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Complexities in Axial Spondyloarthritis in Daily Practice
June 11 2015 11:14 AM ET — via RheumReports
Diagnosis of axial spondyloarthritis (axSpA) can at times be difficult especially when it comes to identification of early disease. Symptoms of back pain can fluctuate over time and may overlap with symptoms from other rheumatic diseases or chronic pain syndromes. Although MRI has emerged as a powerful tool for evaluating patients with axSpA, false negative cases are not infrequent. During today’s session on Clinical SpA, Xenefon Baraliakos discussed two real life complexities in the diagnosis of axSpA .
The ASAS classification criteria for axSpA have been challenged due to the suspicion that FM patients may easily fulfill the clinical arm criteria for axSpA, leading to over-diagnosis of axSpA. Dr. Baraliakos and colleagues consecutively enrolled 93 patients with FM, and 91 axSpA patients who were diagnosed by rheumatologists with the current established clinical criteria. They found that axSpA patients had significantly higher HLA-B27 positivity and CRP levels compared to FM patients, while FM patients were mostly females and reported higher pain scores compared to axSpA patients.
In this study, the ASAS classification criteria were not fulfilled by any FM patients enrolled. In contrast, the 1990 and 2010 FM criteria were fulfilled by 98.3% and 100% of patients with FM, but also by 14.3% and 34.1% of axSpA patients. This study suggests that FM patients are very unlikely to fulfill the current ASAS classification criteria. On the other hand, a subset of axSpA patients may fulfill the FM classification criteria.
In a second presentation by Dr. Baraliakos, he demonstrated that active patients with non-radiographic axial SpA (nr-axSpA) may benefit from repeat MRI and retesting for acute phase reactants. In a subset analysis of the ABILITY-1 phase 3, double-blind RCT in patients with nr-axSpA treated with adalimumab, 31% (9/29) of patients in the placebo group had both a negative MRI of the SIJ and spine at baseline and were MRI-positive in either the SIJ or spine at week 12. Of the 57 placebo patients with normal CRP at baseline, 24.6% (14) had elevated CRP at a time point between baseline and week 12. So the study suggests that MRI changes may be transient in nr-axSpA and we may need to be persistent with our investigations of inflammation (imaging and CRP).
References:
PATIENTS WITH FIBROMYALGIA (FM) DO NOT FULFILL CLASSIFICATION CRITERIA FOR AXIAL SPONDYLOARTHRITIS (AXSPA) BUT PATIENTS WITH AXSPA MAY FULFILL CLASSIFICATION CRITERIA FOR FM (OP0038)
X. Baraliakos1, A. Regel1, U. Kiltz1, D. Kiefer1, H.-J. Menne1, F. Dybowski1, M. Igelmann1, L. Kalthoff1, D. Krause1, E. Saracbasi1, E. Schmitz-Bortz1, J. Braun1
1Rheumazentrum Ruhrgebiet, Herne, Germany
CLINICALLY ACTIVE NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS PATIENTS WHO INITIALLY HAVE A NEGATIVE MRI AND NORMAL CRP MAY DEVELOP A POSITIVE MRI OR ELEVATED CRP AT A LATER TIMEPOINT (OP0045)
X. Baraliakos1, J. Sieper2, S. Chen3, A. L. Pangan3, J. Anderson3
1Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, 2Charité Universitätsmedizin Berlin, Berlin, Germany, 3AbbVie Inc, North Chicago, United States
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About the Author
Dr. Proton Rahman
Proton Rahman, MD is a Clinician Scientist at Memorial University of Newfoundland, where he is also Associate Dean of Clinical Research and a University Research Professor. He practices rheumatology at Eastern Health in St. John’s, Newfoundland.
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