{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:12:25Z","timestamp":1788790345329,"version":"build-2803163510"},"reference-count":114,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017957","name":"Health Commission of Guizhou Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017957","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease primarily affecting the sacroiliac joints and spine, with an estimated global prevalence of 0.3\u20131.5%. Despite advances in classification criteria and imaging techniques, diagnostic delay remains a persistent clinical challenge, with patients waiting a median of 2\u20136 years from symptom onset to confirmed diagnosis. Biomarkers\u2014broadly categorized into clinical, molecular, and imaging modalities\u2014offer the potential to shorten this diagnostic gap by providing objective, quantifiable, and earlier indicators of disease. This narrative review maps the current landscape of biomarkers for the diagnosis of axSpA across all three modalities, with particular attention to how machine learning and multi-omics integration are reshaping the diagnostic paradigm. We examine established clinical markers (HLA-B27, inflammatory back pain criteria, C-reactive protein), survey the molecular biomarker literature spanning genomics, proteomics, metabolomics, and liquid biopsy, and trace the imaging trajectory from conventional radiography and MRI through to radiomics and deep learning models that now approach the performance of expert radiologists. We further explore multimodal fusion\u2014the integration of clinical, molecular, and imaging biomarkers into unified diagnostic models\u2014and identify barriers to clinical translation: the lack of prospective external validation, inconsistent standardization, and unresolved questions about algorithmic fairness across diverse populations. We conclude that biomarker-driven precision diagnosis in axSpA requires continued biomarker discovery alongside the construction of shared infrastructure\u2014multi-modal datasets, standardized pipelines, and prospective validation cohorts\u2014to integrate existing and emerging biomarkers into clinically deployable tools.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1929862","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:16:46Z","timestamp":1788787006000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Biomarkers in axial spondyloarthritis diagnosis: from clinical signs to multi-omics integration"],"prefix":"10.3389","volume":"17","author":[{"given":"Peijin","family":"Xin","sequence":"first","affiliation":[{"name":"Guizhou Province International Science and Technology Cooperation Base for Precision Imaging Diagnosis and Treatment, Key Laboratory of Advanced Medical Imaging and Intelligent Computing of Guizhou Province, Department of Radiology, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi","family":"Xu","sequence":"additional","affiliation":[{"name":"Guizhou Province International Science and Technology Cooperation Base for Precision Imaging Diagnosis and Treatment, Key Laboratory of Advanced Medical Imaging and Intelligent Computing of Guizhou Province, Department of Radiology, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyi","family":"Pan","sequence":"additional","affiliation":[{"name":"Guizhou Province International Science and Technology Cooperation Base for Precision Imaging Diagnosis and Treatment, Key Laboratory of Advanced Medical Imaging and Intelligent Computing of Guizhou Province, Department of Radiology, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mudan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Guizhou Province International Science and Technology Cooperation Base for Precision Imaging Diagnosis and Treatment, Key Laboratory of Advanced Medical Imaging and Intelligent Computing of Guizhou Province, Department of Radiology, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongpin","family":"Wang","sequence":"additional","affiliation":[{"name":"Guizhou Province International Science and Technology Cooperation Base for Precision Imaging Diagnosis and Treatment, Key Laboratory of Advanced Medical Imaging and Intelligent Computing of Guizhou Province, Department of Radiology, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-022-06100-7","article-title":"Diagnostic delay in axial spondyloarthritis: A systematic review","volume":"41","author":"Hay","year":"2022","journal-title":"Clin Rheumatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3390\/jpm14010091","article-title":"Sex bias in diagnostic delay: Are axial spondyloarthritis and ankylosing spondylitis still phantom diseases in women? 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