Axial Spondyloarthritis

Axial spondyloarthritis is an inflammatory arthritis affecting the spine. The main symptoms are severe morning stiffness and back pain. Axial spondyloarthritis most commonly affects males in their teens or 20s and may be associated with the HLA-B27 gene.

What Are the Signs/Symptoms?

Low back pain with morning stiffness is the most common symptom. This may occur anywhere in the spine, but often in the sacroiliac joints where the pelvis connects with the tail bone. Axial spondyloarthritis may also cause pain and swelling in tendons, such as the Achilles (heel). Patients may have pain, fatigue or stiffness that is continuous or comes and goes. Painful, light-sensitive eye inflammation (iritis) is a symptom of spondyloarthritis in some patients.

Correct diagnosis requires a doctor to assess the patient’s medical history and do a physical exam. The doctor also may order imaging and blood tests. X-ray changes of the sacroiliac joints, known as sacroiliitis, are a key sign of axial spondyloarthritis.

The HLA-B27 gene is often present in axial spondyloarthritis, but having this gene does not mean spondyloarthritis will develop.

What Are Common Treatments?

Axial spondyloarthritis patients should get physical therapy and do joint-directed exercises to promote spinal extension and mobility. First-line medications for symptom relief are nonsteroidal anti-inflammatory drugs (NSAIDs). For localized joint swelling, corticosteroid injections into the joint or tendon sheath are quickly effective. If patients do not respond, disease-modifying antirheumatic drugs (DMARDs) may be used to relieve symptoms and prevent joint damage. Medications will be advised based on the areas which are affected, such as spine, tendons or eyes. Some important medications to treat axial spondyloarthritis include methotrexate, sulfasalazine, anti-TNF alpha medications (such as adalimumab, etanercept), anti-IL17 medications (secukinumab, ixikinumab) and many others. Oral corticosteroids are not recommended. Spinal surgery is rarely needed.

Living with Axial Spondyloarthritis

With newer treatment options, most people with axial spondyloarthritis lead normal, productive lives and have a normal lifespan. People with axial spondyloarthritis must exercise frequently to maintain joint and heart health. Patient support groups for people with spondyloarthritis may be helpful and informative.

Updated February 2025 by Rebecca Manno, MD, MHS, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.