We've all had back pain at some point in our lives. Sometimes, the pain that comes with lifting weights or sitting incorrectly will subside in a few days. But if you have back pain that lasts for months, especially at night and when you get up in the morning, don't just ignore it. Today, we're going to talk about Non-Radiographic Axial Spondyloarthritis , or as we doctors call it (nr-axSpA) , a type of arthritis that doesn't show up on an X- ray but can affect your life.
Simply put, what is nr-axSpA?
You may have heard of osteoarthritis , a condition that causes joints like the knees and hips to wear down as you age. But nr-axSpA is a different condition, caused by a malfunction in our body's immune system . Simply put, our body's own defense system, or immune cells, mistakenly attack our own joints, which connect to our spine and pelvis . This causes inflammation in those joints, causing stiffness and pain.
This disease is closely related to a more severe arthritis condition called Ankylosing Spondylitis (AS) . Sometimes nr-axSpA can be an early stage of AS. However, not everyone with nr-axSpA will develop AS.
This is called “Non-Radiographic” (i.e., not visible on X-rays) because the damage to the joints in the early stages of the disease is not visible on a regular X-ray. This does not mean that there is no damage, but that it is too subtle to be detected on an X-ray.
What are the symptoms of this condition?
The main symptom of nr-axSpA is back pain . But this is different from normal back pain. Let's understand this difference clearly.
| Characteristic | Back pain in nr-axSpA | Mechanical back pain |
|---|---|---|
| When the pain increases | The pain and stiffness are worse when resting, especially at night and when getting up in the morning. | The pain increases when working, walking, or lifting weights. It decreases when resting. |
| Duration of pain | Rather than starting suddenly, it starts gradually and lasts for more than 3 months. | It usually subsides within a few days or weeks. |
| The effect of exercise | Warm-up exercises and walking reduce pain and stiffness. | The pain may usually increase during exercise. |
In addition to back pain, several other symptoms may be observed:
- Ankle pain : Pain and stiffness, especially in areas such as the Achilles tendon under the heel.
- Swelling of the fingers: A finger or toe becomes completely swollen like a sausage. We call this dactylitis .
- Pain in other joints: Pain can also occur in other joints, such as the hips, knees, and shoulders.
- Constant fatigue : Feeling extremely tired and exhausted, no matter how much sleep you get.
Why does this happen? What are the risk factors?
As we mentioned earlier, the main reason for this is a disorder in our immune system. The exact reason for this is not known. However, researchers believe that there is a genetic link.
In particular, a gene called HLA-B27 has been found to be associated with this. Many people with nr-axSpA and AS have this gene. However, this does not mean that everyone with the HLA-B27 gene will develop this arthritis. It is just a predisposition to a certain disease.
Other risk factors that contribute to this condition are:
- Age: Symptoms usually begin in young adulthood, between the ages of 20 and 40.
- Family history: If someone in your immediate family (parents, siblings) has nr-axSpA or AS, you are at higher risk of developing it too.
- Smoking : Smokers are at higher risk of developing this disease, as well as the risk of the disease worsening.
How to accurately diagnose the disease?
Diagnosing this disease is a bit challenging because it doesn't show up on X-rays, and the symptoms often appear in young, healthy people. So sometimes, it can be mistaken for a simple backache, leading to delayed treatment.
When you go to see your doctor, he will do these things:
1. He or she will listen carefully to your symptoms: ask in detail about when the pain starts, how long it has been there, and whether it gets better with exercise.
2. Performs a physical examination: Checks the movement of the spine and areas of pain.
3. Blood tests are ordered: to check for the presence of the HLA-B27 gene and to order tests such as CRP and ESR, which indicate inflammation in the body.
4. MRI scan: This is the most important test to diagnose nr-axSpA. An MRI scan can clearly show subtle inflammation and swelling in the joints that are not visible on X-rays.
Early diagnosis and treatment are very important to prevent permanent joint damage in the future.
What are the treatments?
Managing nr-axSpA is a combination of exercise, physical therapy, and medication.
1. Exercise
This is like medicine. Exercising every day is essential. Exercise reduces pain, relieves back stiffness, and reduces the fatigue you feel all the time. It also helps keep your spine in one place and from bending.
2. Drugs
Initially, your doctor may prescribe painkillers and nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., Indomethacin, Naproxen). However, these should only be used under medical supervision . Long-term use can cause side effects such as stomach irritation and kidney damage.
If NSAIDs are not effective, your doctor may prescribe specific medications (biologics) that control the activity of the immune system, such as TNF inhibitors .
3. Physical Therapy
It is very important to learn the correct exercises under the guidance of a trained physical therapist. They will teach you exercises that strengthen the spine, stretch tight muscles, correct posture, and breathing techniques.
Does it only affect the spine? Are there other complications?
Yes, nr-axSpA is not a disease limited to the spine. This immune system inflammation can also affect other parts of the body.
- Eyes: Uveitis is a common condition that causes inflammation inside the eye. Symptoms include redness , pain, blurred vision , and sensitivity to light. If you experience any of these symptoms, you should see an eye doctor immediately .
- Digestive system: Some people may develop inflammatory bowel disease (IBD) , such as Crohn's disease or ulcerative colitis . This can cause symptoms such as stomach pain and prolonged diarrhea.
- Skin: About 10% of patients may also develop psoriasis , a skin disease that causes red, scaly patches on the skin.
It is difficult to say exactly how this disease will affect you over time. Some people's symptoms may remain the same, while others may worsen. Some people's condition may progress to AS. However, with the right treatment and lifestyle, you can manage this condition well and live a normal life.
Take-Home Message
- Back pain that lasts for months, especially in the morning and at night, is not normal. Don't ignore it. See a doctor immediately.
- Even if your X-ray report shows no problems, you may still have nr-axSpA. An MRI scan can accurately diagnose the condition.
- By diagnosing the disease early and properly treating it with exercise, medication, and physical therapy, you can prevent damage to your joints and live a pain-free life.
- This is a manageable condition. So don't lose heart. Stay in regular contact with your doctor and follow his/her advice.
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