Axial Spondyloarthritis

Axial Spondyloarthritis (Axial SpA) is a type of spondyloarthritis – that is an arthritis that most commonly affects the spine.

Axial SpA is an inflammatory condition that mainly affects the bones, joints and ligaments of the spine and pelvis, leading to pain, swelling, and stiffness. It can also cause tendon pain, inflammation of the eye (uveitis) and symptoms in other joints away from the spine. A common subset of Axial SpA is Ankylosing Spondylitis (AS).

Axial SpA and AS usually start in the late teens or early 20s, it is equally common in males and females.

Symptoms of axial SpA

Pain in the pelvis and back are the main symptoms of axial SpA. It particularly affects the sites at which tendons and/or ligaments join onto bone. The most commonly affected region are the sacroiliac joints. Other symptoms and signs of axial SpA include:

• pain and stiffness at the lower back, buttocks, mid-back or neck
• pain and stiffness typically worse at night or after prolonged rest
• pain and stiffness which improves with activity
• joint pain and swelling in the limbs, which can be on different sides and may move around
• swelling of fingers and/or toes
• waking at night with symptoms, especially in the second half of the night
• symptoms that significantly improve with anti-inflammatory medication such as ibuprofen
• recurrent tendon pain, eg Achilles tendon pain, tennis elbow, patella (knee cap)
• tendinopathy, plantar fasciitis (base of heel pain)
• decreased ability to do daily activities including work, home and recreational interests
• fatigue or tiredness
• other organs can also be affected with ongoing inflammation, including the eyes (uveitis), the skin (psoriasis), and the digestive system (Crohn’s disease, ulcerative colitis, and irritable bowel disease)

Prescribed exercise

A specific prescribed exercise plan that is tailored to the patient can help maintain spinal flexibility, whole body flexibility, and reduce pain. Even when the patient has pain, continuing to exercise at levels that suit him/her has significant benefits.

Why exercise with axial SpA

In addition to medication, regular exercise is important in the management of axial SpA. Exercise will:

• help keep moving
• help do the things that are important
• reduce pain and stiffness
• strengthen muscles and joints
• improve heart and lungs
• help manage fatigue and sleep

The role of physiotherapy

People with axial SpA should be referred to a physiotherapist to start an individualised, structured exercise programme, which should include:

• spinal and other joint mobility exercises, including stretching and postural exercises
• muscle strengthening exercises
• deep breathing
• aerobic exercise

A physiotherapist will also provide advice on:

• education about the condition
• how to self manage
• practical pain coping strategies
• activity pacing
• reintegration to work and social activities
• support to adopt healthy behaviours
• management of common co-morbid conditions – tendon pain, osteoporosis

Source : World Physiotherapy