ASAS consensus definition of early axial spondyloarthritis

Ann Rheum Dis. 2024 Aug 27;83(9):1093-1099. doi: 10.1136/ard-2023-224232.

Abstract

Objectives: To develop a consensual definition for the term 'early axial spondyloarthritis-axSpA'-and 'early peripheral spondyloarthritis-pSpA'.

Methods: The ASAS (Assessment of SpondyloArthritis international Society-Spondyloarthritis EARly definition) steering committee convened an international working group (WG). Five consecutive steps were followed: (1) systematic literature review (SLR); (2) discussion of SLR results within the WG and ASAS community; (3) a three-round Delphi survey inviting all ASAS members to select the items that should be considered for the definition; (4) presentation of Delphi results to the WG and ASAS community and (5) ASAS voting and endorsement (2023 annual meeting).

Results: Following the SLR, consensus was to proceed with an expert-based definition for early axSpA (81% in favour) but not for pSpA (54% against). Importantly, early axSpA should be based on symptom duration taking solely axial symptoms into account. 151-164 ASAS members participated in the Delphi surveys. Consensus was achieved for considering the following items within early axSpA definition: duration of symptoms ≤2 years; axial symptoms defined as cervical/thoracic/back/buttock pain or morning stiffness; regardless of the presence/absence of radiographic damage. The WG agreed that in patients with a diagnosis of axSpA 'early axSpA' should be defined as a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA. The ASAS community endorsed this proposal (88% in favour).

Conclusions: Early axSpA has newly been defined, based on expert consensus. This ASAS definition should be adopted in research studies addressing early axSpA.

Keywords: Arthritis; Outcome Assessment, Health Care; Spondylitis, Ankylosing.

Publication types

  • Consensus Development Conference

MeSH terms

  • Axial Spondyloarthritis* / diagnosis
  • Consensus*
  • Delphi Technique*
  • Early Diagnosis
  • Humans
  • Rheumatology / standards
  • Societies, Medical
  • Spondylarthritis / classification
  • Spondylarthritis / diagnosis
  • Terminology as Topic