Axial spondyloarthritis: clinical and paraclinical features

Abstract

Background. Axial spondyloarthritis is a chronic inflammatory rheumatic disease predominantly affecting the axial skeleton and is a high burden on patients and health systems worldwide. Its prevalence ranges between 0.2 and 0.9%, and its diverse presentations and diagnostic delays highlight its ongoing relevance. Objective(s). To describe the main clinical symptoms and paraclinical markers of axial spondyloarthritis, focusing on inflammation, pain features, and laboratory tests that aid in diagnosis and treatment. Materials and methods. Materials were collected from databases including Elsevier, ResearchGate, ScienceDirect, PubMed, and Google Scholar. The review analyzed peerreviewed articles, clinical cohorts, and trials focusing on clinical and paraclinical features of axial spondylarthritis. Emphasis was placed on HLA-B27 status and inflammatory markers. Results. Literature revealed clinical features include inflammatory back pain in nearly all patients, peripheral arthritis (~30%), enthesitis (~40%), dactylitis (~6%), anterior uveitis (25–35%), psoriasis (~10%), and inflammatory bowel disease (4–6%). Paraclinically, HLAB27 positivity occurs in 70–90% of White patients. Acute phase reactants such as CRP and ESR are elevated in 50–60% of radiographic and 30–40% of non-radiographic axSpA. Physical exams often lack sensitivity, emphasizing the role of laboratory tests and clinical evaluation. Progression from non-radiographic to radiographic axSpA occurs in 5–10% at 2 years and up to 30% at 10 years. Conclusion(s). Axial spondyloarthritis presents with diverse clinical features and often subtle paraclinical findings. Early suspicion, careful imaging, and laboratory tests are crucial for prompt diagnosis. Interdisciplinary collaboration improves outcomes and can reduce long-term disability and complications.