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Radiographic and non-radiographic axial spondyloarthritis are not routinely distinguished in everyday clinical care: an analysis of real-world data from rheumatology practices

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Abstract

The categorization of axial spondyloarthritis (axSpA) into radiographic (r-axSpA) and non-radiographic (nr-axSpA) subtypes is important in clinical trials but may be of less value in clinical practice. This exploratory cross-sectional, multi-center study evaluated patients with axSpA under routine care at German clinical rheumatology sites (RHADAR real-world database), with a focus on imaging data used for diagnostic classifications. Our analyses included 371 patients with axSpA. The mean (standard deviation [SD]) age was 50.9 (14.0) years, disease duration was 16.4 (13.5) years, and 39.6% were female. Based on the rheumatologist’s final assessment, almost half of patients had definite r-axSpA (n = 179; 48.2%), 53 (14.3%) had suspected r-axSpA, 112 (30.2%) had non-radiographic-axSpA (nr-axSpA), and 27 (7.3%) had undefined axSpA. Patients assessed with definite or suspected r-axSpA were more likely to be treated with disease-modifying antirheumatic drugs (DMARDs) (62.0% and 64.2%, respectively) compared with nr-axSpA or undefined axSpA patients (37.5% and 48.1%, respectively). Almost all patients (348/371; 93.8%) had sacroiliac joint imaging data (radiographs or magnetic resonance imaging) documented in their charts, but only 216 (58.2%) had conventional radiographs required for formal diagnosis of r-axSpA by modified New York criteria. Follow-up radiographic imaging in nr-axSpA patients was uncommon (23/216 [25.0%]) but confirmed r-axSpA in 9/23 patients (39.1%). In conclusion, radiographs were available for slightly more than half of axSpA patients. Follow-up imaging was infrequent during rheumatology care in Germany but confirmed r-axSpA in ~ 40% of patients originally considered to have nr-axSpA. The distinction between r-axSpA and nr-axSpA may be ill-defined in routine clinical practice.

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Data are available for collaborative research upon reasonable request.

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Acknowledgements

We thank the patients and medical staff who participated in this study. Data management services were provided by Nils Koerber and medical writing support was provided by Sharon L. Cross, PhD under the direction of the authors; both were funded by RHADAR GbR (A Network of Rheumatologists) with a grant from Novartis Pharma GmbH.

Funding

This study was funded by the RheumaDatenRhePort GbR (A Network of Rheumatologists), Bahnhofstr. 32, 82152 Planegg, Germany. RHADAR GbR received a grant for this study from Novartis Pharma GmbH.

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Authors and Affiliations

  1. Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany

    Stefan Kleinert, Florian Schuch, Praxedis Rapp, Monika Ronneberger & Joerg Wendler

  2. Med. Klinik 3, Rheumatologie/Klinische Immunologie, Universitätsklinik Würzburg, Würzburg, Germany

    Stefan Kleinert

  3. RheumaDatenRhePort GbR (A Network of Rheumatologists), Planegg, Germany

    Stefan Kleinert, Peter Bartz-Bazzanella, Cay von der Decken, Kirsten Karberg, Georg Gauler, Patrick Wurth, Susanna Späthling-Mestekemper, Christoph Kuhn, Wolfgang Vorbrüggen & Martin Welcker

  4. Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planegg, Germany

    Patrizia Sternad, Florian Popp & Martin Welcker

  5. Rhein-Maas Klinikum, Wuerselen, Germany

    Peter Bartz-Bazzanella

  6. Medizinisches Versorgungszentrum Stolberg, Stolberg, Germany

    Cay von der Decken

  7. Praxis für Rheumatologie und Innere Medizin, Berlin, Germany

    Kirsten Karberg

  8. Rheumatologische Schwerpunktpraxis, Osnabrück, Germany

    Georg Gauler & Patrick Wurth

  9. Rheumapraxis München, Munich, Germany

    Susanna Späthling-Mestekemper

  10. Rheumaärzte GmbH MVZ, Standort Ettlingen, Ettlingen, Germany

    Christoph Kuhn

  11. Verein zur Förderung der Rheumatologie e.V., Würselen, Germany

    Wolfgang Vorbrüggen

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  1. Stefan Kleinert
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Contributions

All authors met the ICMJE criteria for authorship, made contributions to conception and/or implementation of the study, were involved in reviewing and revising the manuscript, gave final approval to the version to be published, and take full responsibility for the integrity and accuracy of all aspects of this work.

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Correspondence to Stefan Kleinert.

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Conflict of interest

SK, PB-B, CVdD, KK, GG, SS-M, CK, WV, and MW are members of RheumaDatenRhePort. SK received grants or contracts from Abbvie, Novartis, and Sparrow for phase 2/3 clinical trials, received consulting fees or honoraria from Abbvie, Celgene, Galapagos, Novartis, and Siemens Healthineers, and participated on a data safety monitoring or advisory board for Abbvie. FS received consulting or speaker’s fees from Abbvie, Galapagos, Lilly, Novartis, and Rheumaakademie and travel or meeting support from Abbvie. MR received consulting or speaking fees from Abbvie, BMS, Galapagos, Janssen, Novartis, and UCB, travel or meeting support from Pfizer, and participated on data safety monitoring or advisory boards for Abbvie, Galapagos, Novartis, and UCB. JW received consulting fees from Abbvie. FP received consulting fees from Abbvie, Boehringer, Galapagos, Medac, and Viatris. PBB received speaking fees from AbbVie, Boehringer Ingelheim, Chugai/Roche, Janssen-Cilag, Novartis, Pfizer, and UCB, travel or meeting support from Abbvie, and participated on a data safety monitoring or advisory board for RHADAR GbR. KK received speaking fees from Abbvie, Galapagos, Novartis, Rheumakademie, and UCB, travel or meeting support from UCB, and participated on a data safety monitoring or advisory board for RHADAR GbR. GG received speaking fees from Abbvie, Galapagos, and Novartis and travel or meeting support from Abbvie and Novartis. PW received consulting or speaking fees from Abbvie, Galapagos, Jannsen, and Medac. SSM received speaking fees from AbbVie, Boehringer Ingelheim, GSK, Janssen-Cilag, Lilly, Novartis, and UCB and participated on a data safety monitoring or advisory board for RHADAR GbR. MW received grants or contracts from AbbVie, BMS, Boehringer, Galapagos, Gilead, GSK, Hexal, Janssen, Novartis, Pfizer, and UCB, consulting or speaking fees from Abbvie, Aescu, Alexion, Amgen, Biogen, BDI, BDRH, BMS, Boehringer, Celltrion, DGRH, Fresenius, Galapagos, Gilead, GSK, Hexal, Janssen, Medac, MSD, Mundipharma, Mylan, Novartis, Pfizer, RHADAR, RheCORD, Rheumaliga, Riemser, Roche, Sanofi-Aventis, SOBI, and UCB, travel or meeting support from Abbvie, Amgen, Celltrion, Galapagos, GSK, Novartis, Pfizer, Sanofi-Aventis, and UCB, and participated on a data safety monitoring or advisory board for Abbvie, Boehringer, Fresenius, Galapagos, Gilead, GSK, Janssen, Novartis, Pfizer, Sanofi-Aventis, and UCB. PR, PS, CvdD, CK, and WV do not have any competing interests to declare.

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The study was exempted from ethical approval under German law due to the use of anonymized data.

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Written informed consent was obtained from all patients prior to study start.

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Kleinert, S., Schuch, F., Rapp, P. et al. Radiographic and non-radiographic axial spondyloarthritis are not routinely distinguished in everyday clinical care: an analysis of real-world data from rheumatology practices. Rheumatol Int 44, 653–661 (2024). https://doi.org/10.1007/s00296-023-05463-7

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