Understanding the paradigm of non-radiographic axial spondyloarthritis
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REVIEW ARTICLE
Understanding the paradigm of non-radiographic axial spondyloarthritis Diego Benavent 1
&
Victoria Navarro-Compán 1
Received: 18 June 2020 / Revised: 16 September 2020 / Accepted: 21 September 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract The concept of axial spondyloarthritis (axSpA) encompasses both non-radiographic (nr-axSpA) and traditional radiographic axSpA (r-axSpA) forms. The former was conceived following the establishment of the ASAS classification criteria for axSpA, which for the first time included the use of magnetic resonance imaging of the sacroiliac joints. This facilitated the classification of patients with axSpA who did not present substantial structural damage. This conception of nr-axSpA revolutionized the classical understanding of axSpA opening new doors for research and broadening the scope of treatment to the entire spectrum of axSpA. In this sense, epidemiologic patterns of the disease were viewed anew, and early diagnosis became a primary objective in the management of the disease. However, despite these advances, this new axSpA subtype led to some concerns within the scientific community. These issues have been addressed by several studies that set out to clarify the concept of nr-axSpA. In this review, we summarize the findings of the most relevant studies including nr-axSpA and then discuss recent advances in understanding disease clinical patterns, burden of disease, and treatment effects. Current scientific research has shown subtle differences between nr-axSpA and r-axSpA. In the near future, these advances will allow for better management of individual patients across the axSpA spectrum. Keywords Disease characteristics . Non-radiographic axial spondyloarthritis . nr-axSpA . Radiographic progression
Introduction Almost 50 years ago, Moll and Wright identified a group of disorders with clinical and familial interrelationships that resembled ankylosing spondylitis (AS) for which they proposed the name of “seronegative spondarthritides” [1]. Later, this term evolved to “spondyloarthritis (SpA)”. Traditionally, the term SpA has referred to a group of diseases that share genetic characteristics and clinical manifestations including psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease, juvenile arthritis, undifferentiated spondyloarthritis, and AS. Although the latter is the hallmark of this group of diseases, all of these entities are important within SpA spectrum. To profile these entities more accurately, the SpA classification system was modified a decade ago by creating two groups based on the predominant clinical manifestation: axial * Victoria Navarro-Compán [email protected] 1
Hospital Universitario La Paz, IdiPaz, Madrid, Spain
or peripheral. These entities present predominant characteristics of one of these two groups often featuring overlapping presentations with ambiguous boundaries. As a result of these changes, the concept of axial spondyloarthritis (axSpA) emerge
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