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BASDAI, ASDAS, ASAS, Oh My! Outcome Measures for Axial Spondyloarthritis



Axial spondyloarthritis (axSpA) diseases, consisting of radiographic axSpA (ankylosing spondylitis) and non-radiographic axSpA, are inflammatory arthritides that mainly affect the axial skeleton, particularly the sacroiliac joints and spine. Chronic inflammatory back pain and stiffness are often the most salient symptoms, although nonaxial symptoms accompany or may antedate axial symptoms. Enthesitis may also occur.1,2

Due to the heterogeneity of symptoms and lack of a single definitive diagnostic test, patients suffering from axSpA may cycle through different physicians, contributing to diagnostic delay. This delay can have profound effects on the patients, as untreated axSpA can lead to progressive functional impairment over time.1,3

The Evolving Clinical Picture of axSpA

Common Axial Symptoms

Sacroiliitis and spondylitis manifest as pain and stiffness in the pelvis and back, with an insidious onset.1,2



Inflammatory Back Pain (IBP)

Back pain in axSpA is usually caused by inflammation, which presents differently than mechanical back pain.4

A mnemonic to identify IBP is IPAIN5:

ipain graphic


Common Peripheral Symptoms



Extraarticular Manifestations2



Other Symptoms1,7

Some patients have symptoms such as fatigue, loss of appetite, or mild fever.

Delayed Diagnosis of axSpA

A diagnostic delay of nearly 10 years from symptom onset has been reported.

While there are no diagnostic tests for axSpA, genetic testing and acute phase reactants may help.1



Progressive Lower Back Pain

Intermittent pain often begins within the gluteal region.9



Over time this becomes persistent and bilateral.9