Residual Disease in Controlled Axial Spondyloarthritis Save

Despite being in a state of remission or low disease activity (LDA) state, in patients with axial spondyloarthritis (axSpA), up to 42% may still have residual disease.

This cross-sectional SpA observational study, examined 267 patients in SpA-Net, a web-based monitoring registry. Patients in LDA were included and defined by the Ankylosing Spondylitis Disease Activity Score (ASDAS) < 2.1. The mean age of the cohort was 50.6 years, 37.5% being female.

Residual disease was suggested by several variables including:

• 43% with fatigue scores > 4/10
• 18% with pain scores > 4/10) (Same seen for those in remission (ASDAS < 1.3).
• Physical HRQOL was reduced in 27% and moderate/poor in 33%.

Multivariable regression analyses showed that fatigue was more prevalent/severe in female patients (ORfemale = 3.29), as were other indicators of residual disease (ie, pain, peripheral symptoms, physical HRQOL).

This analysis suggests residual disease is common in patients with axSpA who are in an LDA/remission and is especially prevalent in female patients.

(Editor's note: residual disease is defined as fatigue and pain and found mostly in female axSpA patients - how do we know this is residual inflammatory disease or functional or secondary myofascial (fibromyalgia) symptoms?  The distinction should be addressed as this will clearly influence treatment choices.)