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Challenges of the Immune System: Why is Axial Spondyloarthritis Called a Chronic Disease?
Axial spondyloarthritis (axSpA) is a chronic immune-mediated disease that mainly affects the spine and sacroiliac joints. This term covers a diverse family of diseases that are grouped together by common clinical and genetic features, such as effects on the spine. The term "axial spondylitis", introduced in 2009, is now the more commonly used term, replacing the older "ankylosing spondylitis".
Category
Axial spondyloarthritis, along with peripheral spondyloarthritis, reactive arthritis, psoriatic arthritis, and gut-related arthritis (or inflammatory bowel disease-associated spondyloarthritis), belongs to the spondyloarthritis family and is also called Called spondyloarthritis syndrome or spondyloarthropathy. These arthritis conditions can sometimes overlap with each other. For example, psoriatic arthritis may cause both peripheral and axial symptoms, and reactive arthritis may transform into chronic axial spondyloarthritis. All of these are considered inflammatory rheumatic disorders because they involve the immune system's attack on joints, muscles, bones, and organs.
Axis spondyloarthritis can be divided into two categories: nonradiation axial spondyloarthritis (nr-axSpA) and radiation axial spondyloarthritis.
Symptoms and symptoms
Axial spondyloarthritis is primarily characterized by inflammatory pain and/or stiffness, which typically affects the lower back, buttocks, and hips. These symptoms may alternate. Some patients may also have symptoms in their eyes, ribs, shoulders, or neck. Inflammatory back pain usually develops gradually, becomes worse at night or after a period of rest (such as after waking up in the morning), and improves with exercise or the use of nonsteroidal anti-inflammatory drugs (such as ibuprofen). These patients may experience alternating periods of remission and relapse.
Pathophysiology
There have been significant advances in our understanding of the genetic and immunological aspects of axial spondyloarthritis. Research has focused on the mechanisms of chronic inflammation and pathological new bone formation that are hallmarks of the disease. The critical site of the lesion is the "enthesis point" and is also the focus of disease activity. Cytokine dysregulation plays an important role in the immune pathogenesis of axial spondyloarthritis, particularly the presence of a bias toward Th17 phenotype, tumor necrosis factor (TNF), and interleukin 23 (IL-23)/interleukin 17 (IL-17) pathways, and A proinflammatory cytokine profile.
Diagnosis
Patients being tested for axial spondyloarthritis may have X-rays taken to look for signs of inflammation (which is often one of the early signs of the disease) and structural damage to the sacroiliac joints. It can take years from the onset of symptoms to the manifestation of radiographic changes, and some patients may never develop these changes. In terms of diagnosis, the difference between radiation-induced axial spondyloarthritis and non-radiation axial spondyloarthritis depends on imaging changes. Patients may also undergo an MRI, as MRI is more sensitive for detecting inflammatory changes such as enthesitis and synovitis.
Prognosis
Some patients with more severe cases may face fusion of the spine, known as "bamboo shoot ridge." Men are generally more likely to experience radiation joint damage, while women are more likely to experience worse quality of life and disease activity.
Management
There is currently no cure for axial spondyloarthritis, but there are a variety of disease management strategies. Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors are effective in treating axial spondyloarthritis. For some patients who cannot tolerate these drugs or who require stronger treatment, biologics such as TNF-alpha inhibitors may be prescribed to try to modulate the immune response that drives the disease. Physical therapy and exercise have also been found to be effective in improving symptoms.
Society and Culture
A number of famous people have also been affected by axial spondyloarthritis, including former US Vice President Beau Biden, X-Factor contestant Talia Ding, Try Guys' Zach Kornfield, rock band Mötley Crüe's Mick Mars, and Imagine Dragons' Dan Reynolds, among others.
As the disease is better understood and clinically advanced, patients and their families still need to remain vigilant, especially as symptoms develop gradually. Such challenges, compared to those of other long-term diseases, lead us to ask: What can we do to improve the quality of life of these patients?
