Disease modification in axial spondyloarthritis.


Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, University of Toronto, Canada. Electronic address: [Email]


The concept of "disease modification" refers to an intervention that modifies the natural clinical course of the disease along with improvement of symptoms. With regard to this, providing treatment that improves clinical signs and symptoms of axial spondyloarthritis (axSpA) and that impacts disease pathogenesis by slowing/halting bone formation is the main goal of this concept. It has been proven that currently available treatments including biologics and nonsteroidal anti-inflammatory drugs have a symptom-modifying effect in axSpA. The body of evidence showing a beneficial effect of biologic therapy on spinal damage is growing. In this article, by centralizing new bone formation as a main target of disease modification, we reviewed molecular mechanisms related to new bone formation, relevance of imaging studies on assessment of disease progression, clinical predictors of new bone formation, and disease-modifying properties of currently available treatments in axSpA.


Ankylosing spondylitis,Diagnostic imaging,Disease progression,Non-steroidal anti-inflammatory agents,Outcomes assessment,Smoking,Spondylarthropathies,Tumor necrosis factor-alpha,