What are the ways to treat non-radiographic axial spondyloarthritis?

Question

Hello doctor,

I am a 34-year-old male with non-radiographic spondylar arthritis. The morning stiffness has become worse, lasting over two hours now. The pain in my lower back and hips is constant, and I am having trouble sleeping. NSAIDs are not providing much relief anymore. Could we consider starting biological therapy? What exercises are safe to do during flare-ups? Should we repeat the MRI to check for disease progression?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Given the worsening symptoms and limited relief from NSAIDs (non-steroidal anti-inflammatory drugs), starting a biological therapy could indeed be a reasonable next step. Biological therapies are often effective for managing non-radiographic axial spondyloarthritis (nr-axSpA) when traditional treatments fail to control symptoms. These medications target the inflammatory processes that drive the disease and may significantly reduce pain, stiffness, and flare frequency. Here are some points to discuss with your rheumatologist:

Biological therapy consideration:

Response to NSAIDs: Since your symptoms persist despite NSAIDs, this is a critical indicator that a biologic might be beneficial.
Quality of life: Constant pain, prolonged morning stiffness, and poor sleep impact your day-to-day life, all of which support a transition to biological therapy.

Exercise recommendations during flare-ups:

During flare-ups, maintaining safe movement is important, though exercise should be gentle to avoid further aggravation:

Gentle Stretching: Focus on gentle stretches for the lower back, hips, and hamstrings.
Low-Impact Exercise: Walking and gentle swimming are safe and effective for maintaining joint mobility with minimal pressure.
Range of Motion: Regular range-of-motion exercises can prevent stiffness without adding too much strain.

Follow-up imaging:

Repeating an MRI (magnetic resonance imaging) can be helpful in assessing disease progression, significantly since your symptoms have intensified. An MRI will show if there are any changes in inflammation or structural abnormalities that would inform your treatment plan. This imaging can also help document progression, which might reinforce the need for a more aggressive treatment approach.

Your rheumatologist will likely want to conduct a full evaluation, considering factors like your functional ability, blood markers (such as CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate)), and possibly imaging findings. They may also review your entire treatment regimen, potentially considering other non-NSAID options alongside biologics.

In summary, with worsening symptoms and limited response to NSAIDs, biological therapy could be a valuable option to improve your quality of life. Safe, low-impact exercise and a repeat MRI are also good steps to discuss with your care team.

I hope this helps.

Thank you and take care.

Regards.