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Patient’s Journey: Behind a normal X-ray is a person who may be suffering with nr-axSpA

Patients with nr-axSpA can suffer with substantial disease burden.37,52
Proactive diagnosis and treatment is key.

EMILY, age 29

Real Estate Agent

Not an actual patient. Models are for illustrative purposes only.
Emily has back pain and enthesitis. Could she have nr-axSpA?

History

  • Back stiffness in the morning that improves with exercise
  • Some peripheral swelling in left knee
  • Widespread pain
  • Fatigue

Medications

  • Naproxen
  • Duloxetine
  • Recently prescribed pregabalin

Workup and lab results

  • ESR, iron, B12, TSH, T3, T4: normal
  • RF, CCP antibody: negative
  • X-RAYs: no SIJ damage
  • CRP Elevated: 15.4 mg/L
  • HLA-B27: positive

Extraspinal manifestations in nr-axSpA*

Enthesitis
up to 44%58

Peripheral arthritis
up to 41%58

Psoriasis
up to 11%37

Subclinical IBD
up to 42%59

Uveitis
up to 12%53

Dactylitis
up to 7%53

MICHELLE, age 34

Event Planner

Not an actual patient. Models are for illustrative purposes only.
Michelle has uveitis, back pain, and subclinical IBD. Could she have nr-axSpA?

History

  • Back pain that wakes her up at night
  • Enthesitis at the plantar fascia
  • Fatigue
  • HLA-B27 negative
  • Moderately elevated CRP
  • X-RAYs NEGATIVE with no definitive damage to SIJ or lumbar spine

Medications

  • Methotrexate
  • Meloxicam
  • Local corticosteroid injections

Workup and lab results

  • Visual nail exam, ESR, iron: normal
  • Skin changes: none
  • CRP elevated: 15.4 mg/L
  • MRI: Bone marrow edema, presence of fatty lesions
  • ASCA IgG: elevated

Extraspinal manifestations in nr-axSpA*

Enthesitis
up to 44%58

Peripheral arthritis
up to 41%58

Psoriasis
up to 11%37

Subclinical IBD
up to 42%59

Uveitis
up to 12%53

Dactylitis
up to 7%53

*Prevalence includes all axial and peripheral SpA disease states.
ASCA IgG: Saccharomyces cerevisiae antibodies; CCP: cyclic citrullinated peptide; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; HLA-B27+: human leukocyte antigen-B27 positive; IBD: inflammatory bowel disease; nr-axSpA: non-radiographic axial spondyloarthritis; RF: rheumatoid factor; SIJ; sacroiliac joint; SpA: spondyloarthritis; TSH, T3, T4: thyroid panel tests.