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by Dr. David Borenstein M.D. Updated 09/21

EULAR Update on Frequency of Pregnancy Complications and Extra-Spinal Involvement in Ankylosing Spondylitis

Spine Community News: Studies suggest individuals with Ankylosing Spondylitis (AS) are at higher risk of pre-term births and extra spinal manifestations are more common than previously thought.

Dr. Molto presented new data evaluating pregnancy and spondyloarthritis.1 Women with AS are often affected by the disease during their reproductive years. This authors reviewed the available literature about the outcomes of pregnancies in women with AS. Their review found 15 unique studies of pregnancy in women with AS. The findings suggest that there is a higher risk for pre-term births in association with small-for-gestational-age neonates. Similar rates of stillbirths and miscarriages were found in normal women and those with AS.

Most individuals who think of spondyloarthritis consider it an illness affecting only the spine, but that is not correct according to the findings of an abstract presented by Dr. Lopez-Medina.2 In a survey of almost 4000 individuals with spondylorthritis, 2562 or about 64.3% reported at least one episode of a non-spinal (peripheral) manifestation of disease. Involvement was more frequently a single (monoarticular) or a few joints (oligoarticular) and appeared after the onset of spinal manifestations (48.9%) These peripheral manifestations also included swelling at the attachment of tendons (enthesitis), swelling of an entire digit (dactylitis), or the appearance of psoriasis.

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Identification of individuals with spondyloarthritis early in the course of their illness has the potential to prevent disease progression and disability. Finding the needles in the haystack remains a difficulty. Braun suggests that having 3 of 5 specific characteristics identifies individuals at risk for spondyloarthritis. The AWARE criteria include onset of symptoms before age 35, alternating buttock pain, response to nonsteroidal anti-inflammatory drugs within 48 hours of initiation, improvement of pain with exercise, and awakening during the evening because of back pain. If 3 findings were present, the sensitivity for identifying a spondyloarthritis patient was 94%.


  1. Molto A et al:Preganacy outcomes and disease activity in women with axial spondyloarthritis: A systematic literature review. Proceedings from the EULAR 2018 meeting. Abstract THU0242
  2. Lopez-Medina C et al: More than 60% patients with spondyloarthritis report peripheral manifestations: An ancillary analysis of the ASAS-COMPOSPA study. Proceedings from the EULAR 2018 meeting Abstract THU0249
  3. Braun J et al: Identifying patients with axial spondyloarthritis from a cohort of patients with chronic back pain in orthopedics care (AWARE study). Proceedings from the EULAR 2018 meeting Abstract THU0262