Non-radiographic Axial Spondyloarthritis

Who gets Non-radiographic Axial Spondyloarthritis?

It affects women as often as men — a key difference from established ankylosing spondylitis, and part of why the diagnosis is so often missed in women. Onset is typically in the twenties and thirties. Some patients progress to radiographic disease over years; many never do, and remain in this category indefinitely with symptoms that are no less significant.

What are the symptoms of Non-radiographic Axial Spondyloarthritis?

Not everyone has every symptom below, and having one does not confirm the diagnosis. These are the features that most often lead to assessment:

• Chronic lower back and buttock pain beginning before the age of 45
• Morning stiffness of thirty minutes or more
• Pain that eases as the day goes on and with activity, and returns with rest
• Waking in the early hours with back pain
• Heel pain, chest wall pain, or a swollen finger or toe
• Fatigue that is often the most disabling symptom
• Associated psoriasis, uveitis or inflammatory bowel disease

How is Non-radiographic Axial Spondyloarthritis diagnosed?

This is a clinical diagnosis supported by MRI, and it requires a rheumatologist rather than an imaging report alone. MRI of the sacroiliac joints shows bone marrow oedema in active disease, but similar appearances occur in athletes, after childbirth and in mechanical stress, so the images must be read alongside the history.

HLA-B27 carries more weight here than in established disease because the imaging is less definitive. CRP is often normal.

A plain X-ray is still done, since a normal X-ray is part of what defines the category.

How is Non-radiographic Axial Spondyloarthritis treated?

Identical in principle to ankylosing spondylitis: regular exercise and physiotherapy, non-steroidal anti-inflammatories taken consistently during active disease, and biologics — TNF or interleukin-17 inhibitors — where those are inadequate.

Biologics are licensed for this stage where there is objective evidence of inflammation, on MRI or through a raised CRP, together with an inadequate response to anti-inflammatories.

Because structural damage has not yet occurred, controlling inflammation here has more to protect than at any later stage.

Living with Non-radiographic Axial Spondyloarthritis

Being told the X-rays are normal after years of pain is one of the more frustrating experiences in rheumatology, and many patients have been dismissed before reaching a specialist. A normal X-ray does not mean nothing is wrong; it means the damage has not yet occurred — which is the best time to be diagnosed, not the least serious.

When should you see a rheumatologist?

Chronic back pain starting before 45 that improves with movement, with morning stiffness or night pain, deserves specialist assessment even when X-rays, and often CRP, are normal.

Common questions about Non-radiographic Axial Spondyloarthritis

This page is general information to support a consultation. It is not a diagnosis, and it does not replace an assessment by a doctor who has examined you.