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 what active and stable disease means and how they may affect your treatment.

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 is not visible on X-rays. Instead, doctors diagnose nr-axSpA using a combination of other tests and clinical assessment tools.

Typically, nr-axSpA develops in younger adults, with symptoms first emerging before the age of 45.

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 (feeling tired all the time)
• Trouble moving around

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

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

How Is Nonradiographic Axial Spondyloarthritis Diagnosed?

If you’re being tested for nr-axSpA, your doctor may use one or more of these tools to help make a diagnosis:

• Scoring systems using tools like the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) — Tools like BASDAI and ASDAS use information such as family history, blood tests, and current symptoms to give a score that shows how active your nr-axSpA is.
• Magnetic resonance imaging (MRI) scans — MRI uses magnets and radio waves to take pictures of the inside of your body.
• Computed tomography (CT) scans — A CT scan is an imaging technique that uses X-rays to take pictures of the inside of your body.
• 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.

What Is Active Nonradiographic Axial Spondyloarthritis?

Active disease occurs when nr-axSpA causes inflammation, prompting you to feel symptoms such as pain, stiffness, and fatigue. To determine whether you have active disease, your doctor will evaluate whether you have 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 it’s not treated. If left untreated, it can progress to AS, wherein 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?

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

Your rheumatologist may determine that your nr-axSpA is stable based on factors such as symptom improvement, imaging, and clinical assessment scores. It’s important to keep getting regular check-ups 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 that can help ease your symptoms and 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), interleukin (IL)-17, or tumor necrosis factor (TNF) inhibitors. These types of drugs help calm your immune system by preventing certain immune proteins from causing inflammation. In extreme cases, 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 nr-axSpA. These may include:

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

Your rheumatologist will use 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 aren’t likely to have a current risk of 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 doctor 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 92,000 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? What activity level is your nr-axSpA? Share your experience in the comments below, or start a conversation by posting on your Activities page.