Detect the Foe of nr-axSpA for Your Patients Image Text
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axSpA=axial spondyloarthritis;
nr-axSpA=nonradiographic axial spondyloarthritis.
Detect nr-axSpA and know that you can find this foe.
 
axSpA=axial spondyloarthritis;
nr-axSpA=nonradiographic axial spondyloarthritis.
axSpA is a Painful Inflammatory Axial Disease Banner axSpA is a Painful Inflammatory Axial Disease Banner
A spectrum of painful inflammatory axial disease
 
Axial spondyloarthritis (axSpA) is generally considered to be a spectrum of disease ranging from nonradiographic axial spondyloarthritis (nr-axSpA) to ankylosing spondylitis (AS).1
The Progression of axSpA Visual Aid
The Progression of axSpA Visual Aid
At least 50% of patients will eventually progress from nr-axSpA to AS2
Risk factors for progression include2:
HLA B27 Positive Risk Factor Icon
HLA-B27 positive
High Inflammatory Activity Risk Factor Icon

High inflammatory activity

  • Elevated CRP
  • Inflammatory changes of sacroiliac joints on MRI
Buttock Pain Risk Factor Icon
Buttock pain
Smoking Risk Factor Icon
Smoking
History of Uveitis Risk Factor Icon
History of uveitis
Low-grade Sacroiliitis Risk Factor Icon
Low-grade sacroiliitis
axSpA can be a nightmare for patients, whether you can
see it on x-ray or not.
AS=ankylosing spondylitis; CRP=C-reactive protein; HLA=human leukocyte antigen; MRI=magnetic resonance imaging.
The Disease Burden of axSpA Banner The Disease Burden of axSpA Banner
axSpA puts distinct burdens on patients across the disease spectrum3
 
People with nr-axSpA often suffer from IBP causing nightly back pain and morning stiffness for monthsespecially if their stiffness resolves with movementwithout telling you about it.4
Both nr-axSpA and AS have substantial and similar symptom burdens3
Pain is a Symptom Burden Icon
Pain
Fatigue is a Symptom Burden Icon
Fatigue
Functional Impairment is a Symptom Burden Icon
Functional
impairment

Activity Impairment is a Symptom Burden Icon
Work time lost
Activity Impairment is a Symptom Burden Icon
Activity
impairment
nr-axSpA vs AS5-7
Similarities

  • Clinical presentation
  • Level of pain
  • Decrease in functional abilities
  • Decrease in HRQoL*
  • Patient global assessment of disease
Differences

  • Radiographic damage in AS
  • Lower spinal mobility in AS
  • More women with nr-axSpA (2:1 ratio vs men)
  • More men with AS (2:1 ratio vs women)
 
Rheumatologists are in the unique position of being able to clinically
identify patients, even before axSpA is visible on x-ray.
*As measured by SF-36 and ASQoL questionnaires.5

AS=ankylosing spondylitis; ASQoL=Ankylosing Spondylitis Quality of Life; axSpA=axial spondyloarthritis; CRP=C-reactive protein; HRQoL=health-related quality of life; IBP=inflammatory back pain; nr-axSpA=nonradiographic axial spondyloarthritis; SF-36=Short Form 36 Health Survey.
How to Identify axSpA Banner
axSpA can be identified with or without imaging1
 
Due to the lack of radiographic evidence, identifying nr-axSpA requires your clinical judgment to recognize not only inflammatory back pain (IBP) but also other features of SpA.
 
 
Classification criteria with and without imaging
 
You can predict nr-axSpA with 88% accuracy using the clinical arm of the ASAS axSpA classification criteria.8
Classification Criteria for nr-axSpA and AS
Classification Criteria for nr-axSpA and AS
SpA features1
 
A common symptom of nr-axSpA is IBP, which can lead to nightly back pain.4 Are your patients experiencing symptoms in the night? Apply your clinical judgment to identify nr-axSpA based on objective signs of inflammation, positive genetic testing, and at least 2 SpA features.1,10*
A Diagram of the SpA Features Shown on the Human Body
A Diagram of the SpA Features Shown on the Human Body
Identifying IBP
Help your patients understand the cause of their
nightly pain by identifying nr-axSpA today.
*Objective signs of inflammation include, but are not limited to, elevated CRP (with chronic back pain), enthesitis, dactylitis, and sacroiliitis on MRI. Genetic testing refers to HLA-B27 positivity.10

ASAS=Assessment of SpondyloArthritis international Society criteria; axSpA=axial spondyloarthritis; CRP=C-reactive protein; HLA=human leukocyte antigen; MRI=magnetic resonance imaging; nr-axSpA=nonradiographic axial spondyloarthritis; NSAIDs=nonsteroidal anti-inflammatory drugs; SpA=spondyloarthritis; UC=ulcerative colitis.
The Gender Differences for axSpA Banner The Gender Differences for axSpA Banner
nr-axSpA: A particular nightmare for women
 
While AS has a 2:1 ratio of men to women, the opposite is true for nr-axSpA, where up to two-thirds of patients are women.7
 
 
nr-axSpA disproportionately affects women7
 
In general, axSpA is identified later in women than in men. This may be because women may develop radiographic progression later and less frequently than males, even after years of symptoms.7 Despite no visible damage on x-ray, it still has a comparable symptom burden to AS.3
 
Furthermore, symptoms may overlap with those of fibromyalgia, another syndrome that affects more women than men. This can also contribute to diagnostic delays for women.11
axSpA presents differently in women vs men
 
Women and men with axSpA may present with different symptom clusters, with women demonstrating more peripheral pain than men.13
The Different Symptoms Apparent in Men and Women Diagram
The Different Symptoms Apparent in Men and Women Diagram
With longer diagnostic delays, more peripheral pain, and less evidence seen with imaging, its no wonder so many female patients are still in the dark.
When you see female patients younger than 45 years who suffer through the
night with chronic inflammatory back pain, assess them for nr-axSpA.
AS=ankylosing spondylitis; axSpA=axial spondyloarthritis; nr-axSpA=nonradiographic axial spondyloarthritis.
Downloadable Resources to Help Detect axSpA Banner Downloadable Resources to Help Detect axSpA Banner
Detect axSpA: Downloadable educational resources
 
Its time to reconsider your approach to the identification of axSpA.
Learn more facts about axSpA in the downloadable resources found below.

AS prevalence is rising, and symptoms present differently in men vs women.13-15
axSpA can be diagnosed with or without radiographic evidence of sacroiliitis, depending on criteria used.1,9
AS and nr-axSpA have a similar prevalence of extra-articular manifestations.16

AS has a different pathophysiology and different structural outcomes than rheumatoid arthritis (RA).17
Using the SPARTAN-stated goals of AS treatment can be an important discussion point with your patient.18
A patient with inflammatory back pain plus ≥2 SpA features has a 90% probability of progressing to AS.19

Elevated CRP at baseline was the strongest predictor of disease progression in patients with AS and nr-axSpA.20
Fibromyalgia can coexist with or mask AS.21
Validated tools are available to help you assess AS disease activity and/or treatment response.

Prescribing exercise is important for patients with AS.22
axSpA patients may find it difficult to report their true level of pain to their healthcare providers.
Learn more facts about axSpA in the downloadable resources found below.

AS=ankylosing spondylitis; CRP=C-reactive protein; nr-axSpA=nonradiographic axial spondyloarthritis; SpA=spondyloarthritis.

References: 1. Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777-783. 2. Protopopov M, Poddubnyy D. Radiographic progression in non-radiographic axial spondyloarthritis. Expert Rev Clin Immunol. 2018;14(6):525-533. 3. Mease PJ, van der Heijde D, Karki C, et al. Characterization of patients with ankylosing spondylitis and nonradiographic axial spondyloarthritis in the US-based Corrona Registry. Arthritis Care Res (Hoboken). 2018;70(11):1661-1670. 4. Strand V, Singh JA. Evaluation and management of the patient with suspected inflammatory spine disease. Mayo Clin Proc. 2017;92(4):555-564. 5. Kiltz U, Baraliakos X, Karakostas P, et al. Do patients with non-radiographic axial spondylarthritis differ from patients with ankylosing spondylitis? Arthritis Care Res (Hoboken). 2012;64(9):1415-1422. 6. Malaviya AN, Kalyani A, Rawat R, Gogia SB. Comparison of patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) from a single rheumatology clinic in New Delhi. Int J Rheum Dis. 2015;18(7):736-741. 7. Boonen A, Sieper J, van der Heijde D, et al. The burden of non-radiographic axial spondyloarthritis. Semin Arth Rheum. 2015;44(5):556-562. 8. Sepriano A, Landewé R, van der Heijde D, et al. Predictive validity of the ASAS classification criteria for axial and peripheral spondyloarthritis after follow-up in the ASAS cohort: a final analysis. Ann Rheum Dis. 2016;75(6):1034-1042. 9. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361-368. 10. Vidal C, Lukas C, Combe B, et al. Poor efficacy of TNF inhibitors in non-radiographic axial spondyloarthritis in the absence of objective signs: a bicentric retrospective study. Joint Bone Spine. 2018;85(4):461-468. 11. Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician. 2007;76(2):247-254. 12. Sieper J, Rudwaleit M. Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis. 2005;64(5):659-663. 13. Lee W, Reveille JD, Davis JC Jr, Learch TJ, Ward MM, Weisman MH. Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis. 2007;66(5):633-638. 14. Cross MJ, Smith EU, Zochling J, March LM. Differences and similarities between ankylosing spondylitis and rheumatoid arthritis: epidemiology. Clin Exp Rheumatol. 2009;27(4 suppl 55):S36-S42. 15. Chen HH, Chen TJ, Chen YM, Ying-Ming C, Chen DY. Gender differences in ankylosing spondylitis-associated cumulative healthcare utilization: a population-based cohort study. Clinics (Sao Paulo). 2011;66(2):251-254. 16. De Winter JJ, van Mens LJ, van der Heijde D, Landewé R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther. 2016;18:196. 17. Lories RJ, Baeten DL. Differences in pathophysiology between rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27(4 suppl 55):S10-S14. 18. Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Care Res. 2016;68(2):151-166. 19. Rudwaleit M, van der Heijde D, Khan MA, Braun J, Sieper J. How to diagnose axial spondyloarthritis early. Ann Rheum Dis. 2004;63(5):535-543. 20. Poddubnyy D, Rudwaleit M, Haibel H, et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis. 2011;70(8):1369-1374. 21. Ablin JN, Eshed I, Berman M, et al. Prevalence of axial spondyloarthritis among patients with fibromyalgia: a magnetic resonance imaging study with application of the Assessment of SpondyloArthritis international Society classification criteria. Arthritis Care Res (Hoboken). 2017;69(5):724-729. 22. O'Dwyer T, McGowan E, O'Shea F, Wilson F. Physical activity and exercise: perspectives of adults with ankylosing spondylitis. J Phys Act Health. 2016;13(5):504-513.