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

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

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

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

  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]

  The pain, stiffness and fatigue that accompany ankylosing spondylitis (AS), radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA) are barriers and can discourage patients from exercising, the experts said. [the-rheumatologist.org]

  The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) [7] measures pain, fatigue, and stiffness. [content.sciendo.com]

  Axial Spondyloarthritis (axSpA) is a chronic, inflammatory rheumatic disease that affects the axial skeleton, causing severe pain, stiffness and fatigue. [ucb.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]

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

  Paracetamol helps against pain and fever, does not cause stomach problems, usually does not cause side effects and can be easily combined with other medications. • An NSAID, an anti-inflammatory analgesic in a lower dose. [caribbeanarthritisfoundation.org]

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

• 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]

  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]

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

• 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]

  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]

• Chest Pain

  […] more Physical exam: Your doctor will apply pressure to check for pain and tenderness along the back, pelvic bones, sacroiliac joints, chest, and heels. [healthcentral.com]

• Blurred Vision

  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]

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

  vision) Case-finding in people with acute anterior uveitis Ophthalmologists should ask people with acute anterior uveitis whether they have: consulted their GP about joint pains or experienced low back pain that started before the age of 45 years and [guidelines.co.uk]

  If you experience these symptoms in one or both of your eyes, or if you have changes to your vision such as partial loss of sight, blurred vision, or floaters, get to an eye doctor as soon as possible. [healthcentral.com]

• Arthritis

  Arthritis Rheumatol. 2015; 67: 914-923 Paramarta J.E. De Rycke L. Heijda T.F. et al. Efficacy and safety of adalimumab for the treatment of peripheral arthritis in spondyloarthritis patients without ankylosing spondylitis or psoriatic arthritis. [rheumatic.theclinics.com]

  Arthritis und Rheuma 2015; 35(01): 18-23 DOI: 10.1055/s-0037-1618346 Bildgebende Verfahren in der Rheumatologie und Orthopädie Schattauer GmbH MRI in the diagnosis of axial spondylo arthritis U. Kiltz 1  Rheumazentrum Ruhrgebiet Herne, F. [thieme-connect.com]

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

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

  While it’s easy to think that your back pain is due to a muscle sprain or herniated disc, it’s important to see a rheumatologist if your back pain has inflammatory characteristics. [creakyjoints.org]

  Non-Radiographic Axial Spondyloarthritis (Nr-axSpA) Symptom Back Pain There are many causes of pain in the back. [medicinenet.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]

  While morning stiffness lacked sensitivity and specificity as a referral criterion for axial spondyloarthritis, prolonged morning stiffness (lasting more than 30 minutes) can be an important factor when an inflammatory disease is suspected. [csp.org.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]

  “Some symptoms of spondyloarthritis, such as low back pain, morning stiffness and sleep disorders associated with pain, are shared with fibromyalgia. [the-rheumatologist.org]

• Low Back Pain

  […] age of 35 years (this further increases the likelihood that back pain is due to spondyloarthritis compared with low back pain that started between 35 and 44 years) waking during the second half of the night because of symptoms buttock pain improvement [scarboroughryedaleccg.nhs.uk]

  back pain that started before the age of 45 years and has lasted for longer than 3 months, refer the person to a rheumatologist for a spondyloarthritis assessment if 4 or more of the following additional criteria are also present: low back pain that [guidelines.co.uk]

  “Some symptoms of spondyloarthritis, such as low back pain, morning stiffness and sleep disorders associated with pain, are shared with fibromyalgia. [the-rheumatologist.org]

  back pain that started before the age of 45 years and has lasted longer than three months, and if four or more of the following points apply: low back pain started before the age of 35 years (increases likelihood of axial spondyloarthritis) waking during [csp.org.uk]

  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]

• Buttock Pain

  […] anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Motrin and Advil), and naproxen (Aleve) Often occurs with “alternating buttock pain” (read more about buttock pain and AS) Often occurs with limited spinal flexibility, which can become so severe [creakyjoints.org]

  […] age of 35 years (this further increases the likelihood that back pain is due to spondyloarthritis compared with low back pain that started between 35 and 44 years) waking during the second half of the night because of symptoms buttock pain improvement [scarboroughryedaleccg.nhs.uk]

  […] at night or morning stiffness of lumbar or dorsal region 1 Asymmetric oligoarthritis 2 Buttock pain Or if alternate buttock pain 1 2 Sausage-like toe or digit 2 Heel pain or other well- defined enthesitis 2 Iritis 2 Non- gonococcal urethritis or cervicitis [physio-pedia.com]

  […] half of the night because of symptoms buttock pain improvement with movement improvement with taking non-steroidal anti-inflammatory drugs (often within 48 hours) current or past enthesitis current or past psoriasis current or past arthritis first-degree [csp.org.uk]

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]

• HLA-B27

  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]

  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]

  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]

[…] at least 4 years of treatment in studies with low risk of bias. [f1000research.com]

The 2019 ACR–SAA–SPARTAN treatment recommendations for axial spondyloarthritis incorporate useful advice on new therapies, treatment strategy and the use of imaging. [nature.com]

“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]

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

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]

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]

[…] providing information to people and discussing their preferences with them, see the NICE guideline on patient experience in adult NHS services Provide explanations and information about spondyloarthritis, for example: what spondyloarthritis is diagnosis and prognosis [guidelines.co.uk]

Mortality, course of disease and prognosis of patients with ankylosing spondylitis. Clin Exp Rheumatol. 2002 Nov-Dec. 20(6 Suppl 28):S16-22. [Medline]. Ringsdal VS, Helin P. Ankylosing spondylitis--education, employment and invalidity. [medscape.com]

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]

Further, spondyloarthritis can show an inflammation of peripheral joints (for example, knees and ankles), and tendons (for example, the Achilles tendon).[1][2][3][10] Epidemiology /Etiology Spondyloarthritis is a pathology that specifically strikes young [physio-pedia.com]

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

The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice. Ann Rheum Dis 2007; 66: 1072 7 Rudwaleit M, Haibel H, Baraliakos X et al. [thieme-connect.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]

[…] reproductive function, or sex hormones.2,5 axSpA and PsA are two related autoimmune diseases that are associated with elevated levels of the pro-inflammatory cytokine TNF-alpha.6 SpA comprises a group of chronic inflammatory diseases that share common pathophysiological [emjreviews.com]

TNF blockade The strongest evidence supporting the role of the TNF pathway in the pathophysiology of axSpA comes from the use of TNF inhibitors in the clinical setting. [arthritis-research.biomedcentral.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]

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]

“My own experience tells me that now, with the current armamentarium that we have, we can definitely give much better quality of life to these patients and prevent disability if we catch them early and if we treat them aggressively.” [pharmacytimes.com]