Non-Radiographic Axial Spondyloarthritis Complications

Spondyloarthritis that is not radiological usually produces lower back and buttock pain. Co-occurring illnesses and symptoms in other sections of the body are typical of this chronic condition, which is caused by continuous inflammation.

The chronic inflammatory disease known as non-radiographic axial spondyloarthritis (nr-axSpA) affects the sacroiliac (SI) joints of the pelvis and the spine.

It falls under the spectrum of axial spondyloarthritis (axSpA) and is identified as such when plain radiographs (X-rays) show no obvious damage to the SI joints.

Although the precise origins of nr-axSpA are unknown, genetics, environmental factors, and hyperactive immune responses may all be involved. Like other arthritic disorders, nr-axSpA is characterised by a chronic inflammatory response of the musculoskeletal system, which results in pain and limited function.

Many distinct illnesses can be caused by chronic inflammation. nr-axSpA is linked to inflammatory problems and co-occurring disorders all over the body, while the precise connections remain unclear.

Enthesitis

Enthesitis is an inflammation of the entheses, the points where bone and tendons or ligaments unite. Enthesitis can occur in one or more entheses sites, and psoriatic arthritis and axSpA are two inflammatory diseases that are thought to be characterised by enthesitis.

Enthesitis can affect heel attachment sites, such as the point where the Achilles tendon connects to the bone, although it typically affects the spine, chest, and pelvis in nr-axSpA patients.

Symptoms include:

• pain
• localized warmth
• stiffness
• swelling
• tenderness
• reduced functionality

Eye inflammation

Inflammation of the eyes is prevalent in nr-axSpA. A 2020 study found that uveitis affects over 33% of individuals with nr-axSpA, making it one of the most prevalent non-joint problems of the disorder.

Inflammation of the uvea, the middle layer of the eye, is known as uveitis. It may result in symptoms of:

• eye pain
• light sensitivity
• blurry vision
• eye redness
• “floaters” in the field of vision

The subtype of uveitis most commonly observed in axSpA is anterior uveitis or iritis. To prevent vision loss, it's important to treat this critical condition as soon as possible.

Digestive issues

A common consequence of nr-axSpA is inflammation-related bowel illness (IBD), which encompasses Crohn's disease and ulcerative colitis.

People with nr-axSpA are expected to have a 5.3 times higher likelihood of having IBD than the general population, according to a study from 2019.

Although Crohn's disease is the more prevalent of the two IBD forms, both could arise as complications in nr-axSpA.

Symptoms of IBD include:

• persistent diarrhea
• rectal bleeding or bloody stool
• appetite changes
• abdominal cramping and pain
• weight loss
• bowel urgency or incontinence
• fever
• fatigue

Psoriatic disease

The word "psoriatic disease" refers to a group of immune-mediated inflammatory skin and joint disorders, including psoriasis and psoriatic arthritis.

Psoriasis rates in axSpA range from 3.1% to 18.9% in studies, with a 10% overall prevalence, per a 2023 study.

Psoriasis symptoms vary based on the type and might involve different forms of:

• dry skin
• scorching or stinging feeling on the skin
• skin that is bleeding and cracked
• skin lesions that are thicker, discoloured, and frequently have grey or silvery scales
• alterations in thick, ridged, or pitted nails

Because the symptoms of nr-axSpA and psoriatic arthritis overlap significantly, it is less apparent how common these illnesses are. A 2020 study shows that axial spine involvement affects up to 70% of individuals with psoriatic arthritis.

Symptoms of psoriatic arthritis include:

• joint pain and stiffness
• enthesitis
• fatigue
• uveitis
• lower back pain
• limited range of motion
• skin and nail changes
• swollen fingers and toes

Chronic fatigue

In nr-axSpA, chronic weariness may manifest as "brain fog" at times. Your body needs energy to sustain ongoing inflammatory processes, which may explain why you feel more exhausted than normal or less intellectually alert.

Suffering from a chronic illness like nr-axSpA can also exacerbate depression, a mental health disorder that impairs energy and throws off sleep cycles, making exhaustion worse.

Chronic pain

It might be painful to have inflammation. Increased nerve sensitivity and tissue swelling are two aspects of your body's inflammatory response that can cause pressure and pain in musculoskeletal areas.

In a 2020 study, 44% of participants with axSpA reported having persistent, all-over pain.

Cardiovascular disease

Individuals who have axSpA are more susceptible to cardiovascular illnesses. Nonsteroidal anti-inflammatory medicines (NSAIDs) may also be to blame, even though inflammatory processes in the body are largely credited for this.

NSAID medication is effective in treating Nr-axSpA and other axSpA diseases, however, for certain individuals, higher-than-average doses may be required to produce the desired effects. Extended use of high dosages of NSAIDs has been linked to an increased risk of cardiovascular events, including stroke and heart attack.

Cardiovascular disease symptoms might vary depending on the ailment, however, they often include:

• acute discomfort in the upper abdomen, neck, shoulder, or jaw
• discomfort, pressure, or pain in the chest
• palpitations or an erratic pulse
• shortness of breath
• weakness and fatigue
• dizziness and lightheadedness
• swelling in the legs or feet
• cold sweats

Other complications

Your musculoskeletal system's chronic inflammatory processes have long-term consequences. Your body starts tissue repair in response to inflammation, which can result in calcification, bone loss, scarring, and structural alterations that cause pain in unrelated places.

Such complications consist of:

• hip and shoulder pain
• pain when breathing deeply (pleurisy)
• bone weakening (osteoporosis)
• inflammation of the rib cartilage causing chest pain (costochondritis)
• jaw swelling (spondylitis of the jaw)

Rare complications

Seldom may long-standing axSpA be linked to major side effects such as reduced vital capacity and cauda equina syndrome.

A neurological disorder known as cauda equina syndrome arises when the nerves at the base of your spinal cord are squeezed. This compression in nr-axSpA most likely results from scarring following inflammation.

Cauda equina syndrome symptoms include:

• acute or progressively declining lower body sensation
• bladder or bowel incontinence

Reduced vital capacity results from lung scarring, which lowers your body's maximal capacity to breathe in and out.

Symptoms include:

• shortness of breath
• shallow breathing
• chest discomfort
• poor exercise tolerance
• coughing
• fatigue
• wheezing

The takeaway

AxSpA, a chronic inflammatory disease affecting the spine and pelvis, manifests as Nr-axSpA. For unclear causes, difficulties in different body parts are frequently observed in nr-axSpA and other axSpA disorders.

Some individuals have nr-axSpA co-occurring with inflammatory diseases like psoriatic arthritis.