Serene woman intertwined with a glowing spine, symbolizing resilience in managing axSpA.

Unlocking the Mystery: How Axial Spondyloarthritis Impacts Women Differently

Kai Mendoza in Health & Wellness August 2025 • 4 min read.

"New insights reveal why women with axial spondyloarthritis often face unique diagnostic and treatment challenges."

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints. While it's known to cause pain, stiffness, and reduced mobility, emerging research highlights that axSpA can present differently in women, leading to potential delays in diagnosis and tailored management strategies. Understanding these nuances is crucial for empowering women to seek timely and effective care.

Historically, axSpA, particularly its radiographic form known as ankylosing spondylitis (AS), was considered more prevalent in men. However, recent studies suggest that non-radiographic axSpA (nr-axSpA), where joint damage is not yet visible on X-rays, might be more common in women. This distinction is important because diagnostic criteria and treatment approaches may vary depending on whether the condition is radiographic or non-radiographic.

This article aims to explore the latest findings on how axSpA affects women, focusing on the similarities and differences in symptoms, diagnostic challenges, and treatment considerations. By shedding light on these aspects, we hope to provide valuable information for women living with axSpA, their families, and healthcare providers.

The Diagnostic Maze: Recognizing axSpA in Women

Serene woman intertwined with a glowing spine, symbolizing resilience in managing axSpA.

One of the significant challenges in managing axSpA in women is the potential for delayed or missed diagnoses. Women often experience a different symptom profile compared to men, which can lead to misdiagnosis or a delay in recognizing axSpA. Common symptoms reported by women include:

Greater prevalence of peripheral joint involvement: Women may experience more pain and inflammation in joints outside the spine, such as the hands, feet, or knees.
Higher rates of enthesitis: Inflammation at the sites where tendons and ligaments attach to bone (enthesitis), particularly in the heels or feet, may be more frequent in women.
Increased fatigue and fibromyalgia-like symptoms: Women may experience more pronounced fatigue, widespread pain, and other symptoms that overlap with fibromyalgia, making diagnosis more complex.
Lower levels of elevated CRP: Traditional markers of inflammation, such as C-reactive protein (CRP), may not be as elevated in women with nr-axSpA, potentially leading to a missed diagnosis.

Greater prevalence of peripheral joint involvement: Women may experience more pain and inflammation in joints outside the spine, such as the hands, feet, or knees. Higher rates of enthesitis: Inflammation at the sites where tendons and ligaments attach to bone (enthesitis), particularly in the heels or feet, may be more frequent in women. Increased fatigue and fibromyalgia-like symptoms: Women may experience more pronounced fatigue, widespread pain, and other symptoms that overlap with fibromyalgia, making diagnosis more complex. Lower levels of elevated CRP: Traditional markers of inflammation, such as C-reactive protein (CRP), may not be as elevated in women with nr-axSpA, potentially leading to a missed diagnosis.

Because of these factors, healthcare providers may not immediately suspect axSpA in women presenting with chronic pain and fatigue. It's crucial for women to advocate for themselves, describing their symptoms thoroughly and seeking a referral to a rheumatologist if they suspect axSpA.

Empowering Women with axSpA: A Path Forward

Understanding the unique ways axSpA affects women is essential for improving diagnostic accuracy and treatment outcomes. By raising awareness and promoting further research, we can empower women to take control of their health and live fulfilling lives despite the challenges of axSpA. Early diagnosis, personalized treatment strategies, and ongoing support are key to managing the condition effectively.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What is axial spondyloarthritis (axSpA) and how does it uniquely impact women?

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints. Emerging research indicates that axSpA can manifest differently in women. This means women may experience varying symptoms, potentially leading to delays in accurate diagnosis and the implementation of tailored management strategies. Recognizing these distinctions is crucial to ensure women receive timely and effective care for axSpA.

What are the common diagnostic challenges for women with axial spondyloarthritis (axSpA)?

The diagnosis of axial spondyloarthritis (axSpA) in women presents unique challenges due to several factors. Women often exhibit different symptom profiles compared to men, which can result in misdiagnosis or delays in recognizing the condition. Specific symptoms reported more frequently by women include greater peripheral joint involvement (pain and inflammation in joints outside the spine), higher rates of enthesitis (inflammation at tendon and ligament attachment sites), increased fatigue and fibromyalgia-like symptoms (widespread pain), and lower levels of elevated C-reactive protein (CRP), potentially leading to a missed diagnosis.

What is non-radiographic axial spondyloarthritis (nr-axSpA), and why is it important for women?

Non-radiographic axial spondyloarthritis (nr-axSpA) is a form of axSpA where joint damage is not yet visible on X-rays. Recent studies suggest that nr-axSpA might be more prevalent in women compared to the radiographic form known as ankylosing spondylitis (AS). This distinction is important because diagnostic criteria and treatment approaches may differ depending on whether the condition is radiographic or non-radiographic. This means women may need different diagnostic tests and treatment plans compared to men with axSpA.

How can women advocate for themselves when they suspect they have axial spondyloarthritis (axSpA)?

Women experiencing symptoms suggestive of axial spondyloarthritis (axSpA) should proactively advocate for their health. This includes thoroughly describing all symptoms to healthcare providers, emphasizing the presence of peripheral joint involvement, enthesitis, increased fatigue, widespread pain, and any other relevant concerns. If axSpA is suspected, it's crucial to seek a referral to a rheumatologist, a specialist in inflammatory joint conditions, for further evaluation and management.

What key strategies are important for effectively managing axial spondyloarthritis (axSpA) in women?

Managing axial spondyloarthritis (axSpA) effectively involves early diagnosis, personalized treatment strategies, and ongoing support. Early diagnosis allows for timely intervention to slow disease progression and manage symptoms. Personalized treatment strategies take into account the unique ways axSpA affects each woman, including symptom presentation, disease severity, and individual preferences. Ongoing support from healthcare providers, family, and support groups can help women cope with the challenges of living with axSpA and maintain their overall well-being. Further research is needed to optimize diagnostic and therapeutic approaches for women with axSpA.