Nonradiographic Versus Radiographic Axial Spondyloarthritis

Hillary Norton, MD: Axial spondyloarthritis, or axSpA, is a chronic inflammatory disease primarily affecting the axial skeleton. We have now identified nonradiographic axial spondyloarthritis, which is in the same spectrum of disease as the commonly known hallmark disease ankylosing spondyloarthritis. Nonradiographic disease is part of the same spectrum of disease but may occur as early disease or may be a separate entity that never progresses to radiographic disease.

There is some misunderstanding in the medical community about the distinction between nonradiographic disease and ankylosing spondylitis. Our understanding has really evolved in the last few years, and we now understand that these are both in the same spectrum of disease. The symptoms are the same, and the response to treatment is the same, but we don’t yet know who will progress to radiographic disease, and everybody may not progress, particularly women.

It can take up to 10 years for x-rays to show damage from sacroiliitis, and thus the importance of using MRI [magnetic resonance imaging] as well as other criteria to make the diagnosis earlier.

Both nonradiographic axSpA and AS [ankylosing spondylitis] have a similar burden of disease. Both involve decreased quality of life, disability, missed time at work, and increased healthcare costs.

These are young patients when the disease symptoms come on, primarily in their 20s. So these are patients who are trying to have careers and families and participate in other activities, such as sports. So the impact on quality of life can be tremendous. This is largely an invisible disease that rages at night. So loss of sleep is a huge issue for quality of life. Absenteeism from work is a big problem as well. We have data that show that when patients are treated appropriately with biologics, that this does decrease work absenteeism and thus can help quality of life.

We do know that disability increases throughout the decades with axial spondyloarthritis and AS. When we see the data for the decades in the 1960s and ’70s, disability actually increases more for women than for men.