Non radiographic ankylosing spondylitis: Signs and diagnosis Health ConditionsHealth ConditionsAlzheimer's & DementiaAnxietyArthritisAsthma & AllergiesBreast CancerCancerCardiovascular HealthCOVID-19Dermatology & SkincareDiabetesEnvironment & SustainabilityExercise & FitnessEye HealthHeadache & MigraineHealth EquityHIV & AIDSHuman BiologyInflammatory Bowel DiseaseLeukemiaLGBTQIA+Men's HealthMental HealthMultiple Sclerosis (MS)NutritionParkinson's DiseasePsoriasisSexual HealthWomen's HealthDiscoverNewsLatest NewsOriginal SeriesMedical MythsHonest NutritionThrough My EyesNew Normal HealthPodcastsHow to understand chronic painWhat is behind vaccine hesitancy?The amazing story of hepatitis C, from discovery to cureNew directions in dementia researchCan psychedelics rewire a depressed, anxious brain?Why climate change matters for human healthToolsGeneral HealthDrugs A-ZHealth HubsHealth ToolsBMI Calculators and ChartsBlood Pressure Chart: Ranges and GuideBreast Cancer: Self-Examination GuideSleep CalculatorHealth ProductsAffordable Therapy OptionsBlood Pressure MonitorsDiabetic SuppliesFitness TrackersHome GymsGreen Cleaning ProductsHow to Shop for CBDQuizzesRA Myths vs FactsType 2 Diabetes: Managing Blood SugarAnkylosing Spondylitis Pain: Fact or FictionConnectAbout Medical News TodayWho We AreOur Editorial ProcessContent IntegrityConscious LanguageNewslettersSign UpFollow UsMedical News TodayHealth ConditionsDiscoverToolsConnectSubscribe What to know about non-radiographic ankylosing spondylitisMedically reviewed by Nancy Carteron, M.D., FACR — By Jenna Fletcher on June 28, 2022Non-radiographic ankylosing spondylitis (nr-AsSpA) is a type of inflammatory arthritis that primarily affects the spine. “Non-radiographic” means that an X-ray does not show any damage from arthritis, even though symptoms appear. While the term “nr-AsSpA” may refer to a period before damage is visible on the spine’s joints, a person who uses this term is likely referring to non-radiographic axial spondyloarthritis (nr-AxSpA), which falls into the same category of inflammatory arthritis as ankylosing spondylitis (AS). The main difference between nr-AxSpA and AS is that a person with AS has spinal damage that is visible on an X-ray. This article reviews nr-AxSpA, AS, their symptoms, information about diagnosis, and more. What is it Share on Pinterestt.light/Getty Images“Nr-AsSpA” is not an official diagnosis. If a doctor uses this term to describe a person’s condition, the person likely has nr-AxSpA, which is an official diagnosis. A defining feature of AS is visible damage to the joints in the spine. Both nr-AxSpA and AS are types of spondyloarthritis — a group of arthritis types that cause inflammation in the spine. Learn more about non-radiographic axial spondyloarthritis. Experts often consider nr-AxSpA an earlier form of AS because damage from the disease does not yet appear on X-rays. According to the Spondylitis Association of America, 5–30% of people living with nr-AxSpA develop AS over 2–30 years, meaning that their condition progresses to the point that damage shows on X-rays. To receive a diagnosis of AS, a person must have an X-ray showing changes or damage to their spine. However, the two conditions can cause similar symptoms, and both can lead to disability. Learn more about AS. Symptoms Nr-AxSpA and AS have similar symptoms. According to the Arthritis Foundation, common symptoms include:stiffness and pain on either side of the body, where the spine meets the pelvispain in the lower back, buttocks, and hips that develops slowly over weeks or monthsstiffness when first waking up after periods of restback pain during the night or early morningfatigueappetite loss In addition, a person may experience symptoms related to inflammation in the body, such as:pain, swelling, redness, and warmth (inflammation) in the knees, heels, ankles, fingers, toes, ribcage, upper spine, shoulders, or neckchronic diarrhea or gastrointestinal upset and pain (such as Crohn’s disease or ulcerative colitis)pain and redness in the eyes (uveitis)red, flaky skin patches (psoriasis) Causes Nr-AxSpA, like other forms of spondylitis, occurs as a result of chronic inflammation. A person’s immune system mistakenly attacks healthy tissue, which causes inflammation. Over time, the inflammation can damage healthy cells. Some experts suspect that the cause may be genetic. A gene variant known as HLA-B27 is present in many people living with nr-AxSpA. Learn more about joint inflammation. Vs axial spondyloarthritis “Axial spondyloarthritis” is the main term to describe inflammatory arthritis that primarily affects the spine. Both Nr-AxSpA and AS are types of axial spondyloarthritis. According to the authors of a 2015 review, “nr-AxSpA” is the term for the condition people have when they live with symptoms of AS but do not have visual evidence on the spine. The authors note that the term “nr-AxSpA” first appeared in 2009. Vs ankylosing spondylitis AS is another type of axial spondyloarthritis. Some experts believe that nr-AxSpA is an early stage of AS. This is because, in nr-AxSpA, the condition has not yet damaged the spine to the point that a doctor can see it on an X-ray. In some cases, it can take up to 10 years before the damage appears on an X-ray. The symptoms of AS and nr-AxSpA can be similar. Diagnostic criteria Diagnosis of nr-AxSpA often takes several years. Research has shown that it can take anywhere from 6 years to 14 years on average for a person to get a diagnosis of nr-AxSpA. One reason for the delay may be that nr-AxSpA does not have a single set of diagnostic criteria. Among other diagnostic methods for the condition, doctors may use a blood test to check for the HLA-B27 gene and inflammation. They may also review a person’s clinical symptoms, such as lower back pain near the pelvis. Diagnostic methods To diagnose nr-AxSpA, a doctor may use the following methods:blood testsMRI scans to check for inflammationreview of a person’s symptomsphysical examinationreview of family history Treatment and management Treatment often focuses on pain management instead of attempting to prevent disease progression, as is common with AS. Often, the first line of treatment is pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). A doctor may also recommend physical therapy. In some cases, a doctor may recommend using tumor necrosis factor (TNF) inhibitors, a type of biologic drugs that can suspend disease progression and reduce inflammation. Currently, the Food and Drug Administration (FDA) has approved medications for AS and some medications for nr-AxSpA, including Cosentyx (Secukinumab) and Cimzia (Certolizumab). A doctor may be able to prescribe the medication using comorbidities as a leveraging point for nr-AxSpA. If a person’s nr-AxSpA transitions to AS, a doctor may make additional treatment recommendations to help prevent disease progression. Learn more about treatment for AS. Outlook A person living with nr-AxSpA can experience the same symptoms as someone with AS. A person may develop debilitating pain that interferes with their daily life. There is no cure for nr-AxSpA or AS. In some cases, nr-AxSpA may develop into AS. However, progression is not guaranteed. About 10–40% of people living with nr-AxSpA go on to develop AS, though no predictor exists. Some potential risk factors for progression include:high inflammatory markers in blood testsfamily historybeing male Summary AS and nr-AxSpA are two types of spondyloarthritis. The main difference is that AS causes visible damage to the joints, while nr-AxSpA does not. Doctors who use the term “Nr-AsSpA” are likely referring to nr-AxSpA. The symptoms and treatment for the two conditions are similar. Experts do not fully agree on whether nr-AxSpA is an earlier form of AS. However, only a small percentage of people living with nr-AxSpA develop AS. Last medically reviewed on June 28, 2022Body AchesBones / OrthopedicsCrohn's / IBDRehabilitation / Physical TherapyankylosingspondylitisMedically reviewed by Nancy Carteron, M.D., FACR — By Jenna Fletcher on June 28, 2022 Latest newsWhat sets 'SuperAgers' apart? 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