EnA vs AxSpA: Understanding the Differences and Finding Hope

Living with an inflammatory condition that affects the spine, joints, or other parts of the body can be challenging and confusing. With conditions that share many overlapping symptoms, it’s natural to wonder what makes each condition unique. Understanding the differences between Enteropathic Arthritis (EnA) and Axial Spondyloarthritis (axSpA) can help you and your healthcare team find the most effective treatment plan. 

• What is Enteropathic Arthritis (EnA)?
• What is Axial Spondyloarthritis (axSpA)?
• Key Differences between the two
• Treatment Approaches
• A Message of Hope: You Are Not Alone
• Additional Resources for people with EnA

What is Enteropathic Arthritis (EnA)? 

Enteropathic Arthritis, or EnA, is an inflammatory arthritis that occurs in connection with inflammatory bowel diseases (IBD) such as Crohn’s disease or ulcerative colitis. EnA often affects the joints in the lower limbs, but it can also impact the spine. Because it is associated with inflammation of the intestines, flare-ups in bowel symptoms often correlate with flares in joint symptoms. Patients with EnA may experience: 

• Pain, stiffness, and swelling in the joints, particularly in the legs 
• Lower back or pelvic pain, though this is less common than in axSpA 
• Digestive symptoms such as diarrhea, abdominal pain, and bloating from IBD 

The inflammation in EnA is unique in that it stems from the connection between the digestive and musculoskeletal systems. For some, managing the underlying IBD can also help manage the arthritis itself. 

What is Axial Spondyloarthritis (axSpA)? 

Axial Spondyloarthritis, or axSpA, is a type of arthritis primarily affecting the spine and sacroiliac joints (where the spine meets the pelvis). AxSpA causes inflammation in these areas, leading to chronic back pain, stiffness, and sometimes fusion of the vertebrae over time. Unlike EnA, axSpA is not necessarily linked to IBD, though they can co-occur. 

AxSpA encompasses two subtypes: 

• Non-radiographic axSpA: Inflammation in the spine and joints is present but does not show up on X-rays.  However, it is usually present on MRI imaging. 
• Radiographix axSpA:  Sometimes diagnosed as Ankylosing Spondylitis/AS, this Inflammation is visible on X-rays, often showing structural changes or fusion in the spine. 

People with axSpA may experience: 

• Chronic back pain that worsens with rest and improves with movement 
• Stiffness, particularly in the morning or after periods of inactivity 
• Fatigue, eye inflammation, and sometimes psoriasis or bowel symptoms (although these are not the primary features of axSpA) 

Because axSpA targets the axial skeleton (spine and pelvis), pain and stiffness are concentrated there, while EnA’s pain is often more widespread or peripheral. 

Key Differences 

Treatment Approaches 

Both EnA and axSpA benefit from treatments that reduce inflammation, improve mobility, and address specific symptoms. Medications for EnA often target bowel inflammation, which indirectly reduces joint pain. In contrast, axSpA treatment may include biologic medications specifically designed to prevent spinal inflammation and fusion. There is a lot of overlap between these conditions, and often people can meet criteria for both, so this sometimes complicates treatment choice.  Physical therapy, exercise, and self-management strategies are essential for both conditions

A Message of Hope: You Are Not Alone 

Living with either EnA or axSpA can bring physical and emotional challenges but remember that you’re not alone on this journey. The Canadian Spondyloarthritis Association is here to offer support, resources, and a community of people who understand what you’re going through. By staying informed, seeking support, and working with healthcare providers who specialize in these conditions, you can take control of your health and well-being. There is hope, and there is help. We’re here to support you. 

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