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Patients with nr-axSpA may experience chronic lower back pain and inflammation of the sacroiliac joints.5,6 Additionally, lack of sleep and fatigue are commonly reported by these patients.7 Extra-spinal manifestations of disease, including uveitis, psoriasis, inflammatory bowel disease, dactylitis, peripheral arthritis, and enthesitis may also occur.7,8 Symptoms of nr-axSpA can have a significant impact on patients’ function, with patients experiencing reduced ability to work and lower work productivity.9 Patients may also experience anxiety, depression, and an overall reduced quality of life.10
Unlike in the related disease state of ankylosing spondylitis, the prevalence of nr-axSpA is similar in men and women.1-5,11 However, women can experience disease activity differently than men.12 Despite being less likely to experience radiographic progression, women experience greater functional impairments than men.12 Additionally, women with early disease have greater subjective disease activity and are more likely to have widespread pain than men.12,13 Women with definite sacroiliitis may also experience more fatigue and peripheral involvement than men.12 The overlap of clinical features with fibromyalgia can also complicate the diagnosis and treatment of axSpA in women, especially given the predominance of fibromyalgia in women.14
1. Garg N, van den Bosch F, Deodhar A. The concept of spondyloarthritis: where are we now? Best Pract Res Clin Rheumatol. 2014;28(5):663-672.
2. Reveille JD, Witter JP, Weisman MH. Prevalence of axial spondylarthritis in the United States: estimates from a cross-sectional survey. Arthritis Care Res (Hoboken). 2012;64(6):905-910.
3. U.S. and World Population Clock. United States Census Bureau website. Accessed June 26, 2018.
4. Baraliakos X, Braun J. Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences? RMD Open. 2015;1(Suppl 1):e000053. doi: 10.1136/rmdopen-2015-000053.
5. Boonen A, Sieper J, van der Heijde D, et al. The burden of non-radiographic axial spondyloarthritis. Semin Arthritis Rheum. 2015;44(5):556-562.
6. Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777-783.
7. Boonen A, van der Linden SM. The burden of ankylosing spondylitis. J Rheumatol Suppl. 2006;78:4-11.
8. de Winter JJ, van Mens LJ, van der Heijde D, Landewe R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther. 2016;18:196. doi:1186/s13075-016-1093-z.
9. Mease PJ, Heijde DV, Karki C, et al. Characterization of Patients With Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis in the US-Based Corrona Registry. Arthritis Care Res (Hoboken). 2018;70(11):1661-1670.
10. Erol K, Gok K, Cengiz G, Kilic G, Kilic E, Ozgocmen S. Extra-articular manifestations and burden of disease in patients with radiographic and non-radiographic axial spondyloarthritis. Acta Reumatol Port. 2018;43(1):32-39.
11. Deodhar A, Mease PJ, Reveille JD, et al. Frequency of Axial Spondyloarthritis Diagnosis Among Patients Seen by US Rheumatologists for Evaluation of Chronic Back Pain. Arthritis Rheumatol. 2016;68(7):1669-1676.
12. Tournadre A, Pereira B, Lhoste A, et al. Differences between women and men with recent-onset axial spondyloarthritis: results from a prospective multicenter French cohort. Arthritis Care Res (Hoboken). 2013;65(9):1482-1489.
13. Slobodin G, Reyhan I, Avshovich N, et al. Recently diagnosed axial spondyloarthritis: gender differences and factors related to delay in diagnosis. Clin Rheumatol. 2011;30(8):1075-1080.
14. Wendling D, Prati C. Spondyloarthritis and fibromyalgia: interfering association or differential diagnosis? Clin Rheumatol. 2016;35(9):2141-2143.