DIAGNOSING axial spondyloarthritis within 2 years of symptom onset has been associated with less long-term spinal structural damage, according to a new analysis of Swiss registry data. The findings have highlighted the potential value of early recognition.
The Assessment of SpondyloArthritis International Society (ASAS) has recently defined early axial spondyloarthritis as a duration of 2 years or less of axial symptoms. Previous studies found no significant short-term outcome differences between early and established disease under biologic or targeted synthetic therapy. Randomised controlled trials are typically too short to assess structural damage, leaving it unclear whether early diagnosis is associated with less long-term spinal damage.
Researchers analysed Swiss Clinical Quality Management in Rheumatic Diseases registry data (2004–2024) for patients with axial spondyloarthritis and at least two sets of spinal radiographs. Two readers scored radiographs using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS), with an adjudicator for disagreements. Among 376 patients with 1,181 radiograph sets, 138 patients had early disease, and 238 had established disease.
Baseline characteristics were similar between groups, with 61% male and 69% positive for human leukocyte antigen B27 (HLA-B27). Mean overall follow-up was 11.5 years. Progression from diagnosis was compared using a four-parametric logistic model accounting for nonlinear mSASSS progression.
At 10–15 years after diagnosis, patients with early axial spondyloarthritis had a lower long-term mSASSS than those with established disease (difference: −3.85 mSASSS units; 95% CI: −7.28 to −0.42). The difference remained significant after adjustment for baseline radiographic damage (−5.70 mSASSS units; 95% CI: −9.31 to −2.09).
Differences were greater in male patients (6.2 mSASSS units) and similar in HLA-B27 positive and negative male patients (7.5 and 7.3 mSASSS units, respectively), suggesting a stronger link with sex than HLA-B27 status. Syndesmophyte formation validated the findings (difference: one syndesmophyte overall; two in male patients).
These findings have indicated that early diagnosis of axial spondyloarthritis is associated with less long-term spinal structural damage. Although the observational design does not allow causal inference, the results support earlier referral, and more research is needed to clarify the role of specific interventions.
Reference
Steimer A et al. Early diagnosis of axial spondyloarthritis is associated with less long-term spinal structural damage: a longitudinal analysis of the Swiss Clinical Quality Management in rheumatic diseases registry. Arthritis & Rheumatology. 2026;DOI:10.1002/art.70346.
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