Thursday, 18 Oct 2018

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ACR17 Good News – Ankylosing Spondylitis and Spondyloarthritis

The following is a collection of AS/SpA-specific mentions culled from RheumNow's coverage of the Annual ACR 2017 meeting in San Diego.

Visit our RheumNow annual meeting site to read our gout content - http://acr17.rheumnow.com/category/gout-crystal/

Specific items:

  • Bone marrow oedema in sacroiliac joints is common (30-40%) in young athletes and is most frequent in the posterior lower ilium.  Weber et al
  • Only 9-14% people with chronic backache see a rheumatologist 
  • Increased risk of CVA, but not for MI, in AS pts. Abstract #2972 http://ow.ly/kGSZ30fM7fQ
  • Low mean change in radiographic change after 4 years of Secukinumab treatment in AS, Braun 
  • Smoking is associated with higher disease activity and worse quality of life in SpA patients. Abstract #2506 http://ow.ly/7dqo30fKMMs
  • IBD is assoc.tih more severe SpA. Occurs w/ rate of 0.7/100 patient-yrs/ 5 yrs in DESIR cohort. Abstract #2512 http://ow.ly/gdJD30fKN5i
  • FUTURE5: Cosentyx clinically &radiographically superior to PBO. mTSS non-progression rate = 88% for Cosentyx vs 73% PBO #L17 #acr17
  • Dheodar et al-Large study on impact of TNFi on xtra art. comorbidities in AS. Abstract #1527
  • Don't discount spondyloarthropathy in pts >45yo, especially if pt has psoriasis or inflammatory back pain. Abstract #2037
  • Low DMARD use on AS pts on chronic opioids Abstract #1548
  • Significant reduction in immunosuppression load on uveitis pts with long term ADA use. Abstract #1115
  • Abstract #1881  Uveitis & scleritis common in AI disease. Lack of consensus on workup guidelines; calls for Ophth/Rheum collaboration
  • Gut-derived TNF: Connection Between Crohn’s and SpA and Sacroiliitis  https://buff.ly/2zkRc2f
  • Landewe Plenary session: Stopping adalimumab in nrAxSpA patients in sustained remission leads to flare after 8-12 weeks in 53%
  • Plenary Abstract #1787 Landawe presents Atlas 5 study, continuation of ADA is assoc with significantly less flares in nr-AxSpA
  • uSpA pts are younger, more likely +HLA-B27, and higher CRP than nrSpA pts. Abstract  #1506 http://ow.ly/SLPE30fKaty
  • Chronic reactive arthritis due to chlamydia could be treated with longterm antibiotics with up to 70% achieving remission
  • Reactive Arthritis  https://buff.ly/2mJ3NWY 
  •  The Red Eye in the Rheumatology Patient  https://buff.ly/2zl9Hnp
  • Higher risk of VTE on patients hospitalized with SpA, comparable with that of malignancy>OA Abstract #879
  • There was 12% progression in 2yrs to AS from nrAxSpA
  • 53% risk of VTE and 62% DVT in AS compared to general population. Confounders not measured Abstract #3S078
  • Higher prevalence of venous thrombosis in SpA admissions- Inflammation driven thrombosis & NSAIDs to blame? Dilli Poudel Abstract #879
  • Higher risk of VTE on patients hospitalized with SpA, comparable with that of malignancy, but > than OA Abstract #879
  • Abstract #578 Of 10 Biomarkers, combo of 2 showed small value added in terms of rad.progression in AxSpA
  • Abstract #593  EarlyAxSpA DESIR 5 year data showed low rates of structural progression-SI fatty lesions
  • Dr L Gensler at #ACR17: says tobacco use decreases efficacy of TNF inhibitors
  • Dr L Gensler: UK database 1 out of 4 pts with ank spond will have had uveitis after 20 years of AS
  • Dr L Gensler: EDS and JHS can mimic inflammatory arthritis and spondyloarthritis
  • Dr L Gensler: X-rays unreliable to detect sacroilitis; limited CT is gold std. MRI is better
  • In the evaluation of axial spondyloarthropathies MRI without Gad and CRP over ESR are preferred. (LianneGensler)
  • DDX of sacroiliitis: Osteitis condensans ilii -CRP normal, multiparous women with back pain, even with subtle bone marrow edema.

AS/SpA Videos

Dr. Julio Gonzalez: Psoriatic Arthritis and Axial Spondyloarthropathy Studies

 

Dr. Rachel Tate: Gender Bias in AS 

 

Dr. Rachel Tate: Adalimumab and Disease Remission in non-Radiographic Axial SpA

 

 

Dr. David Borenstein: Back Pain

Disclosures: 
The author has received research/grant financial support on this subject
The author has received compensation as an advisor or consultant on this subject

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