Treatment Of Axial Spondyloarthritis Research Articles

Use of nonsteroidal anti-inflammatory drugs in early axial spondyloarthritis in daily practice: Data from the DESIR cohort

ObjectivesNonsteroidal anti-inflammatory drugs (NSAID) are the cornerstone of treatment in axial spondyloarthritis (axSpA). We aimed to describe the real life NSAID use in early axSpA according to the disease characteristics. MethodsThe DESIR cohort is an observational study of patients presenting with inflammatory back pain suggestive of axSpA for less than 3 years. Patients who attended all 6 visits (every 6 months during the first 2 years and yearly at 3 years) were analysed. Data collected at every visit over 3 years was NSAID intake and the ASAS-NSAID score for the 6 months preceding the visit, where 100 reflects the full daily intake of an NSAID. ResultsIn all, 627 patients were assessed: 46.1% males, mean age: 33.7 (standard deviation: 8.7) years, mean symptom duration: 1.5 (0.9) year and mean BASDAI: 44.3 (25.3). Over the 6 months preceding inclusion, 92.8% had received NSAIDs; this proportion significantly decreased over time, to 73% patients after 3 years (P<0.001). This decrease was not different with regard to the fulfillment (or not) of the ASAS criteria at baseline, nor with regard to the “arm” of the ASAS criteria fulfilled (i.e. imaging vs. clinical). The median ASAS-NSAID score was 36 [interquartile range: 13–72] at inclusion, and substantially decreased to reach 7 [0–44] after 3 years (P<0.001), although BASDAI at 3 years was 33.8 (21.7). ConclusionNSAID prescription was very frequent in this early axSpA cohort, but the intake was low, and decreased significantly over time, even though symptoms remained present. Early axSpA patients may not be sufficiently treated with NSAIDs.

Golimumab for treatment of axial spondyloarthritis.

Axial spondyloarthritis comprises two forms: nonradiographic (nonradiographic axial spondyloarthritis) and radiographic (better known as ankylosing spondylitis), which are often considered as two stages of one disease. Historically, all currently available TNF-α inhibitors were first investigated in ankylosing spondylitis and later on in nonradiographic axial spondyloarthritis. This year, EMA has granted golimumab approval for the treatment of active nonradiographic axial spondyloarthritis based on the recently published data from the GO-AHEAD study. This article summarizes recent data on efficacy and safety of golimumab in the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis.

Golimumab for the treatment of axial spondyloarthritis

Axial spondyloarthritis (axSpA) is a chronic, immune-mediated inflammatory disease of the axial skeleton that includes ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). Patients with AS experience chronic pain due to sacroiliac joint and spinal inflammation, and may develop spinal ankylosing with syndesmophyte formation. Tumor necrosis factor α inhibitors (TNFi) have shown promise in the management of AS and axSpA by targeting the underlying inflammatory process, and providing symptomatic relief. Whether they alter the progression of the disease is uncertain. Golimumab is a fully human IgG1 monoclonal antibody that targets and downregulates the pro-inflammatory cytokine TNF-α. The use of golimumab has been shown to reduce the signs and symptoms of axSpA as well as improve patient function and quality reported outcomes. This review focuses on the biological rationale and the results of clinical trials with golimumab for the treatment of axSpA.

Guidelines for magnetic resonance imaging in axial spondyloarthritis: A Delphi study

ObjectiveThe term axial spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases with a common genetic basis that course with axial and peripheral involvement and enthesitis. Recently, the Assessment of SpondyloArthritis international Society (ASAS) established some diagnostic criteria, including for the first time magnetic resonance imaging (MRI) findings. Given the difficulties of obtaining MRI in some environments and the lack of experience with axial spondyloarthritis, a group of radiologists and rheumatologists sought to establish some practical guidelines to ensure the correct use of MRI in this disease. Material and methodsUsing the Delphi method, we used a questionnaire with 49 items stratified into 4 blocks to survey 46 experts in the MRI diagnosis of axial spondyloarthritis. ResultsThe experts agreed on 82% of the items. The degree of agreement was 100% in the block “Importance of early diagnosis of axial spondyloarthritis”, 69% in the block “Optimization of the use of MRI in the diagnosis of axial spondyloarthritis”, 93% in the block “Use of MRI in axial spondyloarthritis: Technical aspects”, and 57% in the block “Usefulness of MRI in the prognosis, follow-up, and evaluation of the response to treatment in axial spondyloarthritis”. ConclusionsDespite the importance of MRI in the early diagnosis of axial spondyloarthritis, this study shows the need for standardization and points to relative disagreement about how to use MRI in the follow-up of the disease and evaluation of the response to treatment. The results of this study can help improve the use of MRI in axial spondyloarthritis.

A UK Best Practice Model for Diagnosis and Treatment of Axial Spondyloarthritis

Objectives: To examine the combined effectiveness of a care pathway for patients with suspected inflammatory back pain (IBP) in conjunction with an educational campaign targeting primary and secondary care and the local community. Methods: Between June 2010 and June 2013, general practitioners referred patients fulfilling the Berlin IBP criteria into our Early Inflammatory Back Pain Service (EIBPS). Investigations were undertaken in line with our service model pathway and consultant rheumatologists made a diagnosis based on the Assessment of SpondyloArthritis international Society criteria. A concurrent educational awareness campaign addressing IBP and axial spondyloarthritis (AxSpA), aimed at primary and secondary care colleagues and the local community, was undertaken in order to assist early identification of IBP. Results: Of the 222 patients referred into the EIBPS, 57 (26%) were newly diagnosed with AxSpA. A diagnosis of AxSpA was made in 48% of the patients with IBP or &gt;1 SpA feature. The median time between onset of back pain and diagnosis was 3.1 years (mean: 5.7 years). Treatment with nonsteroidal anti-inflammatory drugs was initiated or continued as appropriate in 68/71 patients (96%; new and previously diagnosed AxSpA patients). All patients (100%) meeting the National Institute for Health and Care Excellence criteria for tumour necrosis factor inhibitor therapy were offered treatment, with 14 patients (45%) starting this treatment within 6 months of their initial EIBPS appointment. Conclusion: Our EIBPS provides a best practice model for assessment and management of patients with suspected IBP in the UK. The pathway facilitates prompt admission of appropriate patients into the service and assists early diagnosis and management of AxSpA patients.

Blocking Interleukin-12 and Interleukin-23 in the Treatment of Axial Spondyloarthritis

Currently, there are only two effective drug classes approved for treatment of ankylosing spondylitis (AS)/axial spondyloarthritis (axSpA): non-steroidal anti-inflammatory drugs (NSAIDs) and, if NSAIDs fail, tumour necrosis factor (TNF)-α blockers. Although the majority of patients do respond well to these treatment options, there is certainly an unmet need for further therapeutic options for patients who do not respond to, do not tolerate or have contraindications for NSAIDs and TNF-α blockers. Blockade of the Th17 pathway that includes inhibition of interleukins (IL)-12/23 and to a further extent IL-17 represent currently the most promising therapeutic targets in axSpA. The first positive results on the blockade of IL-12/23 in active AS should be confirmed in larger placebo-controlled studies, ideally including the entire population of axSpA. It is very important to identify whether IL-12/23 and IL-17 blockade also works in TNF-α blocker non-responders and if there are specific predictors of response to one or another drug class. Also, effects of this therapy on long-term outcomes including progression of structural damage in the spine in AS/axSpA are of high importance and should be evaluated.

Resonancia magnética en espondiloartritis axial: estudio Delphi sobre pautas de actuación y realización

ObjectiveThe term axial spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases with a common genetic basis that course with axial and peripheral involvement and enthesitis. Recently, the Assessment of SpondyloArthritis international Society (ASAS) established some diagnostic criteria, including for the first time magnetic resonance imaging (MRI) findings. Given the difficulties of obtaining MRI in some environments and the lack of experience with axial spondyloarthritis, a group of radiologists and rheumatologists sought to establish some practical guidelines to ensure the correct use of MRI in this disease. Material and methodsUsing the Delphi method, we used a questionnaire with 49 items stratified into 4 blocks to survey 46 experts in the MRI diagnosis of axial spondyloarthritis. ResultsThe experts agreed on 82% of the items. The degree of agreement was 100% in the block “Importance of early diagnosis of axial spondyloarthritis”, 69% in the block “Optimization of the use of MRI in the diagnosis of axial spondyloarthritis”, 93% in the block “Use of MRI in axial spondyloarthritis: Technical aspects”, and 57% in the block “Usefulness of MRI in the prognosis, follow-up, and evaluation of the response to treatment in axial spondyloarthritis”. ConclusionsDespite the importance of MRI in the early diagnosis of axial spondyloarthritis, this study shows the need for standardization and points to relative disagreement about how to use MRI in the follow-up of the disease and evaluation of the response to treatment. The results of this study can help improve the use of MRI in axial spondyloarthritis.

CERTOLIZUMAB PEGOL IN THE TREATMENT OF AXIAL SPONDYLOARTHRITIS

The paper gives the results of the RAPID-axSpA study that has evaluated for the first time the efficacy of the tumor necrosis factor-α (TNF-α) inhibitor certolizumab pegol (CZP) in treatment of axial spondyloarthritis (axSpA) clinical forms: already developed ankylosing spondylitis and non-radiographic axSpA. CZP was shown to be effective in all forms of axSpA, whether radiographically detected sacroiliitis was present or absent. This study has also demonstrated for the first time the long-term efficacy of TNF-α inhibitors in patients with initially high C-reactive protein level and/or signs of active sacroiliitis by magnetic resonance imaging.

The contribution of imaging in the diagnosis and treatment of axial spondyloarthritis.

The concept of axial Spondyloarthritis (axSpA) includes patients with non-radiographic axSpA and ankylosing spondylitis (AS). Inflammatory and chronic/structural changes of the sacroiliac joints and the spine are pathognomonic in patients who are diagnosed with axSpA. In the last years, the evaluation of the natural course of axSpA has been in the focus of research, especially with respect to the relationship between inflammation or postinflammatory changes [detected by magnetic resonance imaging (MRI)] and bone formation (detected by conventional radiographs). Based on the analysis of spinal MRI data, development of new syndesmophytes is directly associated with the parallel occurrence of inflammatory and postinflammatory (fatty) changes in the edges of the vertebral bodies. In contrast, vertebral edges that show only inflammation but no transformation into fatty lesions show a decreased relative risk for development of new bone formation over time. An inhibitory effect on radiographic progression had not been demonstrated during the first 2years of continuous anti-TNFa treatment, however, very recently first studies reported a decreased rate of radiographic progression when patients were continuously treated with TNFa-blockers for a time period of ≥4years. These data are crucial in the understanding of the long-term clinical course of patients with axSpAin daily practice. According to these results, it becomes obvious that anti-inflammatory treatment, especially by using tumor-necrosis-factor alpha (TNFa)-blockers, has the best effect on the radiographic outcomes when it is started in anearly disease stage, where only inflammation is driving the disease activity and where structural, postinflammatory changes have not yet occurred.

OP0156 Targeting Synovial Mast Cells in Spondyloarthritis: A Proof-Of-Concept Study with Nilotinib A Tyrosine Kinase Inhibitor

BackgroundImmunopathological studies on synovitis recently identified the mast cell as potential novel therapeutic target in spondyloarthritis (SpA).[1] Mast cells can be targeted by inhibiting the signalling of c-Kit, which is...

Aksiyel spondiloartropatinin tanımlama, teşhis ve tedavisi: Türkiye Çalışma Grubu önerileri

Aksiyel spondiloartropatinin tanımlama, teşhis ve tedavisi: Türkiye Çalışma Grubu önerileri

PMS87 - Continued Improvements in Workplace and Household Productivity with Certolizumab Pegol Treatment in Axial Spondyloarthritis, Including Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis: 48-Week Results from the Rapid-axSpA Study

PMS87 - Continued Improvements in Workplace and Household Productivity with Certolizumab Pegol Treatment in Axial Spondyloarthritis, Including Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis: 48-Week Results from the Rapid-axSpA Study

THU0369 The Effect of Anti-TNF Treatment in Axial Spondyloarthritis Patients Treated in Ordinary Clinical Practice – Results from Two Biorheuma Clinics in Norway

BackgroundThe BIORHEUMA (BIOlogic treatment of patients suffering from inflammatory RHEUMAtic disorders in Norway) project encourage participating departments to use outcome measures in daily clinical practice (ref.1). Further to obtain unselected...

New developments in the diagnosis and treatment of axial spondyloarthritis

Spondyloarthritis (SpA) is an umbrella term for a group of diseases sharing genetic, molecular, immunological, clinical and imaging features. The last few years have witnessed a remarkable progress in the understanding of SpA. Notable advances include the recognition of MRI as a sensitive and specific tool for detecting axial inflammation and the recent development and validation of the Assessment of Spondyloarthritis International Society classification criteria for predominantly axial and predominantly peripheral SpA. This approach has the advantage of better describing the disease, allowing earlier identification and treatment of the non-radiographic forms and potentially leading to improved outcomes. TNF α-blockers, which dramatically improve the clinical symptoms and signs of patients with ankylosing spondylitis, are now being tested in patients with non-radiographic axial SpA, with the first studies providing evidence that patients with the non-radiographic form of the disease also benefit from this...

Diagnose und Therapie der axialen Spondyloarthritis einschließlich des Morbus Bechterew

The term axial spondyloarthritis covers patients with established structural changes visible on x-ray in sacroiliac joints and/or in the spine (classical ankylosing spondylitis) but also patients with non-radiographic axial spondyloarthritis in whom early inflammatory signs of the disease can only be visualized with magnetic resonance imaging (MRI). The MRI technique plays an important role in the diagnosis of this disease and an early diagnosis is normally based on a combination of clinical, laboratory and imaging parameters. Only non-steroidal anti-inflammatory drugs and TNF-α blockers are effective in the treatment of axial spondyloarthritis. Patients with short disease duration and elevated acute phase reactant levels demonstrate best therapy response and, therefore, should be closely followed-up and consistently treated.

Frühtherapie bei axialer Spondyloarthritis und Relevanz der radiologischen Progression

In recent years great achievements have been made in terms of early diagnosis of axial spondyloarthritis (SpA). In addition new classification criteria have been established. An early diagnosis offers the possibility for effective early treatment. For the treatment of axial SpA according to the Assessment of Spondyloarthritis International Society-European League Against Rheumatism (ASAS-EULAR) recommendations non-steroidal anti-inflammatory drugs (NSAIDs) should be used first. In cases of non-response to at least 2 different NSAIDs given for at least 4 weeks, tumor necrosis factor alpha (TNF-α) blocking agents can be used. Data from three clinical trials with TNF-α blockers in early axial SpA showed that clinical remission can be reached in about 50% of cases. Furthermore, it could be shown that during TNF-α blocking treatment acute inflammatory lesions of the sacroiliac joints, the spine and entheses could be effectively reduced in magnetic resonance imaging (MRI). Recently a close interaction between acute inflammation, TNFα blockade and the development of fatty lesions could be shown. This is an important step for understanding the process of radiographic progression in axial SpA. Early treatment might prevent radiographic progression.