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Early diagnosis in axSpA still a challenge
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AMSTERDAM — Although receiving an early diagnosis will be key in improving the lives of patients with axial spondyloarthritis, achieving that goal remains a substantial challenge, according to findings presented at the EULAR Annual Congress.
“Axial spondyloarthritis has a large impact on work productivity, quality of life and health care costs, but with many therapies, this may change in the future, especially if we are able to treat patients at an early stage of their disease,” Victoria Navarro-Compán, MD, PhD, of La Paz University Hospital, Madrid, told attendees. “The first thing we need to do to achieve this goal is to make an early diagnosis. However, the current situation is, unfortunately, that it is hard to achieve this aim.”
According to Navarro-Compán, the diagnostic delay in patients with axial spondyloarthritis (axSpA) can be as much as 7 years. She added that this is due to the condition’s heterogeneous presentation, course and outcome. In addition, axSpA lacks a single clinical, laboratory, pathological or radiological feature to serve as a “gold standard” for making a diagnosis, she said.
“One of the main reasons there is an unacceptable diagnosis delay in axial spondyloarthritis may be that the leading symptom of the disease, chronic back pain, is also a very common symptom in the general population,” Navarro-Compán said. “We know that if patients with chronic back pain have also inflammatory characteristics, this means that they have a higher probability of having or developing axial spondyloarthritis. However, we do not know exactly how many patients with inflammatory back pain will develop axial spondyloarthritis.”
To combat this, researchers have been focused on developing strategies to achieve an early diagnosis, with a particular emphasis on imaging, she said.
According to Navarro-Compán, conventional radiograph of the sacroiliac joints is recommended as the fist imaging method to diagnose sacroiliitis as part of axSpA. However, she added that there are limitations to the use of radiography for sacroiliac joint evaluation, including large inter-reader variability in the interpretation and low sensitivity at the early stages.
Navarro-Compán also added that, in terms of imaging acquisition, dedicated views of sacroiliac joints are not superior to anteroposterior pelvic views. In addition, sacroiliac MRI has a higher sensitivity and inter-reader agreement to detect joint space narrowing and erosions than conventional radiograph.
According to Navarro-Compán, although MRI abnormalities may be observed in non-SpA, erosions and deep bone marrow edema lesions are associated with axSpA. Lastly, she stressed the importance of interpreting MRI findings in the appropriate clinical context.
“What we have learned during the last year is that, on the one hand, inflammatory back pain neither necessary nor sufficient to diagnose axial spondyloarthritis,” Navarro-Compán said. “Also, all of the available referral models seem to perform well, but the selected model will depend on the context in which they will be applied. On the other hand, we have learned that imaging is important, but not all-decisive.” – by Jason Laday
Reference:
Navarro-Compán V. Abstract SP0063. Presented at: EULAR Annual Congress; June 13-16, 2018; Amsterdam.
Disclosure: Navarro-Compán reports consulting and speaking fees, as well as research grants, from AbbVie, BMS, Eli Lilly, MSD, Novartis, Pfizer, Roche and UCB.