Radiographic progression in non-radiographic axial spondyloarthritis

ABSTRACT

Introduction: Non-radiographic axial spondyloarthritis (nr-axSpA) represents a subtype of axial spondyloarthritis (axSpA) with no significant structural damage in sacroiliac joints and spine. In addition, patients with nr-axSpA demonstrate a substantial burden of illness, and a considerable share of them might progress to radiographic axSpA (r-axSpA) over time. The amount and quality of published data allows crude estimation of progression rate and factors related to a higher risk of progression.

Areas covered: This review discusses the available data reporting the rates and predictors of radiographic progression in the sacroiliac joints and in the spine in patients with nr-axSpA as well as predisposing factors for such a progression.

Expert commentary: Most of the studies report about 10–40% of patients with nr-axSpA to progress to r-axSpA over a period of 2–10 years. Multiple risk factors for the radiographic sacroiliitis progression are outlined and explored. There are not enough data to presume that any treatment modality may influence progression from nr-axSpA to r-axSpA, with TNFi showing some promising results. Radiographic progression in the spine is in general low in nr-axSpA; thus, long-term studies are required to investigate the natural course of the progression and possible treatment effects.

KEYWORDS:

• Axial spondyloarthritis
• non-radiographic axial spondyloarthritis
• radiographic axial spondyloarthritis
• ankylosing spondylitis
• progression
• radiographic progression

Declaration of interest

D Poddubnyy declares grant/research support from AbbVie, MSD, Novartis; Speaker/Consultant for: AbbVie, Celgene, BMS, Boehringer, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Funding

This article was not funded.