How to diagnose axial spondyloarthropathy early.

P hysicians’ perceptions of the spondyloarthropathies are changing. Ankylosing spondylitis (AS), the prototype of this group, has traditionally been considered a rare disease with few therapeutic options. In addition, diagnosis is difficult, sometimes delayed for decades, mainly owing to the lack of sensitivity of the traditional imaging method, radiography, to detect the hallmark of AS, sacroiliitis. Also, the widespread perception of these diseases as ‘‘innocuous’’ or having a good outcome has hampered the development of protocols for defining early disease and identifying those patients who would benefit from early treatment.