Source: Annals of the Rheumatic Diseases
Chronic back pain, arthritis, enthesitis and dactylitis are among the manifestations associated with axial spondyloarthritis, but no two patients are alike. Here, we highlight key presentations of axSpA.
- Chronic back pain is the leading symptom of axial spondyloarthritis (axSpA). Other musculoskeletal manifestations include arthritis, enthesitis and dactylitis. Extra-articular manifestations include anterior uveitis, psoriasis and inflammatory bowel disease (IBD). End-stage patients are recognized by a characteristic stooped posture, sacroiliitis and the presence of syndesmophytes on spine radiographs are characteristic of end-stage patients.
- “axSpA” refers to the whole spectrum of patients with radiographic sacroiliitis (AS or radiographic axSpA) and without radiographic sacroiliitis (non-radiographic axSpA).
- There is still some debate as to whether radiographic and non-radiographic axSpA are two different entities or whether they are associated with a continuous disease spectrum. The current prevailing opinion is that axSpA encompasses one disease spectrum in which patients with nonradiographic axSpA may develop radiographic changes over time. However, not all non-radiographic axSpA patients develop radiographic sacroiliitis. And, not all patients with radiographic sacroiliitis will develop syndesmophytes. The European Medicines Agency proposes to study patients with axSpA as one entity.
- The Assessment of SpondyloArthritis international Society (ASAS) has two sets of treatment recommendations: one for bDMARDs and a second that was established when axSpA was not yet well established.
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Desiree van der Jeijde, Sofia Ramiro, Robert Landewe, et al. “2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis” Annals of the Rheumatic Diseases. 2017;0:1–14. DOI:10.1136/annrheumdis-2016-210770