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TOPLINE:

Nonradiographic axial spondyloarthritis (nr-axSpA) progressed to radiographic disease (r-axSpA) in approximately 16% of adults with new-onset disease within a 5-year period, and progression was significantly associated with male sex, favorable response to non-steroidal anti-inflammatory drugs (NSAIDs), and meeting the imaging standards for disease classification criteria.

METHODOLOGY:

• Researchers reviewed data from 1050 patients with r-axSpA and 562 with nr-axSpA from 29 countries who were diagnosed within the past year based on Assessment of SpondyloArthritis international Society (ASAS) classification criteria.
• Follow-up radiographs were available for 246 of the nr-axSpA patients, and participants had at least one follow-up sacroiliac joint (SIJ) radiograph over the 5-year study period.
• Progression was based on baseline and follow-up SIJ radiographs that were evaluated by three readers and assessed via Kaplan-Meier analysis.

TAKEAWAY:

• Progression occurred in 40 of the 246 nr-axSpA patients (16%) over 5 years, with progression times ranging from 0.9 to 5.1 years.
• Progression to r-axSpA within 5 years was significantly associated with male sex (hazard ratio [HR], 2.57), favorable response to NSAIDs (HR, 4.36), and meeting the imaging standards for the ASAS classification criteria (HR, 5.55).

IN PRACTICE:

"These results are in line with previous studies that have demonstrated that between 8% and 44% of patients with nr-axSpA progress to r-axSpA over a period of 2-11 years," the researchers wrote.

SOURCE:

First author Denis Poddubnyy, MD, of Charité-Universitätsmedizin Berlin and the German Rheumatism Research Center, Berlin, Germany, and colleagues reported the work online on December 18, 2023, in ACR Open Rheumatology.

LIMITATIONS:

Study limitations included the small number of patients with imaging follow-up data, lack of data on use of biologics other than tumor necrosis factor inhibitors, and lack of central evaluation of MRI findings.

DISCLOSURES:

The study was supported by AbbVie. Poddubnyy also disclosed serving as a speaker, consultant, and/or research grant recipient for multiple companies including AbbVie, Lilly, Merck Sharp and Dohme, Novartis, Pfizer, GlaxoSmithKline, Novartis, and UCB.