The unusual atypical presentations were mainly reported among adult SpA. [dovepress.com]

[…] of radiographic sacroiliitis but present as non-radiographic axial spondyloarthritis (nr-axSpA) where both are varieties of axSpA. [thieme-connect.com]

[…] treatment goals with their doctor Co-creating solutions with all stakeholders will improve quality of life and standard of care for people living with axSpA Expanding the axSpA patient voice We are pleased to announce that seven abstracts have been presented [asif.info]

Clinical presentations also differ between men and women, making a challenging diagnosis even more complex. [healio.com]

Ultimately, the question of whether progression from nr- to r-axSpA or even disease presentation could be prevented remains to be answered. [academic.oup.com]

• Fatigue

  In this study, fatigue severity was reduced on average by 20%, and most patients reported residual fatigue while on treatment.59 Whereas Keat and colleagues60 found that tumor necrosis factor α inhibitor therapy improved patients' capacity for work, other [journals.lww.com]

  Many will experience severe fatigue, as well as a flare at some point which can make socialising, work and exercising problematic. [nihealthcare.com]

  Both conditions have similar symptoms of back pain, fatigue, and reduced activity. [monsterpainintheas.com]

  Learn more about fatigue and how it can be managed Read more Learn more about flares and how to prepare Read more Find out what medications are used to manage your axial SpA (AS) Read more 220k Adults in the UK 1 in 200 of the adult population in the [nass.co.uk]

  Fatigue: Chronic and long-term fatigue in AxSpA is common, affecting up to 68% of people with nr-AxSpA. People who have this condition describe their fatigue as a type of tiredness never before experienced. [verywellhealth.com]

• Fever

  Myopathies Juvenile Arthritis Juvenile Dermatomyositis Kawasaki Disease (KD) Localized Scleroderma (Juvenile) Lupus Lyme Disease Metabolic Myopathies Osteoarthritis Osteonecrosis Osteonecrosis of the Jaw (ONJ) Osteoporosis Paget's Disease of Bone Periodic Fever [rheumatology.org]

  She had a poor appetite but denied a history of fever or weight loss. Systemic review was otherwise unremarkable. [dovepress.com]

  […] your doctor if you: are being treated for an infection have an infection that does not go away or that keeps coming back have TB or have been in close contact with someone with TB think you have an infection or have symptoms of an infection, such as: fevers [cosentyx.com]

  If you suffer from chronic fatigue and fevers, you may not be able to work at a desk very long. [disability-benefits-help.org]

• Weight Loss

  Tell your doctor if you have any of these symptoms or if they get worse: stomach pain, diarrhea, and weight loss. You should not get live vaccines while taking Taltz. You should get the vaccines you need before you start Taltz. [taltz.com]

  loss; warm, red, or painful skin or sores on your body; diarrhea or stomach pain; burning when you urinate or urinate more often than normal After starting COSENTYX, call your doctor right away if you have any signs of infection listed above. [cosentyx.com]

  Symptoms may include chronic diarrhea, abdominal pain, weight loss, and/or blood in the stool. The most common types of inflammatory bowel diseases are Crohn’s, ulcerative colitis, and undifferentiated colitis. [spondylitis.org]

• Reiter Syndrome

  Five subgroups of spondyloarthritis are distinguished: ankylosing spondylitis: 90% HLAB27 positive psoriatic arthritis: 60% HLAB27 positive 1 reactive arthritis (Reiter syndrome): 85% HLAB27 positive enteropathic arthritis (i.e. extraintestinal manifestation [radiopaedia.org]

  Reactive arthritis, also known as Reiter’s syndrome, is a form of inflammatory arthritis caused by an infection. Reactive arthritis usually causes pain in the low back, and it will subside without treatment. [spineuniverse.com]

  There are 4 major seronegative spondyloarthropathies: Ankylosing Spondylitis (AS): is the prototype and effects more men than women Reiter’s Syndrome Psoriatic Arthritis Arthritis of Inflammatory Bowel Disease Sacroiliitis is a common manifestation in [physio-pedia.com]

• Chronic Fatigue Syndrome

  Hypothesis: Cytokines may be activated to cause depressive illness and chronic fatigue syndrome. Eur Arch Psychiatry Clin Neurosci. 1992;241(5):317-22. [41] Roy A, Campbell MK. [content.sciendo.com]

• Chest Wall Pain

  Adult population on the contrary manifests as an inflammatory back pain.2 Additionally, SpA can present with different atypical presentations that include fever of unknown origin,3 thigh pain, anterior chest wall pain, polymyalgia rheumatica,4 and valvular [dovepress.com]

  Chlamydia infections resulting in genitourinary symptoms are also a common trigger.19 Musculoskeletal system: examine patients for the presence of:3 Achilles tendinitis and plantar fasciitis Chest wall pain, which can be caused by intercostal enthesitis [bpac.org.nz]

  Anterior chest wall pain in recent inflammatory back pain suggestive of spondyloarthritis: data from the DESIR cohort. J Rheumatol. 2013;40(7):1148–52. Article PubMed Google Scholar 41. Bogduk N. The innervation of the lumbar spine. [arthritis-research.biomedcentral.com]

• Chest Pain

  Other possible symptoms include: soreness at the heel or in the arch of your foot pain and swelling in a finger or toe tenderness at the base of your pelvis, which can make sitting on a hard chair uncomfortable chest pain or a tightness around the chest [versusarthritis.org]

  On the basis of previous work on anterior chest pain, researchers have reported rather similar sternal pain occurrence between men and women, but focused on local joint pain only [39, 40]. [arthritis-research.biomedcentral.com]

  Other symptoms you may experience include: Soreness at the heel or in the arch of your foot Pain and swelling in your finger or toe Tenderness at the base of your pelvis, which can make sitting uncomfortable Chest pain or tightness that comes on gradually [healthcentral.com]

• Blurred Vision

  See an eye specialist immediately if you develop a painful red eye, severe light sensitivity or blurred vision. Causes Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. [mayoclinic.org]

  vision of the iris (colored part of the eye). [verywellhealth.com]

  […] the neck) Hip pain (linked to AS-related SI joint pain) Neurological symptoms (eg, pain, numbness, weakness) in the arms and legs (this may indicate that inflammation is compressing spinal nerves) Weakness and fatigue Eye-related symptoms, including blurred [spineuniverse.com]

  vision) Referral criteria for suspected axial Spondyloarthritis The person has low back pain that started before the age of 45 years and has lasted for longer than 3 months, with: 4 or more of the additional criteria below OR Exactly 3 of the additional [scarboroughryedaleccg.nhs.uk]

  These include skin/nail psoriasis, inflammatory bowel disease (Crohn's disease/ulcerative colitis) and uveitis (acute severe eye pain, eye redness, sensitivity to light or blurred vision). [csp.org.uk]

• Arthritis

  365 patients with psoriatic arthritis, and 333 patients with AxSpA found that patients with AxSpA and psoriatic arthritis experienced more pain and fatigue than did those with rheumatoid arthritis, and patients with AxSpA had more overall and nighttime [journals.lww.com]

  Reactive arthritis, also known as Reiter’s syndrome, is a form of inflammatory arthritis caused by an infection. Reactive arthritis usually causes pain in the low back, and it will subside without treatment. [spineuniverse.com]

  Arthritis Care Res 64 (2012): 905–10. [medicinenet.com]

  Helmick CG, Felson DT, Lawrence RC, et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. part I. Arthritis Rheum. 2008;58(1):15-25. doi: 10.1002/art.23177. 5. [ajmc.com]

  People with reactive arthritis, enteropathic arthritis, undifferentiated spondyloarthritis, and psoriatic arthritis may fit into the category of either radiographic AxSpA or nonradiographic AxSpA. [spondylitis.ca]

• Back Pain

  Keep Reading Quiz: Is Your Back Pain Inflammatory or Mechanical? Does Fibromyalgia Cause Back Pain? The Latest Treatment Guidelines for Axial Spondyloarthritis: What to Know [creakyjoints.org]

  This is a chronic inflammatory disease primarily resulting in inflammatory back pain. Inflammatory back pain is different from mechanical back pain. [myspondylitisteam.com]

  The signs and symptoms of nr-axSpA may include chronic back pain and some of the following: There may be back pain, especially in the axial (spine) joints of the sacroiliac joints due to inflammation. [emedicinehealth.com]

• Morning Stiffness

  stiffness lasts longer than 30 minutes, versus mild, transient morning stiffness with mechanical pain4,12 Help your patients understand the cause of their nightly pain by identifying nr-axSpA today. nr-axSpA: A particular nightmare for women While AS [factsaboutaxspa.com]

  The typical symptoms of nr-axSpA are back pain and morning stiffness. Patients with nr-axSpA do not have abnormalities of the sacroiliac joints on standard X-rays, such as those seen in classic ankylosing spondylitis. [medicinenet.com]

  Typical symptoms of axial SpA (AS) include: Slow or gradual onset of back pain and stiffness over weeks or months, rather than hours or days Early-morning stiffness and pain, wearing off or reducing during the day with exercise Persistence for more than [nass.co.uk]

  However, the condition is often misdiagnosed with RA because around 90% of patients with axSpA report morning stiffness that can last up to 30 minutes, and more than one swollen joint may be present. [healio.com]

  Patients report on a numeric response scale of 0–10 or by 0- to 10-cm VAS while duration of morning stiffness is anchored by a time scale of 0–2 or more hours. [content.sciendo.com]

• Low Back Pain

  Prevalence of chronic low back pain: systematic review [published online ahead of print October 20, 2015]. [mayoclinicproceedings.org]

  Here, a 27-year-old male patient presented with bilateral heel pain, pain in low back, pain on base of right toes, pain in neck with stiffness for 1 year had refractive response to conventional medication. [thieme-connect.com]

  Axial presentations of spondyloarthritis are often misdiagnosed as mechanical low back pain, leading to delays in access to effective treatments. [scarboroughryedaleccg.nhs.uk]

  Nevertheless, there are patients who cannot be classified using the new ASAS criteria, although their clinical data suggest SpA, as occurs in the following clinical setting: a 40-year-old man with a 1-year history of inflammatory low back pain, HLA B27 [reumatologiaclinica.org]

  back pain of mechanical origin. [ajmc.com]

• Osteoporosis

  The most common comorbidities are osteoporosis (thinning of the bones) and cardiovascular diseases (CVD). Identifying and understanding them will improve the management of this condition. [hra.nhs.uk]

  Osteoporosis of the spine and peripheral bones is common in ankylosing spondylitis. [resident360.nejm.org]

  Related Disease (IgG4-RD) Inflammatory Myopathies Juvenile Arthritis Juvenile Dermatomyositis Kawasaki Disease (KD) Localized Scleroderma (Juvenile) Lupus Lyme Disease Metabolic Myopathies Osteoarthritis Osteonecrosis Osteonecrosis of the Jaw (ONJ) Osteoporosis [rheumatology.org]

  Many patients often experience other manifestations such as enthesitis, peripheral arthritis, dactylitis, uveitis, psoriasis, inflammatory bowel disease and osteoporosis. [ucb.com]

• Sleep Disturbance

  Symptoms tend to worsen in the early morning hours, causing sleep disturbance in many patients. Inflammatory back pain will tend to improve with stretching and physical activity and worsen with prolonged inactivity. [hopkinsarthritis.org]

  Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance. Rheumatol Int. 2012;32:2117–2124. 25. Cakar E, Taskaynatan MA, Dincer U, et al. [journals.lww.com]

If the source of the pain is not accurately diagnosed, patients may be subject to unnecessary diagnostic workups for cardiovascular disease or other intrathoracic diseases. [resident360.nejm.org]

All autoimmune workup including rheumatoid factor, anti-citrullinated peptide antibodies, antineutrophil cytoplasmic antibodies were negative except antinuclear antibody of 27 ( 20). All viral serologies were negative as well. [dovepress.com]

[…] scanning Magnetic resonance imaging (MRI) or computed tomography (CT) scanning of the SI joints, spine, and peripheral joints may reveal evidence of early sacroiliitis, erosions, and enthesitis that are not apparent on standard radiographs. [10, 11] See Workup [emedicine.medscape.com]

• Nephrolithiasis

  Is nephrolithiasis an unrecognized extra-articular manifestation in ankylosing spondylitis? A prospective population-based Swedish national cohort study with matched general population comparator subjects. PLoS ONE 2014;9:e113602. [bpac.org.nz]

• HLA-B27

  Methods In this cross-sectional study, we recruited 70 patients with chronic inflammatory back pain (mean disease duration of 5 years) and high disease activity (BASDAI 4) who had to be either HLA-B27 positive with 1 SpA-feature or HLA-B27 negative with [acrabstracts.org]

  Table 1 Different populations in non-radiographic axSpA (True) Non-radiographic Pre-radiographic (or early AS) F M M F HLA-B27 Neg HLA-B27 Pos MRI-ve MRI ve CRP-ve (unless peripheral arthritis) CRP ve More likely to be classified according to the "clinical [academic.oup.com]

  HLA-B27, a genetic marker, is thought to be present in more than 90% of Caucasians with the disease. However, HLA-B27 is less prevalent among African Americans with axSpA. Read more about the role of HLA-B27 and axSpA. [creakyjoints.org]

  for the ‘diagnostic puzzle,’ HLA-B27 is an important marker, but a negative HLA-B27 does not rule out the diagnosis of ax-SpA at all. [hamdanjournal.org]

“As more treatment options become available, this problem will grow.” [practicalpainmanagement.com]

New treatment targets and future treatment modalities in axial SpA As already mentioned above, only TNF α blockers are currently available as a second-line treatment in patients with AS/axSpA who do not respond to NSAIDs. [ncbi.nlm.nih.gov]

Recent evidence suggests early treatment with exercise, physiotherapy and pharmacological treatments may delay disease progression and therefore improve outcomes. [bpac.org.nz]

“There is a need for additional treatment options. Having a new treatment option for the axSpA community is truly encouraging,” Cassie Shafer, CEO of the Spondylitis Association of America, said in a press release. [healio.com]

What is the prognosis for non-radiographic axial spondyloarthritis (nr-axSpA)? There is no known cure for nr-axSpA. Some patients with nr-axSpA may progress to develop ankylosing spondylitis. [medicinenet.com]

Treatment and prognosis All forms of spondyloarthritis may ultimately develop into ankylosing spondylitis in patients with longstanding disease 3. [radiopaedia.org]

Prognosis The prognosis for many patients with AS will be complete spinal ankylosis, while others will experience intermittent flares between bouts of clinical remission. [hopkinsarthritis.org]

An elevated CRP is associated with more aggressive disease and a worse prognosis.2 Radiographic imaging can detect changes consistent with ankylosing spondylitis, however, patients without radiographic changes may still have back pain due to early stage [bpac.org.nz]

The primary goal of any valid classification criteria for any disease is to provide a homogeneous study population with a common etiopathogenesis, similar prognosis, and similar response to identical treatment 36-38. [onlinelibrary.wiley.com]

Etiology The precise etiology of AS remains mostly unknown, though heritability is frequently cited as a significant contributor. Major histocompatibility alleles, particularly HLA-B27, may account for up to one-third of the genetic effect. [hopkinsarthritis.org]

Neurology assessment again did not reveal any suggestive etiology like multiple sclerosis as her MRI brain and lumbosacral spine were normal. MRI cervical spine showed only small disc herniation at C6–C7. [dovepress.com]

“What is the role of genetics in the etiology of ankylosing spondylitis (AS)?” [healthcentral.com]

Etiology The etiology of AS is unknown, but a combination of genetic and environmental factors works in concert to produce clinical disease. [28] Genetic predisposition The strong association of AS with HLA-B27 is direct evidence of the importance of [emedicine.medscape.com]

Diffuse swelling or puffiness of all digits in an extremity should trigger consideration of an alternative etiology. [mayoclinicproceedings.org]

Mudasir holds a masters in public health specializing in epidemiology from TISS, Mumbai. [decisionresourcesgroup.com]

Epidemiology of Axial Spondyloarthritis 4. Classification Criteria for Axial Spondyloarthritis 5. Genetics of Axial Spondyloarthritis 6. The Gut Microbiome and Ankylosing Spondylitis 7. Pathogenesis of Ankylosing Spondylitis 8. [elsevier.com]

Patient populations, geographical risk factors, and eligibility criteria varied widely among the studies, as did epidemiological estimates of SpA. In eight European studies SpA prevalence ranged from 0.3% in France to 1.7% in Germany. [medpagetoday.com]

By designing a protocol which securely extracts fully anonymised data, The wealth of data stored on this database is invaluable for answering many epidemiological questions. [hra.nhs.uk]

A very detailed review of its epidemiology was published early this year 2. Skeletal specimens in several museum collections testify that the disease has existed from the earliest times 3. [onlinelibrary.wiley.com]

Bone Pathophysiology in Axial Spondyloarthritis 9. Clinical Assessment of Axial Spondyloarthritis 10. Imaging in Axial Spondyloarthritis 11. Extra-articular Manifestations: Uveitis, Colitis, Psoriasis 12. Co-morbidities 13. [elsevier.com]

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. [factsaboutaxspa.com]

Not only because of the close relationship with the pathophysiology of the disease, but also because it constitutes an outcome of interest to be evaluated for all interventions, whether pharmacological or non-pharmacological. [elsevier.es]

“The available evidence suggests a common pathophysiological foundation of SpA as a whole, and thereby supports the concept that SpA is a single disease with a heterogenous phenotype,” Wright, who is president and founder of AWIR, told attendees. [healio.com]

Differences in pathophysiology between rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27:S10–S14. 17. Hamilton-West KE, Quine L. Living with ankylosing spondylitis: the patient's perspective. [journals.lww.com]

This exploratory analysis looked at the efficacy of secukinumab using data from the PREVENT study stratified by CRP and MRI status at study entry. [rheumatologynetwork.com]

About PREVENT PREVENT is an ongoing two-year randomized, double-blind, placebo-controlled Phase III study (with a two-year extension phase) to investigate the efficacy and safety of Cosentyx in patients with active nr-axSpA. [globenewswire.com]

[…] in the PREVENT clinical trial, said in the release. [healio.com]

Timely treatment can help to prevent permanent damage to bones and joints." [medicalxpress.com]

About PREVENT PREVENT is an ongoing two-year randomized, double-blind, placebo-controlled Phase III study (with a two-year extension phase) to investigate the efficacy and safety of Cosentyx, in patients with active nr-axSpA. [novartis.com]