If your back pain has never quite made sense, this may be worth a read

Back pain can have a big impact on your life, even when there's no serious cause behind it. But there's one condition we always keep an eye out for, because it behaves differently and is often missed for years: axial spondyloarthritis (axSpA).

What is it?

Axial spondyloarthritis is an inflammatory condition that mainly affects the spine and the sacroiliac joints. It's an umbrella term that includes ankylosing spondylitis.

It belongs to a wider family of related conditions called spondyloarthritis, which also includes psoriatic arthritis, arthritis linked to inflammatory bowel disease, and reactive arthritis.

It's relatively uncommon, affecting somewhere between 0.3% and 1.4% of people. But it's an important one not to miss.

Signs worth mentioning to your GP

The main thing to look for is back pain that has lasted 3 months or more and started before age 45. On top of that, some of the following features may point towards axSpA. On their own, each one doesn't mean much. It's when several show up together that it becomes worth looking into:

• Morning stiffness that lasts more than 30 minutes

• Waking with pain in the second half of the night

• Pain that improves with exercise and gets worse with rest

• Pain that eases noticeably with anti-inflammatory medication

• Ongoing fatigue

• Psoriasis (a skin condition)

• Episodes of a painful red eye, often with sensitivity to light (uveitis)

• Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis

• A whole finger or toe swelling up, not just around the joint (dactylitis)

• Past or ongoing pain where tendons attach to bone, especially Achilles pain or plantar fasciitis

• A family history of axSpA or related conditions

Why is it so hard to diagnose?

On average, people wait around 7 years from their first symptoms to a diagnosis. That's largely because there's no single test that can confirm whether you have it or not.

• Blood tests such as CRP and ESR measure inflammation in the body. But they can be raised for lots of reasons, and they can be normal in people with axSpA.

• The HLA-B27 gene is found in around 70 to 90% of people with axSpA. Interestingly, only around 1 to 5% of people who carry the gene go on to develop the condition. So a positive result doesn't mean you have it, and a negative result doesn't completely rule it out.

• X-rays and other scans are often normal, especially in the early stages.

So what can you do?

If several of the features above sound familiar, book in with your GP. Let them know which symptoms you've noticed, and ask whether axial spondyloarthritis could be a possibility. If you both agree it's worth looking into, you'll likely be referred to a rheumatologist (a doctor who specialises in inflammatory and autoimmune conditions). They can confirm the diagnosis and are often involved in ongoing care.

Why it matters not to miss it

It behaves differently from most back pain. It tends to feel better with movement and worse with rest, and morning stiffness is common. Movement usually helps, although overdoing it can mean more pain the next day.

The outlook is different. Flare-ups, when symptoms get worse for a while, are a common part of the condition. A flare doesn't automatically mean damage or that things are getting worse overall. But frequent or long-lasting flares are worth raising with your GP or rheumatologist. There is no cure for this condition. However, for quite a number of people it can be managed well.

The management is different. Unlike most back pain, axSpA can respond well to specific medical treatment. That's why getting an accurate diagnosis matters.

Managing axSpA

Medical treatment can be very effective for many people. It usually starts with anti-inflammatory medication and may include biologics (a group of targeted medications) if needed. Your GP or rheumatologist will guide this.

Alongside medical care, there's plenty you can do:

• Exercise! Regular exercise is one of the most strongly recommended parts of managing axSpA.

• Stay active, and pace yourself. Keep active across the day, and spread activity out to help avoid next-day flares.

• Stop smoking if you smoke. Smoking is linked with poorer outcomes in axSpA, including how well medication works.

• Prioritise your sleep.

• Eat well.

• Look after your mental health.

Written by

Samuel Bulten

Exercise Physiologist | Masters in Medicine (Pain Management)

Director, Adapt Movement

Disclaimer

This information is for educational purposes only and is not a substitute for personal medical advice. These blogs are written by Sam Bulten and represent his opinions and insights and are based on his experience and interpretation of the research. As Sam is a human, these opinions and insights are not absolute truths.