Journal Article

Axial spondyloarthritis

Navarro-Compán, Victoria, Capelusnik, Dafne, Baraliakos, Xenofon, Sepriano, Alexandre

2025

Overview

Axial spondyloarthritis manifests as a chronic inflammatory disease primarily affecting the sacroiliac joints and spine. Although chronic back pain and spinal stiffness are typical initial symptoms, peripheral (ie, enthesitis, arthritis, and dactylitis) and extra-musculoskeletal (ie, uveitis, inflammatory bowel disease, and psoriasis) manifestations are also common. Timely and accurate diagnosis is challenging and relies on identifying a clinical pattern with a combination of clinical, laboratory (HLA-B27 positivity), and imaging findings (eg, structural damage on pelvic radiographs and bone marrow oedema on MRI of the sacroiliac joints). The Assessment in SpondyloArthritis international Society classification criteria for axial spondyloarthritis are widely used for research and have contributed to a better understanding of the gestalt of axial spondyloarthritis. Persistent disease activity, assessed mainly by the Axial Spondyloarthritis Disease Activity Score, leads to irreversible structural damage and functional impairment. Management involves non-pharmacological (eg, education, smoking cessation, exercise, physiotherapy) and pharmacological therapy. Non-steroidal anti-inflammatory drugs remain first line pharmacotherapy, while tumour necrosis factor, IL-17, and Janus kinase inhibitors are considered second-line therapies. Future advances are expected to increase disease awareness, facilitate early and accurate diagnosis, optimise disease management, and enhance overall quality of life in patients with axial spondyloarthritis.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Algorithms / Anti-inflammatory agents / Anti-Inflammatory Agents, Non-Steroidal - therapeutic use / Arthritis / Axial skeleton / Axial Spondyloarthritis - diagnosis / Axial Spondyloarthritis - therapy / Back pain / Bone imaging / Bone marrow / Chronic pain / Cigarette smoking / Cytokines / Dactylitis / Damage assessment / Decades / Diagnosis / Disease management / Drug addiction / Drug therapy / Edema / HLA-B27 Antigen / Humans / Inflammation / Inflammatory bowel diseases / Inflammatory diseases / Janus kinase / Joint diseases / Joints (anatomy) / Kinases / Magnetic Resonance Imaging / Medical diagnosis / Nonsteroidal anti-inflammatory drugs / Pathogenesis / Pathogens / Patients / Pelvis / Pharmacology / Physical therapy / Psoriasis / Quality of life / Rheumatic diseases / Sacroiliac Joint - diagnostic imaging / Sacroiliac Joint - pathology / Skin diseases / Spine / Structure-function relationships / Tumor necrosis factor-TNF / Uveitis