120 - Clinical features of axial spondyloarthritis

Abstract

The spectrum of axial spondyloarthritis (axSpA) covers radiographic axSpA (r-axSpA) and nonradiographic axSpA (nr-axSpA). Chronic back pain—most frequently with inflammatory characteristics—is the most common manifestation of the disease. AxSpA may also present peripheral manifestations such as arthritis, enthesitis or dactylitis, and extra-musculoskeletal manifestations, the most relevant being acute anterior uveitis, inflammatory bowel disease, and psoriasis. Other possible manifestations include constitutional symptoms as well as cardiovascular, pulmonary, renal, neurologic, and psychosocial disorders. AxSpA is also associated with the presence of comorbidities, the most common being osteoporosis, fibromyalgia, and cardiovascular diseases. Structural damage with new bone formation leading to ankylosis of the sacroiliac joints and spine is the cornerstone of axSpA. Inflammation is an important determinant of progression of structural damage. Approaching patients with a suspicion for axSpA starts by making a correct diagnosis. The diagnosis of axSpA is clinical, based on the recognition of a pattern matching the Gestalt of the disease, making use of clinical, laboratory, and imaging findings. In patients with axSpA, a thorough clinical assessment is important, making use of validated instruments covering several relevant domains of the disease. AxSpA is a disease associated with a high burden, with patients suffering from symptoms reflecting inflammation and disease activity, and impairment in spinal mobility, functional ability, work participation, and quality of life.