Axial spondyloarthritis - A challenging inflammatory rheumatic disease

Axial spondyloarthritis (ax-SpA) belongs to the most common inflammatory rheumatic diseases. The disease can be subdivided into non-radiographic ax-SpA and radiographic SpA or ankylosing spondylitis. The broad availability of magnetic resonance imaging has enabled us to diagnose this disease earlier. However, the fact that chronic back pain represents one of the most common symptoms and also in a healthy population is a remarkable pitfall for the diagnosis of ax-SpA. Aside from imaging, laboratory parameters, especially HLA-B27 as well as parameters of inflammation in conjunction with the medical history and the clinical examination are required to perform the diagnosis, which still can be challenging. Regarding therapy, biologics and especially tumour necrosis factor blockers have widely broadened our capabilities to treat this disease for patients who are not adequately responding to non-steroidal anti-rheumatic drugs. Interleukin-17 blockade represents a newer option, and Janus Kinase inhibition has shown some promising results in clinical trials. However, despite all efforts that have been achieved in ax-SpA, still the period between the onset of symptoms and diagnosis remains too long and must be further shortened.