Early axial spondyloarthritis defined as a symptom duration of less than 2 years
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Key takeaways:
- The new consensus definition includes symptoms lasting less than 2 years.
- Results were approved at a meeting of the Assessment of Spondyloarthritis International Society.
A new consensus definition for early axial spondyloarthritis indicates disease that has manifested symptoms for less than 2 years, according to a recommendation published in Annals of the Rheumatic Diseases.
“One of the main challenges in the management of SpA has always been the identification of the disease at an early stage,” Victoria Navarro-Compan, MD, of La Paz University, in Spain, and colleagues wrote. “In this sense, [axial SpA (axSpA)] is more challenging as it involves deep anatomical structures, where inflammation at this level is often only manifested by axial pain, such that both the patient and physician may either not recognize it or relate it to a possible axSpA.”
To craft a definition for early axial SpA — as well as for early peripheral spondyloarthritis — Navarro-Compan and colleagues in the Assessment in Spondyloarthritis International Society (ASAS) convened an international working group. Members completed a systemic literature review to investigate all definitions that have been published for axial SpA and early axial SpA, as well as the relationship between early disease and the response to therapy in these patients.
The results of the review were discussed among the working group in December 2021, before being presented to the full ASAS membership in 2022. The authors then conducted a Delphi survey to narrow down the terms and points to be included in the final definition. The results of the voting were presented and discussed with the whole community in January 2023. Following a presentation, the definition was negotiated, edited and voted upon again until a consensus was reached.
According to the authors, the voting group ultimately decided that early disease definition should only consider axial symptoms. The final definition, as decided by the voting members of the group, included symptoms that have been present for 2 or fewer years. The symptoms of relevance included cervical pain, thoracic pain, back pain, buttock pain or morning stiffness. Additionally, these symptoms are sufficient in the presence of, or lack of, radiographic evidence of damage.
“The ASAS-SPEAR project has successfully developed, for the first time, a consensus definition of ‘early axSpA,’ fulfilling an unmet need in research in this field,” Navarro-Compan and colleagues wrote. “It is now proposed that going forward, this definition should be used for research studies addressing early axSpA.”
Perspective
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The advent of biologic disease modifying/remittive therapies, now more than 2 decades ago, has changed the practice of rheumatology in significant ways. In particular, patient outcomes in many rheumatic diseases have been greatly improved with these new therapeutics.
However, with new treatments come new questions.
Navarro and colleagues in this consensus study addresses the lack of an approved definition for early axial spondyloarthritis. A standardized definition would help to create a more homogeneous patient selection for clinical trials, improving study outcomes. The authors point out: “One of the main challenges in the management of SpA has always been the identification of disease at an early stage.”
Rheumatologists in particular are familiar with long delays, sometimes approaching a decade, between symptom onset and the diagnosis of axial SpA. This delay allows time for an untreated inflammatory response to potentially cause permanent structural damage. As such, a better understanding of early axial SpA through standardized clinical trials might ultimately improve patient outcomes.
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