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What is axial spondyloarthritis?

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Spondyloarthritis is a type of inflammatory arthritis. This happens when the body's immune system, which is meant to keep us well by fighting infection, starts to cause inflammation in the joints and the areas around them, causing damage.

There are two main types of spondyloarthritis:

• Axial spondyloarthritis, which mainly causes pain and stiffness in the spine and sacroiliac joints.

• Peripheral spondyloarthritis, which mainly causes pain, stiffness and swelling in the hands, feet, arms and legs.

Some people with axial spondyloarthritis also have peripheral symptoms and some people with peripheral spondyloarthritis have back symptoms.

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If arthritis of the sacroiliac joints (pelvis) or spine and sacroiliac joints can be seen on X-ray, the term used is radiographic axial spondyloarthritis (r-axSpA). This condition is also called ankylosing spondylitis. See also the separate leaflet called Ankylosing spondylitis per ulteriori informazioni.

If there are no signs of sacroiliitis on X-ray but there is evidence of inflammation in the joints on magnetic resonance imaging (MRI) scan, the term used is non-radiographic axial spondyloarthritis (nr-axSpA).

Some people with nr-axSpA go on to develop r-axSpA. It is estimated that this occurs in about 1 in 20 within 5 years, and 1 in 5 within 10 years.

Axial spondylitis most often begins between 20 and 30 years of age. Nearly all people affected by axial spondyloarthritis are aged less than 45 years when the disease first appears.

About twice as many men as women have ankylosing spondylitis. However, non-radiographic axial spondyloarthritis affects a similar number of women and men.

The exact cause of axial spondyloarthritis is not clear. Researchers believe that people with certain genes develop axial spondyloarthritis when they are exposed to a certain virus, bacteria or other environmental trigger.

More than 9 out of 10 people with axial spondyloarthritis have a gene called HLA-B27. However, most people who have this gene never develop axial spondyloarthritis.

Low back, buttocks and hip pain are usually the first symptoms. The symptoms of axial spondyloarthritis include:

• Pain in the low back, buttocks and hips that develops slowly over weeks or months.

• Pain, swelling, redness and warmth in the toes, heels, ankles, knees, ribcage, upper spine, shoulders and neck.

• Stiffness when first waking up or after long periods of rest.

• Back pain during the night or early morning.

• Pain that gets better with exercise but doesn't improve with rest.

• Non-steroidal anti-inflammatory drugs (NSAIDs) usually work well to relieve the pain.

• Affaticamento.

• Perdita di appetito.

Some people with axial spondyloarthritis also develop symptoms of peripheral spondyloarthritis.

People with spondyloarthritis also have an increased risk of developing other conditions, including:

• Malattie cardiovascolari, including heart disease (eg, angina e attacco di cuore), cerebrovascular disease (transient ischaemic attacks e ictus) e malattia arteriosa periferica.

• Thinning of bones (osteoporosi).

• Psoriasi.

• Inflammatory bowel disease (morbo di Crohn e colite ulcerosa).

• Certain infections, such as some stomach bugs or infezioni sessualmente trasmissibili (STIs)

• A painful eye condition called uveite.

Over time, the ligaments of the lower spine become inflamed at the points where they attach to the spinal bones (vertebrae). This gradually encourages the bone-making cells to grow bone within the ligaments. In time, these bony growths may become larger and form bony bridges between vertebrae that are next to each other. Eventually this can fuse some of the vertebrae together so that they effectively form one larger bone.

The sacroiliac joints and their nearby ligaments are also commonly affected. This inflammation too can ultimately end in fusion between the sacrum and pelvis.

This fusion can lead to a reduction in mobility of the spine. Exercise is essential to enable mobility to continue.

Axial spondyloarthritis can be difficult to diagnose and there is no one single test that confirms or rules out the diagnosis. Investigations include:

• Esami del sangue, which may include an HLA-B27 test.

• radiografie: radiographic axial spondyloarthritis (ankylosing spondylitis) is suggested by X-ray changes of the sacroiliac joints and spine.

• Risonanza magnetica: in some people with symptoms of axial spondyloarthritis, inflammation of the sacroiliac joints can be detected on MRI despite X-rays having appeared normal. The diagnosis is then non-radiographic axial spondyloarthritis.

There is no cure for axial spondyloarthritis, but treatment aims to:

• Relieve pain and stiffness in the back and any other affected areas.

• Keep the spine straight.

• Prevent joint and organ damage.

• Preserve joint function and mobility.

• Improve quality of life.

Early, treatment is very important to prevent long-term complications and joint damage. Treatments include medication, non-drug therapies and healthy lifestyle habits.

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Because of the increased risk of malattie cardiovascolari, it is even more important to reduce your risk of cardiovascular disease:

• Mangia una dieta sana. Eating anti-inflammatory foods, like the ones found in a Dieta mediterranea possono aiutare.

• Evita di fumare. Smoking worsens overall health, and it can speed up disease activity and joint damage. It can also make it harder to breathe. Consult your doctor about ways to help you quit.

Regular physical activity helps prevent stiffness and preserves the range of movement in your neck and back. Activities such as walking, swimming, yoga and t'ai chi can help with flexibility and posture.

Good posture can help ease pain and stiffness. Simple changes such as adjusting the height of a computer monitor or desk can help. Avoid staying in cramped or bent positions, and try to alternate between standing and sitting positions.

Stretching exercises are essential to relieve pain and stiffness.

Physiotherapy

Physiotherapy helps to develop an exercise plan, and teaches exercises to strengthen and stretch muscles helping mobility and the reduction of pain.

Farmaci

Farmaci antinfiammatori non steroidei (FANS)
NSAIDs are the most commonly used drugs to treat axial spondyloarthritis and help relieve pain. Examples of NSAIDs are ibuprofene, naprossene, indometacina, diclofenac e celecoxib.

Altri antidolorifici
Altre antidolorifici such as paracetamol may also be used to help reduce pain.

Biological medicines
Biologics can be used to control the disease process. The main ones used for axial spondyloarthritis are called tumour necrosis factor (TNF) inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab or infliximab).

Other medicines, such as secukinumab, bimekizumab or ixekizumab, may be used if TNF inhibitors have been unsuccessful or if they are contra-indicated.

Iniezioni di steroidi
Injecting steroids into a knee or shoulder can provide relief of pain and stiffness.

Chirurgia

Most people with axial spondyloarthritis will not need surgery. Joint replacement can sometimes help people with severe pain or joint damage.

In addition to the increased risk of associated conditions as outlined above, there is:

• Increased risk of fractures of the spine.

• The complication of experiencing side-effects from the medicines used for treatment.

People with persistent and severe symptoms of axial spondyloarthritis may have a reduced quality of life due to pain, stiffness, fatigue and sleep problems though these can usually be helped by regular exercises.

No. Axial spondyloarthritis is a condition that develops due to genetic predisposition and auto-immune activity. However, early regular exercise can prevent most of the longer-term symptoms and complications.

There is no cure for axial spondyloarthritis and the outlook (prognosis) tends to be variable. The pattern of symptoms within the first 10 years of disease often suggests the likely long-term severity of symptoms.