Symptoms and Signs of Non-Radiographic Axial Spondyloarthritis (nr-axSpA)

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Medically Reviewed on 10/16/2019

Doctor's Notes on Non-Radiographic Axial Spondyloarthritis (nr-axSpA)

Non-radiographic axial spondyloarthritis (nr-axSpA) is a diagnosis that doctors give to patients who have symptoms (for example, chronic [3 months or longer] back pain in the spine) of ankylosing spondylitis (AS) with no X-ray findings. In contrast, AS, as part of the criteria for diagnosis, shows X-ray changes in the spine joints. Some doctors consider nr-axSpA to be an early and/or less severe form of AS. The signs and symptoms of nr-axSpA may include chronic back pain and some of the following:

  • There may be back pain, especially in the axial (spine) joints of the sacroiliac joints due to inflammation.
  • Back pain and/or stiffness is worse at night or in the morning and may feel better after exercise.
  • Back pain begins in teen or young adults and usually before age 40.
  • There are no X-ray findings on routine axial X-rays.
  • MRIs may show some axial joint tendon swelling.
  • Other joints may show tendon swelling.
  • Some individuals may have uveitis (eye inflammation, redness, an blurry vision).
  • Patients with psoriatic arthritis and enteropathic arthritis commonly have nr-axSpA.

The cause of nr-axSpA is not known. However, most researchers consider that genetics and environmental interactions that can trigger inflammation cause the disease. The prevalence is somewhat unclear because the data is limited. However, estimates range between 15%-24% among those seeking a back pain diagnosis from general practitioners and rheumatologists.

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.