Non-Radiographic Axial Spondyloarthritis

Medically Reviewed by Carmelita Swiner, MD on November 12, 2022
Written by Sharon Liao
6 min read

Non-radiographic axial spondyloarthritis (nr-axSpA) is a type of arthritis in your spine. It causes inflammation, which leads to symptoms like redness, swelling, heat, stiffness, and pain.

The condition affects the joints and the entheses -- tissues that connect bones to ligaments or tendons. With nr-axSpA, even though you have symptoms, X-rays don't show any damage to the joints.

Some of the time, the disease gets worse and harms your joints. If this happens, it means your condition turned into another kind of arthritis called ankylosing spondylitis (AS). Research shows that as many as 30% of people with nr-axSpA get the more serious AS within 2 to 30 years.

Nr-axSpA isn't common. It affects less than 1% of Americans.

Nr-axSpA is a long-term inflammatory disease. Your immune system turns on itself and attacks healthy tissue in your joints.

Experts don't know what causes it. But they think genetics may play a role. About 85% of people with the disease have a gene called HLA-B27. HLA-B27 is often a sign of problems with the immune system, your body's defense against germs.

Men and women have the same chances of getting non-radiographic axial spondyloarthritis. Most of the time, symptoms crop up when you're a young adult -- before the age of 45.

One of the most common symptoms of nr-axSpA is back pain. There are lots of reasons your back might hurt, but these signs suggest your pain is due to the disease and not some other cause:

  • You start getting it before age 40.
  • It comes on gradually.
  • It gets better with exercise.
  • Resting doesn't help.
  • It bothers you at night but eases when you get up.

Other symptoms you can get with nr-axSpA include:

  • Weakness and fatigue
  • Joint stiffness and swelling
  • Buttock pain that switches sides
  • Swollen fingers
  • Heel pain

People with nr-axSpA are also more likely to have certain conditions at the same time, such as:

  • Eye inflammation (uveitis)
  • Inflammatory bowel disease
  • Psoriasis

The signs of non-radiographic axial spondyloarthritis don't always show up on tests. And the symptoms can sometimes look like other health problems.  As a result, your doctor may not spot it right away. It often takes years to get the right diagnosis.

If your regular doctor thinks you have the disease, they'll likely suggest you see a rheumatologist, a specialist in joint and muscle conditions.

To see if you have nr-axSpA, your doctor will ask questions about your symptoms and your family's health history. Having relatives with certain conditions, like axial spondyloarthritis, uveitis, reactive arthritis, or inflammatory bowel disease, may mean you're more likely to have nr-axSpA.

Your doctor will also do a physical exam. They'll look for swollen joints, fingers, and feet. They'll also check your eyes and skin.

Next, you'll get a combination of tests:

Genetic test. A blood test checks for the HLA-B27 gene. If you have the gene, it doesn't automatically mean you have the disease. But if you already show signs of nr-axSpA, having the gene makes it more likely that you do.

Blood tests. These tests look for inflammation in your body.

X-ray. Your doctor will order this test if you have damage in the joins in your pelvis called the sacroiliac joints. This damage is a sign of ankylosing spondylitis.

MRI. If your X-ray doesn't show damage in the sacroiliac joints, you'll get an MRI. This test looks for inflammation in the joints or spine.

To prepare for your appointment, it's a good idea to write down a list of questions and take it with you to your doctor's office. If possible, bring a friend or family member to help you remember what your doctor says.

The questions can include:

  • What's causing my symptoms?
  • What's the goal of my treatment and what do you recommend? Are there any side effects?
  • How will you check my progress?
  • Are there any other options I should consider, such as physical therapy or exercise?
  • Should I see a specialist?
  • What's the best way to manage my other health issues?
  • How often should I return for follow-up visits?
  • Are there any resources or websites that you recommend?

There's no cure, so your treatment will focus on helping you feel better and slowing down the progress of the disease. Some options your doctor might suggest are:

Non-steroidal anti-inflammatory drugs (NSAIDs). These medicines, such as ibuprofen and naproxen, treat the inflammation and pain. Research shows that they work best when you take them every day. There are some possible long-term side effects for NSAIDs, such as heart, kidney, and digestive problems.

If NSAIDs don’t ease your symptoms, your doctor may suggest some other types of drugs. These include:

Tumor necrosis factor (TNF) inhibitors. These drugs target a specific inflammation-causing substance. You take them by getting a shot or through an IV. There are some risks. In the short term, they may raise your chances of infections. Over the long run, they've been linked to greater chances of getting cancer. There are five TNF inhibitor drugs approved by the FDA:

  • Adalimumab (Humira)
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Infliximab (Avsola, Remicade)

IL-17 inhibitors. This type of drug includes ixekizumab (Taltz) and secukinumab (Cosentyx). They stop a group of proteins in the body known as IL-17 proteins from causing inflammation. You’ll take them as a shot. Your chances of getting infections and cancer are greater if you take them.

DMARDs. If your main symptoms are in joints in your arms or legs instead of your spine, your doctor may recommend disease-modifying antirheumatic drugs instead of TNF or IL-17 inhibitors. These include sulfasalazine and methotrexate. Most DMARDs come in pill form. You’ll likely take them in addition to NSAIDs. DMARDs affect your immune system, so you may have a greater chance of getting infections. 

Physical therapy. You'll learn how to do exercises and stretches to ease your pain and keep a good range of motion with your joints.

Your doctor may also prescribe medicine for other conditions you might have, such as psoriasis and uveitis.

Your everyday habits can affect your symptoms. Making these moves may help you feel better:

If you smoke, quit. Studies show that tobacco makes your symptoms worse.

Exercise regularly. It may sound contradictory, but you can ease your back pain if you get moving. Physical activity also strengthens and stretches your muscles, which can prevent the stiffness caused by the disease. 

Eat healthy food. There isn't a specific diet to treat your condition. But making sure you get plenty of vegetables, fruit, protein, calcium, and omega-3 fats can help you keep to a healthy weight. That will lessen the strain on your joints. A healthy eating plan may also help ease inflammation in your body.

When you have non-radiographic axial spondyloarthritis, you can live a full life and continue to enjoy the things you love. With the right treatment, the pain often improves. You may have times when your symptoms are better and times when they get worse or flare up.

It will take time to find the right medicines for your disease. You may have to see your doctor regularly. In some cases, the medicines stop working as well as they used to. Or your disease changes over time. You may sometimes get more pain or new pain in different joints.

When you have nr-axSpA, it's important to reach out to family and friends. They can give you the backing you need for the swirl of emotions that you may feel while you manage your disease. Your loved ones can also be a big help when you're tired or hurting. They can lend a hand during those times when you find it hard to keep up with some of your daily chores.

If you find that you're getting depressed while you deal with the symptoms of non-radiographic axial spondyloarthritis, talk to your doctor. They can put you in touch with a mental health professional who has experience in helping people in your situation.

It's also a good idea to look for a support group. You'll get a chance to meet people with your condition who understand what you're going through. You'll be able to get fresh insights into your disease and share tips on how to manage the symptoms. Your doctor might be able to recommend one that's nearby. You can also check for support group suggestions from online sources, such as the Arthritis Foundation.