Chinese recommendations for the diagnosis and management of non-radiographic axial spondyloarthritis

BACKGROUND: The term of non-radiographic axial spondyloarthritis (nr-axSpA) has stimulated a number of practice-changing developments, but the meaning of nr-axSpA has not been well understood by clinicians, including rheumatologists. The diagnosis of nr-axSpA remains clinically problematic, with substantial risks of overdiagnosis. OBJECTIVE: To generate a set of evidence-based recommendations for the diagnosis and management of patients with nr-axSpA for physicians, health professionals, and rheumatologists. METHODS: The recommendations were developed through a Delphi method prioritizing 37 key clinical questions. Evidence Synthesis Group performed systematic literature searches and evidence evaluation. In task force meetings, the evidence was presented and discussed, resulting in formulation and updating of overarching principles and recommendations that were subsequently voted on by an Expert Panel. RESULTS: Six overarching principles and 17 recommendations were agreed. The principles focus on differential diagnosis, treatment target, monitoring and re-assessment. The recommendations deal with: Definitions of axSpA and nr-axSpA (#1-2); The value of MRI and CT in diagnosis (#3-7); The specificity of the ASAS-axSpA classification criteria, the long-term outcome and risk factors of progressing to AS (#8-9); Non-pharmacological management and NSAIDs treatment (#10-11); The indication of biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) for patients with or without specific comorbidities(#12-14); Switching to another bDMARD or JAKi in primary failure and secondary failure (#15-16); Tapering of a bDMARD in sustained remission (#17). CONCLUSIONS: The recommendations represent the first effort to establish a clear definition of axSpA, to critically evaluate the imaging clues in and performance of the classification criteria for diagnosing nr-axSpA, and to provide specific guidance for nr-axSpA management.