If you have nonradiographic axial spondyloarthritis (nr-axSpA), you may have heard your rheumatologist talk about “active” or “stable” disease. These terms are important to understand because they can affect how your doctor treats your condition.

In this article, we will explain the difference between active and stable disease, how each may affect your treatment, and the importance of talking to your doctor about all of your symptoms.

What Is Nonradiographic Axial Spondyloarthritis?

Axial spondyloarthritis is a type of inflammatory arthritis that affects your spine and sacroiliac joints (the joints that connect your spine to your pelvis). Nonradiographic axSpA is one type of axial spondyloarthritis. The main factor that defines nr-axSpA is that it can't be seen on X-rays. Instead, doctors diagnose nr-axSpA using a combination of other tests.

Typically, nr-axSpA develops in younger adults, with symptoms such as inflammatory back pain and morning stiffness first emerging before the age of 45. Nonradiographic axSpA often goes undiagnosed, so it’s difficult to know how common it is.

What Are the Symptoms of nr-axSpA?

Some of the symptoms of nr-axSpA include:

• Pain and stiffness in the lower back and hips, which may be worse in the morning or after sitting or standing for a long time
• Swelling and pain in other joints, like your knees, ankles, or shoulders
• Fatigue
• Trouble moving around

More serious symptoms of nr-axSpA may occur if your disease progresses to ankylosing spondylitis (AS), a more severe form of spondyloarthritis that shows up on X-rays. These symptoms include:

• Spine fractures
• Uveitis, which causes painful swelling in your eyes
• Heart disease
• Inflammatory bowel disease, which causes gastrointestinal issues
• Brain fog, or trouble focusing or thinking clearly

Some people with axSpA also report experiencing jaw pain and changes to their skin and nails, such as those seen in psoriasis. Sharing all of your symptoms with your doctor is vital for a proper diagnosis.

How Is Nonradiographic Axial Spondyloarthritis Diagnosed?

Your doctor may use scoring systems like the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) to help make a diagnosis. The BASDAI and ASDAS use information such as family history, C-reactive protein blood tests results, and your current symptoms to give a score that shows how active your nr-axSpA is.

Your doctor may also look at:

• Magnetic resonance imaging (MRI) scans — MRI uses magnets and radio waves to take pictures of the inside of your body to look for abnormalities.
• Computed tomography (CT) scans — A CT scan is another imaging technique that uses X-rays.
• Ultrasound — This test uses sound waves to create pictures of the inside of your body. It’s particularly helpful for finding inflammation in the areas where tendons and ligaments connect to bones, which is a common symptom of nr-axSpA called enthesitis.
• Genetic tests — Mutations in the HLA-B27 gene are associated with AS, but not everyone who has AS also has these mutations.

Your doctor will also need to rule out other rheumatic diseases, such as psoriatic arthritis and rheumatoid arthritis.

What Is Active Nonradiographic Axial Spondyloarthritis?

Active disease occurs when nr-axSpA is causing inflammation, prompting you to feel symptoms such as pain, stiffness, and fatigue. To determine whether you have active nr-axSpA, your doctor will check for inflammation in your spine or sacroiliac joints using the imaging tests and clinical tools discussed above.

Active nr-axSpA Can Damage Your Spine and Sacroiliac Joints

Active nr-axSpA may be a serious concern because it can potentially harm your spine and sacroiliac joints. If left untreated, nr-axSpA can progress to ankylosing spondylitis. This means active inflammation causes new bone to grow in your spine and the vertebrae to fuse (grow together). This can make it harder for you to move and can lower your quality of life. Treating active nr-axSpA right away is essential to avoiding these problems.

What Is Stable Nonradiographic Axial Spondyloarthritis?

With nr-axSpA, stable disease means you’ve experienced no inflammation in your spine or sacroiliac joints for six months. Additionally, either you aren’t feeling any symptoms or your symptoms are managed well with your current treatment.

Your rheumatologist may determine your nr-axSpA is stable based on factors such as symptom improvement, imaging, and clinical assessment scores. It’s important to keep getting regular checkups and tests to make sure your nr-axSpA remains stable.

How Does Activity Level Influence Treatment Options?

While there is currently no cure for nr-axSpA, treatments are available to help ease your symptoms. Some can also decrease inflammation in your body to prevent future damage. Common treatments for active nr-axSpA involve a combination of medications and physical therapy.

The first medications used to treat nr-axSpA are usually nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve). These drugs can help reduce pain and inflammation in your spine and other affected joints.

If NSAIDs don’t work for you, your doctor might have you try disease-modifying antirheumatic drugs (DMARDs). DMARDs may include drugs such as:

• Janus kinase (JAK) inhibitors such as upadacitinib (Rinvoq)
• Biologics including interleukin (IL)-17 inhibitors such as secukinumab (Cosentyx) or tumor necrosis factor (TNF) inhibitors like certolizumab (Cimzia)

These types of drugs help calm your immune system by preventing certain immune proteins from causing inflammation. In extreme cases of spondylitis, you may need surgery to replace a joint if it becomes too damaged.

Physical therapy and exercise can be important aspects of a treatment plan for active nr-axSpA, helping you maintain flexibility, strength, and range of motion in the spine and other affected joints. A physical therapist can work with you to develop an exercise program that is safe and effective for your specific needs.

Lifestyle changes can also help you manage active nonradiographic axial spondyloarthritis. These may include:

• Maintaining a healthy weight
• Not smoking
• Getting enough sleep
• Managing stress

Your rheumatologist will assess your nr-axSpA activity level to see how well your current treatment plan is working. If you still have inflammation despite taking medications or doing physical therapy, you may need to try another medication.

If the doctor finds that you have stable disease, you’re less likely to risk irreversible damage. In this case, the focus of treatment is to maintain control of your symptoms and prevent future flares.

Whether you have active or stable nr-axSpA, your doctor will still monitor you to make sure your current treatment plan is working.

Your Health Care Providers Are Your Best Resource

Communication is key when it comes to managing nr-axSpA. You should be open and honest with your health care providers about your symptoms. Many people find it helpful to keep a symptom journal to track their symptoms over time. This information can help your rheumatology specialist develop a treatment plan. By keeping on top of your nr-axSpA, it’s possible to maintain your spinal health and live a fulfilling life.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 95,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you living with nonradiographic axial spondyloarthritis? Is your nr-axSpA stable or active? Share your experience in the comments below, or start a conversation by posting on your Activities page.