Nonradiographic Axial Spondyloarthritis

Clinical and Therapeutic Relevance

Nilasha Ghosh; Eric M. Ruderman

Arthritis Res Ther. 2017;19(286)

Abstract and Introduction

Abstract

Current classification criteria for axial spondyloarthritis (axSpA) provide for the inclusion of patients with a wide range of presentations and manifestations. While not considered a formal subclassification, patients are often divided into radiographic or nonradiographic axSpA based on the presence or absence of radiographic sacroiliitis. This review will focus on nonradiographic axSpA and will discuss clinical manifestations of disease that distinguish, or in many cases do not distinguish, this entity from other individuals with axSpA. This review will also cover treatment paradigms for nonradiographic axSpA, particularly the use of biologic therapies, where current data suggest that nonradiographic disease should be managed largely the same as radiographic disease, or classical ankylosing spondylitis.

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Arthritis Res Ther. 2017;19(286) © 2017 BioMed Central, Ltd.
Copyright to this article is held by the author(s), licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original citation.

Abstract and Introduction
Background
Conclusion
References

Table 1. Items in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), scored on a numerical rating scale [17]
How would you describe the overall level of fatigue/tiredness you have experienced?
How would you describe the overall level of ankylosing spondylitis neck, back or hip pain you have had?
How would you describe the overall level of pain/swelling in joints other than neck, back or hips you have had?
How would you describe the overall level of discomfort you have had from any areas tender to touch or pressure?
How would you describe the overall level of morning stiffness you have had from the time you wake up?
How long does your morning stiffness last from the time you wake up?

Table 2. Items in the Bath Ankylosing Spondylitis Functional Index (BASFI), scored on a numerical rating scale [18]
Putting on your socks or tights without help or aids (e.g., sock aid).
Bending forward from the waist to pick up a pen from the floor without an aid.
Reaching up to a high shelf without help or aids (e.g., helping hand).
Getting up out of an armless dining room chair without using your hands or any other help
Getting up off the floor without help from lying on your back.
Standing unsupported for 10 min without discomfort.
Climbing 12 to 15 steps without using a handrail or walking aid. One foot at each step.
Looking over your shoulder without turning your body.
Doing physically demanding activities (e.g., physiotherapy, exercises, gardening or sports).
Doing a full days activities, whether it be at home or at work.

Table 3. Phase 3 trials of tumor necrosis factor (TNF) inhibitors in nonradiographic spondyloarthritis and ankylosing spondylitis
Trial	TNF inhibitor	Dose	Primary endpoint	Comparator	Results
nr-axSpA Trials
ABILITY-1 [27]	Adalimumab	40 mg q 2 weeks	ASAS40 response at week 12	Placebo	ASAS20: 52% vs. 41% ASAS40: 36% vs. 15%
RAPID-axSpA (nr-axSpA subset) [19]	Certolizumab pegol	400 mg q 4 weeks	ASAS20 response at week 12	Placebo	ASAS20: 63% vs. 40% ASAS40: 47% vs. 16%
EMBARK [51]	Etanercept	50 mg q week	ASAS40 response at week 12	Placebo	ASAS20: 52% vs. 36% ASAS40: 33% vs. 15%
GO-AHEAD [26]	Golimumab	50 mg q 4 weeks	ASAS20 response at week 16	Placebo	ASAS20: 72% vs. 40% ASAS40: 57% vs. 23%
AS Trials
ATLAS [56]	Adalimumab	40 mg q 2 weeks	ASAS20 response at week 12	Placebo	ASAS20: 58% vs. 21% ASAS40: 40% vs. 13%
RAPID-axSpA (AS subset) [19]	Certolizumab pegol	400 mg q 4 weeks	ASAS20 response at week 12	Placebo	ASAS20: 64% vs. 37% ASAS40: 50% vs. 19%
Etanercept phase III [57]	Etanercept	50 mg q week	ASAS20 response at week 12	Placebo	ASAS20: 59% vs. 28% ASAS50: 44% vs. 16%
GO-RAISE [53]	Golimumab	50 mg q 4 weeks	ASAS20 response at week 14	Placebo	ASAS20: 59% vs. 22% ASAS40: 44% vs. 15%