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Axial spondyloarthritis and ankylosing spondylitis: the names explained
Axial spondyloarthritis is an inflammatory condition that can affect the joints between the sacrum and pelvis, called sacroiliac joints, and the spine. Axial refers mainly to the central axis of the body. Other joints and places where tendons attach can also be affected.
Ankylosing spondylitis, also known as Bechterew's disease, is a form with characteristic changes visible on sacroiliac X-rays. In non-radiographic axial spondyloarthritis, those changes are not visible on an ordinary X-ray, although symptoms can be significant. A normal X-ray therefore does not mean pain is imaginary or exclude every inflammatory condition.
Understand the picture
The spine and sacroiliac joints
Spine
Different spinal regions may be involved.
Sacroiliac joints
These connect the sacrum with either side of the pelvis.
Beyond the back
Eyes, skin, bowel or other joints may provide useful information during assessment.
Which symptoms are useful to discuss?
The pattern can include gradually developing low back or buttock pain, stiffness on waking and waking during the night. Movement may ease symptoms while rest does not help much. Unusual fatigue or other joint symptoms may accompany them.
Age at onset matters: pain beginning before 45 and lasting more than three months deserves particular context. These are not diagnostic rules to apply yourself. Other types of back pain can also feel stiff in the morning or improve with movement. Clinicians consider several clues, their duration and your history when deciding whether rheumatology assessment is appropriate.
Chapter sources [1]
Why mention the skin, eyes and bowel?
Spondyloarthritis may occur alongside psoriasis, eye inflammation called uveitis or inflammatory bowel disease. Persistent heel pain or pain at another tendon attachment may be relevant. Mention spondyloarthritis or psoriasis in the family as well.
The condition involves inflammatory processes; it is not explained by poor posture or one physical effort. The genetic marker HLA-B27 may contribute to assessment but cannot establish a diagnosis on its own. Some people have the marker without disease, while others have the condition without it. Both women and men can be affected.
How is it investigated?
Your doctor takes a pain history and checks associated symptoms. A rheumatologist may be involved depending on the findings. Assessment can include examination, blood tests and imaging of the sacroiliac joints or spine.
Blood markers of inflammation may be normal. X-rays can show no changes early on; MRI may sometimes provide further information. None of these results is interpreted alone. If uncertainty remains, later reassessment may be needed as symptoms develop. Explain your age when symptoms began and what has changed, even if an earlier investigation found no explanation.
When is prompt help important?
A red, painful eye, light sensitivity or blurred vision needs an eye assessment the same day. Do not wait for physiotherapy or assume it is simple eyestrain. Uveitis can need prompt treatment to protect the eye.
Sudden pain after a fall also needs assessment, even after a relatively small injury when the spine is stiff or fragile. The neurological and bladder signs above remain emergencies. Contact your medical team for fever or suspected infection, especially while taking treatment that affects immunity. Not every deterioration should automatically be treated as a routine flare.
What does medical treatment do?
Care is coordinated with a doctor, often a rheumatologist. It aims to reduce inflammatory activity, preserve function and limit consequences. Anti-inflammatory treatment may be offered according to your health. Other targeted treatments can be considered when disease remains active and medical criteria are met.
Choices also depend on eye, skin or bowel problems, other illnesses and medication risks. Treatment needs monitoring. Do not stop medicines because exercise helps, or increase doses yourself during a flare. Ask the team what to do with infection, new symptoms or inadequate benefit.
What does physiotherapy work on?
An individual programme may combine spinal mobility, suitable stretching, strength, endurance and breathing exercises. NICE recommends a physiotherapist with relevant specialist expertise. The choice depends on movement, pain, fatigue and possible bone fragility.
The aim is not to force a stiff spine towards an ideal range. It is to maintain useful abilities and support regular practice. Better movement or less pain does not by itself measure inflammation, so medical follow-up remains important. This general information does not claim that the practice specialises in every form of spondyloarthritis.
Chapter sources [1]
Activity and fatigue in daily life
Choose activities you can sustain and distribute them according to your energy. Varying positions, short movement breaks and adjusting longer tasks can help organise the day. Fatigue deserves discussion with your team; it is not simply a lack of effort.
During a flare, the programme may need reducing rather than being abandoned without a plan. An agreed flare plan explains whom to contact and how care can be adjusted. Sleep, work and wellbeing belong in the conversation. If you smoke, ask for support to stop as part of your long-term health care.
In everyday life
Complementary care over time
Doctor / rheumatologist
Assess the disease, inflammation, treatment and its effects.
Physiotherapist
Build and adapt mobility, strength and endurance work.
Your daily life
Report changes, keep suitable activity and use the agreed flare plan.
Exercises: use a specific programme
Your needs may involve the neck, chest, lower back and hips as well as breathing capacity. Ask your professional to demonstrate the chosen movements, pace, amount and adjustments for more painful periods. A short programme you understand is easier to use than a long list without a clear purpose.
The general lumbar exercises here do not replace individual advice. Fracture, surgery or a very stiff spine can require particular precautions. Do not force sudden movements. Stop and seek appropriate advice for unusual pain, weakness, altered sensation or feeling unwell.
Chapter sources [1]
How does the condition develop?
The course varies and may include quieter periods and flares. Some people maintain good independence; others need more care or adjustments. Extensive spinal fusion is not inevitable for every person. Treatment and follow-up aim to preserve abilities over time.
Track stiffness, sleep, fatigue, activities and associated symptoms rather than pain alone. Prepare questions before review: do current symptoms fit a flare, should treatment change and which exercises remain suitable? New symptoms may need a specific assessment rather than simply increasing exercise.
Your questions
Do normal blood tests rule it out?
No. Normal inflammatory markers alone do not exclude axial spondyloarthritis. They are considered with symptoms, examination and imaging. Similarly, a positive HLA-B27 result is not a diagnosis on its own.
Chapter sources [1]
If movement helps, does that prove inflammation?
No. This is one clue, not a diagnostic test. Non-inflammatory pain can also change with movement. Duration, age at onset and associated features guide the medical discussion.
Chapter sources [1]
Can physiotherapy replace medication?
It is an important part of treatment, but does not automatically replace medical control of inflammation. The approaches have complementary roles. Medication changes should be agreed with the prescriber.
Chapter sources [1]
Will my spine definitely become rigid?
No; the course varies. The name ankylosing spondylitis can sound frightening, but severe stiffness is not inevitable. Medical follow-up, suitable treatment and regular activity support function without promising the same result for everyone.
Sources and references
- [1] NICE NG65 · Spondyloarthritis: recommendations
- [2] NHS · Ankylosing spondylitis: diagnosis
- [3] Assurance Maladie · Spondylarthrite ankylosante
- [4] CGDIS Luxembourg · 112
- [5] NHS · Ankylosing spondylitis: complications
- [6] NHS · Ankylosing spondylitis: treatment
Text updated on
Medical review: awaiting Hasib Selimovic.