title: Challenges of diagnosis and management of axial spondyloarthritis in North Africa and the Middle East: An expert consensus.
abstract: Axial spondyloarthritis (SpA) is a spectrum of inflammatory disease with stages characterized by both nonradiographic and radiographic sacroiliitis. Nonradiographic axial SpA is associated with health-related quality-of-life impairment and may progress to ankylosing spondylitis. Axial SpA has a low prevalence in some countries in North Africa and the Middle East, and pooling of data and resources is needed to increase understanding of the regional picture. Early diagnosis and effective treatment are required to reduce disease burden and prevent progression. Anti-TNF therapy is recommended for patients with persistently high disease activity despite conventional treatment, and has been shown to be effective in patients without radiographic damage. Diagnostic delays can be an obstacle to early treatment and appropriate referral strategies are needed. In some countries, restricted access to magnetic resonance imaging and anti-TNF agents presents a challenge. In this article, a group of experts from North Africa and the Middle East evaluated the diagnosis and management of axial SpA with particular reference to this region.
authors.affiliation: Department of Medicine, Weill Cornell Medical College Qatar, Hamad Medical Corporation, Doha, Qatar mhamoudeh@hmc.org.qa.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hammoudeh
authors.affiliation: Department of Medicine, King Fahad Hospital, Jeddah, Saudi Arabia.
authors.forename: Sultana
authors.initials: S
authors.lastname: Abdulaziz
authors.affiliation: Rheumatology Section, Department of Internal Medicine/Rheumatology, Military Hospital, Jeddah, Saudi Arabia.
authors.forename: Hanan
authors.initials: H
authors.lastname: Alosaimi
authors.affiliation: Department of Medicine, Armed Force Hospital, Riyadh, Saudi Arabia.
authors.forename: Hanan
authors.initials: H
authors.lastname: Al-Rayes
authors.affiliation: Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Hussam
authors.initials: H
authors.lastname: Aldeen Sarakbi
authors.affiliation: Department of Medicine, King Abdulaziz Hospital and Oncology Centre, Jeddah, Saudi Arabia.
authors.forename: Matouqa
authors.initials: M
authors.lastname: Baamer
authors.affiliation: Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany.
authors.forename: Xenofon
authors.initials: X
authors.lastname: Baraliakos
authors.affiliation: Department of Rheumatology, Bab El Oued Hospital, Algiers, Algeria.
authors.forename: Chafia
authors.initials: C
authors.lastname: Dahou Makhloufi
authors.affiliation: Department of Rheumatology, DSFH Hospital, Jeddah, Saudi Arabia.
authors.forename: Nahid
authors.initials: N
authors.lastname: Janoudi
authors.affiliation: Pfizer AfME, Media City, Dubai, United Arab Emirates.
authors.forename: Khalid
authors.initials: K
authors.lastname: Shirazy
authors.affiliation: Klinikum Benjamin Franklin, Freien Universität Berlin, Berlin, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Sieper
authors.affiliation: Rheumatology Division, University Hospital, Sharjah, United Arab Emirates.
authors.forename: Uppal
authors.initials: U
authors.lastname: Sukhbir
mesh_terms: D000352:Africa, Northern / Q000453:epidemiology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001416:Back Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D057210:Delayed Diagnosis; D018450:Disease Progression; D000068800:Etanercept / Q000627:therapeutic use*; D015796:HLA-B27 Antigen / Q000235:genetics / Q000276:immunology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008877:Middle East / Q000453:epidemiology; D015995:Prevalence; D058566:Sacroiliitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D013131:Spine / Q000000981:diagnostic imaging / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D025241:Spondylarthritis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000235:genetics / Q000276:immunology
chemical_list: D000893:Anti-Inflammatory Agents; D015796:HLA-B27 Antigen; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept
keywords: North Africa and Middle East; TNF inhibitors; ankylosing spondylitis; axial spondyloarthritis; inflammatory back pain; sacroiliitis
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