Non Radiographic Axial Spondyloarthritis

Non-radiographic axial spondyloarthritis is a prolonged inflammatory condition that leads to discomfort and swelling in the spine and joints around the lower pelvic region. This form of spondyloarthritis is distinct because inflammation does not appear on X-rays; thus, an MRI scan is usually required for accurate diagnosis. Treatment generally involves nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain, coupled with other medications aimed at reducing inflammation.

Causes

The primary causes of non-radiographic axial spondyloarthritis include:

• An inflammatory disorder primarily affecting the spine and joints, caused by the immune system erroneously attacking healthy tissues.

• Genetic predispositions play a crucial role, with about 85% of patients carrying the HLA-B27 gene.

• The HLA-B27 gene is linked to immune system issues, although not everyone with this gene will develop the disease, suggesting the involvement of other factors.

• Most commonly presents in individuals under 45, with equal incidence in men and women.

• The exact cause remains unclear, but environmental factors such as certain bacterial or viral infections might trigger the disease.

Symptoms

Common symptoms include:

• Persistent pain and stiffness in the lower back and buttocks, worsening at night and typically improving with exercise or a warm shower, usually first appearing before age 45.

• Stiffness and discomfort in the neck, shoulders, hips, and heels.

• Fatigue that can affect daily functioning, work, and emotional health.

• Eye inflammation, known as iritis or uveitis, causing redness, pain, and blurred vision.

• Some may experience gastrointestinal issues.

Due to symptom variability, diagnosis can be complex, highlighting the importance of consulting a healthcare provider for appropriate management.

Diagnosis

Diagnosis is usually performed by a rheumatologist who conducts a detailed physical examination, reviews the patient’s family history, and orders specific tests. Since no definitive test exists for this condition, the focus is on persistent symptoms, such as back pain improving with exercise but persisting during rest. Blood tests can reveal inflammation through markers like C-reactive protein, and a genetic test for the HLA-B27 gene supports diagnosis if symptoms align. MRI scans are typically necessary to detect spinal and sacroiliac joint inflammation, as X-rays usually don't show joint damage in this condition. Symptoms’ similarity to other disorders can delay diagnosis, reinforcing the need for specialist consultations.

Treatments

Managing non-radiographic axial spondyloarthritis requires a comprehensive approach involving medication, lifestyle modifications, and physical therapy. NSAIDs are commonly prescribed to reduce pain and inflammation. For patients not responding to NSAIDs, biologics such as TNF inhibitors may be recommended. Physical activity is essential to keep the spine and joints flexible and aid in pain reduction. Physical therapy plays a crucial role by focusing on enhancing mobility and posture. Avoiding smoking is vital, as it can exacerbate inflammation. Collaborating with a healthcare team is crucial to develop a personalized plan to manage the condition and improve daily living capabilities.

Medications

To manage non-radiographic axial spondyloarthritis, various medications help control symptoms and improve quality of life. The commonly used treatments include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): First-line treatment for pain relief and inflammation reduction.

• Corticosteroids: Applied in severe cases for rapid inflammation control.

• Disease-Modifying Antirheumatic Drugs (DMARDs): Aims to slow down disease progression and manage symptoms.

• Biologics - TNF Inhibitors: Medications like Cimzia are used to block inflammation-inducing proteins, providing relief from back pain and stiffness.

• Interleukin Inhibitors: Newer options such as Cosentyx and Taltz target alternate inflammatory pathways for inflammation reduction.

Consulting healthcare providers to tailor treatment plans according to specific needs is critical.

Prevention

Though prevention of non-radiographic axial spondyloarthritis isn't possible, the progression can be managed effectively through:

• Regular Exercise: Activities like walking and stretching help maintain joint mobility and reduce stiffness.

• Avoid Smoking: Critical to avoid smoking, as it can intensify symptoms by increasing inflammation.

• Balanced Diet: A diet rich in fruits and vegetables supports overall health and aids in controlling body-wide inflammation.

• Healthcare Monitoring: Regular check-ups, particularly with a rheumatologist, are essential for condition monitoring and treatment plan adjustments.

These strategies are instrumental in managing symptoms and enhancing life quality for individuals experiencing this chronic condition.