Axial Spondyloarthritis: A Review

Area of Science:

• Rheumatology
• Immunology
• Inflammatory Diseases

Background:

• Axial spondyloarthritis (AxSpA) is an immune-mediated inflammatory condition impacting the sacroiliac joints and spine.
• It affects about 1% of US adults, leading to impaired physical function and reduced quality of life.
• Key symptoms include chronic inflammatory back pain, enthesitis, and potential extraskeletal manifestations like uveitis, psoriasis, and inflammatory bowel disease.

Purpose of the Study:

• To summarize the current understanding of axial spondyloarthritis (AxSpA) pathogenesis, diagnosis, and treatment.
• To highlight the limitations of first-line treatments and the necessity of advanced therapies.

Main Methods:

• Diagnosis relies on patient history of inflammatory back pain, human leukocyte antigen B27 (HLA-B27) positivity, elevated C-reactive protein (CRP) levels, and imaging findings (sacroiliitis).
• Treatment strategies progress from physical therapy and NSAIDs to biologics (anti-TNF, anti-IL-17) and JAK inhibitors when initial therapies are insufficient.

Main Results:

• NSAIDs provide complete symptom control for less than 25% of patients.
• Approximately 75% of patients necessitate biologic agents or JAK inhibitors for effective management.
• Clinical trials show significant improvements in ASAS20 scores with anti-TNF, anti-IL-17, and JAK inhibitors compared to placebo.
• These advanced therapies are associated with reduced radiographic progression of AxSpA.

Conclusions:

• Axial spondyloarthritis requires advanced treatment beyond NSAIDs for most patients.
• Biologics (anti-TNF, anti-IL-17) and JAK inhibitors are crucial for symptom improvement, inflammation control, and preventing structural damage.
• Effective management strategies are essential to improve the quality of life for individuals with AxSpA.