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The term 'non-radiographic axial spondyloarthritis' is much more important to classify than to diagnose patients with axial spondyloarthritis.
Ann Rheum Dis. 2016 May; 75(5):791-4.AR

Abstract

The term axial spondyloarthritis (axSpA) now is used frequently to describe patients with predominantly axial symptoms who fit into the spectrum of a well-recognised rheumatic disease that continues to be known as ankylosing spondylitis (AS). The 2009 Assessment of SpondyloArthritis international Society (ASAS) classification criteria, developed to identify patients with early or atypical disease which could not be classified by the 1984 modified New York (mNY) criteria for AS, have led to a differentiation between non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA, which is largely synonymous with AS. The main reason to distinguish between these ends of the spectrum of axSpA was that tumor necrosis factor (TNF) inhibitors (TNFi) approved for AS could obtain additional labelling for nr-axSpA and be used to treat all patients manifesting clinical features of axSpA. These two terms are distinguished by the degree of 'radiographic sacroiliitis' assessed by conventional radiography, according to the 1984 mNY criteria for AS. Since this differentiation has been shown to be not very reliable, we argue that the terms nr-axSpA and AS should only be used for classification of patients with axSpA and not as separate diagnoses. Therefore, we propose that only the term axSpA be used to diagnose patients, unless there is a meaningful medical reason to differentiate nr-axSpA from AS. The available data justify performing randomised controlled trials designed to obtain regulatory approval for therapeutic agents in patients across the entire spectrum of axSpA.

Authors+Show Affiliations

Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA.Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA.Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts, USA.Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26768406

Citation

Deodhar, Atul, et al. "The Term 'non-radiographic Axial Spondyloarthritis' Is Much More Important to Classify Than to Diagnose Patients With Axial Spondyloarthritis." Annals of the Rheumatic Diseases, vol. 75, no. 5, 2016, pp. 791-4.
Deodhar A, Strand V, Kay J, et al. The term 'non-radiographic axial spondyloarthritis' is much more important to classify than to diagnose patients with axial spondyloarthritis. Ann Rheum Dis. 2016;75(5):791-4.
Deodhar, A., Strand, V., Kay, J., & Braun, J. (2016). The term 'non-radiographic axial spondyloarthritis' is much more important to classify than to diagnose patients with axial spondyloarthritis. Annals of the Rheumatic Diseases, 75(5), 791-4. https://doi.org/10.1136/annrheumdis-2015-208852
Deodhar A, et al. The Term 'non-radiographic Axial Spondyloarthritis' Is Much More Important to Classify Than to Diagnose Patients With Axial Spondyloarthritis. Ann Rheum Dis. 2016;75(5):791-4. PubMed PMID: 26768406.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The term 'non-radiographic axial spondyloarthritis' is much more important to classify than to diagnose patients with axial spondyloarthritis. AU - Deodhar,Atul, AU - Strand,Vibeke, AU - Kay,Jonathan, AU - Braun,Juergen, Y1 - 2016/01/14/ PY - 2015/11/01/received PY - 2015/12/14/accepted PY - 2016/1/16/entrez PY - 2016/1/16/pubmed PY - 2016/8/30/medline KW - Ankylosing Spondylitis KW - DMARDs (biologic) KW - Epidemiology KW - Spondyloarthritis KW - Treatment SP - 791 EP - 4 JF - Annals of the rheumatic diseases JO - Ann. Rheum. Dis. VL - 75 IS - 5 N2 - The term axial spondyloarthritis (axSpA) now is used frequently to describe patients with predominantly axial symptoms who fit into the spectrum of a well-recognised rheumatic disease that continues to be known as ankylosing spondylitis (AS). The 2009 Assessment of SpondyloArthritis international Society (ASAS) classification criteria, developed to identify patients with early or atypical disease which could not be classified by the 1984 modified New York (mNY) criteria for AS, have led to a differentiation between non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA, which is largely synonymous with AS. The main reason to distinguish between these ends of the spectrum of axSpA was that tumor necrosis factor (TNF) inhibitors (TNFi) approved for AS could obtain additional labelling for nr-axSpA and be used to treat all patients manifesting clinical features of axSpA. These two terms are distinguished by the degree of 'radiographic sacroiliitis' assessed by conventional radiography, according to the 1984 mNY criteria for AS. Since this differentiation has been shown to be not very reliable, we argue that the terms nr-axSpA and AS should only be used for classification of patients with axSpA and not as separate diagnoses. Therefore, we propose that only the term axSpA be used to diagnose patients, unless there is a meaningful medical reason to differentiate nr-axSpA from AS. The available data justify performing randomised controlled trials designed to obtain regulatory approval for therapeutic agents in patients across the entire spectrum of axSpA. SN - 1468-2060 UR - https://www.unboundmedicine.com/medline/citation/26768406/The_term_'non_radiographic_axial_spondyloarthritis'_is_much_more_important_to_classify_than_to_diagnose_patients_with_axial_spondyloarthritis_ L2 - https://ard.bmj.com/cgi/pmidlookup?view=long&pmid=26768406 DB - PRIME DP - Unbound Medicine ER -