Axial spondyloarthritis (axSpA) is a long-term inflammatory condition that mainly affects the spine and the sacroiliac joints where the spine meets the pelvis. It includes ankylosing spondylitis. It typically causes back pain and stiffness that starts before the age of 45, is worse with rest and better with movement, and needs diagnosis and medical treatment by a rheumatologist.
Also known as axSpA, ankylosing spondylitis, inflammatory back pain, non-radiographic axial spondyloarthritis
Symptoms
- Back pain lasting more than three months that started before age 45
- Pain and stiffness that are worse after rest and better with movement or exercise
- Waking in the second half of the night with back pain
- Pain in the buttocks, sometimes alternating sides
- Pain where tendons attach to bone, such as the heel (enthesitis)
- Associated conditions such as psoriasis, inflammatory bowel disease or eye inflammation (uveitis)
Causes and risk factors
- An immune-related inflammatory process; the exact cause is not fully understood
- A strong genetic link, including the HLA-B27 gene, although a negative test does not rule it out
- A family history of spondyloarthritis
- A personal history of psoriasis or inflammatory bowel disease
What the evidence says helps
- NICE guidance advises referral to a rheumatologist when back pain has lasted more than three months, started before 45, and has several inflammatory features, such as night waking, buttock pain, improvement with movement or a family history.1
- NICE and international ASAS-EULAR recommendations advise anti-inflammatory medicines (NSAIDs) as the first drug treatment, with biological medicines considered by specialists if symptoms remain active.12
- Longer delays to diagnosis are associated with poorer function and quality of life, so early recognition and referral matter.3
- NICE recommends an individualised, structured exercise programme including stretching, strengthening, posture, breathing, spinal mobility and aerobic exercise.1
- A meta-analysis of randomised trials found exercise therapy improved disease activity, physical function, pain and fatigue in people with axSpA.4
Things you can try at home
- If your back pain fits the inflammatory pattern, ask your GP whether axSpA could be the cause
- Exercise regularly – daily mobility work plus strength and aerobic exercise
- If you smoke, ask your GP or pharmacist about support to stop
- Keep a symptom diary of stiffness, night pain and response to anti-inflammatories to share with your GP
- Seek help promptly for a red, painful eye
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A painful red eye, light sensitivity or blurred vision – seek same-day help from an eye casualty service, GP or NHS 111
- Sudden severe back or neck pain after a minor fall or knock if you have long-standing axSpA – seek urgent medical help, as the spine can fracture more easily
- Numbness around your genitals, bottom or inner thighs, or new bladder or bowel problems – go to A&E or call 999
- Back pain with fever, unexplained weight loss or feeling very unwell – see your GP urgently
- Back pain under 45 that has lasted more than three months, with night waking and morning stiffness – book a GP appointment and ask about inflammatory back pain
How Apollo can help
Our role is to recognise back pain that may be inflammatory and make sure you are referred to your GP, with a letter outlining the features that suggest axSpA, so you can be assessed for a rheumatology referral. Alongside your medical care, we offer structured, individualised exercise programmes focused on mobility, strength, posture and fitness, as recommended by NICE. Osteopathy and Reformer Pilates can support you in staying active as part of this plan.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How do I know if my back pain is inflammatory?
Inflammatory back pain usually starts before 45, comes on gradually and lasts more than three months. It tends to be worse after rest and in the second half of the night, and better with movement. If this sounds familiar, speak to your GP.
Is ankylosing spondylitis the same as axial spondyloarthritis?
Ankylosing spondylitis is part of axial spondyloarthritis. The term axSpA covers both people with visible changes on X-ray and people whose inflammation only shows on MRI or through symptoms and blood tests.
Can exercise help axial spondyloarthritis?
Yes. Exercise is a core part of managing axSpA alongside medical treatment. Research shows it can improve pain, function, fatigue and disease activity, and NICE recommends a structured, individual programme.
References
- National Institute for Health and Care Excellence (2017). Spondyloarthritis in over 16s: diagnosis and management (NG65). NICE. View source
- Ramiro S et al. (2023). ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Annals of the Rheumatic Diseases. View source
- Zhao SS et al. (2021). Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology. View source
- Zhang M et al. (2024). Effects of exercise therapy in axial spondyloarthritis: a systematic review, meta-analysis and meta-regression of randomized trials. Archives of Physical Medicine and Rehabilitation. View source
- van Hoeven L et al. (2014). Identifying axial spondyloarthritis in Dutch primary care patients, ages 20–45 years, with chronic low back pain. Arthritis Care & Research. View source
- Duarte V et al. (2024). Prevalence of axial spondyloarthritis in young people with chronic low back pain at a hospital-based health management organization. Journal of Clinical Rheumatology. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
