Characterization of Patients With Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis in the US‐Based Corrona Registry

Abstract

ObjectiveTo describe the characteristics of patients with ankylosing spondylitis (AS) and patients with nonradiographic axial spondyloarthritis (SpA) in the US.MethodsDemographics, clinical characteristics, patient‐reported outcomes, and treatment characteristics of patients with AS and those with nonradiographic axial SpA were assessed at the time of enrollment in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. Patients with AS were defined as those who fulfilled the 1984 modified New York criteria for AS; patients with nonradiographic axial SpA were defined as all other patients with axial SpA who did not fulfill the radiology criterion.ResultsOf the 407 patients with a diagnosis of axial SpA who were included in this study, 310 had AS, and 97 had nonradiographic axial SpA. Although patients with nonradiographic axial SpA were younger and showed a trend toward a shorter symptom duration, the nonradiographic axial SpA and AS groups shared a similar disease burden, as reflected by comparisons of disease activity and function, quality of life, pain, fatigue, job absenteeism, and loss of work productivity (all P > 0.05). The proportions of patients with nonradiographic axial SpA and patients with AS who received prior biologic disease‐modifying drugs (DMARDs) (74.2% and 64.8%, respectively) or were currently receiving biologic DMARDs (63.9% and 61.3%, respectively) were also similar (P > 0.05).ConclusionThis was the first nationwide study to characterize patients with AS and nonradiographic axial SpA in the US. Consistent with studies published outside of the US, this study showed that patients with nonradiographic axial SpA and patients with AS shared a comparable degree of disease burden and had similar treatment patterns in clinical practice.

Spinal radiographic progression in axial spondyloarthritis and the impact of classification as nonradiographic versus radiographic disease: Data from the Swiss Clinical Quality Management cohort

“…Evidence is accumulating from observational studies that tumour necrosis factor inhibitors (TNFi) might retard spinal damage, if treatment is continued for several years [11][12][13][14]. Very limited data on spinal radiographic progression exists for the nonradiographic disease form (nr-axSpA) [4,10], an entity differentiated from r-axSpA by the absence of definite sacroiliac damage on radiographs [15,16], according to the modified New York criteria (mNYc) [5], but presenting from a clinical point of view, a burden of disease comparable to r-axSpA despite lower spinal structural damage [17][18][19][20][21][22][23]. It remains, however, unclear whether radiographic sacroiliitis is by itself associated with progression of spinal structural damage.…”

Clinical manifestations, disease activity and disease burden of radiographic versus non-radiographic axial spondyloarthritis over 5 years of follow-up in the DESIR cohort

“…This debate is particularly important in North America, where the Food and Drug Administration expressed several concerns about the incompletely characterisation of the natural history of axSpA, which led to the non-approval of several biological disease-modifying antirheumatic drugs (bDMARDs) to treat patients with nr-axSpA 3. These questions resulted in the publication of some studies that compare these two groups of patients, showing a similar disease burden but a higher prevalence of males and smokers, a larger mean disease duration and a higher level of acute phase reactants in r-axSpA patients 4–8. However, most of these studies have a cross-sectional design which does not allow us to understand the natural history of these two subgroups.…”

Comparison of ankylosing spondylitis and non‐radiographic axial spondyloarthritis in a multi‐ethnic Asian population of Singapore

“…Following the footsteps of treat‐to‐target strategies in rheumatoid arthritis, there has been an increasing emphasis to treat inflammatory back pain early, which may halt disease progression and prevent chronic damage. Some cohorts of SpA such as GESPIC, Herne, DESIR and Corrona have shown similar clinical characteristics of AS and nr‐AxSpA, as well as notable differences. For instance, AS patients were predominantly male, having higher C‐reactive protein (CRP) and Bath Ankylosing Spondylitis Metrology Index (BASMI) scores compared to nr‐axSpA patients.…”