Axial spondyloarthritis (spondyloarthritis) – assessment and treatment at Charlottenlund Privathospital

What is axial spondyloarthritis?



Axial spondyloarthritis is a group of inflammatory rheumatic diseases in which the immune system causes inflammation in the sacroiliac joints, the joints of the spine, and where tendons attach to bones. According to the Danish Society for Rheumatology’s national treatment guidelines, the disease is defined by pain in the buttocks and back lasting more than three months and meeting the international classification criteria. The milder form, without visible changes on X-rays, is called non-radiographic axial spondyloarthritis; the advanced form with bone changes is called ankylosing spondylitis or morbus Bechterew.

The disease is closely related to psoriatic arthritis and the arthritis associated with inflammatory bowel disease, and a large proportion of patients have the HLA-B27 tissue type. The treatment guidelines highlight that both underdiagnosis and overdiagnosis are problems: the disease can be missed in very young people, while non-specific MRI findings in older people can easily be misinterpreted. This means the diagnosis must be based on the overall picture, not on a single test.

What are the symptoms of axial spondyloarthritis?

The key symptom is inflammatory back pain, which differs from ordinary mechanical back pain in five ways: it starts before the age of 45, develops gradually over weeks to months, improves with movement, does not improve with rest, and is worst at night and in the early morning, waking you and forcing you to get up. The pain is typically deep in the lower back and buttocks, often alternating between the right and left sides, and morning stiffness is pronounced.

Many people also have inflammation where tendons attach to bone—particularly at the heel—as well as swollen knee or ankle joints, fatigue, and reduced spinal mobility. Some experience episodes of a red, painful, light-sensitive eye (iritis), psoriasis, or bowel symptoms. These associated symptoms are important because they strengthen the suspicion of axial spondyloarthritis.

What causes axial spondyloarthritis?

The cause is not fully understood, but heredity plays a greater role than it does in most other rheumatic diseases. The HLA-B27 tissue type is found in a large proportion of patients, but also in many healthy people, so it is a risk factor, not a diagnosis. The disease is probably triggered by an interaction between genetics, the gut microbiome, and the immune system. Smoking worsens the disease. Axial spondyloarthritis is not caused by exertion, wear and tear, or poor posture.

How is axial spondyloarthritis diagnosed?

The assessment begins with a medical history. The specialist systematically reviews the five features of inflammatory back pain, as well as associated symptoms affecting the tendons, joints, eyes, skin, and bowel, and any family history. The clinical examination includes spinal and chest mobility, tenderness over the sacroiliac joints and tendon attachment sites, and an examination of the peripheral joints. Ultrasound can detect inflammation at tendon attachment sites and in peripheral joints.

Blood tests include inflammatory markers and the HLA-B27 tissue type; inflammatory markers can be normal even when the disease is active. Inflammation in the sacroiliac joints is detected by MRI, and bone changes in advanced disease by X-ray—the specialist will refer you, and the results will form part of the overall assessment. According to the international ASAS criteria, diagnosis is based on chronic back pain that begins before the age of 45, combined with either inflammation in the sacroiliac joints on imaging or HLA-B27 together with typical clinical features.

How is axial spondyloarthritis treated?

Treatment has three components. Exercise and physiotherapy are the foundation and should be maintained lifelong to preserve spinal mobility and posture. Anti-inflammatory arthritis medication is, according to the treatment guidelines, the first choice for pain and stiffness, and a clear response supports the diagnosis. If the disease remains active despite this, the next step is biologic medication, which under current Danish regulations is administered through a hospital.

At Charlottenlund Privathospital, assessment and diagnosis are provided, along with starting arthritis medication, advice on exercise and quitting smoking, and ultrasound-guided injections for inflammation in tendons and peripheral joints. If the assessment indicates that biologic treatment is needed, you will be referred on with the completed work-up so treatment can continue without delay. Eye symptoms are referred to an ophthalmologist the same day.

When should I see a rheumatologist?

Rheumatology assessment is appropriate when back pain has lasted for more than three months, began before the age of 45, and meets at least four of the five features of inflammatory back pain. This is especially relevant if accompanied by heel pain, swollen joints, psoriasis, bowel disease, eye inflammation, or a family history of axial spondyloarthritis. Back pain that starts after lifting, exertion, or an awkward movement and improves with rest is usually mechanical and is investigated and treated differently.

Assessment and treatment at Charlottenlund Privathospital

Assessment and treatment are provided by rheumatology specialists on an outpatient basis. The initial consultation typically lasts 20–30 minutes; blood tests and an ultrasound scan can often be done the same day. If an MRI scan or X-ray is needed, the specialist will refer you. Once the diagnosis is confirmed, a treatment and exercise plan is drawn up, and you will be followed by the same specialist.

Most patients come through health insurance; insurers typically require a referral from your GP and prior authorisation before an appointment can be booked. No referral is needed if you are paying for your treatment yourself, and prices are listed in the price list. Appointments can be booked online around the clock or by phone on 44 98 19 21 Monday to Friday, 08:00–14:00. Outside phone hours, the digital phone assistant Anna can book, cancel and reschedule appointments.