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The Long View of Diagnostic Delay in Axial Spondyloarthritis
Axial spondyloarthritis (axSpA) remains a diagnostic challenge, particularly in its early stages before structural sacroiliitis is visible on imaging.
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Should we be using JAKi more in female SpA patients?
In recent years, data has emerged suggesting that female patients with spondyloarthritis, both psoriatic arthritis and axial spondyloarthritis, may have worse outcomes than male patients. A number of post-hoc analyses of randomised controlled trials of both TNF inhibitors and IL-17 inhibitors suggest that this phenomenon is also manifested in the responses to these agents; female patients do less well than male patients. The mechanisms behind this remain to be fully elucidated.
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Late-Breaking Trials in axSpA and PsA https://t.co/Fw8wiAPLoN
The amazing @Janetbirdope discussing head to head trials in Axial SpA and PsA with primary failure to TNF.
To switch to another TNF or IL17?
IL17 for my PsA patient for sure.
@RheumNow
#ACR25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Abstract 1657: Can LLMs track medication history? GPT-4 outperformed most LLMs in identifying TNFi start/stop events and reasons for switch. 💊 Common reasons for TNFi switching: lack of effectiveness, adverse events, and insurance/cost barriers. @RheumNow #ACR25 https://t.co/5FUR9tBoyu
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Dr. Gensler gave a fantastic talk on SpA mimics
☝️Not all IBP is axSpA - interpret in the appropriate context + imaging
WOF other mimics
🔸 Sacral insufficiency fractures
🔸 Infections
🔸DISH
#ACR25 @RheumNow https://t.co/7TIqyp5rYe
Links:
sheila RHEUMarampa ( View Tweet)
In a Brazilian cohort (n=791), axSpA diagnosis delay dropped from 41.7 yrs (1960s) to 1.9 yrs (2020s). Female representation rose to 50%. Non-radiographic axSpA now 16.7%. MRI and updated criteria driving earlier, more equitable recognition. Abstract#1407 @RheumNow #ACR25 https://t.co/8hIpX0a1Sa
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
DYK?
A bipartite ilium is a common SIJ variant.
More common among women.
SpA mimics involving biomechanical stress: BME & sclerosis
🔸OCI - assoc w/ multiparity, obesity
🔸Degenerative dse
#ACR25 @RheumNow https://t.co/IoZepAJKJ6
Links:
sheila RHEUMarampa ( View Tweet)
12 year follow up radiographic data in axial SpA - ASAS definition of early stage does not significantly influence long term radiographic outcomes. Abt#1432 #ACR25 @RheumNow https://t.co/fFP2CW6X0B
Bella Mehta bella_mehta ( View Tweet)
Survival outcomes in patients with axial SpA and concomitant cancer are the same as those without. #abst1429 #ACR25 @RheumNow https://t.co/wicN3s9JrR
Bella Mehta bella_mehta ( View Tweet)
Classification of sacrioilitis using new york criteria vs a convolutional neural network. Abst#1421 #acr25 @RheumNow
Yes no results - accuracy was 70 percent. But the exact grade was right 22 percent times only! https://t.co/9o8OGesH0n
Bella Mehta bella_mehta ( View Tweet)
Gensler et al. Bimekizumab in male and female axSpA patients. Greater benefit in males at week 16, but similar responses at week 52 @RheumNow #ACR25 Abstr#1449 https://t.co/zDYI2zItqT
Richard Conway RichardPAConway ( View Tweet)
Mac Gearailt et al. Depression in axSpA. Depression in 10%. Associated higher disease activity, worse functional status, and increased peripheral manifestations. @RheumNow #ACR25 Abstr#1409 https://t.co/8pnoQiaiQr
Richard Conway RichardPAConway ( View Tweet)
Bimekizumab showed sustained 1-year efficacy in axSpA across age, BMI, CRP, and HLA-B27 subgroups. ASAS40, ASDAS, BASDAI, ASQoL, and MRI scores improved in most groups—especially age ≤35, BMI 25–30, CRP >5, and HLA-B27+. Abstract 1451 @RheumNow #ACR25
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Abstract 1431: Radiographic sacroiliitis in #PsA: insights from an Indian cohort
- Cervical and lumbosacral spine syndesmophytes were common
- Levels C5, C6, and L4 vertebrae frequently involved including syndesmophyte damage w/ non-marginal bridging
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
The axSpA Registry of Ireland (ASRI): 10% reported depression, w/ higher prev in older cohorts.
Pts w/ depression had ⬆️peripheral involvement, ⬆️dse activity & poor functional status
💡Consider the impact of non-inflamm factors in dse burden
#ACR25 @RheumNow Abs1409 https://t.co/yDfHA24M6e
sheila RHEUMarampa ( View Tweet)
A randomized trial of app-based behavioral (acceptance and commitment) therapy (ACT) showed reduced pain interference and affective distress in axial SpA compared to standard of care. Acceptance was moderate, but impact was meaningful. Abstract 1461 @RheumNow #ACR25 https://t.co/sF5Ldtc61R
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
The CLASSIC study (n=1015, 27 countries) validated revised ASAS-SPARTAN axSpA criteria. Final model achieved 79.5% sensitivity & 90.4% specificity vs global diagnosis. MRI SIJ (active + structural) was strongest predictor. HLA-B27, CRP, IBD, uveitis also included. Abstract#0854 https://t.co/GjSHE2ihVI
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#0854 @Official_ASAS & @SPARTAN_Updates revised #axSpA criteria meet targets: Sn 79.5% / Sp 90.4%.
Imaging is central (SIJ MRI + structural lesions) with focused clinical items: HLA-B27, IBP, uveitis, IBD, heel enthesitis, psoriasis, ↑CRP
@RheumNow #ACR25 https://t.co/i2d12y9HcD
Mrinalini Dey DrMiniDey ( View Tweet)
To #cycle within or go to another drug class I #axSpA?
#RCT of #TNFi-IR
👇
2nd #TNFi v #IL17i
#IJDM it doesn’t matter what choice as
#IL17i WAS NOT superior to TNFi cycling from 1st -2nd
👍 stay in #TNFi class = change to #IL17i
#ACR25 @RheumNow abst#LB09
#ACRBest @ACRheum https://t.co/VCdL5CUYUa
Links:
Janet Pope Janetbirdope ( View Tweet)
The CLASSIC study validated the performance of the 2009 ASAS classification criteria
Model A was chosen for the revised criteria since it achieved prespecified performance targets of SN ≥75% and SP ≥90%
🔸Pso was included
🔸⬆️CRP replaced dactylitis
#ACR25 @RheumNow Abs0854 https://t.co/tK52rQyaRa
Links:
sheila RHEUMarampa ( View Tweet)
