About Axial Spondyloarthritis
Axial spondyloarthritis (axSpA) is a form of arthritis primarily affecting the spine, especially the joints connecting the lower spine to the pelvis, known as the sacroiliac joints. However, it can also impact other joints and parts of the body. It's a systemic condition, meaning it can influence various organs. Often, there's a family history associated with it.
There are two main categories:
Radiographic axSpA, also known as ankylosing spondylitis (AS), displays visible damage in the sacroiliac joints and spine on X-rays.
Nonradiographic axSpA (nr-axSpA) may not reveal damage on X-rays but can be detected through MRIs.
While it can manifest at any age, the typical onset is between 20 and 40 years. AS tends to be more prevalent in men, whereas nr-axSpA appears to be equally common in both men and women. It's worth noting that axSpA is less frequently observed among African Americans compared to other racial groups.
Diagnosis
AxSpA, a condition that often targets the joint where the spine connects with the pelvis, frequently presents itself as discomfort in the lower back, hips, and buttocks. It's not limited to these areas, though; it can also manifest in places like the shoulders, knees, toes, fingers, eyes, and even the gastrointestinal tract. It's interesting to note that these symptoms typically start to appear during one's teenage years or early adulthood.
When diving into the types of axSpA, there are two primary categories:
Radiographic axSpA: This is where X-rays depict bone damage, more commonly known as ankylosing spondylitis. It seems that men tend to experience this more than women.
Non-radiographic axSpA (nr-axSpA): In these cases, even though the symptoms are evident, X-rays don’t display any bone damage. This version is often found in women but can sometimes be misdiagnosed. It's worth mentioning that nr-axSpA could progress into ankylosing spondylitis, particularly in men.
Now, when it comes to identifying axSpA, there isn't a single decisive test. It's a combination of a hands-on physical exam, blood and imaging tests, and, importantly, the expertise of the doctor.
If you're curious about other potential indicators of axSpA, they can include:
Gradual onset of symptoms.
Persistent pain that lasts for a minimum of three months.
Experiencing discomfort at night and stiffness upon waking.
A noticeable decrease in pain when moving.
Blood tests hinting at inflammation throughout the body. Moreover, a positive outcome on the HLA-B27 gene test or any noticeable changes in the pelvic joints through X-rays or MRIs can be suggestive of axSpA, but they don't conclusively establish it.
Treatment
While there isn't a known cure for axial spondyloarthritis, prompt and proactive treatment can offer numerous benefits:
Alleviate back pain and support good posture
Minimize the risk of joint damage
Ensure ongoing mobility and an enhanced quality of life
The symptoms can differ from person to person, but there are several treatment options available:
Engaging in Exercise: Regular physical activity is crucial for easing pain and improving neck and back flexibility.
Posture Training: Helps in maintaining a good stance and spinal alignment.
Medications:
NSAIDs (Nonsteroidal anti-inflammatory drugs): These are frequently recommended for axial spondyloarthritis and can be available over the counter or through a prescription.
Corticosteroid Injections: These can reduce joint pain and swelling, though they're not recommended for spinal use.
Biologics: These medicines address the inflammation that underlies the condition. They encompass drugs like TNF blockers and IL-17 blockers. However, it's worth noting that they may not be necessary for everyone diagnosed with the disease.
To further alleviate symptoms, consider the following lifestyle choices:
Engage in regular, low-impact exercises like walking.
Avoid smoking as it can exacerbate the condition and impact the efficacy of certain medications.
Use hot and cold treatments for relief.
Embrace relaxation techniques such as deep breathing and mindful meditation to manage stress.
Shared Decision-Making
Collaborating closely with your doctor through shared decision-making ensures that your voice is heard and you're actively engaged in choices about your health.
This approach allows you to converse, ask informed questions, and express your feelings about various treatment possibilities. Your doctor values your input and will consider your preferences in their recommendations. Tools known as patient decision aids are used in this process to present the advantages and disadvantages of treatments in an unbiased, clear manner.
These aids are particularly useful for those accustomed to a more doctor-driven decision-making model. In this collaboration, your doctor will elucidate the options and provide insights, while you remain at the helm of your health care decisions. This method is proven to enhance patient contentment, optimize health outcomes, and even reduce overall healthcare necessities.
Given that doctor visits are time-constrained, it's a good idea to prepare your questions beforehand, prioritizing the most pressing ones.
If you're managing axSpA, you might consider asking:
What additional challenges might arise due to axSpA?
What can I anticipate moving forward?
How soon can I expect my treatment to show results?
Is this treatment covered by my insurance?
Which other healthcare professionals should I consult to manage this condition optimally?
Are there self-help strategies I can employ to cope?
Always keep your doctor informed about any new symptoms, maintain a journal to track what's effective, and regularly discuss your treatment approach with your physician to ensure both of you are on the same page regarding what's working.
Nutrition and Exercise
When you have axial spondyloarthritis, physical activity is a key part of treatment. Among other benefits, it helps preserve your range of motion, flexibility, muscle strength, posture, balance and lung capacity.
Aim for at least 150 minutes per week of moderate-intensity exercise, and ask your doctor for a referral to a physical therapist, who can show you appropriate exercises and how to do them properly. The therapist can design a workout that protects your back, strengthens the muscles around your spine and helps your posture.
Once you know what you should and shouldn’t do to protect your joints, you can work out on your own or in a group class.
The best activity is the one you’ll stick with, but it’s best to include stretching and balance exercises, like yoga, strength training with machines, free weights or resistance bands and cardiovascular activities like walking or swimming.
Deep breathing is also important to expand your chest and prevent stiffness in your rib cage and upper back.
Mind-body exercises like yoga, tai chi or Pilates provide mental as well as physical benefits. Work with an instructor familiar with axSpA who can help you modify moves to protect your joints.
Although there’s no axSpA diet, some people find that certain foods affect their symptoms.
A Mediterranean diet is a healthy, anti-inflammatory choice. Focus on eating more fruits, vegetables and healthy fats like olive oil and fish rich in omega-3 fatty acids, and minimize red meat, added sugars and processed foods.
This type of diet also can help you reach or maintain a healthy weight. Being overweight can increase joint pain and inflammation and may make certain medications less effective.
Continue taking your medications as prescribed and be sure to eat well and stay active to help your axSpA symptoms. Talk to your doctor before making any exercise or diet changes, and keep a journal to monitor your symptoms and what affects them.
Emotional Wellbeing
Living with axSpA can be challenging, especially as symptoms often start during some of life's pivotal moments, such as during school, starting a family, or building a career. It might change some of the ways you'd envisioned your life, including daily activities, career plans, and even self-perception. It's not uncommon for the inflammation associated with this disease to influence mental well-being, sometimes leading to feelings of depression.
However, there's hope. You have the power to manage the impact of axSpA on your life. By adopting a healthy lifestyle – eating nutritiously, staying active, and practicing good posture – you can enhance your overall well-being. If you're a smoker, it's beneficial to consider quitting since it can exacerbate the disease and affect the efficacy of medications.
Many find solace in mindfulness exercises, meditation, or speaking to a mental health professional. Prioritizing sleep by creating a calming bedtime routine, ensuring your room is conducive to rest, and maintaining a consistent sleep schedule can also be beneficial.
Engaging socially is wonderful, but remember, it's okay to step back when you need to. Listen to your body and don't hesitate to seek help when necessary.
If you ever feel overwhelmed, struggle with sleep, or experience depressive feelings, please reach out to your doctor. Documenting your daily experiences can also be a great way to identify patterns in your symptoms and activities. Remember, you're not alone in this journey, and there are many resources available to support you.
Causes
The precise origin of axSpA remains undetermined. Studies suggest that individuals with specific genetic markers may develop axSpA upon exposure to certain viruses, bacteria, or other triggers. A significant number of those with axSpA possess the HLA-B27 gene. However, the majority of individuals with this gene do not experience axSpA.
Symptoms
Commonly, individuals experience discomfort in the lower back, hips, and buttocks as initial symptoms. For children, it might begin with pain in the hips, knees, or heels even before affecting the back. Some characteristics of axSpA are:
Gradual onset of pain in the lower back, hips, and buttocks over weeks or months.
Sensations of pain, swelling, and warmth, potentially accompanied by redness, in areas like the toes, heels, ankles, knees, rib cage, upper spine, shoulders, and neck.
Feeling stiff after waking up or after extended periods of rest.
Experiencing back discomfort during nighttime or early in the morning.
Tiredness or fatigue.
Decreased appetite.
Health Effects
Understanding the effects on different parts of the body:
Spine & Joints: As time progresses, it's possible for the bones and joints of the spine to naturally merge together, primarily starting at the base. This can result in a reduced flexibility in the back, making movement more challenging. In some instances, the rib cage might join together, which can affect how easily the chest expands.
Eyes: Continuous eye inflammation, known as uveitis, may lead to symptoms such as dryness, discomfort, redness, light sensitivity, and vision changes. Occasionally, the white portion of the eye might show redness, a condition termed scleritis.
Digestive System: In some cases, inflammation can result in discomfort in the abdomen and instances of diarrhea.
Heart: While it's less frequent, inflammation might impact the primary artery connected to the heart, the aorta. It's also worth noting that individuals with axSpA may experience a heightened risk for conditions like heart attacks and strokes.
Lungs: Though it's uncommon, lung-related complications can arise. In these situations, individuals might notice symptoms such as breathlessness and diminished lung efficiency.
It's essential to stay informed and regularly consult with healthcare professionals regarding these potential effects.
Self-Care
For optimal well-being when managing axSpA:
Healthy Eating: While there's no exclusive diet for axSpA, it's beneficial to opt for anti-inflammatory foods similar to those in the Mediterranean diet. This means savoring dishes rich in fatty fish, fresh fruits, wholesome grains, vibrant vegetables, and extra virgin olive oil. It's also wise to moderate the intake of red meat, sugary delights, and processed goodies.
Say No to Smoking: Smoking not only impacts your overall health but can also intensify disease progression and joint wear. Plus, it can pose challenges to your breathing. If you're thinking of quitting, your doctor can provide valuable guidance.
Posture Matters: Maintaining a good posture can alleviate pain and stiffness. When at your computer, ensure the screen is eye-level, and keep your feet grounded. Refrain from confining yourself in uncomfortable positions for extended periods. Alternate between sitting and standing stances, and consider a cushion for back support. And, with our frequent cellphone usage, be mindful of the 'texting neck'.
Stretch and Relax: Feel the difference with stretching, especially after indulging in a warm shower or bath. It's a fantastic way to diminish pain and counteract stiffness.
Manage Your Energy: On those challenging days, be kind to yourself. Strategize your tasks, intersperse them with brief respites, and ensure you manage fatigue efficiently.
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