Introduction to Axial Spondyloarthritis (axSpA)
Early diagnosis and prompt treatment initiation are essential in the management of axial spondyloarthritis (axSpA), also known as ankylosing spondylitis, remembering that underdiagnosis and overdiagnosis of axSpA are common. These South African guidelines offer screening tools and details of useful investigations, including imaging. Care of the axSpA patient requires a multidisciplinary holistic
| Early diagnosis and prompt treatment initiation are essential in the management of axial spondyloarthritis (axSpA), also known as ankylosing spondylitis, remembering that underdiagnosis and overdiagnosis of axSpA are common. These South African guidelines offer screening tools and details of useful investigations, including imaging. Care of the axSpA patient requires a multidisciplinary holistic approach emphasising lifestyle interventions, particularly exercise, smoking cessation and psychosocial support. The ankylosing spondylitis disease activity score is recommended as a measure of disease activity, and a stepwise algorithm for therapy is provided. Screening for comorbidities and vaccination is advised. |
Axial spondyloarthritis (axSpA) is a chronic inflammatory joint disease affecting the axial skeleton, and falls within the ‘family’ of spondyloarthritides. Within this family, conditions including psoriatic arthritis, reactive arthritis and inflammatory bowel disease (IBD)-associated arthritis, as well as the prototype of axial disease (also referred to as ankylosing spondylitis), are found.[1] The prevalence of axSpA usually parallels that of HLA-B27 positivity.[2-4] Prevalence and incidence data from Africa are sparse.[3,5]
The original classification of axSpA relied on the presence of radiographic (X-ray) evidence of sacroiliitis. With the use of magnetic resonance imaging (MRI) in patients with back pain since the 1990s, inflammatory sacroiliitis was identified in patients with no features of sacroiliitis on plain X-rays, known as non-radiographic axSpA (nr-axSpA).
Peripheral joint involvement and musculoskeletal features (dactylitis, enthesitis) and extra-articular features (psoriasis, IBD and uveitis) often co-exist with axSpA, and clinicians are referred to the peripheral SpA guidelines for details of management of these problems.
Maharaj, A. B., et al. (2024). South African Rheumatism and Arthritis Association 2024 guidelines for the management of axial spondyloarthritis. South African Medical Journal, 114(10), e2668.