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New approaches in ankylosing spondylitis

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There have been marked improvements in treatment options but none have yet been shown to induce remission

The past decade has seen major advances in the diagnosis and management of ankylosing spondylitis (AS) and in research into its pathogenesis. It remains the case that no current treatments have been shown to lead to disease remissions or to halt the progression of the bony ankylosis that causes the major morbidity associated with this condition. Nonetheless, improved diagnostic methods and management have led to major benefits for patients, with marked improvements in quality of life with reduced treatment-associated side effects.

Early diagnosis and non-radiographic axial spondyloarthritis

AS is diagnosed using the modified New York classification criteria for the disease,1 which are highly specific for AS but require the presence of x-ray changes in the sacroiliac joints to establish a diagnosis. Consequently, they lack sensitivity, particularly early in disease. It is estimated that it takes on average a decade between onset of axial spondyloarthritis symptoms before these x-ray changes develop, although in some cases more rapid progression occurs.2

The introduction of magnetic resonance imaging (MRI) scanning for the diagnosis of axial spondyloarthritis has greatly improved the ability to diagnose patients with less severe x-ray…