What Is Axial Spondyloarthritis? Symptoms, Causes, and Treatment
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is axial spondyloarthritis?
Axial spondyloarthritis is a form of inflammatory arthritis in which an overactive immune system damages joints of the spine, chest and pelvis. [1] Its main symptom is chronic back pain lasting three months or longer that improves with exercise and worsens at rest. [1] It can also cause fatigue and eye inflammation. [1] There is no cure, but medications and therapy control symptoms. [1]
Key takeaways
Axial spondyloarthritis (axSpA) is an inflammatory arthritis affecting the joints of the chest, spine, and pelvis. [1]
It most often causes chronic back pain (lasting 3+ months) that starts before age 45, frequently in the teens or 20s, and improves with movement but worsens at rest. [1]
It affects about 1% of people worldwide and occurs equally in males and females. [1]
Most people with axSpA carry the HLA-B27 gene, and it often runs in families, though the gene alone does not guarantee the condition. [1]
Untreated, axSpA can fuse the spine bones (ankylosis), cause osteoporosis, and raise the risk of spinal fractures. [1]
There is no cure, but NSAIDs, physical therapy, steroid injections, DMARDs, and biologics can control symptoms. [1]
Not smoking, exercising regularly, and eating an anti-inflammatory diet help manage the condition. [1]
What the research says
Exercise therapy improves disease activity, function, pain, and fatigue. A meta-analysis of 20 randomized trials with 1,670 patients found that exercise lowered BASDAI disease-activity scores (weighted mean difference −0.78), BASFI function scores (−0.49), and ASDAS scores (−0.44) compared with controls, and also reduced pain and fatigue. It did not significantly change chest expansion, CRP, or ESR (Zhang et al., Arch Phys Med Rehabil, 2025) [2].
No single type of exercise has been proven best. A network meta-analysis of 59 randomized trials with 3,404 participants found that Pilates had the largest effects on BASDAI, BASFI, and pain compared with usual care, but certainty was low to moderate and the authors concluded that no modality was definitively superior and that exercise should be individualized (Huo et al., Ann Phys Rehabil Med, 2026) [3].
Delayed diagnosis is common, and longer delays go with worse function. A meta-analysis of 14 studies (2,581 patients with spondyloarthritis and uveitis and 13,972 without) found a pooled mean diagnostic delay of 6.08 years with uveitis versus 5.41 years without. Functional scores (BASFI, where higher means worse function) rose from 2.92 with under 2 years of delay to 4.17 with more than 10 years (Lee et al., Sci Rep, 2023) [4].
What Is Axial Spondyloarthritis?
Axial spondyloarthritis (axSpA) is a type of arthritis that affects the joints in your axial skeleton: your chest, spine, and pelvis. People with axSpA often have back pain before the age of 45, and some may experience stiffness and pain as early as their teens or young adult years. [1] This pain can be severe and debilitating. [1]
AxSpA belongs to a larger group called spondyloarthritis, a family of inflammatory arthritis conditions that cause joint pain and other symptoms. The word "inflammatory" points to an unregulated or overactive immune system, which causes joint or soft tissue swelling and damage. [1]
What sets spondyloarthritis apart from other types of arthritis is that it can affect body systems beyond the joints. If you have axSpA, you might experience eye inflammation, diarrhea, or other problems that seem unrelated to joint pain. [1]
How Common Is Axial Spondyloarthritis?
Anyone can get axSpA; the condition affects about 1% of people in the world. [1] It usually occurs in people younger than 40, often starting during their teens or 20s, and it occurs equally in males and females. [1]
How Does Axial Spondyloarthritis Affect the Body?
Over time, untreated axSpA can cause the bones of the spine to fuse together. The medical name for this fusion is ankylosis, and it can cause osteoporosis in the spine. [1]
Long-term effect | What happens |
Ankylosis | The bones of the spine fuse together |
Osteoporosis | Bone density drops in the spine |
Spinal fractures | Breakdown of spine bones raises the risk of a broken bone in the spine |
This is why early diagnosis and consistent treatment matter so much.
What Causes Axial Spondyloarthritis?
AxSpA often runs in families. Most people with axSpA have a gene called HLA-B27. [1] However, some people get axSpA who do not have this gene or a family history of the condition, and many people with the HLA-B27 gene never develop axSpA. [1]
Genetic factor | What it means |
HLA-B27 gene | Most people with axSpA carry it |
Family history | Having a parent or sibling with axSpA raises your risk |
Without the gene | Some people still develop axSpA without HLA-B27 or family history |
With the gene | Many carriers never develop the condition |
What Are the Symptoms of Axial Spondyloarthritis?
The most common symptom of axSpA is back pain that is chronic (lasting three months or longer) and not caused by an injury or mechanical problem such as a slipped disk or muscle spasm. [1]
Symptom pattern | How it behaves |
Improves with activity | The pain feels better when you exercise or move around |
Worsens at rest | The pain gets worse at night or during rest |
Morning stiffness | Pain occurs with back stiffness, especially in the morning |
Spreading pain | The pain can spread to your hips or buttocks |
Because the inflammation from axSpA can also affect other systems in your body, you may experience additional symptoms:
System symptom | What it involves |
Digestive problems | Such as diarrhea |
Fatigue | Persistent tiredness |
Enthesitis | Swelling, calcification, and bone spurs where tendons attach to bone |
Dactylitis | Inflammation of fingers or toes ("sausage digits") |
Psoriasis | A skin condition marked by scaly patches (see our psoriasis guide) |
Uveitis | Inflammation of the eye (see our uveitis guide) |
How Is Axial Spondyloarthritis Diagnosed?
When you see a provider about back pain, they will check your vital signs and perform a physical exam. They may also order blood tests to look for the HLA-B27 gene and C-reactive protein, a sign of inflammation in your body. [1]
Diagnostic tool | What it reveals |
Physical exam and vital signs | General health information |
Blood test for HLA-B27 | Whether you carry the gene most associated with axSpA |
Blood test for C-reactive protein | A marker of inflammation in your body |
X-ray | Can show axSpA or other bone problems |
MRI | Highly detailed images that may show spine problems sooner than X-rays |
Providers diagnose axSpA if you have back pain and other symptoms of axSpA, even if an imaging test does not show inflammation. If you have symptoms but no visible inflammation in the spine, your provider may diagnose non-radiographic axSpA, meaning it cannot be seen on an imaging test like an X-ray or MRI. [1] Some cases of non-radiographic axSpA worsen over time and eventually show up on imaging, but in many cases it never becomes visible on tests. [1]
How Is Axial Spondyloarthritis Treated?
There is no cure for axSpA, but treatment can help you get relief from symptoms and improve your quality of life. [1]
Treatment | How it helps |
NSAIDs (nonsteroidal anti-inflammatory drugs) | Over-the-counter medications that relieve pain and decrease inflammation; the most common types are aspirin, ibuprofen, and naproxen sodium |
Physical therapy | A therapist guides you through exercises designed for your needs, relieving pain and increasing flexibility and strength |
Steroid injections | Corticosteroids fight pain and inflammation in a specific area of pain or swelling |
DMARDs | Conventional DMARDs such as sulfasalazine can help swollen joints in the arms and legs but do not work for spine symptoms; for back symptoms not controlled by NSAIDs, biologics or JAK inhibitors are used |
Biologics | A type of DMARD that controls inflammation by targeting the immune system; effective, but with potential side effects such as a higher risk of infections |
What Is the Outlook for People With Axial Spondyloarthritis?
There is no cure for axSpA. Your symptoms may come and go, or you might feel them all the time. People with this condition can live long, full lives. [1] The key is working with your provider to manage symptoms and stay as healthy as possible.
Can Axial Spondyloarthritis Be Prevented?
There is no known way to prevent axial spondyloarthritis, and it is not caused by back injuries. [1] If you have a parent or sibling with axSpA, you have a higher risk of getting this condition. [1] However, having a family history or the HLA-B27 gene does not mean you will get axSpA. [1]
How Do I Take Care of Myself?
Several habits can boost your health and help manage axSpA symptoms:
Self-care habit | Why it helps |
See your provider regularly | Keeps your care plan on track; attend physical therapy if it is part of your plan |
Take medications as prescribed | Controls inflammation and pain consistently |
Do not smoke | Smoking makes axSpA worse by raising inflammation and decreasing bone health; get help quitting if you smoke |
Exercise regularly | Activities like walking keep bones and joints healthy, can slow the progression of axSpA, and increase flexibility in your spine |
Eat a healthy diet | Plenty of fruits and vegetables can help fight inflammation |
When Should I Contact My Healthcare Provider?
Contact your provider if you notice unwanted side effects from your treatment, if your symptoms are getting worse, or if you see no improvement from your current treatment.
What Is the Difference Between Axial Spondyloarthritis and Ankylosing Spondylitis?
Ankylosing spondylitis is a type of axSpA. [1] It mainly affects the sacroiliac joints, the joints that connect the lower part of your spine to your hips. [1] AxSpA can also affect your chest or other areas of your spine. [1]
Type of spondyloarthritis | What it affects |
Axial spondyloarthritis (axSpA) | Chest, spine, and pelvis (axial joints) |
Ankylosing spondylitis (AS) | A type of axSpA; mainly the sacroiliac joints connecting the lower spine to the hips |
Peripheral spondyloarthritis | Usually the arms and legs |
Psoriatic arthritis | Linked to the skin condition psoriasis |
Reactive arthritis | A rare type caused by a bacterial infection |
IBD-associated arthritis | Common in people with Crohn's disease or ulcerative colitis |
Conclusion
Axial spondyloarthritis is an inflammatory arthritis that targets the joints of the chest, spine, and pelvis, most often causing chronic back pain that begins before age 45, typically in the teens or 20s. [1] Unlike mechanical back pain, axSpA pain improves with movement, worsens at rest, and frequently arrives with morning stiffness. [1] Because the condition is immune-driven, it can also affect the eyes, gut, skin, fingers, and toes. [1]
While there is no cure, the outlook is genuinely hopeful. With NSAIDs, physical therapy, steroid injections, DMARDs, or biologics, combined with regular exercise, a healthy diet, and no smoking, people with axSpA can live long, full lives. [1] If you have unexplained chronic back pain that improves with exercise and worsens at night, talk to a healthcare provider about whether axSpA could be the cause.
Take the next step in understanding your health. If you create health education materials, Rinnit's library of infographic templates can help you turn conditions like this into clear, visual guides for your audience.
Frequently Asked Questions
What is axial spondyloarthritis in simple terms?
Axial spondyloarthritis (axSpA) is a type of inflammatory arthritis that affects the joints of the axial skeleton: the chest, spine, and pelvis. [1] It is caused by an overactive immune system that causes swelling and damage in these joints, most often producing chronic back pain. [1]
How does axSpA back pain differ from ordinary back pain?
AxSpA back pain is chronic (lasting three months or longer) and is not caused by an injury or mechanical problem like a slipped disk. [1] It tends to feel better when you exercise or move, gets worse at night or during rest, comes with morning stiffness, and can spread to the hips or buttocks. [1]
Who typically gets axial spondyloarthritis?
Anyone can get it, but it usually occurs in people younger than 40, often starting in their teens or 20s. [1] It affects about 1% of people worldwide and occurs equally in males and females. [1]
Is axial spondyloarthritis genetic?
Axial spondyloarthritis often runs in families. Most people with axSpA carry the HLA-B27 gene, and having a parent or sibling with the condition raises your risk. [1] However, many people with the gene never develop axSpA, and some people with axSpA do not carry it. [1]
What other symptoms can axSpA cause besides back pain?
Because the inflammation can affect other body systems, axSpA may also cause fatigue, digestive problems such as diarrhea, enthesitis (swelling and bone spurs where tendons attach), dactylitis (swollen fingers or toes), psoriasis, and uveitis (eye inflammation). [1]
What happens if axSpA is left untreated?
Over time, untreated axSpA can cause the spine bones to fuse together (ankylosis), cause osteoporosis in the spine, and raise the risk of spinal fractures. [1]
How is axSpA diagnosed?
A provider uses a physical exam, blood tests for the HLA-B27 gene and C-reactive protein (an inflammation marker), and imaging such as X-rays and MRI. [1] AxSpA can be diagnosed even when imaging does not show inflammation; that form is called non-radiographic axSpA. [1]
What is non-radiographic axial spondyloarthritis?
Non-radiographic axSpA means you have axSpA symptoms but no visible inflammation on imaging tests like X-rays or MRI. [1] Some cases eventually show up on imaging as they progress, but many never become visible on tests. [1]
Is axial spondyloarthritis the same as ankylosing spondylitis?
Not exactly. Ankylosing spondylitis is a type of axSpA. [1] It mainly affects the sacroiliac joints (where the lower spine meets the hips), while axSpA is the broader category that can also involve the chest and other areas of the spine. [1]
Is there a cure for axial spondyloarthritis?
No, there is no cure. [1] However, symptoms can be effectively managed with NSAIDs, physical therapy, steroid injections, DMARDs, and biologics [1], and people can live long, full lives with the condition. [1]
Can exercise really help axSpA?
Yes. Regular exercise, such as walking, helps keep bones and joints healthy, can slow the progression of axSpA, and increases flexibility in the spine. [1] Notably, axSpA back pain typically improves with movement. [1]
What self-care habits matter most?
See your provider regularly, take medications as prescribed, avoid smoking (it raises inflammation and weakens bones), exercise regularly, and eat a healthy diet rich in fruits and vegetables to help fight inflammation. [1]
Related Reading
References
Cleveland Clinic. Axial Spondyloarthritis. Cleveland Clinic Health Library. Last updated March 20, 2023. Accessed October 15, 2026. https://my.clevelandclinic.org/health/diseases/24843-axial-spondyloarthritis
Zhang M, Liang Z, Tian L, et al. Effects of exercise therapy in axial spondyloarthritis: a systematic review, meta-analysis, and meta-regression of randomized trials. Arch Phys Med Rehabil. 2025;106(1):113-123. PMID: 38942347. https://doi.org/10.1016/j.apmr.2024.06.005
Huo R, Huang W, Su N, et al. Comparative effectiveness of exercise interventions for axial spondyloarthritis: a systematic review and network meta-analysis. Ann Phys Rehabil Med. 2026;69(7):102169. PMID: 42759302. https://doi.org/10.1016/j.rehab.2026.102169
Lee SC, Yang CH, Tsai YC, et al. The effect of uveitis and undiagnosed spondyloarthritis: a systematic review and meta-analysis. Sci Rep. 2023;13(1):14779. PMID: 37679498. https://doi.org/10.1038/s41598-023-41971-z
Medical disclaimer
The information provided in this article is for educational purposes only and is not intended as medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Comments