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ASAS consensus definition of early axial spondyloarthritis
  1. Victoria Navarro-Compán1,2,
  2. Diego Benavent1,2,
  3. Dafne Capelusnik3,4,
  4. Désirée van der Heijde5,
  5. Robert BM Landewé6,7,
  6. Denis Poddubnyy8,9,
  7. Astrid van Tubergen10,11,
  8. Xenofon Baraliakos12,13,
  9. Filip E Van den Bosch14,15,
  10. Floris A van Gaalen5,
  11. Lianne Gensler16,
  12. Clementina López-Medina17,18,
  13. Helena Marzo-Ortega19,20,
  14. Anna Molto21,22,
  15. Rodolfo Pérez-Alamino23,
  16. Martin Rudwaleit24,
  17. Marleen van de Sande25,
  18. Raj Sengupta26,
  19. Ulrich Weber27,
  20. Sofia Ramiro5,7
  1. 1Rheumatology, La Paz University Hospital, Madrid, Spain
  2. 2IdiPAZ, Madrid, Spain
  3. 3Universiteit Maastricht Care and Public Health Research Institute, Maastricht, The Netherlands
  4. 4Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  5. 5Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  6. 6Department of Rheumatology & Clinical Immunology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
  7. 7Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
  8. 8Department of Gastroenterology, Infectious Diseases and Rheumatology, Charite Universitatsmedizin Berlin, Berlin, Germany
  9. 9German Rheumatism Research Center, Berlin, Germany
  10. 10Maastricht University Care and Public Health Research Institute, Maastricht, The Netherlands
  11. 11Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
  12. 12Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
  13. 13Ruhr-Universitat Bochum, Bochum, Germany
  14. 14Internal Medicine and Pediatrics, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
  15. 15Ghent University, Gent, Belgium
  16. 16Medicine, Division of Rheumatology, University of California, San Francisco, California, USA
  17. 17Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
  18. 18Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
  19. 19Rheumatology, Leeds Biomedical Research Centre, Leeds, UK
  20. 20University of Leeds Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
  21. 21APHP, INSERM U-1158, Rheumatology, Hospital Cochin, Paris, France
  22. 22Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
  23. 23Rheumatology, Avellaneda Hospital, Tucuman, Argentina
  24. 24Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhohe, Bielefeld, Germany
  25. 25Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, The Netherlands
  26. 26Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
  27. 27Practice Buchsbaum, Rheumatology, Schaffhausen Hospitals, Schaffhausen, Switzerland
  1. Correspondence to Dr Victoria Navarro-Compán, Rheumatology, La Paz University Hospital, Madrid 28046, Spain; mvictoria.navarroc{at}


Objectives To develop a consensual definition for the term ‘early axial spondyloarthritis—axSpA’—and ‘early peripheral spondyloarthritis—pSpA’.

Methods The ASAS (Assessment of SpondyloArthritis international Society-Spondyloarthritis EARly definition) steering committee convened an international working group (WG). Five consecutive steps were followed: (1) systematic literature review (SLR); (2) discussion of SLR results within the WG and ASAS community; (3) a three-round Delphi survey inviting all ASAS members to select the items that should be considered for the definition; (4) presentation of Delphi results to the WG and ASAS community and (5) ASAS voting and endorsement (2023 annual meeting).

Results Following the SLR, consensus was to proceed with an expert-based definition for early axSpA (81% in favour) but not for pSpA (54% against). Importantly, early axSpA should be based on symptom duration taking solely axial symptoms into account. 151–164 ASAS members participated in the Delphi surveys. Consensus was achieved for considering the following items within early axSpA definition: duration of symptoms ≤2 years; axial symptoms defined as cervical/thoracic/back/buttock pain or morning stiffness; regardless of the presence/absence of radiographic damage. The WG agreed that in patients with a diagnosis of axSpA ‘early axSpA’ should be defined as a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA. The ASAS community endorsed this proposal (88% in favour).

Conclusions Early axSpA has newly been defined, based on expert consensus. This ASAS definition should be adopted in research studies addressing early axSpA.

  • Spondylitis, Ankylosing
  • Arthritis
  • Outcome Assessment, Health Care

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  • Handling editor Josef S Smolen

  • Twitter @annamolto, @sofiaramiro82

  • Contributors VN-C and SR designed the study and developed the study protocol. DB and DC performed the survey and summarised the data. All authors participated actively in the project. VN-C and SR wrote the first draft of the manuscript. All authors critically reviewed the manuscript for important intellectual contribution and approved the final version.

  • Funding The Assessment of SpondyloArthritis international Society (ASAS) funded Diego Benavent to work on this project.

  • Competing interests VN-C: Speaker fees—AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma; Consultancy fees- AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma; Grants: AbbVie, Novartis. DB: Grant/research support from Novartis, and speaker fees from Janssen, Abbvie, and Galapagos. DvdH: Consulting AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma. Director of Imaging Rheumatology bv. RBML: Consulting AbbVie, Eli-Lilly, Janssen, Galapagos, Gilead, Novartis, Pfizer, UCB. Director of Rheumatology Consultancy BVD. DP: Research grant from AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Consultation AbbVie, Biocad, BMS, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Samsung Bioepis, UCB, Speaker AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB. AvT: Speaker fees: Pfizer; Consulting fees: Novartis, Galapagos, UCB; Grants: Pfizer, UCB, Novartis XB: Abbvie, Amgen, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB. FEVdB: received speaker and/or consultancy fees from AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB FAvG: Research Grants—Novartis; consultancy -MSD, AbbVie, Novartis and BMS LG: Research grants UCB, Novartis, Consulting fees AbbVie, Acelyrin, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, UCB Pharma CL-M: Speaker fees AbbVie, Eli Lilly, Novartis, Janssen, UCB Pharma. Consulting fees Eli Lilly, Novartis, UCB Pharma. HM-O: Speaker fees/consultancy: ABvie, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer and UCB. Research grants from Janssen, Novartis and UCB. AM: Consulting fees AbbVie, Biogen, BMS, Cyxone, Eisai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB Pharma. Grants: UCB RP-A: Speaker fees Abbvie, Eli Lilly, Novartis, Janssen, Pfizer. Consulting fees Abbvie, Eli Lilly, Janssen, Novartis. MR: Speaker- AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Novartis, UCB Pharma; Consultancy AbbVie, Eli Lilly, Novartis, Pfizer, UCB Pharma MvdS: Speaker -Janssen, Novartis, UCB; Consultancy Abbvie, Eli Lilly, Novartis, UCB; Research Grants: Eli Lily, Novartis, UCB RS: Speaker - AbbVie, Biogen, Eli Lilly, MSD, Novartis, UCB; Consultancy—AbbVie, Eli Lilly, Novartis, Pfizer, UCB. Grants: AbbVie, Novartis, UCB UW: Speaker fees NovartisS. SR: Research Grants—AbbVie, Galapagos, MSD, Novartis, Pfizer, UCB; consultancy—AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Sanofi, UCB.

  • Provenance and peer review Not commissioned; externally peer reviewed.