The first symptoms of nr-axSpA are often described as persistent pain and stiffness in the lower back and buttocks, which come on gradually over the course of a few weeks or months. This pain and stiffness are usually worse in the mornings and during the night, but may improve after a warm shower or light exercise. At first, discomfort may only be felt on one side, or alternate sides. The pain is usually dull and diffuse, rather than localized. Sometimes, these symptoms can be severe.
Although symptoms usually start to appear in late adolescence or early adulthood (ages 17 to 45), symptoms can occur in children or much later in life. The course of nr-axSpA varies greatly from person to person — no two individuals may have the exact same symptoms.
The back pain people with nr-axSpA experience is usually inflammatory back pain. Key characteristics of inflammatory back pain include pain and stiffness that:
Pain and stiffness in other areas of the body, such as the neck, shoulders, the ribs, hips, knees, and heels, are also common. In some individuals, pain does not start in the lower back, or even the neck, but in one of the peripheral joints mentioned above. This can be confusing since, without the immediate presence of back pain, nr-axSpA may look like other forms of arthritis. A person’s sex can affect the location of initial pain in nr-axSpA. For some women, the neck and peripheral joints are often affected first, whereas in men it is more likely to be the lower back.
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