Benavent Diego, Navarro-Compán Victoria
Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
Clin Rheumatol. 2021 Feb;40(2):501-512. doi: 10.1007/s10067-020-05423-7. Epub 2020 Sep 29.
The concept of axial spondyloarthritis (axSpA) encompasses both non-radiographic (nr-axSpA) and traditional radiographic axSpA (r-axSpA) forms. The former was conceived following the establishment of the ASAS classification criteria for axSpA, which for the first time included the use of magnetic resonance imaging of the sacroiliac joints. This facilitated the classification of patients with axSpA who did not present substantial structural damage. This conception of nr-axSpA revolutionized the classical understanding of axSpA opening new doors for research and broadening the scope of treatment to the entire spectrum of axSpA. In this sense, epidemiologic patterns of the disease were viewed anew, and early diagnosis became a primary objective in the management of the disease. However, despite these advances, this new axSpA subtype led to some concerns within the scientific community. These issues have been addressed by several studies that set out to clarify the concept of nr-axSpA. In this review, we summarize the findings of the most relevant studies including nr-axSpA and then discuss recent advances in understanding disease clinical patterns, burden of disease, and treatment effects. Current scientific research has shown subtle differences between nr-axSpA and r-axSpA. In the near future, these advances will allow for better management of individual patients across the axSpA spectrum.
中轴型脊柱关节炎（axSpA）的概念涵盖了非放射学（nr-axSpA）和传统放射学axSpA（r-axSpA）两种形式。前者是在axSpA的ASAS分类标准确立之后提出的，该标准首次纳入了骶髂关节的磁共振成像检查。这有助于对未出现明显结构损伤的axSpA患者进行分类。nr-axSpA的这一概念彻底改变了对axSpA的传统认识，为研究打开了新的大门，并将治疗范围扩大到了整个axSpA谱系。从这个意义上说，对该疾病的流行病学模式有了新的认识，早期诊断成为了疾病管理的首要目标。然而，尽管取得了这些进展，这种新的axSpA亚型在科学界引发了一些担忧。一些旨在阐明nr-axSpA概念的研究已经解决了这些问题。在本综述中，我们总结了包括nr-axSpA在内的最相关研究的结果，然后讨论了在理解疾病临床模式、疾病负担和治疗效果方面的最新进展。目前的科学研究已经表明nr-axSpA和r-axSpA之间存在细微差异。在不久的将来，这些进展将有助于更好地管理整个axSpA谱系中的个体患者。
