Importance of Early Diagnosis of Ankylosing Spondylitis
Importance of Early Diagnosis of Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting primarily the sacroiliac joints and the spine. AS may be associated with peripheral joint involvement and can also be accompanied by the presence of extra-articular manifestations, such as uveitis, inflammatory bowel disease or skin psoriasis.
For decades, making a diagnosis of AS was dependent on the modified New York criteria, which rely on the combination of clinical symptoms and established radiographic sacroiliitis of at least grade 2 bilaterally or grade 3 unilaterally. However, radiographs are very often normal in the early stages of the disease after the onset of back pain and it may take many years for radiographic sacroillitis to develop. As such, the modified New York criteria allow for diagnosis at an advanced stage of disease evolution, a time when structural damage is irreversible. From the clinical standpoint this diagnostic delay is of great significance since the degree of pain and disability that patients experience during this nonradiographic phase is comparable to that reported by patients who have been affected with the disease for many years. The absence of a diagnosis will lead to patients missing out on early and timely initiation of appropriate treatment. Furthermore, early diagnosis is of paramount importance as there are a number of highly efficacious therapies that have become available in recent years.
Introduction
Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting primarily the sacroiliac joints and the spine. AS may be associated with peripheral joint involvement and can also be accompanied by the presence of extra-articular manifestations, such as uveitis, inflammatory bowel disease or skin psoriasis.
For decades, making a diagnosis of AS was dependent on the modified New York criteria, which rely on the combination of clinical symptoms and established radiographic sacroiliitis of at least grade 2 bilaterally or grade 3 unilaterally. However, radiographs are very often normal in the early stages of the disease after the onset of back pain and it may take many years for radiographic sacroillitis to develop. As such, the modified New York criteria allow for diagnosis at an advanced stage of disease evolution, a time when structural damage is irreversible. From the clinical standpoint this diagnostic delay is of great significance since the degree of pain and disability that patients experience during this nonradiographic phase is comparable to that reported by patients who have been affected with the disease for many years. The absence of a diagnosis will lead to patients missing out on early and timely initiation of appropriate treatment. Furthermore, early diagnosis is of paramount importance as there are a number of highly efficacious therapies that have become available in recent years.
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