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Axial Spondyloarthritis

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Axial spondylarthritis is a general term that includes:


Ankylosing Spondylitis (AS) – Where there is visible changes to yours spinal x-ray mainly to sacroiliac joint (one or both).


Non-Radiographic Axial Spondylarthritis – You may be diagnosed with this by a specialist or your GP where there is no changes in x ray but visible inflammation on MRI.


It’s a painful, progressive form of inflammatory arthritis. It mainly affects the spine but can also affect other joints, tendons and ligaments. It can also give you symptoms such as foot pain (known as plantar fasciitis) heel pain (Achilles tendinopathy), bowel irritation and red eye (Uveitis).

Signs & Symptoms

  • Slow or gradual onset of back pain and stiffness over weeks or months, rather than hours or days.
  • Early-morning stiffness and pain that lasts more than 30 minutes to an hour, wearing off or reducing during the day with exercise.
  • Persistent pain for more than 3 months (note: persistent not intermittent).
  • Feeling better after exercise and worse with rest.
  • Losing weight without any reason.
  • Fatigue or tiredness.
  • Feeling feverish with or without night sweats.

Assessment & Diagnosis

Before considering an X-ray or an MRI, your Physiotherapist or GP will be looking for various other symptoms such as your age, when you started to experience the back pain, and, duration of the symptoms. This must be before the age of 45 and should have had back pain for more than 3 months. If you meet this criterion then your physiotherapist or GP will look for other symptoms:


  • Low back pain started before the age of 35.
  • Buttock pain – this can be on one or both sides.
  • Waking up at night due to back pain – mainly second half of the night.
  • Pain and stiffness of the back improve with movement or exercise.
  • A drastic improvement in pain and stiffness after taking NSAID’s (eg. Naproxen/Ibuprofen) mostly within first 48 hours.
  • A first degree relative (parent) who has Spondyloarthritis.
  • Current or past arthritis.
  • Current or past enthesopathy (mostly back of the heel pain where your Achilles tendon is attached).


If you are under 45 and have back pain for more than 3 months and also have 4 or more above mentioned symptoms, then your Physiotherapist or GP may consider sending you to a Rheumatologist. A Rheumatologist is a specialist in conditions affecting muscles and joints, they will carry out further tests that may include X-ray/MRI with or without blood tests.


There is no cure for Axial spondylarthritis however, treatment is available to relieve symptoms and help prevent its progression, as well as learning to self-manage. Your Physiotherapist will at Pure can answer your queries regarding your condition, assess your posture and periodically measure your flexibility; especially of your back, neck, trunk and hips. They will also suggest useful strategies for managing your activity levels so that you are able to control your symptoms. Regular re-assessment will ensure you are maintaining health, fitness and function and will allow for changes to be made to your treatment programme.


Your Physio will also start you on appropriate progressive exercise plan to improve/maintain your flexibility and strength which will be individualised to your needs and capabilities, based on the goals established in discussion with your clinician. This will be regularly modified in line with your progress to help maintain optimal function and outcomes. Your Physio can also offer you manual therapy (hands on) treatment to help you improve or maintain spinal flexibility and reduce symptoms in tandem with the bespoke exercise plan. We offer ongoing support and guidance so your can confidently manage your symptoms.

Medical Therapy

Often you will be started with lowest effective dosage of NSAID’s such as Ibuprofen or Naproxen to fight the inflammation along with gastroprotective medication. If your Rheumatologist thinks that you have a form of Severe Active Axial Spondylarthritis then they may start you on medications known as Disease Modifying Anti-Rheumatic Drugs (DMARDS) to slow down the disease progression. However, please note that DMARDS is an umbrella term for several medications which comes under this category.

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