Changes in physicians' perceptions of the spondyloarthropathies

A recent review in the Annals of the Rheumatic Diseases considers physicians' perceptions of spondyloarthropathies. The report highlights disease prevalence, its economic impact, diagnosis, therapeutic options and management approach.Dr Barkham and colleagues from the Academic Unit of Musculoskeletal Disease, (University of Leeds, UK) comment that physicians' perceptions of spondyloarthropathies are changing. In particular, the authors consider traditional misassumptions that ankylosing spondylitis (AS) is a rare disease with few therapeutic options by highlighting recent data which estimates a prevalence as high as 1%. Importantly, the authors add, it affects people at a time when they are economically active and has a major impact on a person's ability to work. Barkham et al consider the main hurdle faced by the clinician has been the inability to establish a diagnosis early enough to allow treatment to be started. This delay may be compounded, sometimes delayed for decades, as a result of the lack of sensitivity of radiological imaging methods, the authors write, adding that the advent of new imaging methods, especially magnetic resonance imaging (MRI), has facilitated the possibility of early diagnosis of AS. Barkham et al cite one study reporting that MRI predicted the development of radiographic sacroiliitis with a sensitivity of 85% and a specificity of 47%.The review continues by challenging the assumption of a good clinical outcome, commenting on previous work identifying 70% of patients progressing to fusion of the spine by 10-15 years. Furthermore, mortality is also reported to be 1.5-4 times that of the general population, with a 12% decrease in survival over 40 years.When considering therapeutic options the authors believe that tumour necrosis factor a(TNFa) blocking drugs have revolutionised the approach to the management of the spondyloarthropathies. Traditionally treatments such as non-steroidal anti-inflammatory drugs and physiotherapy, although useful in a number of patients, fail in others to demonstrate a clear level of efficacy which may be conferred by anti-TNF agents, the authors write.The reviewers summarize by commenting that the widespread perception of the spondyloarthropathies as "innocuous" or having a good outcome has hampered the development of protocols for defining early disease and call for further research to develop this approach and identify those who would benefit from early treatment.Reference...