• Start before age 45
  • Develop and worsen gradually
  • Persist for more than three months
  • Ease with physical activity and exercise
  • Get worse with immobility (especially overnight and early morning)
  • Iritis / Uveitis – Inflammation of the eye. Symptoms often occur in one eye at a time, and may include redness, pain, sensitivity to light, and skewed vision. (Note: iritis is a medical emergency and needs immediate attention as untreated eye inflammation can lead to permanent damage and even blindness.)
  • Enthesitis– Inflammation of the entheses, which is where ligaments or tendons attach to the bone. Symptoms include swelling and tenderness. Common areas impacted include the Achilles tendon at the back of the heel, the plantar fascia at the base of the heel, the rib cage, and the spine.
  • IBD – Gastrointestinal issues and bowel inflammation, which may be associated with Crohn’s disease or ulcerative colitis.
  • Psoriasis – A scaly skin rash.

Fatigue is a common complaint in nr-axSpA, and one that doesn’t often receive the attention it deserves. Fatigue can negatively impact one’s work, family or social life, ability to focus, and even emotional state.

Uncontrolled inflammation is the factor most closely associated with fatigue in nr-axSpA. If inflammation is extensive, then the body must use energy to deal with it, producing feelings of profound, chronic tiredness. The release of certain cell messengers (cytokines) during the inflammatory process also can produce the sensation of fatigue, as well as mild to moderate anemia in some cases, which itself can further exacerbate fatigue. When inflammation is well controlled and the disease is properly managed, fatigue often lessens and energy returns.

Uncontrolled pain and stiffness can make it difficult to sleep. Besides causing fatigue, sleep deprivation can increase pain, creating a feedback loop of pain causing sleeplessness, which then causes more pain, and so on.

For all these reasons, effective pain management is crucial. Though many people with nr-axSpA respond well to medications alongside exercise and physical therapy, others experience more severe pain even with appropriate treatment. In these cases, it is important to work with your medical team to find appropriate solutions and design a comprehensive plan to treat the pain. Speaking with your rheumatologist about pain and fatigue is the first step.