Spondyloarthritis (SpA) encompasses the closely related, but clinically heterogeneous, inflammatory rheumatic diseases ankylosing spondylitis, psoriatic arthritis, reactive arthritis, undifferentiated SpA, arthritis and/or spondylitis associated with inflammatory bowel disease, and some forms of juvenile idiopathic arthritis. Hallmark features of these diseases include inflammatory arthritis of the spine, peripheral arthritis, enthesopathy, sacroiliitis, negativity for rheumatoid factor and a degree of heritability.
Symptoms of SpA tend to present in people in their early twenties–in general men are more frequently affected than women–and a 10-year gap often separates symptom onset and diagnosis. Approximately 0.5% of white individuals worldwide are thought to be affected by SpA, which, if left undiagnosed and untreated, can result in considerable pain, stiffness, reduced mobility and disability.
Although a cure for SpA is currently lacking, research over the past decade has led to incredible advances in both adult and juvenile disease in terms of new approaches and referral strategies for early diagnosis, accurate disease classification, therapeutic developments, insights into extra-articular manifestations of SpA, and advances in our understanding of the genetics and pathophysiology of SpA. This unique collection of articles aims to translate the latest research developments in the field of SpA into clinical practice.
RESEARCH HIGHLIGHT
Spondyloarthritis: Evidence from animal studies supports the 'entheseal stress' hypothesis of ankylosing spondylitis
Sarah Onuora
doi:10.1038/nrrheum.2012.52
Nature Reviews Rheumatology 8, 248 (2012)
NEWS & VIEWS
Spondyloarthritis: The eyes have it: uveitis in patients with spondyloarthritis
James T. Rosenbaum & Holly L. Rosenzweig
doi:10.1038/nrrheum.2012.43
Nature Reviews Rheumatology 8, 249-250 (2012)
Spondyloarthritis: Is methotrexate effective in psoriatic arthritis?
Philip J. Mease
doi:10.1038/nrrheum.2012.56
Nature Reviews Rheumatology 8, 251-252 (2012)
REVIEWS
Diagnosis and classification in spondyloarthritis: identifying a chameleon
Astrid van Tubergen & Ulrich Weber
doi:10.1038/nrrheum.2012.33
Nature Reviews Rheumatology 8, 253-261 (2012)
The heterogeneity and interrelatedness of the conditions comprising spondyloarthritis (SpA) complicate diagnosis and patient classification; however, a number of criteria sets have been developed to aid these processes. Here, the authors critically review the currently available SpA classification criteria and highlight the important part that MRI will play in facilitating early diagnosis of this disease.
New advances in juvenile spondyloarthritis
Shirley M. L. Tse & Ronald M. Laxer
doi:10.1038/nrrheum.2012.37
Nature Reviews Rheumatology 8, 269-279 (2012)
Spondyloarthritis in childhood (juvenile SpA) is distinct from the disease in adults, typically affecting the lower extremities (peripheral arthritis and enthesitis) with spinal or sacroiliac joint involvement rare at disease onset. This Review provides an update on the advances in diagnosis and management of juvenile SpA, summarizing classification and diagnostic criteria, clinical features, outcomes and guidelines for treatment.
Referral strategies for early diagnosis of axial spondyloarthritis
Martin Rudwaleit & Joachim Sieper
doi:10.1038/nrrheum.2012.39
Nature Reviews Rheumatology 8, 262-268 (2012)
Owing to the long diagnostic delay in spondyloarthritis (SpA), the effective identification of those individuals who are likely to have axial SpA among patients with chronic back pain in primary care and their subsequent referral to a rheumatologist for establishing a correct diagnosis is worth pursuing. In this article, the authors discuss potential referral criteria and present clinical studies in which their effectiveness in identifying patients with SpA has been examined.
Developments in therapies for spondyloarthritis
Joachim Sieper
doi:10.1038/nrrheum.2012.40
Nature Reviews Rheumatology 8, 280-287 (2012)
Although NSAIDs and physical therapy remain the first-line treatment recommendations for SpA, therapy options are evolving rapidly with advances in understanding, classifying and diagnosing the disease. TNF blockers are effective in NSAID-resistant disease but other biologic agents have thus far failed to deliver results. New capacities to enroll patients at an earlier stage in the disease, and to stratify studies by SpA subtype, will facilitate further therapeutic developments.
Genetics of spondyloarthritis—beyond the MHC
John D. Reveille
doi:10.1038/nrrheum.2012.41
Nature Reviews Rheumatology 8, 296-304 (2012)
Overlapping heredity in ankylosing spondylitis, psoriasis and inflammatory bowel disease indicates common pathological pathways between these diseases. Modern genetic techniques are unraveling the similarities—and differences—in the genetic backgrounds of these complex inflammatory disorders, and promising new approaches to tackle them. How the association of HLA-B27 with SpA might contribute to the disease process is among the factors discussed in this Review.
The transition of acute to chronic bowel inflammation in spondyloarthritis
Liesbet Van Praet, Peggy Jacques, Filip Van den Bosch & Dirk Elewaut
doi:10.1038/nrrheum.2012.42
Nature Reviews Rheumatology 8, 288-295 (2012)
Why does chronic inflammation manifest not only in the joints but also in the gut in a substantial proportion of patients with SpA? Insights into the genetic and environmental factors that link inflammatory bowel disease and SpA are provided in this Review. Furthermore, the authors present a transition model, describing a phase in the disease process during which acute inflammation is transformed into chronic pathology, and suggest that it might present the opportunity for effective therapeutic intervention.
© 2018 Macmillan Publishers Limited, part of Springer Nature. All Rights Reserved.
