Page 22 - Recognizing axial spondyloarthritis - Janneke de Winter

CHAPTER TWO
ABSTRACT
Objective
Spondyloarthritis (SpA) can encompass axial, peripheral, and extra-articular disease manifestations. Patients are classified as axial or peripheral SpA depending on the presence or absence of back pain, independently of the other disease manifestations. Therefore, we aimed to assess the percentage of axial SpA patients with peripheral disease and how this peripheral disease contributes to the overall disease burden.
Methods
Prevalence and burden of peripheral disease manifestations were assessed in a real-life observational cohort of 314 patients with the clinical diagnosis of SpA and fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria.
Results
Of the 314 patients fulfilling the ASAS criteria, 230 fulfilled the axial and 84 the peripheral SpA criteria. Of the 230 axial SpA patients, 49% had purely axial disease without peripheral disease manifestations whereas 51% had combined axial (back pain) and peripheral (arthritis, enthesitis, and/or dactylitis) disease. The latter group had the highest disease activity in comparison with pure axial SpA as well as with peripheral SpA.
Conclusion
Half of the patients classified as axial SpA according to the ASAS criteria have also peripheral disease manifestations such as arthritis, enthesitis, and/or dactylitis. These peripheral disease manifestations contribute significantly to overall disease burden.
Key messages
• SpA patients with back pain are by definition classified as axial SpA, regardless of which disease manifestations, peripheral or axial, predominate.
• Half of the patients classified as axial SpA according to the ASAS criteria also have peripheral disease manifestations such as arthritis, enthesitis and/or dactylitis.
• Patients with combined axial and peripheral SpA have the highest disease activity when compared to purely axial SpA and purely peripheral SpA.
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