve cardiovascular health (Dagfinrud et al., 2008).
Hydrotherapy: Exercising in water can reduce joint stress and improve mobility. 4. Posture Training: Teaching proper posture and ergonomics to reduce strain on the spine and joints.
Benefits and Success Stories
Physiotherapy has been shown to significantly improve pain levels, spinal mobility, and overall function in individuals with axSpA. Regular exercise and manual therapy can help delay the progression of spinal deformities and maintain a higher quality of life (Kiltz et al., 2012). Many patients report reduced pain and stiffness and improved daily functioning after consistent physiotherapy sessions.
Recommendations from Certified Physiotherapists
Certified physiotherapists recommend a personalized approach to managing axSpA. This includes:
Consistency: Regular physiotherapy sessions and home exercise programs are crucial for long-term benefits.
Variety: Incorporating different types of exercises to address various aspects of physical health.
Adaptation: Adjusting exercise routines based on the individual's current condition and response to therapy.
Education: Providing education on self-management techniques and lifestyle modifications to complement physiotherapy (Sieper et al., 2015).
Conclusion
Understanding axial spondyloarthritis (axSpA) is essential due to its impact on spinal health and overall quality of life. Recognizing the signs and symptoms early, along with understanding the importance of genetic and environmental factors, can aid in timely diagnosis and treatment.
Seeking professional help for accurate diagnosis and appropriate treatment is crucial. Early intervention can prevent disease progression and improve long-term outcomes. Medical professionals, including rheumatologists and physiotherapists, play a pivotal role in managing axSpA.
Physiotherapy stands out as a significant component of treatment, offering numerous benefits such as pain reduction, improved mobility, and enhanced quality of life. Tailored exercise programs, manual therapy, and other physiotherapeutic techniques are vital in managing axSpA effectively. Engaging in regular physiotherapy can make a substantial difference in the lives of those affected by this chronic condition.
Embrace the journey towards better spinal health with the support of knowledgeable healthcare professionals, and remember that consistent physiotherapy can lead to meaningful improvements and a better quality of life.
References:
Dagfinrud, H., Kvien, T. K., & Hagen, K. B. (2008). Physiotherapy interventions for ankylosing spondylitis. The Cochrane Database of Systematic Reviews, 1, CD002822. https://doi.org/10.1002/14651858.CD002822.pub3
Kiltz, U., van der Heijde, D., Boonen, A., Braun, J., & ASAS Health Index Study Group. (2012). The ASAS health index: The first patient-reported outcome measure for assessing the impact of axial spondyloarthritis on health and functioning. Annals of the Rheumatic Diseases, 74(1), 83-89. https://doi.org/10.1136/annrheumdis-2013-203967
Poddubnyy, D., Rudwaleit, M., Haibel, H., Listing, J., Märker-Hermann, E., Zeidler, H., Braun, J., Sieper, J. (2017). Effect of non-steroidal anti-inflammatory drugs on radiographic progression in axial spondyloarthritis: 10-year results from the German spondyloarthritis inception cohort. Annals of the Rheumatic Diseases, 76(12), 1825-1832. https://doi.org/10.1136/annrheumdis-2017-211198
Reveille, J. D., Witter, J. P., & Weisman, M. H. (2012). Prevalence of axial spondyloarthritis in the United States: Estimates from a cross-sectional survey. Arthritis Care & Research, 64(6), 905-910. https://doi.org/10.1002/acr.21621
Rosenbaum, J. T., & Asquith, M. (2018). The microbiome and HLA-B27-associated acute anterior uveitis and ankylosing spondylitis. Nature Reviews Rheumatology, 14(10), 704-713. https://doi.org/10.1038/s41584-018-0101-1
Rudwaleit, M., van der Heijde, D., Landewe, R., Listing, J., Akkoc, N., Brandt, J., ... & Sieper, J. (2009). The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Annals of the Rheumatic Diseases, 68(6), 777-783. https://doi.org/10.1136/ard.2009.108233
Sieper, J., Braun, J., Dougados, M., & Baeten, D. (2015). Axial spondyloarthritis. Nature Reviews Disease Primers, 1(1), 15013. https://doi.org/10.1038/nrdp.2015.13
Related links:
Understanding lower back pain: Types, causes, and treatments, and the role of physiotherapy
Understanding acute non-specific low back pain: Causes, treatments, and the role of physiotherapy
Understanding radicular pain: Causes, treatments, and the role of physiotherapy
Understanding spinal canal stenosis: Causes, treatments, and the role of physiotherapy
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.