Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center and CAPHRI Research Institute, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
Charité-Universitätsmedizin Berlin, Berlin, Germany.
Semin Arthritis Rheum. 2015 Apr;44(5):556-562. doi: 10.1016/j.semarthrit.2014.10.009. Epub 2014 Oct 22.
To identify patients earlier, new classification criteria have been introduced for axial spondyloarthritis (axSpA). Patients who satisfy the clinical or imaging criteria for axSpA in the absence of definite sacroiliac joint changes on pelvic x-rays are classified as having non-radiographic axSpA. Although the burden associated with radiographic axSpA (i.e., ankylosing spondylitis) has been extensively studied, the impact of non-radiographic disease is not well understood. The purpose of this review is to provide an overview of the burden of illness in non-radiographic axSpA, including epidemiology and effects on patients׳ functioning and health-related quality of life (HR-QoL).
A PubMed search was performed using relevant key words (e.g., "spondyloarthritis," "ankylosing spondylitis," "epidemiology," and "quality of life") to examine literature published from 2003 to 2013.
Studies conducted to date suggest that radiographic progression is detected in approximately 10% of patients with non-radiographic axSpA over 2 years. Differences between patients with non-radiographic and radiographic axSpA were found in age, symptom duration, and gender distribution. Although less inflammation (i.e., lower C-reactive protein levels and less spinal inflammation on MRI) and less impairment in spinal mobility are observed in non-radiographic than in radiographic axSpA, the 2 conditions pose a similar burden in terms of disease activity, physical function, HR-QoL impairment.
Patients with non-radiographic axSpA are more frequently female. Although patients with non-radiographic axSpA have shorter disease duration and lack radiological changes, they demonstrate a substantial burden of illness, with self-reported disease activity and functional impairments comparable to those found in patients with radiographic disease.
为了更早地发现患者，现已引入新的中轴型脊柱关节炎（axSpA）分类标准。对于那些在骨盆 X 线片上没有明确的骶髂关节改变，但符合 axSpA 临床或影像学标准的患者，将其归类为非放射学 axSpA。虽然放射学 axSpA（即强直性脊柱炎）相关的负担已经得到了广泛的研究，但非放射学疾病的影响尚不清楚。本综述的目的是概述非放射学 axSpA 的疾病负担，包括流行病学以及对患者功能和健康相关生活质量（HR-QoL）的影响。
使用相关关键词（例如“脊柱关节炎”、“强直性脊柱炎”、“流行病学”和“生活质量”）在 PubMed 上进行检索，以检查 2003 年至 2013 年期间发表的文献。
迄今为止进行的研究表明，在非放射学 axSpA 患者中，约有 10%的患者在 2 年内会出现放射学进展。在年龄、症状持续时间和性别分布方面，非放射学 axSpA 患者与放射学 axSpA 患者存在差异。虽然非放射学 axSpA 患者的炎症（即 C 反应蛋白水平较低，MRI 上的脊柱炎症较少）和脊柱活动度受损程度较轻，但在疾病活动度、身体功能和 HR-QoL 受损方面，这两种情况的负担相似。
非放射学 axSpA 患者中女性更为常见。尽管非放射学 axSpA 患者的疾病持续时间较短且没有放射学改变，但他们表现出相当大的疾病负担，自我报告的疾病活动度和功能障碍与放射学疾病患者相当。
