Nov. 1, 2020

The Differences Between Ankylosing Spondylitis and Axial Spondyloarthritis

The Differences Between Ankylosing Spondylitis and Axial Spondyloarthritis

For episode 074, I explain what the difference between the terms Ankylosing Spondylitis and Axial Spondyloarthritis. With these two terms  visible in many articles, do you know the difference? Is there a difference? Listen to this weeks episode and discover the difference.


Hello, and welcome to this week's episode of The Ankylosing Spondylitis Podcast. I hope this message finds everybody doing fantastic. Can't believe that this will be the 74th episode so far. I never really thought anybody would listen to the first couple episodes, let alone have finally be putting out the 74th episode and I can't wait for you to see what the 75th and 76th episodes are going to be. I've got really two fantastic guests coming up, but back to today. First things I want to go over is in the next month or so, you're going to see a whole new, got a whole new website coming up. And I looked at it and I wanted to try and make it easier for the listener to listen to the show or shows. So when you go on to the new page, on the right hand side of the page, it's going to have every place like where you can listen to it, that I have acceptance from our shows available. So it'd be like you know Apple podcast, Spotify, Overcast, Castro, Stitcher, iHeart Radio, Pocketcast, and the list goes on. Also in there, you can listen on Podchaser. And then on the left side of the main landing page is going to be just a list of the last seven episodes will have a link there for you to just click on it and go right to it and listen to it and then across the top, it'll have episodes, again, just another slot to go and find episodes about the podcast links to both the Facebook as well as the Instagram page, I really hope you go out and follow them both and if you go out on Instagram, please shoot me a message and let me know you've come in from listening to one of the podcasts and you're on Instagram and you wanted to follow and I'd love to hear from you. And then last but not least, there will also be a link to the affiliates. So if you want to make a one time or ongoing donation to the show through either Patreon or Buy Me a Coffee, those links will be there as well as the links to some of the different products. Now remember, these links are all affiliate links. So just so I'm doing my due diligence, if you click on one and buy something, then the show may get a small commission off of that. I say maybe because I don't know how every one works a little different and there could be other ones that are supersede that. So just know it doesn't change the price of anything you're buying. It just may pay the show a small commission. So also while you're on spondypodcast, com, please sign up for the newsletter. Man it has been cranking, there have been so many people signed up the last like four weeks. It's been amazing and it's really cool. And another record that the show hit and it's beyond what I even thought whatever happened is the show was just downloaded in the 102nd country and that country was Iran. Somebody came up from Iran downloaded four episodes, so that was really, really cool. 102 countries, can you imagine that? Literally, this show has gone around the world. You're no longer just somebody with Ankylosing Spondylitis sitting in some place in Finland, or Brazil or Mexico City or, you know, California or the Philippines, you can come on this show, and come and talk on the page and the listeners are from around the world. You connect with people from all over the place and I think that's just for somebody that grew up in a time before the internet, when all there was was an encyclopedia, as I've told others to then put out this item for everybody that has listeners around the globe is just amazing to me and couldn't have done it without all of you. So please sign up for that newsletter. I can't thank everyone enough. There are some pictures coming up of shirts. If you want a shirt, there'll be a link in the show notes. But you can go to the website to and order a shirt. We've set some off to Canada and Australia and it worked out just fine. So I know that they can go to other places in Europe and wherever, I know it worked fine. Just unfortunately, with all the COVID stuff going on, it is slowing down the mail process.


So onto today's episode. Well I wanted to go back to talk more about axial spondyloarthritis. I really think that is where this disease is headed and that's where we are all going to be diagnosed. There's going to be no more non-radiographic or Ankylosing Spondylitis, you just have axial spondyloarthritis, but I see a lot of people still going well, do I have axial spondyloarthritis? Or do I have Ankylosing Spondylitis? And I try to figure out what's the best way to explain it to them that I want folks to understand that there's non-radiographic axial spondyloarthritis on the left side, and Ankylosing Spondylitis on the right side. Those are this, in essence kind of on the same, you know continuum, you're from non-radiographic you may progress over to Ankylosing Spondylitis. But instead of being diagnosed two different ways, two different medications that might work for one not work for the other, you know, blah, blah, blah, blah, different treatment plans. Instead, use an umbrella term called Axial Spondyloarthritis, which is really just encompassing these two so no longer does somebody say, ‘I have Ankylosing Spondylitis’. Why of non-radiographic, ah, now you have axial spondyloarthritis. Now, under that everybody's treatments going to be different because we all sit on different levels of what we're dealing with some maybe just starting their journey and just getting some sacroilliac joint pain, others may be fully fused, we don't know. What we do know, is by using one term, we give the doctors a lot more leeway to start encompassing this disease as a  single disease and not multiple diseases and start to say, if I can come up with not cures, but maybe preventative medicines that slow somebody as they move along from non-radiographic to the Ankylosing Spondylitis, then I can end up maybe stopping their progression completely or slowing it down so that they never have to deal with a fullon fusing. Now, they may still get flares and those things but if they're not working through the fusing, that can create a better quality of life and that's really what we want to look at. So I found a cool article, and I have a link below and it says How are Axial Spondyloarthritis and Ankylosing Spondylitis Related? And I really think this is the key is we've got to really start to understand the term axial spondyloarthritis. So when you learn about spondyloarthritis, the article says, it's easy to get confused about terminology and categories. Isn't that the truth there all over the terminology is particularly confusing because doctors have been changing the way these conditions are categorized over recent years and not even medical professionals always use the terms consistently. We know that's a big problem because you just have to read the forums and stay up to date with people when they go to their different doctor's appointments. So, we look at spondyloarthritis that refers to a family of inflammatory rheumatological conditions that can affect the joints including the joints of the spine as well as other bodily systems also, you have axial spondyloarthritis and that can be considered a subset of spondyloarthritis that affects primarily the axial joints, you know, the joints of the spine, the chest and the pelvis and then Ankylosing Spondylitis is generally considered a specific subset of axial spondyloarthritis. So, you can see they really kind of just tuck underneath each other and maybe as I mentioned in a prior episode, ankylosing spondylitis and non-radiographic axial spondyloarthritis maybe those terms go away in the use with you and I as patients and are kept really just on the research side. So with spaniel rapa these that's the broadest category in the topic Spondyloarthopies, sorry, I'm gonna butcher that no matter, now I got a mind blank, are a group of related inflammatory illnesses that have some overlapping characteristics. And it could be some of these overlapping characteristics could be inflammation, the spine and the pelvis bone, inflammation of peripheral joints, inflammation of part of the eye like uveitis inflammation at insertion point of ligaments and tendons, which is enthesitis inflammation of the bowel, skin lesions and association with you know, something like HLA-B27. In the old terms, and classically, people with spondylorapathy are often diagnosed into smaller subsets depending on other symptoms. For example, people who have these symptoms along with psoriasis would be diagnosed with psoriatic spondyloarthritis. People who had inflammatory bowel disease along with symptoms might be told they had a neuropathy spondyloarthritis people didn't fit neatly into a category might be told that they had undifferentiated spondyloarthritis, well, then it came axial versus peripheral. And when you look at the two with axial, you're really talking about symptoms affecting the actual joints, the chest, the spine, the hips, were with peripheral spondyloarthritis you're really talking about things that affect say the fingers, the knees, the toes, so that's really the main difference. And then you say, okay, that's great, Jayson, but I was told I have Ankylosing Spondylitis. How does that fit in? Well, Ankylosing Spondylitis is an older disease category, but one that many physicians and patients still use, myself included. Just look at the name of this podcast. The term spondylitis simply means inflammation of the vertebrae, the small bones that make up your spine, as is considered a variety of axial spondylouropathy, jeez, this word it's going to kill me. It primarily affects the axial joints, patients with axial spondyloarthritis experienced inflammatory back pain, limited movement of the spine, and sometimes other characteristic symptoms found in spondylitis or apathy ease, like enthesitis a uveitis, or somebody like me who's got it all and just wrapped up into one big ball of fun. In some cases, it can be quite severe and lead to disability. Historically, x rays were an important part of diagnosing as when viewed under x rays. You can see signs of substantial inflammation of the SI joints, which is termed sacredly itis and a person with as when I got My first x rays when I was 14, that's really all there was MRIs were available, but it was something that was so far beyond the thought process of what you would use that my rheumatologist just use x rays. And that's what he worked off of. So because of this Ankylosing Spondylitis is more or less synonymous with a newer term, radiographic axial spondyloarthritis. The radiographic being the X rays, you might also view Ankylosing Spondylitis as a more advanced or severe form of axial spondyloarthritis. That's what I want people to start to do. And then there's non-radiographic axial spondyloarthritis. Once, MRIs became much more common, and they were used much more often through the 90s and beyond, the MRI can pick up more detail than an X ray can. So practitioners, doctors began to notice that some people had many of the symptoms of as, although changes in chronic inflammation couldn't be seen on x rays. However, those patients did have inflammation of the SI joint that had been seen when an MRI was done. So that MRI allowed a much deeper, more detailed viewing of what was going on. And so as many of you that listen to the show can attest to that were diagnosed in the 80s and 90s. Before that, you were just put off as any other different disease because they could not see it in the x rays. Once you had an MRI done, boom. It was either non radiographic or advanced to a spot where it was now radiographic. And then lastly, non-radiographic axial spondyloarthritis vers Ankylosing Spondylitis? Well, researchers and clinicians aren't sure about the relationship between non-radiographic and Ankylosing Spondylitis. According to this article. Some people diagnosed with non radiographic go on to later develop the symptoms classic as you know, ie the radiographic axial spine arthritis in the inflammation of the SI joints becomes severe enough that it can be viewed on an X ray. In other words, their sacred itis goes from non-radiographic to radiographic. But it also appears that many people don't progress in this way. So it's interesting to note that more women are diagnosed with non-radiographic then are diagnosed with AS. But people with non radiographic tend to have a shorter length of disease and lower levels of inflammation markers, they also tend to have less severe disease doesn't mean it doesn't hurt doesn't mean that's the case for all of them. It's a very generic thing. So don't write me saying, well, that's not me. Again, I'm not talking specifically on one person. I'm talking in general. And so with that, there's currently the treatment of these two conditions is similar, but it's different. They both use physical therapy, exercise, some over the counter pain meds, and prescription treatments. Until you possibly move from non radiographic to radiographic your treatment plan might change a lot might not change much, because more and more biologics are being approved for non radiographic, so getting put on the biologic, you might have progression going on, it's just very slow, which in reality is good for you. Keep up with the physical therapy, keep up with the exercise, keep up with the biologics, you might be able to better keep it under control, and just have a very good quality of life, you really don't see anybody also with multiple diagnosis as far as you're not likely to have both non radiographic axial spondyloarthritis and another form of spondyloarthropathy. Currently, researchers are generally categorizing other classic forms of these spondee lo are up at these as kinds of peripherial spondyloaropathies, Oh jeez, I should have picked a different word today. So for example, you might be told you have peripherial spondyloarthritis, with psoriasis peripherals under arthritis with inflammatory bowel disease, or peripheral sponder. Arthritis from a seating infection, like a reactive arthritis. So people with these conditions are generally not considered in this group. However, they do sometimes have symptoms from problems with axial joints. So overall, we've come a long way in the last 40 years with the looking at these diseases a very, very long way. But we're not done. There's a long way still to go. And I think a big part of that change is going to be the adoption of one term that covers the disease that axial spondyloarthritis. Once there's one terminology, I think that you're no longer going to see splitting of research dollars, hopefully, and again, I'm not on the research team. So I don't know, but maybe you'll see more cooperation, because what affects one can affect the other and, you know, that would be something interesting. I'd love to have more research doctors on to talk about how they look at this and what they're doing.


So with that, I hope everybody has a wonderful day. I can't thank you enough for joining the show. Really, really appreciate every one of you that reaches out, go to spondee podcast comm and sign up for the newsletter and let me know you're on there. Hit Up Instagram, and if there's anything you ever need help with or understanding with one of the episodes, please shoot me a message. I'd love to hear from you. Thank you and take care