Early Axial Spondyloarthritis
DOI:
https://doi.org/10.15305/ijrci/v14i1/356Keywords:
axial spondyloarthritis; early axSpA; window of opportunity; HLA-B27; IL-17; TNF inhibitors; JAK inhibitors; IndiaAbstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder of the axial skeleton encompassing non-radiographic and radiographic disease. Early diagnosis remains challenging globally, with median diagnostic delays of 2–6 years. The immunopathology of early axSpA involves HLA-B27-mediated immune dysregulation, TNF-α and IL-23/IL-17 pathway activation, entheseal inflammation, gut–entheseal crosstalk, and an acknowledged role for PGE2/EP4-mediated osteoproliferation. NSAIDs remain first-line therapy, with escalation to TNF inhibitors, IL-17 inhibitors, or JAK inhibitors in refractory disease. While the concept of a therapeutic window of opportunity in early axSpA has biological plausibility, current evidence remains heterogeneous and requires further validation. Data from an Indian multicenter early axSpA cohort highlight a distinct disease phenotype characterized by younger age at onset, higher disease activity, greater peripheral involvement, and a 54% prevalence of radiographic sacroiliitis at diagnosis, underscoring a substantial burden of structural damage at the time of presentation. Indigenous guidelines and larger prospective Indian cohorts are needed to optimize early management strategies in this population.
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