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Title: Australian Consensus Statements for the Assessment and Management of Non-radiographic Axial Spondyloarthritis.
Austin Authors: Truong, Steven L;McEwan, Tim;Bird, Paul;Lim, Irwin;Saad, Nivene F;Schachna, Lionel ;Taylor, Andrew L;Robinson, Philip C
Affiliation: Rheumatology
Department of Medicine, University of Melbourne, Parkville, VIC, Australia
School of Medicine, University of Queensland, Brisbane, Australia
Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
BJC Health, Sydney, NSW, Australia
St George Hospital Clinical School, University of New South Wales, Sydney, Australia
School of Clinical Medicine, University of Queensland, Herston, QLD, 4006, Australia
Department of Rheumatology, Medical School, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
Coast Joint Care, Maroochydore, QLD, Australia
School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
School of Clinical Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
Metro North, Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
Issue Date: Feb-2022
Date: 2021-12-28
Publication information: Rheumatology and Therapy 2022; 9(1):1-24
Abstract: The understanding of non-radiographic axial spondyloarthritis (nr-axSpA) has accelerated over the last decade, producing a number of practice-changing developments. Diagnosis is challenging. No diagnostic criteria exist, no single finding is diagnostic, and other causes of back pain may act as confounders. To update and expand the 2014 consensus statement on the investigation and management of non-radiographic axial spondyloarthritis (nr-axSpA). We created search questions based on our previous statements and four new topics then searched the MEDLINE and Cochrane databases. We assessed relevant publications by full-text review and rated their level of evidence using the GRADE system. We compiled a GRADE evidence summary then produced and voted on consensus statements. We identified 5145 relevant publications, full-text reviewed 504, and included 176 in the evidence summary. We developed and voted on 22 consensus statements. All had high agreement. Diagnosis of nr-axSpA should be made by experienced clinicians, considering clinical features of spondyloarthritis, blood tests, and imaging. History and examination should also assess alternative causes of back pain and related conditions including non-specific back pain and fibromyalgia. Initial investigations should include CRP, HLA-B27, and AP pelvic radiography. Further imaging by T1 and STIR MRI of the sacroiliac joints is useful if radiography does not show definite changes. MRI provides moderate-to-high sensitivity and high specificity for nr-axSpA. Acute signs of sacroiliitis on MRI are not specific and have been observed in the absence of spondyloarthritis. Initial management should involve NSAIDs and a regular exercise program, while TNF and IL-17 inhibitors can be used for high disease activity unresponsive to these interventions. Goals of treatment include improving the frequent impairment of social and occupational function that occurs in nr-axSpA. We provide 22 evidence-based consensus statements to provide practical guidance in the assessment and management of nr-axSpA.
DOI: 10.1007/s40744-021-00416-7
ORCID: 0000-0002-9093-3853
Journal: Rheumatology and Therapy
PubMed URL: 34962620
PubMed URL:
ISSN: 2198-6576
Type: Journal Article
Subjects: Consensus statements
Non-radiographic axial spondyloarthritis
TNF inhibitor
Appears in Collections:Journal articles

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