Clinical Pearls: What We Know About Nonradiographic Axial Spondyloarthritis

Conclusion
Dr. Reveille concluded by noting how far rheumatologists have come in better understanding such conditions as nr-axSpA, but he also indicated that much remains to be done to best care for patients with this condition.

As in many other areas of rheumatology, patient-reported outcomes are, and will be, essential in understanding the patient’s experience with their disease, and allowing clinicians to have a reliable and validated tool to measure disease activity and change treatment plans accordingly.

The lecture was stimulating and helped demonstrate the importance of recognizing disease symptoms and signs early and not reflexively misattributing symptoms of inflammatory back pain to other etiologies. It is only by honing in on the inflammatory underpinnings of spondyloarthritis that clinicians will be able to help these patients, with the goal of getting them back to a higher quality of life.

Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.

References

1. Rudwaleit M, Landewé R, van der Heijde D, et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part I): Classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009 Jun;68(6):770–776.
2. Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis. 2009 Jun;68(6):777–783.
3. Deodhar A, Reveille JD, van den Bosch F, et al. The concept of axial spondyloarthritis: Joint statement of the Spondyloarthritis Research and Treatment Network and the Assessment of SpondyloArthritis International Society in response to the U.S. Food and Drug Administration’s comments and concerns. Arthritis Rheumatol. 2014 Oct;66(10):2649–2656.
4. Weisman MH, Witter JP, Reveille JD. The prevalence of inflammatory back pain: Population-based estimates from the U.S. national health and nutrition examination survey, 2009–10. Ann Rheum Dis. 2013 Mar;72(3):369–373.
5. Redeker I, Callhoff J, Hoffmann F, et al. Determinants of diagnostic delay in axial spondyloarthritis: An analysis based on linked claims and patient-reported survey data. Rheumatology (Oxford). 2019 Sep 1;58(9):1634–1638.
6. Protopopov M, Poddubnyy D. Radiographic progression in non-radiographic axial spondyloarthritis. Expert Rev Clin Immunol. 2018 Jun;14(6):525–533.
7. Laloo F, Herregods N, Jaremko JL, et al. MRI of the axial skeleton in spondyloarthritis: The many faces of new bone formation. Insights Imaging. 2019 Jul 24;10(1):67.
8. Ward MM, Deodhar A, Gensler LS, et al. 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Care Res (Hoboken). 2019 Oct;71(10):1285–1299.
9. Michelena X, Marzo-Ortega H. Axial spondyloarthritis: Time to stop the split 10 years on. Nat Rev Rheumatol. 2020 Jan;16(1):5–6.