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Review
. 2020 Oct 1;59(Suppl4):iv18-iv24.
doi: 10.1093/rheumatology/keaa422.

Non-radiographic versus radiographic axSpA: what's in a name?

Xabier Michelena  1   2 , Clementina López-Medina  3   4 , Helena Marzo-Ortega  1   2
Affiliations
Review

Non-radiographic versus radiographic axSpA: what's in a name?

Xabier Michelena et al. Rheumatology (Oxford). .

Abstract

Axial spondyloarthritis is a heterogeneous inflammatory condition with variable clinical presentations and outcomes. The complexity of its diagnosis and absence of biomarkers hamper the development of diagnostic criteria with the risk of misuse of the available classification criteria in clinical practice and its consequences. Axial spondyloarthritis should be regarded as a continuum in which some patients, but not all, will have a more severe phenotype characterized by progression into new bone formation and joint fusion. Growing understanding of the factors that might drive disease progression and treatment response will allow for better characterization of treatment options and outcome for each affected individual. The aim of this review is to update the current evidence of what is axial spondyloarthritis and to highlight the need to focus on the concept rather than its classification.

Keywords: axial spondyloarthritis; nomenclature; non-radiographic axial spondyloarthritis.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Axial spondyloarthritis continuum Nr-axSpA, which may or may not be identified with and without bone marrow oedema as seen by MRI, may evolve over the years to r-axSpA previously known as AS, which is characterized by established changes of sclerosis, erosions and/or fusion in the sacroiliac joints and syndesmophytes or vertebral fusion in the spine in a proportion of cases. These changes are represented with the different colour grading (yellow/red) to illustrate the nr-axSpA–r-axSpA continuum. Those who will develop radiographic changes are represented as ‘progressors’ with risk factors such as a previously positive MRI, raised CRP and positive HLA-B27. A proportion of HLA-B27 positive subjects with negative MRIs may develop a raised CRP, placing them in the more severe or ‘progressor’ category. With time and a possible treatment effect, the number of ‘non-progressors’ can increase as shown. Fat metaplasia is represented as a post-inflammatory lesion after bone marrow oedema occurs and is a possible precursor of radiographic structural lesions. nr-axSpA: non-radiographic axial spondyloarthritis; r-axSpA: radiographic axSpA.
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References

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