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Semin Arthritis Rheum. 2015 Apr;44(5):556-562. doi: 10.1016/j.semarthrit.2014.10.009. Epub 2014 Oct 22.

The burden of non-radiographic axial spondyloarthritis.

Author information

Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center and CAPHRI Research Institute, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands. Electronic address:
Charité-Universitätsmedizin Berlin, Berlin, Germany.
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Rheumatology, Paris Descartes University, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
Pfizer Inc., Collegeville, PA.



To identify patients earlier, new classification criteria have been introduced for axial spondyloarthritis (axSpA). Patients who satisfy the clinical or imaging criteria for axSpA in the absence of definite sacroiliac joint changes on pelvic x-rays are classified as having non-radiographic axSpA. Although the burden associated with radiographic axSpA (i.e., ankylosing spondylitis) has been extensively studied, the impact of non-radiographic disease is not well understood. The purpose of this review is to provide an overview of the burden of illness in non-radiographic axSpA, including epidemiology and effects on patients׳ functioning and health-related quality of life (HR-QoL).


A PubMed search was performed using relevant key words (e.g., "spondyloarthritis," "ankylosing spondylitis," "epidemiology," and "quality of life") to examine literature published from 2003 to 2013.


Studies conducted to date suggest that radiographic progression is detected in approximately 10% of patients with non-radiographic axSpA over 2 years. Differences between patients with non-radiographic and radiographic axSpA were found in age, symptom duration, and gender distribution. Although less inflammation (i.e., lower C-reactive protein levels and less spinal inflammation on MRI) and less impairment in spinal mobility are observed in non-radiographic than in radiographic axSpA, the 2 conditions pose a similar burden in terms of disease activity, physical function, HR-QoL impairment.


Patients with non-radiographic axSpA are more frequently female. Although patients with non-radiographic axSpA have shorter disease duration and lack radiological changes, they demonstrate a substantial burden of illness, with self-reported disease activity and functional impairments comparable to those found in patients with radiographic disease.


Ankylosing spondylitis; Burden of illness; Cost, work productivity; Disease activity; Epidemiology; Non-radiographic axial spondyloarthritis; Physical function; Quality of life

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