Robinson Philip C, Sengupta Raj, Siebert Stefan
Royal Brisbane and Women's Hospital, School of Clinical Medicine, University of Queensland, Herston, QLD, 4029, Australia.
Royal National Hospital for Rheumatic Diseases, Bath, UK.
Rheumatol Ther. 2019 Jun;6(2):165-177. doi: 10.1007/s40744-019-0146-6. Epub 2019 Feb 20.
Non-radiographic axial spondyloarthritis (nr-axSpA) is a recently described form of axial inflammatory arthritis that has not caused substantial erosive damage to the sacroiliac joints. Nr-axSpA is associated with significant impairment in quality of life and, in a proportion of patients, it can evolve into ankylosing spondylitis (AS, also termed radiographic axSpA). The identification in the clinic of nr-axSpA has been made possible by advances in magnetic resonance imaging (MRI). Classification criteria for nr-axSpA have been proposed but there remains discussion in the international community regarding this. Studies are ongoing to further define the classification and diagnosis of nr-axSpA. There is much further research required regarding the optimal use of MRI in nr-axSpA, including distinguishing sacroiliac MRI changes in the normal population and the definition of a positive MRI in spinal disease. Non-steroidal anti-inflammatory drugs and physiotherapy are the core first-line therapy for nr-axSpA. Tumour necrosis factor inhibitors also play a very important role in treatment of patients with active nr-axSpA who do not respond to first-line therapy. Agents directed at interleukin-17, interleukin-23 and Janus kinase inhibitors are proving effective in AS with ongoing and planned studies in nr-axSpA. A great deal of active research is being undertaken in classification, imaging and therapy in nr-axSpA and so the future for improving the lives of patients with nr-axSpA is promising.
非放射学中轴型脊柱关节炎（nr-axSpA）是一种最近被描述的中轴型炎性关节炎，尚未对骶髂关节造成实质性侵蚀性损害。Nr-axSpA与生活质量的显著受损相关，并且在一部分患者中，它可演变为强直性脊柱炎（AS，也称为放射学中轴型脊柱关节炎）。磁共振成像（MRI）技术的进步使得在临床上识别nr-axSpA成为可能。已经提出了nr-axSpA的分类标准，但国际上对此仍存在讨论。正在进行研究以进一步明确nr-axSpA的分类和诊断。关于MRI在nr-axSpA中的最佳应用，还需要进行更多研究，包括区分正常人群的骶髂关节MRI变化以及脊柱疾病中MRI阳性的定义。非甾体类抗炎药和物理治疗是nr-axSpA的核心一线治疗方法。肿瘤坏死因子抑制剂在治疗对一线治疗无反应的活动性nr-axSpA患者中也起着非常重要的作用。针对白细胞介素-17、白细胞介素-23的药物以及Janus激酶抑制剂在AS治疗中已被证明有效，并且正在对nr-axSpA进行相关的持续和计划中的研究。目前在nr-axSpA的分类、成像和治疗方面正在进行大量积极的研究，因此改善nr-axSpA患者生活的前景是光明的。
