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Joint Bone Spine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le vendredi 24 mai 2019
Doi : 10.1016/j.jbspin.2019.04.006
accepted : 16 April 2019
Structural progression in axial spondyloarthritis
 

Krystel Aouad a, b, Nelly Ziade a, b, Xenofon Baraliakos c,
a Rheumatology department, Saint-Joseph University, Beirut, Lebanon 
b Hotel-Dieu de France Hospital, Alfred Naccache boulevard, Achrafieh, PO BOX 166830, Beirut, Lebanon 
c Rheumatology Department, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany 

Corresponding author.
Highlights

Diagnosis at an early inflammatory stage of axial spondyloarthritis is a key condition for a better disease control and management.
The natural history of axSpA is now better understood with imaging studies and long-term follow-up data, with some predictive factors for structural progression being identified, particularly smoking, mechanical stress, obesity, elevated CRP, ASDAS, BASDAI, Bone Marrow Edema on MRI and baseline syndesmophytes.
Non-steroidal anti-inflammatory drugs are still considered as the first line treatment for axSpA, however, their impact on structural progression is conflicting.
Recent data on biologic disease-modifying antirheumatic drugs, such as tumor necrosis factor inhibitors have shown significant retardation of radiographic damage after several years of treatment, while first data with interleukin-17 inhibitors were also positive.
Novel emerging drugs are being evaluated with promising results on halting disease progression.

The full text of this article is available in PDF format.
Abstract

Functional disability in axial spondyloarthritis is related to the structural progression caused by the disease, thus largely contributing to its global burden and still representing a major challenge in management. Diagnosis at an early inflammatory stage of the disease is the hallmark for a better disease control and management. The natural history of axial spondyloarthritis is now better understood with imaging studies and long-term follow-up data, with some predictive factors for structural progression being identified. Non-steroidal anti-inflammatory drugs are still considered as the first line treatment for axial spondyloarthritis, however, their impact on structural progression is conflicting. Recent data on biologic disease-modifying anti-rheumatic drugs, such as tumor necrosis factor inhibitors have shown significant retardation of radiographic damage after several years of treatment, while first data with interleukin-17 inhibitors were also positive. Novel emerging drugs are being evaluated with promising results on halting disease progression. This review summarizes the predictors of radiographic progression in patients with axial spondyloarthritis as well as the current evidence on the effect of available treatments on structural progression.

The full text of this article is available in PDF format.

Keywords : Axial spondyloarthritis, Structural progression, NSAID, Anti-TNF, Secukinumab




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