The early disease stage in axial spondylarthritis: Results from the german spondyloarthritis inception cohort

Abstract

Objective. Ankylosing spondylitis (AS) is diagnosed late, because radiographs of the sacroiliac joints often do not show definite sacroiliitis at the time of disease onset. The aim of this study was to investigate whether patients without definite radiographically defined sacroiliitis, referred to as nonradiographic axial spondylarthritis (SpA), are different from patients with AS with regard to clinical manifestations and disease activity measures. Moreover, we sought to identify determinants of the development of radiographic sacroiliitis.Methods. In a cross-sectional analysis of 462 patients, we compared 226 patients with nonradiographic axial SpA (symptom duration <5 years) and 236 patients with AS (symptom duration <10 years) who are participants in the German Spondyloarthritis Inception Cohort. Radiographs of the sacroiliac joints and the spine were assessed by 2 readers in a blinded manner. Logistic regression analysis was applied to identify parameters associated with structural damage.Results. The 2 groups did not differ in the frequency of HLA-B27 positivity, inflammatory back pain, arthritis, enthesitis, and uveitis and had similar levels of disease activity, using measures such as the Bath Ankylosing Spondylitis Disease Activity Index. In both groups, HLA-B27 positivity determined the age at disease onset. Conclusion. Clinical manifestations and disease activity measures are highly comparable between patients with early nonradiographic axial SpA and those with early AS, suggesting that these 2 entities are part of the same disease. Male sex and an elevated CRP level are associated with structural damage on radiographs, whereas HLA-B27 positivity determines the age at disease onset.

Do patients with non‐radiographic axial spondylarthritis differ from patients with ankylosing spondylitis?

“…Therefore, the majority of the patients did not develop radiographic changes, and 23% went into remission. Another study compared 2 patient groups with inflammatory back pain who either had structural changes in the SI joint or did not have structural changes in the SI joint (11). Of interest, there was no evidence that the latter group of patients had a milder disease course or less severe clinical symptoms; however, using the new criteria, patients with axial SpA who have structural changes (AS) or not (nr-axSpA) have not been directly compared.…”

Ankylosing Spondylitis – the changing role of imaging

“…However one of the most important advances in the clinical understanding of AS has been the recognition of the significant time delay between the onset of symptoms, i.e., inflammatory back pain, and the development of radiographic evidence of sacroiliac joint damage, which can take an average of eight to ten years to become detectable. Furthermore, recent studies have shown that patients in the early stages of disease, prior to the appearance of radiographic sacroiliitis, have just as much pain, stiffness and functional limitation as those with established or radiographic AS [2]. This has led to increasing interest in the use of magnetic resonance (MR) imaging to detect changes at the sacroiliac joint or spine at an earlier stage.…”

Improvement in pain intensity, spine stiffness, and mobility during a controlled individualized physiotherapy program in ankylosing spondylitis

“…Sacroiliac pain may irradiate to the back, buttocks, groin and lower extremity similarly to pain patterns originating from other lumbosacral regions (Table 1). However, there is still a delay of years from the first symptoms until the final diagnosis is established [4]. Radiological changes are often detectable only years after the onset of AS, despite the presence of inflammation and clinical manifestations, such as pain and stiffness ( Figure 1) [5][6][7].…”