Peripheral disease contributes significantly to the level of disease activity in axial spondyloarthritis

RMD Open. 2019 Jan 11;5(1):e000802. doi: 10.1136/rmdopen-2018-000802. eCollection 2019.


Objective: Spondyloarthritis (SpA) can encompass axial, peripheral and extra-articular disease manifestations. Patients are classified as axial or peripheral SpA depending on the presence or absence of current back pain, independently of the other disease manifestations. Therefore, we aimed to assess the percentage of patients with axial SpA with peripheral disease and how this peripheral disease contributes to the overall disease activity.

Methods: Prevalence and disease activity of peripheral disease manifestations were assessed in a real-life observational cohort of 314 patients with the clinical diagnosis of SpA and fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria.

Results: Of the 314 patients fulfilling the ASAS criteria, 230 fulfilled the axial and 84 the peripheral SpA criteria. Of the 230 patients with axial SpA, 49% had purely axial disease without peripheral disease manifestations whereas 51% had combined axial (back pain) and peripheral (arthritis, enthesitis and/or dactylitis) disease. The latter group had the highest disease activity in comparison with pure axial SpA as well as with peripheral SpA.

Conclusion: Half of the patients classified as axial SpA according to the ASAS criteria also have peripheral disease manifestations such as arthritis, enthesitis and/or dactylitis. These peripheral disease manifestations contribute significantly to overall disease activity.

Keywords: ankylosing spondylitis; disease activity; spondyloarthritis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Back Pain / diagnosis
  • Back Pain / etiology
  • Biomarkers
  • Cohort Studies
  • Comorbidity
  • Female
  • Humans
  • Male
  • Middle Aged
  • Phenotype
  • Prevalence
  • Severity of Illness Index
  • Spondylarthritis / complications
  • Spondylarthritis / diagnosis*
  • Spondylarthritis / epidemiology*


  • Biomarkers