Assessment and Management of Axial Spondyloarthritis

Axial spondyloarthritis encompasses a spectrum of chronic inflammatory conditions primarily affecting the spine and sacroiliac joints. Early assessment integrates clinical evaluation of back pain characteristics, extra-articular manifestations such as enthesitis and uveitis, laboratory measures of acute-phase reactants and imaging by magnetic resonance to detect active inflammation before structural damage is visible on radiographs. Classification criteria distinguish radiographic disease from non-radiographic forms, guiding therapeutic decision-making. Management begins with education, physiotherapy and non-steroidal anti-inflammatory drugs, progressing to biologic agents when disease activity remains high. Tumour necrosis factor inhibitors have transformed outcomes by reducing inflammation, improving function and slowing structural progression. Novel strategies target interleukin-17 and specific autoreactive T-cell subsets, while genetic insights into HLA-B*27 and related loci pave the way for precision medicine. Multidisciplinary care addresses spinal mobility, comorbidities and work productivity, underlining the importance of early diagnosis and tailored intervention to optimise long-term quality of life.

Research from Nature Portfolio

Recent studies have demonstrated the potential of precision immunotherapy by selectively depleting T cells bearing a defined T-cell receptor motif associated with disease activity, leading to sustained remission and improved spinal mobility without broad immunosuppression. Complementary genetic analyses have elaborated the complexity of major histocompatibility complex contributions beyond the classical HLA-B*27 allele, identifying additional HLA class I and II associations and epistatic interactions with peptide-trimming enzymes. These advances refine understanding of disease susceptibility and open avenues for antigen-specific interventions that target pathogenic pathways while preserving global immune competence.

Assessment and Management of Axial Spondyloarthritis publication trend

The graph below shows the total number of articles in assessment and management of axial spondyloarthritis across all publications each year (not limited to Nature Index journals).

Technical terms

Axial spondyloarthritis: A group of inflammatory rheumatic diseases affecting the spinal column and sacroiliac joints, including radiographic and non-radiographic forms.

Non-radiographic axial spondyloarthritis (nr-axSpA): Early or mild axial disease meeting clinical and imaging criteria without definitive radiographic sacroiliitis.

BASDAI (Bath Ankylosing Spondylitis Disease Activity Index): A patient-reported questionnaire assessing fatigue, spinal and peripheral joint pain, enthesitis and stiffness to quantify disease activity.

ASAS40: A composite measure indicating at least 40% improvement in disease activity parameters as defined by the Assessment of SpondyloArthritis international Society.

HLA-B*27: A human leukocyte antigen allele strongly associated with susceptibility to axial spondyloarthritis.

Enthesitis: Inflammation at the insertion sites of tendons, ligaments or joint capsules into bone, a characteristic feature of spondyloarthritis.

References

1. Targeted depletion of TRBV9+ T cells as immunotherapy in a patient with ankylosing spondylitis. Nature Medicine (2023).
2. Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1). Annals of the Rheumatic Diseases (2012).
3. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Research (2019).
4. Major histocompatibility complex associations of ankylosing spondylitis are complex and involve further epistasis with ERAP1. Nature Communications (2015).
5. Assessment of radiographic progression in the spines of patients with ankylosing spondylitis treated with adalimumab for up to 2 years. Arthritis Research & Therapy (2009).
6. Efficacy and Safety of Ixekizumab in the Treatment of Radiographic Axial Spondyloarthritis: Sixteen‐Week Results From a Phase III Randomized, Double‐Blind, Placebo‐Controlled Trial in Patients With Prior Inadequate Response to or Intolerance of Tumor Necrosis Factor Inhibitors. Arthritis & Rheumatology (2019).