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New developments in the diagnosis and treatment of axial spondyloarthritis

Pedro Machado, Robert Landewe, Desiree van der Heijde

Spondyloarthritis (SpA) is an umbrella term for a group of diseases sharing genetic, molecular, immunological, clinical and imaging features. The last few years have witnessed a remarkable progress in the understanding of SpA. Notable advances include the recognition of MRI as a sensitive and specific tool for detecting axial inflammation and the recent development and validation of the Assessment of Spondyloarthritis International Society classification criteria for predominantly axial and predominantly peripheral SpA. This approach has the advantage of better describing the disease, allowing earlier identification and treatment of the nonradiographic forms and potentially leading to improved outcomes. TNF a-blockers, which dramatically improve the clinical symptoms and signs of patients with ankylosing spondylitis, are now being tested in patients with non-radiographic axial SpA, with the first studies providing evidence that patients with the non-radiographic form of the disease also benefit from this treatment in the same order as patients with ankylosing spondylitis. Important advances have been made in clarifying the natural history and pathophysiological mechanisms of axial SpA, which may lead to the discovery of new therapies and innovative treatment strategies in the future.