The possibilities of early diagnosis and progression of non-radiographic axial spondyloarthritis (experience of Kaliningrad region)
Abstract. The diagnosis of spondyloarthritis (SpA) is often delayed, that is resulted from several factors like the absence of specific manifestations of SpA in the early stages, insufficient alertness of physicians of related specialties, patients late seek medical care, etc. The introduction of the concept of ”non-radiographic axial spondyloarthritis” (nr-axSpA) increased the total number of patients with SpA, but did not lead to a significant reduction in the time for diagnosis and a reduction in the burden of the disease.Grabovetskaya Yu.Yu., Smirnov A.V., Mikhailov E.S., Shcherbanev K.G.
The aim of the study was conducting an experience with the participation of physicians of various specialties and a reference center for V.A. Nasonova Research Institute of Rheumatology for the purpose of early detection of patients with nr-axSpA and subsequent dynamic follow-up.
Material and methods. 284 physicians of different specialties have been informed the early symptoms of axSpA. 361 patients were directed to rheumatologist consultation. Nr-axSpA were diagnosed in 80 of 361 patients. Then we compared 80 patients with nr-axSpA and 99 patients with ankylosing spondylitis (AS) with an average duration of the disease of 14 years.
Results. The study included 80 patients with nr-axSpA diagnosed on ASAS 2009 criteria. The diagnosis was reclassified to AS in 12 (15%) by specialists of the reference center of the Nasonova Research Institute of Rheumatology reviewed the MRI and X-ray data. After 3 years of observation, 30 of 68 (44%) patients had clinical manifestations consistent with nr-axSpA, 16/68 (23.5%) were diagnosed with AS, 7/68 (10.3%) – psoriatic spondyloarthritis, in 13/68 (14.7%) SpA was excluded, 2/68 (3%) dropped out of participation due to loss of contact. Women (61.5%) prevailed among patients with nr-axSpA, men (74.7%) prevailed in AS. HLA-B27 was detected in 39.7% of patients with nr-axSpA. Significant differences in disease activity between nr-axSpA and AS patients weren’t reveled.
Conclusions. The conducted experience in Kaliningrad region have demonstrated the effectiveness of attracting related specialists for early diagnostics of the nr-axSpA, as well as the existing difficulties in interpreting radiological data at the early stages of the disease and the need to use a reference center for a federal institution.
Keywords
non-radiographic axial spondyloarthritis
ankylosing spondylitis
radiography
magnetic resonance imaging
reference center for spondyloarthritis
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About the Authors
Yulia Yu. Grabovetskaya, MD, chief freelance rheumatologist of the Ministry of Healthcare of Kaliningrad Region, head of Anti-cytokine Therapy Center, Regional Clinical Hospital of Kaliningrad Region. Address: 236016, Kaliningrad, 74 Klinicheskaya St.E-mail: dr.grabovetskaya@mail.ru
ORCID: https://orcid.org/0000-0003-1758-3065
Alexander V. Smirnov, MD, Dr. Sci. (Medicine), leading researcher at the Department of instrumental diagnostics, V.A. Nasonova Research Institute of Rheumatology; professor of the Department of radiology and ultrasound diagnostics, Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies of FMBA. Address: 115682, Moscow, 28 Orekhovy Boulevard.
E-mail: smirale@mail.ru
ORCID: https://orcid.org/0000-0001-7418-9369
Evgeny S. Mikhailov, MD, PhD (Medicine), radiologist at Regional Clinical Hospital of Kaliningrad Region. Address: 236016, Kaliningrad, 74 Klinicheskaya St.
E-mail: esmikhailov@gmail.com
ORCID: https://orcid.org/0009-0005-7357-3912
Kirill G. Shcherbanev, MD, therapist, rheumatologist at Anti-cytokine Therapy Center, Regional Clinical Hospital of Kaliningrad Region. Address: 236016, Kaliningrad, 74 Klinicheskaya St.
E-mail: sherbanev1997@mail.ru
ORCID: https://orcid.org/0000-0002-4230-1974
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