There are certain symptoms that seem obviously linked together: If you have heartburn and regurgitation, the signs point to gastroesophageal reflux disease, or GERD. If you have bad headaches, nausea, and sensitivity to loud noises, odds are you have migraines. But not every health condition has symptoms that are so clearly related, and as a result you may not think to tell your doctor everything you’re experiencing. This can lead to a missed diagnosis, potentially delaying treatment.
Take non-radiographic axial spondyloarthritis (nr-axSpA). While the condition’s trademark sign is lower back pain, it can also cause light sensitivity, skin issues, and GI problems—symptoms that seem like they have nothing to do with one another. Here’s what to look out for so you know what to bring up to your doctor.
The basics of nr-axSpA
To understand what nr-axSpA is, you first have to learn about a disease called ankylosing spondylitis (AS). The inflammatory condition affects the lower back, spine, and sacroiliac joints, which connect the bottom of your spinal column to your pelvis. Nr-axSpA is very similar to AS, with one key difference: While people with AS have spinal changes that are visible on X-rays, those with nr-axSpA do not. That’s because the damage folks with nr-axSpA experience isn’t severe enough to show up on this sort of imaging. Some people with nr-axSpA will ultimately develop AS if enough damage occurs.
Like other inflammatory diseases, including rheumatoid arthritis and lupus, nr-axSpA is the result of an immune system that’s gone rogue. “Your body has an inflammatory process to fight off infections, but sometimes there’s misregulation of your immune system and it starts to attack your body,” explains Chris Morris, MD, a Tennessee-based rheumatologist. “That’s what’s happening here.”
Symptoms of nr-axSpA
The hallmark thing to watch for: pain in your lower back that lingers for months and isn’t linked to an obvious injury. It’s a specific kind of back discomfort called inflammatory back pain, which differs from what you’d feel if, say, you tweaked your back while playing pickleball. “Inflammatory back pain gets better with activity and stiffens with inactivity, so it’s usually the worst in the morning,” Dr. Morris says.
However, what can really point to nr-axSpA is your back pain being accompanied by certain other symptoms. While the following signs may seem somewhat random, they’re all caused by excess inflammation tied to an unruly immune system. This is precisely what’s behind nr-axSpA too.
- Your eyes become supersensitive to sunlight: Some people with nr-axSpA will also have a condition called uveitis. “This is inflammation in the eye that results in bright light bothering you a lot,” says Dr. Morris. “You could also have eye irritation or pain.”
- You have patches of red, scaly skin: Nr-axSpA can also go hand in hand with psoriasis, an inflammatory skin condition. Certain parts of your body, such as the scalp, elbows, and knees, may develop raised, red patches with silvery scales.
- You have gut issues: Some patients may develop an inflammatory bowel disease, or IBD, such as Crohn’s disease or ulcerative colitis. As a result you may experience diarrhea, stomach pain, cramping, or loss of appetite.
Getting the right diagnosis
Since imaging tests show no evidence of nr-axSpA, the condition can be challenging to diagnose. “It’s a clinical diagnosis in many ways,” says Dr. Morris. That means your doctor will need to look for specific signs and connect the dots.
