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  • Review Article
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The changing clinical picture and epidemiology of spondyloarthritis

Nature Reviews Rheumatology volume 11, pages 110–118 (2015)Cite this article

Subjects

Key Points

  • The same features are considered for diagnosis and classification of spondyloarthritis (SpA); for diagnosis, the probability of disease increases with the presence of more features; for classification, patients need to fulfill criteria

  • Limitations of the existing classification criteria prompted the Assessment of SpondyloArthritis international Society (ASAS) to develop new classification criteria for the full spectrum of axial and peripheral SpA

  • Patients with radiographically evident disease are not substantially different (in a clinical sense) from those without radiographic signs of SpA

  • The global prevalence of SpA is reported to be ∼1%, but this estimation is subject to many factors, including the prevalence of HLA-B27 and the methodology used

  • The reported prevalence of SpA might be expected to increase with better recognition of the disease; therefore, healthcare budgets might be affected

  • Timely diagnosis of SpA is important for educating patients about their disease and how to cope with it, and for providing information on lifestyle modifications, exercises and work participation

Abstract

In the past decade, major progress has been made in the recognition, classification and treatment of spondyloarthritis (SpA). Classification criteria have been developed for axial and peripheral SpA by the Assessment of SpondyloArthritis international Society (ASAS) as a response to new insight into the clinical picture and unmet needs. The ASAS criteria have contributed to a better understanding of the full spectrum of axial and peripheral SpA and of the potential for treatment. However, whether all patients fulfilling these criteria should be considered as having true SpA is a matter of debate. Furthermore, the implementation of the ASAS criteria might lead to an increase in the reported prevalence of SpA, as patients who were previously unidentified could now be classified as having the disease, which might have consequences for healthcare budgets. In this Review, the changes in the clinical picture and epidemiology of SpA are discussed in light of the ASAS classification criteria for SpA.

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Figure 1: Venn diagram of features of the SpA criteria sets.
Figure 2: ASAS classification criteria for axial and peripheral SpA.

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Acknowledgements

The author thanks A. Boonen for critically reading the manuscript.

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  1. Department of Medicine, Division of Rheumatology and School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, Netherlands

    Astrid van Tubergen

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Correspondence to Astrid van Tubergen.

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The author declares that she has received speaker's fees from Abbvie, MSD, Pfizer and UCB, consultancy honoraria from Abbvie, Janssen–Cilag, MSD, Pfizer and UCB, and that she has an unrestricted research grant from Pfizer and Roche.

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van Tubergen, A. The changing clinical picture and epidemiology of spondyloarthritis. Nat Rev Rheumatol 11, 110–118 (2015). https://doi.org/10.1038/nrrheum.2014.181

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