u/SunshineYesterday587

Hi everyone,

I’m trying to better understand the difference between axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS). My rheumatologist diagnosed me with spondyloarthritis and ordered an SI joint MRI after my X-rays showed irregularity about the SI joints. The MRI reports sclerosis, erosions, and sacroiliitis.

I’m confused because I keep reading that AS is the “radiographic” form of axial SpA, but if MRI already shows erosions/sclerosis and the X-ray showed SI irregularities, how do doctors determine whether it’s considered:

• non-radiographic axial SpA vs
• ankylosing spondylitis/radiographic axial SpA?

Is the distinction mainly based on whether the X-ray findings are considered “definite” sacroiliitis under criteria, even if MRI already shows inflammatory damage?

Would especially appreciate hearing from anyone who was HLA-B27 negative or diagnosed early!

I’m grateful to be able to connect with people in this community and really appreciate everyone sharing their experiences. I recently received a diagnosis of axial SpA and just received the results of my MRI.

Findings showed bilateral sacroiliitis, subchondral sclerosis, and small erosions.

To be honest, it’s been a lot to process. I am so new to this world and don't know if this damage is consistent with AS or more the umbrella axial SpA. Part of me feels relieved to finally have answers, while another part feels nervous about what this means long term. I know many of you have probably been in a similar place at diagnosis, so I wanted to reach out and connect.

If anyone is comfortable sharing:

• What helped you most early on?
• Did treatment help slow progression or improve your quality of life?
• Any advice for someone newly diagnosed?

I’m really thankful to have found this space. Thank you!

Recently diagnosed. Has anyone with AS experienced heaviness, tightness, or pain when taking a deep breath? Lately I’ve been noticing pain and discomfort in my chest/ribs when I breathe deeply, almost like a heavy or restricted feeling. I know AS can affect the rib cage and inflammation around the spine/chest wall, so I’m curious if others have experienced something similar.

I’ve been trying to manage it with Epsom salt baths and rest, but I’m currently off my NSAID because I have upcoming MRIs, and I’m wondering if stopping the medication may be contributing to a flare or increased inflammation. The stiffness and pain definitely seem more noticeable right now.

Would appreciate hearing if anyone else has dealt with this and what helped you get some relief.

Hi everyone,

I’m 24M and currently being worked up by rheumatology for suspected axial spondyloarthritis vs psoriatic arthritis. I’m still early in the diagnostic process and waiting on further testing, but I wanted to see if anyone has had a similar presentation.

Symptoms:

• Advanced tenosynovitis affects the middle finger of the left hand extending from the mid to distal palm through to the DIP joint. Mild surrounding soft tissue
• That finger did not respond to corticosteroid injection, hence referral to rheumatologist. She started me on Celebrex (NSAID) and swelling has gone down significantly.
• Neck and lower back/hip stiffness in the mornings (not severe, but persistent enough to notice) and persists although taking Celebrex
• Generally active (I do yoga regularly)

Imaging:

• C-spine: reversal of lordosis at C4, otherwise no major abnormalities
• L-spine: mild disc height loss at L2-3 and L3-4
• Hips: normal joint spaces, no acute findings
• SI joints: radiologist noted irregularity and recommended MRI to evaluate for sacroiliitis

Labs:

• Elevated CRP (only abnormal lab so far)

Prior to these X-rays, my rheumatologist mentioned this pattern could fit axial spondyloarthritis or psoriatic arthritis. I have dry, scaly, peeling skin on my toes (not athlete's foot) and some dryness and scaling on my left elbow.

Not looking for a diagnosis, just trying to understand others’ real-world experiences with similar early presentations. Would DMARDs or biologics help with the imaging results?

Thanks in advance.