Mauro Daniele, Forte Giulio, Poddubnyy Denis, Ciccia Francesco
Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Via Sergio Pansini 5, 80131, Naples, Italy.
Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Rheumatol Ther. 2024 Feb;11(1):19-34. doi: 10.1007/s40744-023-00627-0. Epub 2023 Dec 18.
Axial spondyloarthritis (axSpA) is a chronic, inflammatory rheumatic disease that primarily affects the axial skeleton, often inflicting severe pain, diminished mobility, and a compromised quality of life. The advent of Assessment of SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis (SpA) have enabled the classification of patients with axSpA in the non-radiographic stage but poorly perform if mistakenly used for diagnostic purposes. Despite notable progress in early diagnosis facilitated by referral strategies and extensive magnetic resonance imaging (MRI) utilization, diagnostic delays persist as a concerning issue. This underscores the urgency to narrow the diagnostic gap and highlights the critical role of early diagnosis in mitigating the long-term structural damage associated with this condition. Research into the impact of non-steroidal anti-inflammatory drugs (NSAIDs) and biologic disease-modifying antirheumatic drugs (bDMARDs) on inflammatory symptoms and radiographic progression has been extensive. A compelling body of evidence suggests that early intervention leads to superior disease outcomes. However, most of these studies have centered on patients with established diseases rather than those in the early stages. Consequently, findings from studies on early pharmacological intervention remain inconclusive, and the potential for modifying the disease trajectory is still debatable. Without precise data from clinical trials, insights from basic science regarding the pathogenic mechanisms might point toward potential targets that warrant early intervention in the disease process. This review underscores the urgency of early diagnosis and intervention in axSpA, highlighting ongoing research gaps and the need for further exploration to improve patient outcomes.
轴性脊柱关节炎（axSpA）是一种慢性炎症性风湿性疾病，主要影响中轴骨骼，常导致严重疼痛、活动能力下降和生活质量受损。国际脊柱关节炎评估协会（ASAS）的脊柱关节炎（SpA）分类标准的出现，使得非放射学阶段的axSpA患者能够得到分类，但如果错误地用于诊断目的，则效果不佳。尽管转诊策略和广泛使用磁共振成像（MRI）在早期诊断方面取得了显著进展，但诊断延迟仍然是一个令人担忧的问题。这凸显了缩小诊断差距的紧迫性，并强调了早期诊断在减轻与该疾病相关的长期结构损伤方面的关键作用。关于非甾体抗炎药（NSAIDs）和生物改善病情抗风湿药（bDMARDs）对炎症症状和影像学进展影响的研究已经广泛开展。大量令人信服的证据表明，早期干预会带来更好的疾病结局。然而，这些研究大多集中在已确诊疾病的患者身上，而非早期患者。因此，关于早期药物干预的研究结果仍无定论，改变疾病轨迹的潜力仍存在争议。如果没有来自临床试验的精确数据，基础科学关于致病机制的见解可能会指向疾病过程中值得早期干预的潜在靶点。本综述强调了axSpA早期诊断和干预的紧迫性，突出了当前存在的研究差距以及进一步探索以改善患者结局的必要性。
