What Is Nr-axSpA?

What Is Non-Radiographic Axial

Understanding nr-axSpA

Non-radiographic axial spondyloarthritis, or nr-axSpA (pronounced N-R-Ax-Spa), is a chronic inflammatory condition. It’s characterized by active inflammation of the spine and sacroiliac (SI) joints, which are the joints that connect the lower spine and pelvis.

Identifying nr-axSpA

Nr-axSpA belongs to the axial spondyloarthritis (axSpA) family of inflammatory conditions. These conditions affect the spine and SI joints, but signs and symptoms can occur in other parts of the body. Another condition classified in the axSpA family is ankylosing spondylitis (AS). Many of the signs and symptoms of nr-axSpA and AS overlap, but a rheumatologist can distinguish between these two conditions using x-ray imaging, a key diagnostic test, as well as other tests like blood tests.


No visible damage on x-rays
The part of the skeleton that includes the spine and SI joints
A family of chronic inflammatory conditions

SpA Family

Not visible on x-ray
Visible on x-ray

Not All Back Pain Is The Same

Because back pain is common, many people attribute the symptoms of nr-axSpA to mechanical conditions in the structure of the back (eg, dislocation, pinched nerve, slipped disc, or muscle strain). However, since the pain from nr-axSpA is caused by inflammation, it should be treated differently.

Signs of inflammatory back pain related to nr-axSpA:

  • Pain that lasts 3 months or longer
  • Pain that goes away with exercise and activity
  • Pain while sleeping
  • Age of onset <45 years

Additional signs and symptoms:

  • Morning stiffness
  • Reduced mobility
  • Limitations at work and home
  • Fatigue

Some people with nr-axSpA can experience symptoms that are more widespread, such as:

  • Swelling around the joints
  • Diarrhea
  • Abdominal pain
  • Sensitivity to light

Nr-axSpA in Women


Women, over half of the nr-axSpA population, may experience symptoms differently than men. Women tend to have pain that is more widespread, which can result in a diagnostic delay. On average, an nr-axSpA diagnosis takes more than a year longer in women than in men.

Nearly 1.7 million individuals in the US live with nr-axSpA

nr-axSpA in the US

You Don’t Have Time
For Chronic Back Pain
And Stiffness


Non-radiographic axial spondyloarthritis can start slowing you down even before you get out of bed; it’s hard to start the day with stiffness, decreased mobility, and debilitating chronic back pain. You may be tired of calling in sick and canceling plans with friends. In addition to the pressure of commitments, the list of things to do around the house is getting longer.

Feeling discouraged and misunderstood with nr-axSpA is warranted. Talking to a rheumatologist can help you take control of your condition.

Download our Doctor Discussion Guide to prepare for your appointment with a rheumatologist. Through open conversation with your doctor about how your nr-axSpA symptoms are affecting you physically and emotionally, together you can decide the best treatment option for you.


Chronic Back Pain
Prolonged by Misdiagnosis


It’s a long road to answers for many people living with inflammatory back pain. On average, it takes 5 to 8 years for those with nr-axSpA to receive an accurate diagnosis.

Since the awareness for nr-axSpA is low, it is often misdiagnosed. Most back pain conditions are mechanical-related, and it’s difficult for many physicians to discern the difference between mechanical pain (eg, muscle strain, slipped disc or pinched nerve) and inflammatory pain. Nr-axSpA is often misdiagnosed as fibromyalgia (a neurological condition) since chronic pain in the back and other parts of the body is often a feature of both conditions.

Misdiagnosis and visits to multiple specialists can be discouraging. However, being aware of the signs of inflammation and working with the right specialist can help uncover the cause. Trained to diagnose and treat inflammatory conditions, a rheumatologist is the best physician to evaluate you for nr-axSpA.

If x-rays do not show visible changes in your joints or spine, it could be nr-axSpA. Your rheumatologist may then recommend an MRI (magnetic resonance imaging) to detect inflammation. Additional tests in the diagnostic process may include, but are not limited to:

  • Evaluation of medical history, including family history
  • Laboratory tests for erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels, which indicate inflammation
  • Certain blood tests for genetic markers, like HLA-B27

How To Treat Nr-axSpA


Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to people living with nr-axSpA. Pain relievers may help temporarily relieve pain, but they do not address the inflammation causing the symptoms.

CIMZIA (certolizumab pegol) is an anti-tumor necrosis factor (TNF) biologic. In people with nr-axSpA, the body makes too much TNF, causing immune cells to attack healthy tissue. This leads to inflammation and the symptoms you may be experiencing. By working to block these extra signals to immune cells, CIMZIA treats nr-axSpA where it starts, inside the body.

CIMZIA is the first and only therapy of its kind for nr-axSpA* proven to improve symptoms and disease activity over time. 

Learn more about how CIMZIA may work for you.

*CIMZIA is an anti-tumor necrosis factor (TNF) biologic.

In addition to CIMZIA, there are other ways to help manage the symptoms of nr-axSpA:

  • Exercising regularly can help reduce pain and improve flexibility in those with nr-axSpA.†
  • Keeping a food journal can help uncover whether certain foods are causing your symptoms to worsen, since diet and nutrition can make a difference.
  • Reducing stress with meditation or yoga can be beneficial, as stress and anxiety can make it difficult to manage nr-axSpA symptoms and may cause them to worsen.

†Be sure to check with your doctor before increasing physical activity or beginning any new exercises.

Resources for Support

CIMplicity® is a free program that provides support at each step of your experience when treating your nr-axSpA with CIMZIA (certolizumab pegol). For more details, enroll now.*

Spondylitis Association of America strives to be a leader in the quest to cure nr-axSpA, AS, and related diseases. It has a mission to empower those affected to live life to the fullest. Call 1-818-892-1616 to learn more.

American College of Rheumatology works to advance rheumatology treatment through programs to improve care for people with rheumatic and musculoskeletal diseases and arthritis.

The Arthritis Foundation works to advance the treatment of more than 100 types of arthritis and related conditions. Call 1-800-283-7800 for more information.

The American Journal of Managed Care (AJMC), while a publication for healthcare providers, addressed nr-axSpA from a patient’s perspective in this AJMC Insights video.

*The CIMplicity program is provided as a service of UCB and is intended to support the appropriate use of CIMZIA. The CIMplicity program may be amended or canceled at any time without notice. Some program and eligibility restrictions may apply.


CIMplicity® Savings Program is available to eligible individuals with commercial prescription insurance coverage for CIMZIA

Your Cost
May Be $0‡

Find out if you're eligible for CIMZIA with $0 co-pay. The CIMplicity® Savings Program may be able to help lower or even eliminate your out-of-pocket costs for treatment. See eligibility requirements and full terms and conditions here.

‡The CIMplicity Savings Program is available to eligible individuals with commercial prescription insurance coverage for CIMZIA.
Program and eligibility restrictions apply. If you are uninsured, other financial assistance may be available.

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