Background Axial Spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly affecting the sacroiliac joints and spine. Ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA) have been considered to represent the same axial spondyloarthritis disorder, but are differentiated by the presence or absence of structural changes in the sacroiliac joints as determined by common imaging modalities.
Objectives To better understand the symptoms and clinical characteristics of nr-axSpA patients and how they compare to ankylosing spondylitis patients in Europe.
Methods Data drom the 2015 SpA Disease Specific Programme, a cross-sectional, multi-national survey of patients and rheumatologists conducted in France, Germany, Italy, Spain, and the UNited Kingdom were analyzed. Rheumatologists (n=299) completed forms containing patient demographics, clinical results and symptomology. Symptoms, disease activity, and disease status (defined as improving, stable, unstable, deteriorating) of AS and nr-axSpA patients were compared.
Results A total of 3,033 patients (AS: 1,520; nr-axSpA: 1,513) were included in the analysis. A higher proportion of AS patients were male (72% vs. 53%), older (mean age=44.8 vs. 41.0), had a higher BMI and were employed when compared to nr-axSpA patients. Nr-axSpA patients' current disease status was less likely to be stable (p<0.0001) in comparison to AS patients. Nr-axSpA patients were also less likely to be in remission (p<0.0001). Nr-axSpA patients were reported as having higher pain level (p=0.0333) than AS patients. AS patients had more axSpA symptoms, such as spinal fusion and loss of movement, however nr-axSpA patients were more likely to have inflammatory back pain, enthesitis, persistent lower back pain, and nocturnal wakening.
Conclusions Both nr-axSpA and AS appear to have many similar clinical characteristics with few distinct features between them. However, in spite of these similarities, nr-axSpA patients show less stability and a lower likelihood of remission when compared to AS patients. These findings may suggest that nr-axSpA is as burdensome as AS, and that both conditions may warrant similar treatment approaches from an early stage.
Disclosure of Interest T. Hunter Employee of: Eli Lilly and Company, D. Sandoval Employee of: Eli Lilly and Company, S. Lobosco Employee of: Adelphi Real World, R. Moon Employee of: Adelphi Real World, J. Birt Employee of: Eli Lilly and Company, G. Miligan Employee of: Adelphi Real World