Current concept of spondyloarthritis: special emphasis on early referral and diagnosis

Ankylosing spondylitis is the prototype of inflammatory rheumatic diseases grouped under the term spondyloarthritis or spondyloarthropathy (SpA). New classification criteria for SpA have now been proposed; the patients are subgrouped into (1) a predominantly axial disease, termed axial SpA, which includes AS, and (2) peripheral SpA. There is an unacceptable delay in the diagnosis of axial SpA, and there are still no validated diagnostic criteria for SpA. An early diagnosis has now become increasingly important because effective therapies in the form of TNF antagonists have become available that are even more effective if used in early stages of the disease. Therefore, new strategies are being proposed that will assist in making an early diagnosis and will also help primary care physicians in screening for these patients so that they can be referred to rheumatologists when the disease is still in its early stages. These strategies may be less efficient for early referral of children and adolescents suffering from SpA, because their most important early manifestation is not inflammatory back pain but peripheral arthritis and enthesitis. There is, therefore, a need to develop a different strategy for children and adolescents with SpA through the use, preferably, of the ASAS/EULAR classification criteria for peripheral SpA, more so than the classification criteria for axSpA.