Concerning the Back: Updates in AS & nr-axSpA

When all actions on the part of the clinician seem to have failed, the rheumatologist should ask themselves several questions:

• Is the diagnosis correct?
• Is the disease still active, and am I treating inflammation or damage?
• Is the patient compliant with treatment?
• Are fibromyalgia, depression, sleep disturbance or different issues at play?
• Have I set realistic expectations for the patient in terms of anticipated results?

By running through this list of questions, the clinician can step back and gain a better understanding of the whole picture of the patient, thereby enabling holistic, more effective care of the patient as a person.

In Sum

The session provided by Dr. Deodhar was rich with insight, and the audience was left with many clinical pearls to help in the management of axSpA and non-radiographic axSpA.

Jason Liebowitz, MD, is an assistant professor of medicine in the Division of Rheumatology at Columbia University Vagelos College of Physicians and Surgeons, New York.

References

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2. Bohn R, Cooney M, Deodhar A, et al. Incidence and prevalence of axial spondyloarthritis: methodologic challenges and gaps in the literature. Clin Exp Rheumatol. 2018 Mar–Apr;36(2):263–274.
3. Weber U, Lambert RG, Østergaard M, et al. The diagnostic utility of magnetic resonance imaging in spondyloarthritis: An international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum. 2010 Oct;62(10):3048–3058.
4. Deodhar A, Gill T, Magrey M. Human leukocyte antigen b27-negative axial spondyloarthritis: What do we know? ACR Open Rheumatol. 2023 Jul;5(7):333–344.
5. Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82(1):19–34.
6. Hamilton L, Barkham N, Bhalla A, et al. BSR and BHPR guideline for the treatment of axial spondyloarthritis (including ankylosing spondylitis) with biologics. Rheumatology (Oxford). 2017 Feb;56(2):313­–316.