Axial Spondyloarthritis Flares - Whatever They Are.

Abstract

Of the many things that people with ankylosing spondylitis (AS)/axial spondyloarthritis (axSpA) would like the medical profession to achieve for them, among the most pressing is providing effective ways of managing or preventing flares. Flares present a difficult set of problems: They are not predictable and often occur when contact with a physician or physiotherapist is not possible; and in any event, we can neither define nor measure them. And yet they are a major problem that needs to be tackled. Moreover, whatever they are, effective treatment of axSpA ought to prevent them. In this issue of The Journal , Jacquemin, et al 1 have therefore rightly drawn attention to the issue of flares in axSpA and explored frequency and duration in a group of Canadian patients at a time when few were receiving biologic treatment. Although no definition or description of flare was used, they found that most patients admit to having flares with a mean duration of 2 weeks. Indeed, this and other studies2,3,4 agree that many people with axSpA consider that flares are very common and sometimes virtually continuous. So what is a flare? In rheumatoid arthritis (RA), the term flare implies a periodic increase in symptoms, generally associated with an increase in inflammatory activity, evidenced by clinical signs and a rise in the acute-phase response. In RA, flare can be defined numerically according to validated criteria5. By analogy, it may be assumed that in axSpA a flare also represents a periodic worsening of symptoms associated with an increase in inflammatory activity. However, objective evidence of the latter is not generally available — especially when spinal symptoms are the issue — and a range of other associated problems may cause people with AS to feel worse. The problematic nature of … Address correspondence to Dr. Keat. E-mail: a.keat{at}nhs.net