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Difficult to Manage Axial Spondyloarthritis
Studies show that patients with difficult-to-manage axSpA have a higher disease activity; however, the lack of a consensus definition led researchers and clinicians to utilize their own proposed definition, resulting in variability of the characteristics of non-responders.
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Systematic review & meta-analysis by DrHChaudhary et al @DaoudAnsaam @mmagrey1
showed that males w/ axSpA who were treated with biologics had ⬆️ BASDAI150 response & likely w/ ASDAS low dse activity vs. females w/axSpA
Again, effect of gender differences
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sheila RHEUMarampa ( View Tweet)
How early is early?
Data from SPACE cohort included 548 pts with CBP (<2y duration) and different SpA features followed over 2years.
-At the end of 2 years, 39% pts were dx with axSpA.
-Median time to dx: 35 months.
-HLAB27+, sacroilitis on MR and peripheral arthritis were the… https://t.co/AYtJCp8yno https://t.co/VL7KSrpvp9
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Adela Castro AdelaCastro222 ( View Tweet)
Prof @WalterMaks et al reports the validation of data-driven quantitative MRI cutoffs for a +SIJ MRI perform highly in pts with established axSpA.
- Deep fat lesions & sclerosis: high specificity for #axSpA
@RheumNow #ACR24 abs821 https://t.co/sSAtTt1GGV
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sheila RHEUMarampa ( View Tweet)
Does alcohol consumption affect radiographic progression in axSpA?
Canadian cohort study over 6 years found greater radiographic progression among alcohol consumers.
Still a lot of confounding factors to fully establish an association.
Abst#0822 #ACR24
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Adela Castro AdelaCastro222 ( View Tweet)
ASAS definition of Difficult-to-Manage Axial Spondyloarthritis (D2M axSpA) with criteria including treatment failure, suboptimal control, and persistent problematic symptoms. 89% of ASAS members endorsed the definition, including treatment-refractory cases with specific… https://t.co/3qWPQAGZ7c https://t.co/mVQzfLtaiI
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
The 2009 ASAS classification criteria did not meet the set targets of 75% sensitivity and 90% specificity in the CLASSIC cohort, indicating the need for revision of these criteria to increase its performance and validity in classification of axSpA.
Abst#0820 #ACR24 #ACRBest… https://t.co/lF3QbRUpx3 https://t.co/SHPMpCjizS
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Adela Castro AdelaCastro222 ( View Tweet)
Gender based response in Axial SpA. A hot topic at ACR @ACRheum @RheumNow @hac28 @SPARTAN_Updates https://t.co/zbnE6kjQhL
Marina Magrey mmagrey1 ( View Tweet)
Ab#0458 #ACR24
10 year outcomes of 176 patients with seroneg RA
32 pts (18%) had change in dx - SpA (11), seropos RA (6), OA (5), crystal (3), CTD (3), Ifn-related/paraneopl/RS3PE, sarcoid (1)
40 (23%) had drug-free remission
30 (17%) started b/tsDMARD
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
Gender differences in axSpA extend to dse activity assessment tools.
PREDICT-SpA:
🔶️BASDAI score performed better in women.
🔶️ ASDAS-CRP homogenous performance on both genders.
Consider BASDAI for assessing dse activity in women?
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@rheumarhyme https://t.co/rKJXn2EPXa
sheila RHEUMarampa ( View Tweet)
A study from the EuroSpA collaboration validates new BASDAI cut-offs for disease activity in axial spondyloarthritis based in ASDAS: <1.4 for remission, <2.8 for low activity, and >5.9 for very high activity. This research enhances our understanding of disease states and their… https://t.co/OkPiTwSHz6 https://t.co/NjIDeme9dm
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
A 6-year study of the link between alcohol consumption and spinal radiographic progression in axial spondyloarthritis (axSpA). Results indicate that alcohol may worsen spinal damage, particularly in males and those with radiographic axSpA. Future research should explore… https://t.co/IIvTyq7kBe
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Using #MachineLearning for predicting flares in axSpA @DiegoBenavent et al, data from METEOR-SpA registry showed the ff predictors of flares thru the reduced logistic regression model:
🔅lower ASDAS
🔅enthesitis
🔅prior flares
🔅longer treatment duration
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sheila RHEUMarampa ( View Tweet)
Characteristics of difficult-to-treat AS accdg to a retrospective study by @DaoudAnsaam @mmagrey1 et al
⬆️ BMI
+ comorbidities: HTN, CKD, depression
+ EAMs: IBD, Pso, iridocyclitis
+ HLA-B27
Interesting real world data.
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sheila RHEUMarampa ( View Tweet)
Data from the study by Dr. Aguilar et al showed that high dose NSAID use was not assoc'd with incident HTN in their cohort of early axSpA patients.
Shows important role of NSAIDs in #axSpA but still should be used judiciously
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@rheum_cat @rheumarhyme https://t.co/LK5yFZynu4
sheila RHEUMarampa ( View Tweet)
Switching vs cycling - which is better? In PsA & axSpA, a real-world analysis shows that switching to IL-17Ai after TNFi discontinuation may lead to similar or better outcomes compared to cycling to another TNFi. Data from the CorEvitas PsA/SpA Registry. Abstr#0585.… https://t.co/AJP4NBjmzr
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
The risk of discontinuing first line biologics was twice higher in non-radiographic female patients compared to males. Abstr#0572 @RheumNow #ACR24 https://t.co/1tQUhsbqUu
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Data from the French DESIR cohort reveals no significant link between high-dose NSAID use and incident hypertension in patients with axial spondyloarthritis. Two thirds were high dose NSAID users at baseline. Incident hypertension occurred in 11% individuals during follow-up.… https://t.co/EAICDwzxNT
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#0585 🔬PsA/axSpA: TNFi Cycling v IL-17Ai Switch
➡️470 pts: Switchers to IL-17Ai had similar/better outcomes v TNFi cyclers @ 6 mo
➡️PsA: Switchers had improved arthritis/psoriasis(-5.0, p=0.02)
➡️axSpA: Switchers had improved fatigue(-9.4, p=0.01)
#ACR24 @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
In the SPACE cohort, patients with chronic back pain suspected of axial spondyloarthritis often receive a diagnosis within 35 months from symptom onset. Key determinants for early diagnosis include HLA-B27 positivity and sacroiliitis on imaging. Early diagnosis can be a game… https://t.co/RrcrtRoMfL
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
