Axial Spondyloarthitis

Question 1

Axial Spondyloarthritis:

What are they?

Answer 1

Axial Spondyloarthritis is an umbrella term for Ankylosing Spondylitis and its prodromal symptoms.

Ankylosing Spondylitis = radiological diagnosis on X-ray of Sacro Iliac Joint erosive damage
symptoms often start long before this

non Radiographic Axial Spondylarthritis (nr-axSpA) = MRI evidence of SIJ inflammation

Question 2

Axial Spondyloarthritis:

Who gets it?

Answer 2

Ankylosing spondylitis - M > F
nr-axSpA - F > M

Onset typically prior to 40yo

Question 3

Axial Spondyloarthritis:

Symptoms?

Answer 3

Primary symptoms - Inflammatory Back pain:

• ≤40yo at onset
• insidious
• nocturnal waking
• alternating buttock
• morning stiffness
• improved with movement
• exacerbated by rest
• no injury mechanism

Associated with:

• peripheral arthritis
• skin psoriasis
• IBD
• iritis
• enthesitis

Question 4

Axial Spondyloarthritis:

Investigations?

Answer 4

CRP and ESR

• can be normal
• additive in diagnosis not exclusionary

HLA B27

• between 50 - 80% of Ankylosing Spondylitis are positive
• lacks specificity

X-ray AP pelvis
-SIJ changes can take 5 - 10 years to develop

MRI SIJ

• not contrast
• evaluated by Assessment of Spondyloarthritis International Society (ASAS) criteria (must request this on the form)
• does have a high false positive rate

Question 5

Axial Spondyloarthritis:

Evidence based approach?

Answer 5

42% of patients meeting the following criteria go on to be confirmed to have Axial Spondyloarthritis

chronic pain ≥3 months  AND onset of pain was prior to 45yo
AND ≥1 of:
-inflammatory back pain symptoms
-HAL B27 positive
-sacroiliitis on x-ray of pelvis

Question 6

Axial Spondyloarthritis:

Treatment?

Answer 6

1) Movement - specifically to maintain ROM in all spine regions
2) NSAID PRN
3) Biologic agents (as per specialist)

*DO NOT USE prednisolone as dose above 50mg are often required for only temporary relief