Challenges of diagnosis and management of axial spondyloarthritis in North Africa and the Middle East: An expert consensus

Journal of International Medical Research, Mar 2016

Axial spondyloarthritis (SpA) is a spectrum of inflammatory disease with stages characterized by both nonradiographic and radiographic sacroiliitis. Nonradiographic axial SpA is associated with health-related quality-of-life impairment and may progress to ankylosing spondylitis. Axial SpA has a low prevalence in some countries in North Africa and the Middle East, and pooling of data and resources is needed to increase understanding of the regional picture. Early diagnosis and effective treatment are required to reduce disease burden and prevent progression. Anti-TNF therapy is recommended for patients with persistently high disease activity despite conventional treatment, and has been shown to be effective in patients without radiographic damage. Diagnostic delays can be an obstacle to early treatment and appropriate referral strategies are needed. In some countries, restricted access to magnetic resonance imaging and anti-TNF agents presents a challenge. In this article, a group of experts from North Africa and the Middle East evaluated the diagnosis and management of axial SpA with particular reference to this region.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://imr.sagepub.com/content/44/2/216.full.pdf

Challenges of diagnosis and management of axial spondyloarthritis in North Africa and the Middle East: An expert consensus

Downloaded from imr.sagepub.com by guest on March Challenges of diagnosis and management of axial spondyloarthritis in North Africa and the Middle East: An expert consensus Mohammed Hammoudeh 4 Sultana Abdulaziz 3 Hanan Alosaimi 2 Hanan Al-Rayes 9 Hussam Aldeen Sarakbi 8 Matouqa Baamer 7 Xenofon Baraliakos 6 Chafia Dahou Makhloufi 11 Nahid Janoudi 10 Khalid Shirazy 5 Joachim Sieper 0 Uppal Sukhbir 1 0 Klinikum Benjamin Franklin, Freien Universita ̈t Berlin , Berlin , Germany 1 Rheumatology Division, University Hospital , Sharjah , United Arab Emirates 2 Rheumatology Section, Department of Internal Medicine/ Rheumatology, Military Hospital , Jeddah , Saudi Arabia 3 Department of Medicine, King Fahad Hospital , Jeddah , Saudi Arabia 4 Department of Medicine, Weill Cornell Medical College Qatar, Hamad Medical Corporation , Doha , Qatar 5 Pfizer AfME , Media City, Dubai , United Arab Emirates 6 Rheumazentrum Ruhrgebiet, Ruhr-University Bochum , Herne , Germany 7 Department of Medicine, King Abdulaziz Hospital and Oncology Centre , Jeddah , Saudi Arabia 8 Department of Medicine, Hamad Medical Corporation , Doha , Qatar 9 Department of Medicine, Armed Force Hospital , Riyadh , Saudi Arabia 10 Department of Rheumatology, DSFH Hospital , Jeddah , Saudi Arabia 11 Department of Rheumatology, Bab El Oued Hospital , Algiers , Algeria Axial spondyloarthritis (SpA) is a spectrum of inflammatory disease with stages characterized by both nonradiographic and radiographic sacroiliitis. Nonradiographic axial SpA is associated with health-related quality-of-life impairment and may progress to ankylosing spondylitis. Axial SpA has a low prevalence in some countries in North Africa and the Middle East, and pooling of data and resources is needed to increase understanding of the regional picture. Early diagnosis and effective treatment are required to reduce disease burden and prevent progression. Anti-TNF therapy is recommended for patients with persistently high disease activity despite conventional treatment, and has been shown to be effective in patients without radiographic damage. Diagnostic delays can - be an obstacle to early treatment and appropriate referral strategies are needed. In some countries, restricted access to magnetic resonance imaging and anti-TNF agents presents a challenge. In this article, a group of experts from North Africa and the Middle East evaluated the diagnosis and management of axial SpA with particular reference to this region. Introduction Axial spondyloarthritis (SpA) is a spectrum of inflammatory disease with stages characterized by both nonradiographic and radiographic sacroiliitis.1 Sacroiliac joint involvement is considered to be the hallmark of SpA, and the disease course is characterized by ongoing axial inflammation and radiographic progression, associated with restricted mobility of the spine and decreased function.2 The Assessment of Spondyloarthritis International Society (ASAS) classification criteria define axial SpA as either the presence of sacroiliitis by radiography or by magnetic resonance imaging (MRI) plus at least one SpA feature (‘‘imaging arm’’), or the presence of human leukocyte antigen (HLA)-B27 plus at least two SpA features (‘‘clinical arm’’).3 This diagnostic method is more reliable than older criteria (ESSG4 or Amor5), which were developed before MRI was widely used. In addition, the ASAS classification criteria enable early diagnosis and treatment of axial SpA,6 reducing signs and symptoms and decreasing the risk of radiographic progression and further functional impairment.7 Patients with nonradiographic axial SpA are demographically similar to those with radiographic disease (ankylosing spondylitis [AS]).2,8 Women are more likely than men to have nonradiographic disease, while men are more likely than women to have radiographic forms, and patients with AS are more likely to have a family history of SpA compared with those with nonradiographic disease.2,8 Both groups are similar in terms of comorbidities, clinical characteristics, disease activity index (Bath Ankylosing Spondylitis Disease Activity Index; BASDAI), and the proportion of patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Patients with AS tend to have higher C-reactive protein (CRP) levels, and worse function (Bath Ankylosing Spondylitis Functional Index; BASFI) and spinal mobility (Bath Ankylosing Spondylitis metrology index; BASMI) than those with nonradiographic disease. By definition, patients with AS have radiographic sacroiliitis, whereas those with nonradiographic axial SpA have a lower modified Stoke Ankylosing Spondylitis Spine Score (mSASSS).2,8 Spinal inflammation, as assessed by MRI, is seen in 60% of patients with AS and 47% of those with nonradiographic axial SpA.2 Nonradiographic axial SpA is a subset of axial SpA in which no clear structural damage is visible using conventional radiography. The term includes patients with early radiographic sacroiliitis (gra (...truncated)


This is a preview of a remote PDF: https://imr.sagepub.com/content/44/2/216.full.pdf

Mohammed Hammoudeh, Sultana Abdulaziz, Hanan Alosaimi, Hanan Al-Rayes, Hussam Aldeen Sarakbi, Matouqa Baamer, Xenofon Baraliakos, Chafia Dahou Makhloufi, Nahid Janoudi, Khalid Shirazy, Joachim Sieper, Uppal Sukhbir. Challenges of diagnosis and management of axial spondyloarthritis in North Africa and the Middle East: An expert consensus, Journal of International Medical Research, 2016, pp. 216-230, 44/2, DOI: 10.1177/0300060515611536