11/2026
Many people with axial spondyloarthritis (axSpA) wait years for an answer. One large international survey found that diagnosis of axSpA is delayed by an average of 7.4 years worldwide. A new study from Switzerland suggests that this time may matter for the spine. Researchers found that people diagnosed soon after their back pain began had noticeably less spinal damage on X-rays over the long term than people diagnosed later, when the disease was more established. The authors call it the first study to show a long-term benefit of early diagnosis in axSpA.
The researchers used data from a Swiss national registry that follows people with inflammatory rheumatic diseases over time. They included 376 people with axSpA who had at least two sets of spinal X-rays recorded between 2004 and 2024. Of these, 138 people were diagnosed with early axSpA, meaning they had two years or less of back symptoms, a definition set by the Assessment of SpondyloArthritis International Society. The other 238 people had established axSpA, and the two groups looked similar at the start. About 61% were men, 69% tested positive for the HLA-B27 gene, and the average follow-up lasted 11.5 years. Everyone received standard care from their rheumatologists. To measure damage, the team scored 1,181 sets of X-rays with the mSASSS. This is a tool rheumatologists use to measure bony changes in the neck and lower spine, such as new bone growing between vertebrae. The score runs from 0 to 72, and higher numbers mean more damage.
Over the long term, the early-diagnosis group scored 3.85 points lower than the established group. That gap appeared 10 to 15 years after diagnosis. When researchers accounted for damage that was already present at diagnosis, the gap grew to 5.70 points. In both groups, about half of all long-term progression happened within roughly three years of diagnosis. Just as important, only some people with axSpA develop these long-term bony changes in the spine, and many people in both groups showed no X-ray progression at all during follow-up.
Why might earlier diagnosis help? The authors write that it isn’t yet known whether the benefit comes partly from starting treatment sooner, though they consider that explanation plausible. If you’ve had back pain for three months or longer and still don’t have answers, this research supports getting evaluated sooner rather than later. If you were diagnosed after many years, these findings aren’t a prediction about your spine. The study compares groups of people and can’t say what will happen to any one person. Regular care with a rheumatologist and a treatment plan that works for you matter at every stage of axSpA.
The study has important limits. It was observational, so it shows a link between early diagnosis and less spinal damage, but it can’t prove that early diagnosis caused the difference. People who were diagnosed early may have differed in ways the researchers couldn’t fully measure, such as how easily they could see a specialist. The study included only people who had repeat X-rays, and it took place in Switzerland, so the results may not apply to every healthcare system. X-rays show bony changes only. They don’t capture pain, stiffness, fatigue, or how well someone moves through the day. The difference was a few points on a 72-point scale, and it isn’t yet clear how a difference of that size affects daily mobility. Open questions remain, including whether starting treatment earlier explains the benefit and how to identify which patients are most at risk for spinal damage.
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