Background Axial spondyloarthritis (axSpA) is still a relatively new term in rheumatology and the recent nomenclature separating axial vs. peripheral and radiographic and non-radiographic spondyloarthritis has changed the perspective of ankylosing spondylitis (AS) by switching the focus towards earlier diagnosis and treatment of the disease.
Objectives The aim of our study was to better understand the differences between patients with non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis and assess whether treatment strategies that have demonstrated efficacy in AS can be applied to earlier forms of the disease.
Methods We used patient record data collected as part of an online treatment survey conducted among a panel of 257 European rheumatologists in 2014 across the main 5 EU markets of France, Germany, Italy, Spain, UK. We review 2038 patient cases for nr-axSpA and 5569 for AS. All data were tested for statistical significance using two-sided tests with a significance level of 0.05
Results On average, nr-axSpA patients were significantly younger (38.5 year) than AS patients (40.0) and were significantly more likely to be female (41.2% vs. 27.1%). We observed a similarly high proportion of comorbidities among patients from both groups and AS patients were significantly more likely to suffer from enthesitis, hypertension, uveitis and Crohn's disease. Nr-axSpA patients more commonly suffered from fibromyalgia and depression. There were no significant differences in physicians' perceptions of patients' current disease severity although nr-axSpA patients were more commonly thought to have mild disease at diagnosis (21.4% vs. 14.6% for AS) while AS patients were more likely to be severe (26.9% vs. 19.8% for nr-axSpA). While nr-axSpA patients were reported to have significantly higher mean BASDAI scores (2.6 vs. 2.1) a greater proportion of AS patients were unable to work due to their disease (3.1% vs. 2.0%). This may in part be due to the fact that a greater proportion of AS patients had axial and peripheral joint involvement (38.9% vs. 31.7% for nr-axSpA). We also observed key differences in the treatment approaches used in both groups. While the mean time between diagnosis and first biologic was significantly shorter for nr-axSpA patients (24.1 months vs. 44.9 for AS) and they tried, on average, fewer non-steroidal anti-inflammatories (NSAIDS) before biologic therapy, overall use of biologics was higher among AS patients (52.3% vs. 43.8% for nr-axSpA). Conversely nr-axSpA patients were significantly more likely to be treated with corticosteroids and NSAIDS.
Conclusions Overall, our data suggests that nr-axial SpA is a more heterogenous disease when compared to AS however, physicians appear to be comfortable with using therapies that have demonstrated efficacy in AS and using aggresive step-up approaches to treatment combining biologics, steroids and NSAIDS early in the disease to maximise patient outcomes.
Disclosure of Interest None declared