title: Consensus statement on the investigation and management of non-radiographic axial spondyloarthritis (nr-axSpA).
abstract: OBJECTIVE
  Non-radiographic axial spondyloarthritis (nr-axSpA) is axial inflammatory arthritis where plain radiographic damage is not evident. An unknown proportion of these patients will progress to ankylosing spondylitis (AS). The increasing recognition of nr-axSpA has been greatly assisted by the widespread use of magnetic resonance imaging. The aim of this article was to construct a set of consensus statements based on a literature review to guide investigation and promote best management of nr-axSpA.
  
  
  METHODS
  A literature review using Medline was conducted covering the major investigation modalities and treatment options available. A group of rheumatologists and a radiologist with expertise in investigation and management of SpA reviewed the literature and formulated a set of consensus statements. The Grade system encompassing the level of evidence and strength of recommendation was used. The opinion of a patient with nr-axSpA and a nurse experienced in the care of SpA patients was also sought and included.
  
  
  RESULTS
  The literature review found few studies specifically addressing nr-axSpA, or if these patients were included, their results were often not separately reported. Fourteen consensus statements covering investigation and management of nr-axSpA were formulated. The level of agreement was high and ranged from 8.1 to 9.8. Treatment recommendations vary little with established AS, but this is primarily due to the lack of available evidence on the specific treatment of nr-axSpA.
  
  
  CONCLUSIONS
  The consensus statements aim to improve the diagnosis and management of nr-axSpA. We aim to raise awareness of this condition by the public and doctors and promote appropriate investigation and management.
authors.affiliation: University of Queensland Diamantina Institute, Brisbane, Queensland, Australia; Department of Rheumatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Robinson
authors.forename: Paul
authors.initials: P
authors.lastname: Bird
authors.forename: Irwin
authors.initials: I
authors.lastname: Lim
authors.forename: Nivene
authors.initials: N
authors.lastname: Saad
authors.forename: Lionel
authors.initials: L
authors.lastname: Schachna
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Taylor
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Whittle
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Brown
mesh_terms: D018450:Disease Progression; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D011237:Predictive Value of Tests; D011859:Radiography; D012219:Rheumatology / Q000592:standards*; D025241:Spondylarthritis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000451:nursing / Q000628:therapy*; D016896:Treatment Outcome
keywords: ankylosing spondylitis; non-radiographic axial spondyloarthritis; spondyloarthritis; tumor necrosis factor-alpha inhibitors