Axial spondyloarthritis (axSpA) is a rheumatological condition that affects the axial joints (joints of the spine, chest, and pelvis). The primary symptoms include back pain, fatigue, joint pain, heel pain, sleep problems, and abdominal pain. Symptoms vary from person to person, but for many the first symptom is a gradual onset of pain in the lower back and hips, especially after periods of inactivity, such as sleeping.
This article discusses the common and rarer symptoms of axial spondyloarthritis, as well as its complications.
AxSpA symptoms are caused by autoimmune and inflammatory activity in the body. The disease causes inflammation in the spine and joints in the body, which can lead to other symptoms associated with inflammation.
For most people with axSpA, symptoms tend to be worse in the morning or after periods of rest.
The duration and severity of your symptoms may change over time as the condition progresses. Symptoms can come and go, and they may vary in intensity depending on the treatment you receive and your overall health status. Most people are diagnosed with axial spondyloarthritis in their young adulthood.
Common symptoms of axial spondyloarthritis include:
- Chronic back pain: The first and predominant symptom of axSpA is slow-onset back pain, which lasts three months or longer. Pain is particularly intense in the mornings or after periods of inactivity, and it may begin to ease during the day with stretching and exercise.
- Fatigue: Physical and mental exhaustion often go hand in hand with chronic pain. AxSpA can disrupt your sleep, which can lead to feeling chronically fatigued.
- Heel pain: Sharp, stabbing pains can be felt in the heel or sole of the foot, which are particularly worse in the mornings. Inflammation can cause this heel pain, known as plantar fasciitis. As many as 17% of people with axSpA may experience heel pain.
- Sleep problems: Due to pain and discomfort, the inability to fall asleep and/or stay asleep is common in people with axSpA.
- Enthesitis: Enthesitis is inflammation of the part of the body where tendons and ligaments attach to bone. It is most common in the heel, bottom of the foot, hips, and knees in those with axSpA.
- Eye inflammation: Sensitivity to light, eye pain, redness and blurred vision are common with axSpA. It usually comes on suddenly and lasts anywhere from a few weeks to three months. Recurrence is possible if you’ve experienced one bout of eye inflammation.
- Joint pain: Stiff, achy, sore joints can occur due to inflammation and swelling throughout the body. Many people have axSpA-related joint pain in the ankles, hips, and knees.
- Abdominal pain/diarrhea: Stomach pain and diarrhea are caused by inflammation affecting the digestive tract.
Less common symptoms of axSpA can also be experienced in relation to the disease.
Rare symptoms of axial spondyloarthritis include:
- Anemia: Fatigue, weakness, shortness of breath, and irregular heartbeat are associated with anemia, which is caused by a lack of healthy red blood cells to distribute oxygen throughout the body. It sometimes develops in response to inflammation caused by autoimmune conditions. The severity of anemia increases as the body’s inflammatory response to axSpA increases.
- Fever: Increased temperature (higher than 100.4 degrees) that can cause chills, body aches, and fatigue. With inflammatory conditions like axSpA, a fever may develop as the body’s response to chronic inflammation. This is because inflammation-causing proteins, called cytokines, bind to receptors in the brain that trigger a fever.
- Loss of appetite: Chronic pain, fatigue, and other axSpA symptoms can cause a loss of appetite. Brief periods of not eating are unlikely to lead to problems, but prolonged lack of appetite can lead to weight loss, lack of energy, and increased fatigue.
- Psoriasis: Psoriasis is a condition that causes red, itchy, scaly patches of skin mainly on the knees, elbows, torso, and scalp. People with one autoimmune condition are more likely to develop at least one more (known as comorbidity), such as psoriasis.
Complications can occur as a result of having axial spondyloarthritis. Not everyone with axSpA will experience complications, but they are important to be aware of.
Possible complications of axSpA include:
- Osteoporosis: This disease weakens bones and causes the body to slow down bone production, making you more susceptible to bone fractures. Patients with axSpA have a high likelihood of developing osteoporosis.
- Osteoarthritis: A type of arthritis that occurs when the cartilage that provides cushioning for joints gradually deteriorates. Research shows that axSpA may be associated with an increased risk of secondary osteoarthritis. Men with axSpA have a significantly higher risk of developing osteoarthritis.
- Inflammatory bowel disease (IBD): Diarrhea, stomach pain, rectal bleeding, bloody stools, and weight loss are symptoms of IBD associated with inflammation in the digestive tract. Nearly 60% of axSpA patients have gut inflammation.
- Reduced flexibility: Some people with axSpA have restricted mobility in their spine. This occurs when two or more vertebrae in the spine fuse together, resulting in stiffness and loss of flexibility.
- Spinal fractures: Individuals with axSpA are more vulnerable to fractures from seemingly minor injuries. Many are accompanied by spinal cord injuries.
- Heart disease: High blood pressure (hypertension) and high cholesterol are common in people with axSpA. Research shows that the more axSpA progresses, the higher the likelihood of developing cardiovascular disease.
When to See a Doctor
If you suspect you have axial spondyloarthritis, it’s important to see your healthcare provider so you can be formally diagnosed and begin treatment to help manage your symptoms.
If you already have a diagnosis of axSpA, see your healthcare provider right away if you:
- Have had a fall or accident (your healthcare provider may order X-rays to determine if there was a fracture)
- Have new, unexplained pain
- Experience numbness or tingling in your arms or legs
- Have a fever for more than 24 hours
Depending on your symptoms, your healthcare provider may run additional tests to determine what potential complications you are experiencing or prescribe different medications to help reduce your symptoms.
Axial spondyloarthritis (axSpA)—a condition affecting the joints of the spine, chest, and pelvis—can cause back pain, fatigue, joint pain, heel pain, sleep problems, abdominal pain, and more. These symptoms often occur after periods of inactivity, like sleeping or resting.
A Word From Verywell
Reviewing the list of various axial spondyloarthritis symptoms can feel overwhelming. It’s important to remember that you aren’t likely to experience all of the symptoms and complications. Following your treatment protocol and taking care of your body by eating healthy foods, avoiding smoking, and getting regular exercise can help you manage symptoms, feel better, and prevent potential complications.