Spondyloarthropathy for practicing rheumatologists: diagnosis, indication for disease-controlling antirheumatic therapy, and evaluation of the response

SpA consists of several disorders characterized by axial or peripheral articular involvement, enthesitis, and potential extra-articular manifestations. Diagnosis can be made by checking each possible clinical manifestation encountered in SpA. Amor or ESSG classification criteria are commonly used in daily practice as diagnostic tool when fulfilled. Accurate criteria for considering initiation of DC-ARTs in SpA are not yet established, but the members of the ASAS working group are currently debating that question. Second-line agents are indicated in cases of active, severe disease that is refractory to NSAIDs. To be helpful in clinical practice, such a definition needs to be made more precise and adapted to the clinical presentation of the patient. A standardized monitoring of patients seems inevitable to clearly define such treatment indications. The assessment of a patient suffering from SpA must differentiate the following clinical features: axial involvement, peripheral articular involvement, enthesitis, and extra-articular manifestations. Other parameters such as the functional disability, fatigue, concomitant therapies, and laboratory and structural parameters must be collected whatever the clinical manifestations are. Criteria for response to DC-ART treatments in SpA must still be defined, but, logically, those finally chosen for consideration of initiation of DC-ART will represent targets to define patients as either responders or nonresponders to such treatments.