Axial Spondyloarthritis is a progressive form of inflammatory arthritis, which involves the spine. It affects up to 1 in 200 people in the general population, and may account for as much as 15% of cases of chronic low back pain in younger adults. Classically, it starts for no identifiable reason in the late teens or twenties, and likes affecting the sacroiliac joints at the base of the spine, usually one at a time. It can also affect any other joint in the spine and rib cage; but also the tendon attachments elsewhere in the body, especially at the heel, knee, fingers and toes. There can also be a history of inflammation in parts of the eye (uveitis), bowel (IBD) and/or skin (psoriasis).
Spinal pain will typically present in a cyclical nature, often with no identifiable reasons for periods of exacerbation; and can be combined with extreme stiffness of the lower back, and with night pain. Pain is often worse with rest, but relieved by activity / exercise, and anti-inflammatory medications such as Ibuprofen or Naproxen.
To diagnose AxSpAr, your GP will ask you about the above common factors, and take a blood test, for genetic and inflammatory markers and refer you to a rheumatologist; who can arrange a specific type (STIR sequence) of MRI scan to make the actual diagnosis. Further imaging may be necessary to confirm which joints are affected.
Undiagnosed and untreated, AxSpAr can result in fusion of spinal segments, bone weakening, and even fracture. Consequently, spinal manipulation as often provided by chiropractors, osteopaths and physiotherapists should not be performed, though other forms of physical therapy targeting exercise, mobility and pain relief can be appropriate for symptom relief, but only a rheumatologist can treat the underlying condition.