6533b851fe1ef96bd12aa2b7

RESEARCH PRODUCT

Flare in axial spondyloarthritis. The dark side of the outcome

subject

description

Spondyloarthritis (SpA) is a chronic inflammatory rheumatic disease with many phenotypes,1 but the frame of the disease is still a matter of debate, particularly regarding the non-radiographic forms of axial SpA.2 ,3 The disease evolution may have several profiles, mainly related to the treatment strategy, balancing from periods of remission or low disease activity to flares of the disease. The recommended treatment strategies are supposed to be tailored to the disease activity, aiming to reach remission or low disease activity in a T2T strategy,4 with management of remission (reduction of dosage or increase in interval of administration), as well as treatment intensification in case of flares. Definition of a flare may be difficult, particularly in a multifaceted disease like SpA, and in fact there is currently no clear, universally recognised, definition of a flare in axial SpA. This is part of the research agenda of recent recommendations.5 Looking at a medical dictionary, flare is defined as a sudden intensification in disease. In first analysis, one may propose that flare represents a worsening of symptoms with an increase in disease activity. Taking this into consideration, many questions arise: should we consider relative variation or absolute value above a significant threshold? Should we consider only generalised increase in activity? Should we include extra rheumatic manifestations such as uveitis or inflammatory bowel disease (IBD)? Are synovitis and enthesitis also part of this evaluation? Should we include biological markers (but reliable biomarkers are lacking in …