Preventing irreversible changes in axial spondyloarthritis

In addition to medications, physical therapy and exercise still play an important role in axial spondyloarthritis (axSpA). Last but not least, early intervention is crucial because movement restrictions are reversible as long as they are not yet supported by a bone substrate.

Axial spondyloarthritis (axSpA) is an autoimmune inflammatory disease characterized by enthesitis, osteomyelitis, osteomyelitis, and arthritis. The cytokines TNF-alpha and interleukin 17 can be identified as mediators of inflammation, leading to bone erosion and bone proliferation. Over time, the inflammation manifests itself initially in a destructive manner and then turns into a proliferative course. The disease usually begins as a non-radiographic axSpA with inflammatory back pain and active sacroiliitis on MRI. With further development of the radiological axSpA, inflammation of the sacroiliitis initially becomes visible on X-ray and finally syndesmotic mycelia appear, which are new bone formations that reshape the outer edge of the intervertebral discs and thus limit the movement of the vertebral bodies in relation to each other. University-Prof. Dr. Josef Herrmann from the Department of Clinical Immunology at the Medical University Hospital Graz points out the characteristics of the main symptoms of inflammatory back pain. This occurs gradually before the age of forty as night pain with improvement upon waking. Movement provides relief, but there is no improvement with rest. However, morning stiffness usually lasts more than 30 minutes.

Herman also emphasizes that the movement limitations typical of axSpA do not only exist when the disease is advanced, but occur early in the course of the disease. However, there are no bone changes at an early stage, so timely interventions promise good success. Therefore, the development of damage, to which those affected can contribute themselves, must be addressed. Joint recommendations from ASAS and EULAR state that patients should be informed about the disease and encouraged to exercise regularly. Physical therapy should be considered.¹ Herman speaks – with strong individual fluctuations – of a time window of several years during which changes can be corrected before they develop into a bone substrate.