Should axial spondyloarthritis without radiographic changes be treated with anti-TNF agents?

Andrew Keat, Alexander N Bennett, Karl Gaffney, Helena Marzo-Ortega, Raj Sengupta, Tamara Everiss

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

A spectrum of disease extends beyond the rigid confines of ankylosing spondylitis (AS). Axial spondyloarthritis (axSpA) encompasses non-radiographic axSpA (nr-axSpA) in individuals without established radiographic changes but with other clinical/imaging axSpA features and AS in those with definite sacroiliac joint changes on pelvic X-rays. A broad consensus about the management of nr-axSpA is emerging among clinicians, but the evidence base remains open to question. To explore whether nr-axSpA and AS should be treated similarly, we examined the literature on their prevalence, natural history, disease burden, and treatment. There is strong evidence that nr-axSpA and AS are expressions of the same disease. Approximately 10% of patients with nr-axSpA will develop radiographic disease over 2 years; after >20 years, the figure may exceed 80%. Nr-axSpA patients have lower CRP and less spinal inflammation on MRI than AS patients but similar disease activity, pain, and quality-of-life impairment. Most patients with nr-axSpA manage well with conservative treatment, but a minority has severe disabling symptoms. Anti-TNF therapy has demonstrated similar efficacy and safety in nr-axSpA and AS. Current evidence does not clearly indicate that anti-TNF treatment can inhibit or limit bony progression of AS, the basis of conservative and anti-TNF treatment is control of symptoms and function. For some patients with nr-axSpA, the need for powerful treatments is as great as in some with AS; thus, treatment of axSpA should be consistent across the axSpA spectrum with anti-TNF agents being available, irrespective of radiographic change, according to the same criteria as those applied to AS.

Original languageEnglish
Pages (from-to)327-336
Number of pages10
JournalRheumatology International
Volume37
Issue number3
Early online date29 Dec 2016
DOIs
Publication statusPublished - Mar 2017

Fingerprint

Ankylosing Spondylitis
Therapeutics
Sacroiliac Joint
Natural History
Consensus
Quality of Life
X-Rays
Inflammation
Safety
Pain

Keywords

  • Antirheumatic Agents
  • Biological Products
  • Cost of Illness
  • Disease Progression
  • Humans
  • Prevalence
  • Radiography
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Spondylarthropathies
  • Time Factors
  • Tumor Necrosis Factor-alpha
  • Journal Article
  • Review

Cite this

Should axial spondyloarthritis without radiographic changes be treated with anti-TNF agents? / Keat, Andrew; Bennett, Alexander N; Gaffney, Karl; Marzo-Ortega, Helena; Sengupta, Raj; Everiss, Tamara.

In: Rheumatology International, Vol. 37, No. 3, 03.2017, p. 327-336.

Research output: Contribution to journalReview article

Keat, Andrew ; Bennett, Alexander N ; Gaffney, Karl ; Marzo-Ortega, Helena ; Sengupta, Raj ; Everiss, Tamara. / Should axial spondyloarthritis without radiographic changes be treated with anti-TNF agents?. In: Rheumatology International. 2017 ; Vol. 37, No. 3. pp. 327-336.
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AB - A spectrum of disease extends beyond the rigid confines of ankylosing spondylitis (AS). Axial spondyloarthritis (axSpA) encompasses non-radiographic axSpA (nr-axSpA) in individuals without established radiographic changes but with other clinical/imaging axSpA features and AS in those with definite sacroiliac joint changes on pelvic X-rays. A broad consensus about the management of nr-axSpA is emerging among clinicians, but the evidence base remains open to question. To explore whether nr-axSpA and AS should be treated similarly, we examined the literature on their prevalence, natural history, disease burden, and treatment. There is strong evidence that nr-axSpA and AS are expressions of the same disease. Approximately 10% of patients with nr-axSpA will develop radiographic disease over 2 years; after >20 years, the figure may exceed 80%. Nr-axSpA patients have lower CRP and less spinal inflammation on MRI than AS patients but similar disease activity, pain, and quality-of-life impairment. Most patients with nr-axSpA manage well with conservative treatment, but a minority has severe disabling symptoms. Anti-TNF therapy has demonstrated similar efficacy and safety in nr-axSpA and AS. Current evidence does not clearly indicate that anti-TNF treatment can inhibit or limit bony progression of AS, the basis of conservative and anti-TNF treatment is control of symptoms and function. For some patients with nr-axSpA, the need for powerful treatments is as great as in some with AS; thus, treatment of axSpA should be consistent across the axSpA spectrum with anti-TNF agents being available, irrespective of radiographic change, according to the same criteria as those applied to AS.

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JF - Rheumatology International

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