Redefining axial spondyloarthritis Save
An editorial in Lancet Rheumatology calls for "..reframing axSpA as a systemic, autoimmune inflammatory disease with multiorgan involvement and substantial unmet need."
The pathogenesis relies on not only HLA-B27, but also on environmental triggers, immune dysregulation, and gut inflammation. AxSpA is not confined to the spine, as gut dysbiosis leads to immune activation, driven by IL-17, IL-22, and TNF.
AxSpA patients may have comorbid inflammatory bowel disease (~10%), and 50–60% have Crohn's-like bowel inflammation, that may have earlier disease onset, worse prognosis or may go undiagnosed.
The systemic nature of axSpA is also reflected by the presence of uveitis, psoriasis, and comorbidities, all associated with increased risk spinal radiographic progression. Despite the systemic nature of axSpA, there still exists a significant (~7 years) diagnostic delay, leading many to call for earlier use of MRI to diagnose sacroiliitis.
This editorial was written to address a 2026 study by Bressem et al, where almost a third of people had bone marrow edema (BME).This was a German national, population-based, cross-sectional study that found SI BME to be nonspecific at times, being more common in Obesity, women, or with pregnancy or mechanical stress.
The systemic, functional and wider spectrum of axSpA calls for the new care models that incorporate multidisciplinary treatment strategies. A as well as a greater awareness among primary care clinicians to recognise inflammatory back pain early. Until we alter our approach, axSpA patients may be dismissed, delayed, or defined by a single symptom.
Continue Reading
ADD THE FIRST COMMENT
Disclosures
The author has no conflicts of interest to disclose related to this subject
If you are a health practitioner, you may Login/Register to comment.
Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.