M45.A4

Clinical Causes: Genetic predisposition, especially the presence of the HLA-B27 gene Immune system dysfunction leading to chronic inflammation Environmental factors, such as infections triggering immune responses Potential environmental triggers or stressors that may contribute to disease onset

Key Symptoms: Chronic back pain centered in the upper or middle back (thoracic region), often worse at rest and improving with activity Stiffness in the thoracic spine, especially in the morning or after periods of inactivity Limited range of motion in the thoracic spine Tenderness or pain in the chest or rib area Fatigue and general feelings of illness Sometimes, symptoms may include inflammation in sites where tendons and ligaments attach to bones (enthesitis) Possible involvement of other joints or areas, such as the hips or shoulders

Diagnosis Path: Diagnosing non-radiographic axial spondyloarthritis involves a combination of clinical evaluation, detailed medical history, and imaging studies. Key diagnostic components include: - Clinical criteria: chronic back pain lasting more than three months that improves with exercise and does not improve with rest - MRI imaging: revealing inflammation in the thoracic spine and sacroiliac joints, even when X-rays appear normal - Laboratory tests: positive for HLA-B27 gene, elevated inflammatory markers such as ESR or C-reactive protein (CRP) - Exclusion of other causes of back pain and spinal inflammation Regular monitoring and collaboration between rheumatologists and radiologists are essential for accurate diagnosis.

Treatment Protocols: Management of non-radiographic axial spondyloarthritis aims to reduce inflammation, manage symptoms, and prevent disease progression. Typical treatment options include: - Nonsteroidal anti-inflammatory drugs (NSAIDs): to relieve pain and decrease inflammation - Physical therapy and regular exercise: improving flexibility, posture, and overall spinal health - Disease-modifying antirheumatic drugs (DMARDs): such as sulfasalazine or methotrexate, especially if peripheral joint involvement occurs - Biologic therapies: tumor necrosis factor (TNF) inhibitors or interleukin-17 inhibitors, used in cases resistant to conventional treatments - Lifestyle modifications: maintaining good posture, avoiding activities that worsen symptoms, and quitting smoking Patients should work closely with healthcare providers to develop personalized management plans, focusing on improving quality of life and minimizing complications.