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What is non-radiographic axial SpA anyway? Does it really matter?
June 9 2016 10:39 PM ET — via RheumReports
There continues to be much interest in the concept of non-radiographic axial SpA (nr-axSpA) here in London.
Non-radiographic axial SpA is a classification criteria recently developed by ASAS describing patients with AS before X-ray changes occur. The exact profile of these patients as well as prognostic and therapeutic implications is still under investigation. To be classified in this category, a patient can have sacroiilitis on MRI (not plain films) plus one or more SpA feature(s) or HLA-B27 positive and two or more clinical features with no X-ray changes at all.
In today's poster session, there was an elegant cross-sectional study by Philip Mease et al. from the US Corona SpA/PsA registry. This study included 310 AS patients by NY modified criteria and 97 who met the nr-axSpA criteria. Patients with AS were slightly older and there were more males (65% vs 57%) than the nr-axSpA cohort.
Patients with nr-axSpA had slightly lower disease duration but patient characteristics were otherwise similar in terms of co-morbidities, biologic use, and disease activity measures. The nr-axSpA group had more enthesitis and dactylitis. The authors concluded that the main differences between the two groups were age and sex with the nr-axSpA cohort being younger and more likely to be female. This confirms information we have heard before.
An important issue is what percentage of these nr-axSpA patients progress to AS? And most importantly, does intervening early with biologic therapy stop that progression? This is the subject of ongoing research. If it is confirmed that we can slow or prevent progression from the non-radiographic stage to radiographic disease, then it most definitely does matter!
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About the Author
Dr. Shelly Dunne
Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.
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