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New: Classification Critiera and Recommendations in SpA
2026 EULAR Press Release
ASAS and the SPARTAN have updated their key classification criteria for axial SpA (axSpA). EULAR has also recently revised their recommendations on the role of imaging in the diagnosis and clinical management of spondyloarthritis (SpA). Both were presented at the EULAR 2026 annual Congress in London.
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Strike First: TNFi vs. Step-Up Therapy in Early Peripheral SpA
The approach to the treatment of peripheral SpA has been the same for a long time. The guidelines recommend starting with NSAIDs, escalate to conventional synthetic DMARDs, typically sulfasalazine or methotrexate and reserve biologics for patients who fail those. According to a new phase 3 trial presented at EULAR 2026, there may be a different way to approach this.
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LB0002: Sonelokimab (IL-17A/F Nanobody, ~40 kDa) in #axSpA Phase 2: 81% ASAS40 and 54% ASAS partial remission at 12 weeks. Mean ASDAS improvement of −2.0 from baseline. @RheumNow #EULAR2026 https://t.co/TjvtnFPCdj
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Even with tight T2T, ARCTIC 10yr follow-up (n=170) show 9% had RA-ILD on HRCT, plus another 19% with non-specific interstitial findings. Male sex and older age were risk factors. Seropositivity was not. Vigilance remains essential. @RheumNow #EULAR2026 POS1270
Jiha Lee JihaRheum ( View Tweet)
Which b/tsDMARDs are effective in #axSpA? Stratified by extramusculoskeletal manifestations
Check out the latest update of the treatment heatmap 🔥
By Astrid van Tubergen
At axial and peripheral SpA at a crossroads session
#EULAR2026
@RheumNow https://t.co/uTxEJqbDBm
Nelly ZIADE 🍀 Nellziade ( View Tweet)
Which b/tsDMARDs are NOT effective in #axSpA?
Check out the latest update of the treatment heatmap 🔥
By Astrid van Tubergen
At axial and peripheral SpA at a crossroads session
#EULAR2026
@RheumNow https://t.co/hqfLAYeri3
Nelly ZIADE 🍀 Nellziade ( View Tweet)
Key messages in the tx of ax/p-SpA:
>csDMARDs only effective in pSpA
>consider individualized treatment for bDMARDs and JAKis
>Cycling TNFi equally effective to switching
@RheumNow #EULAR2026 https://t.co/oeO3BxmYYo
sheila RHEUMarampa ( View Tweet)
Which b/tsDMARDs are effective in #axSpA?
Check out the latest update of the treatment heatmap 🔥
By Astrid van Tubergen
At axial and peripheral SpA at a crossroads session
#EULAR2026
@RheumNow https://t.co/8mj24lAOTk
Nelly ZIADE 🍀 Nellziade ( View Tweet)
What b/ts DMARDs are effective and not effective in axSpA?
Prof. Astrid van Tubergen presents this very informative summary slide summarizing treatment in axSpA.
@RheumNow #EULAR2026 https://t.co/5udGPB1Hrr
Links:
sheila RHEUMarampa ( View Tweet)
What is the @Official_ASAS recommended instrument for evaluating peripheral disease activity in axial and peripheral spondyloarthritis?
👉 DAPSA44
✔️Good construct validity
✔️ High discriminatory capacity
From the ASAS-Sparadise study
#EULAR2026
@RheumNow https://t.co/Jbdvpn95jE
Nelly ZIADE 🍀 Nellziade ( View Tweet)
Not just ticking boxes!
Prof. Rudwaleit on the revised 2025 ASAS/SPARTAN criteria for axSpA
What’s new?
Providing a stem so criteria will be applied only if w/SpA dx, not just imaging
MRI:active inflamm + structural lesions
Some SpA features omitted
@RheumNow #EULAR2026 https://t.co/NCV0EFvjYa
Links:
sheila RHEUMarampa ( View Tweet)
Large French nationwide cohort (n=56,591 SpA patients) showed that >6 months/year of targeted therapy exposure was associated with reduced overall cancer risk (wHR 0.86), especially for haematological malignancies (wHR 0.65). Reassuring long-term safety signal. Abstr OP0238
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
The axSpA classification has been revised with the 2025 ASAS SPARTAN criteria. 5 abstracts at #EULAR2026 Abstr OP0236, OP0100, OP0239, POS0190 and POS1341.
The single most important change in the 2025 criteria: MRI is now the highest-weighted variable and what counts as a https://t.co/xg4R4xRH2D
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
SPARTAN-SSR: New quantitative criteria: BME in ≥3 consecutive slices OR any two of (BME, Erosion, Fat lesion each in ≥3 SIJ quadrants) or ankylosis in ≥3 halves achieves 88-96% sensitivity and 90-98% specificity across 3 cohorts. Precision #axSpA imaging. Abstr OP0100
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Gecacitinib (pan-JAK inhibitor) vs placebo in radiographic #axSpA ASAS40 51.9% vs 12.9% (p<0.0001) at 16 weeks. ASAS20 69.2% vs 21.2% (p<0.0001). Pan-JAK inhibition showed efficacy in TNFi-experienced patients. Abstr OP0240 @RheumNow #EULAR2026
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Does sequential therapy infliximab —> tofacitinib outperform tofa alone in axSpA?
Yes: faster remission at week 4 (84.6% vs 15%)
But: equal at week 24
Prospective study in 46 patients
#POS0201 #EULAR2026 @RheumNow https://t.co/rmtoJQtYc0
Nelly ZIADE 🍀 Nellziade ( View Tweet)
Interesting poster #POS0939 from @SteZhao #EULAR2026
Long-term or recurrent antibiotic use in childhood associated w doubled risk of axSpA in HLA-B27+ individuals
11,611 HLA-B27+ UK biobank
Recall bias? Yes but self-reported exposure validated with primary care data
@RheumNow https://t.co/VmxI3BW6FE
Nelly ZIADE 🍀 Nellziade ( View Tweet)
In this posthoc analysis of pooled data from BE MOBILE 1&2, BKZ showed ⬆️clinical imprvements vs. PBO at 1 yr regardless of age, BMI, HLAB27 status & CRP.
At wk 52, ASAS40/ASDAS <2.1 was higher in pts w/BKZ who were ≤35y, BMI ≥25–<30 or HLA-B27+
POS0949 @RheumNow #EULAR2026 https://t.co/9sfil6y5Qr
sheila RHEUMarampa ( View Tweet)
Double targeted therapy in refractory SpA/PsA.
76 patients, 17 Spanish centres, up to 6 years follow-up. Median 4 prior biologics.
Remission achieved in 55.6% during follow-up. 28.6% in remission at final visit.
ASDAS improved significantly from 3 months, sustained to 5 https://t.co/g1IPstYYuX
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
10yr ffup data on 49pts from the OG CRESPA study (GOL vs PBO in very early pSpA):
81.6% (40/49) were in clinical remission
15 pts on drug-free remission
21 pts w/remission on meds still on GOL, no unSSAEs
Early aggressive tx is key!
AbsPOS0931 @RheumNow #EULAR2026 https://t.co/HrTF5XtAZt
Links:
sheila RHEUMarampa ( View Tweet)
