ASAS consensus definition of early axial spondyloarthritis.

To develop a consensual definition for the term 'early axial spondyloarthritis-axSpA'-and 'early peripheral spondyloarthritis-pSpA'. The ASAS (Assessment of SpondyloArthritis international Society-Spondyloarthritis EARly definition) steering committee convened an international working group (WG). Five consecutive steps were followed: (1) systematic literature review (SLR); (2) discussion of SLR results within the WG and ASAS community; (3) a three-round Delphi survey inviting all ASAS members to select the items that should be considered for the definition; (4) presentation of Delphi results to the WG and ASAS community and (5) ASAS voting and endorsement (2023 annual meeting). Following the SLR, consensus was to proceed with an expert-based definition for early axSpA (81% in favour) but not for pSpA (54% against). Importantly, early axSpA should be based on symptom duration taking solely axial symptoms into account. 151-164 ASAS members participated in the Delphi surveys. Consensus was achieved for considering the following items within early axSpA definition: duration of symptoms ≤2 years; axial symptoms defined as cervical/thoracic/back/buttock pain or morning stiffness; regardless of the presence/absence of radiographic damage. The WG agreed that in patients with a diagnosis of axSpA 'early axSpA' should be defined as a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA. The ASAS community endorsed this proposal (88% in favour). Early axSpA has newly been defined, based on expert consensus. This ASAS definition should be adopted in research studies addressing early axSpA.

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Competing interests: VN-C: Speaker fees—AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma; Consultancy fees- AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma; Grants: AbbVie, Novartis. DB: Grant/research support from Novartis, and speaker fees from Janssen, Abbvie, and Galapagos. DvdH: Consulting AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma. Director of Imaging Rheumatology bv. RBML: Consulting AbbVie, Eli-Lilly, Janssen, Galapagos, Gilead, Novartis, Pfizer, UCB. Director of Rheumatology Consultancy BVD. DP: Research grant from AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Consultation AbbVie, Biocad, BMS, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Samsung Bioepis, UCB, Speaker AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB. AvT: Speaker fees: Pfizer; Consulting fees: Novartis, Galapagos, UCB; Grants: Pfizer, UCB, Novartis XB: Abbvie, Amgen, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB. FEVdB: received speaker and/or consultancy fees from AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB FAvG: Research Grants—Novartis; consultancy -MSD, AbbVie, Novartis and BMS LG: Research grants UCB, Novartis, Consulting fees AbbVie, Acelyrin, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, UCB Pharma CL-M: Speaker fees AbbVie, Eli Lilly, Novartis, Janssen, UCB Pharma. Consulting fees Eli Lilly, Novartis, UCB Pharma. HM-O: Speaker fees/consultancy: ABvie, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer and UCB. Research grants from Janssen, Novartis and UCB. AM: Consulting fees AbbVie, Biogen, BMS, Cyxone, Eisai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB Pharma. Grants: UCB RP-A: Speaker fees Abbvie, Eli Lilly, Novartis, Janssen, Pfizer. Consulting fees Abbvie, Eli Lilly, Janssen, Novartis. MR: Speaker- AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Novartis, UCB Pharma; Consultancy AbbVie, Eli Lilly, Novartis, Pfizer, UCB Pharma MvdS: Speaker -Janssen, Novartis, UCB; Consultancy Abbvie, Eli Lilly, Novartis, UCB; Research Grants: Eli Lily, Novartis, UCB RS: Speaker - AbbVie, Biogen, Eli Lilly, MSD, Novartis, UCB; Consultancy—AbbVie, Eli Lilly, Novartis, Pfizer, UCB. Grants: AbbVie, Novartis, UCB UW: Speaker fees NovartisS. SR: Research Grants—AbbVie, Galapagos, MSD, Novartis, Pfizer, UCB; consultancy—AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Sanofi, UCB.