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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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Agrawal et al. Case study of tofacitinib + bDMARDs in refractory IA. 7 SpA, 2 RA, 1 JIA. Effective and safe. @RheumNow #ACR25 Abstr#2338 https://t.co/Y0B3W4csJX
Richard Conway RichardPAConway ( View Tweet)
In a 4-year study of 85 SpA patients, ChatGPT-4o matched SPSS in analyzing NLR/PLR trends. Outputs were identical, but ChatGPT offered faster interpretation and clinical context, highlighting AI’s potential to streamline early-stage research. Abstract#2354 @RheumNow #ACR25 https://t.co/W3pPQijPBD
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
ROC-SpA study assessed whether changing to an IL-17Ai was superior to rotating to a 2nd TNFi in axSpA pts who failed on a 1st TNFi
At wk 24, no significant diff in ASAS40 rates bet the 2 groups
IL-17Ai not superior to a 2nd TNFi
Rotate or change?
#ACR25 @Rheumnow AbsLB09 https://t.co/4EtNEFTSN9
sheila RHEUMarampa ( View Tweet)
To be continued (or discontinued?): Abstract 2360: Compared to TNFi, IL-17i & JAKi users had 🔹 Higher odds of med switching <180 days 🔹 Shorter time to discontinuation @RheumNow #ACR25 #axSpA https://t.co/IOHaFSJqHn
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Is taking NSAIDs +TNFi better for the joints?
Abstract 2359: In radiographic axSpA, NSAIDS + TNFi associated with
-fewer syndesmophytes 36% vs 58% TNFi
- no significant effect on hip structural changes
- @RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
In case you have a (gut) feeling something’s off…
Abstract 2315: The gut microbiome in #SpA 🔬
⬆️ Proteobacteria (incl. Escherichia spp)
⬇️ Firmicutes (“good” bacteria)
Higher disease activity ↔️ lower alpha diversity
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Zavada et al. 52 patients. bDMARD therapy improves sexual function at 6 months in r-axSpA. Improvements in function, desire, satisfaction in those with baseline erectile dysfunction @RheumNow #ACR25 Abstr#2346 https://t.co/IUMGCFnXZh
Richard Conway RichardPAConway ( View Tweet)
Konsta et al. Adding NSAID to TNF inhibits spinal but not hip radiograpic progress. 262 patients, TNF+NSAID 100, TNF alone 162. New syndesmophytes 36% vs 58%. ΔmSASSS-score/year 0.1 vs 0.7. No effect on progression of hip radiographs. @RheumNow #ACR25 Abstr#2359 #ACRBest https://t.co/k9j2M2E3ze
Richard Conway RichardPAConway ( View Tweet)
Macedo et al. Increasing exercise improved QoL in axSpA. Mobility limitation and obesity worsened it. At least to some degree these effects appear independent. @RheumNow #ACR25 Abstr#2326 https://t.co/Ei4cKTNHyn
Richard Conway RichardPAConway ( View Tweet)
Gender differences in p/axSpA in Turkiye from ASAS-PerSpA:
Males - early onset IBP (<45yrs); sacroiliitis on CR, HLA-B27+ (vs. females)
Females - peripheral dse, enthesitis, Pso, dactylitis; ⬆️dse activity, FM (vs. males)
Individualize & optimize tx.
#ACR25 @RheumNow Abs2322 https://t.co/vcisNguJLB
sheila RHEUMarampa ( View Tweet)
Rotation or Change in Biologic post TNFi failure in axSpA. Switching biologic class after TNFi failure improved outcomes in axial SpA. In a randomized trial of axSpA patients with inadequate response to a first TNFi, switching to an IL-17Ai was not superior to cycling to a second https://t.co/MEsokWeT8e
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
This cohort study from Ontario of 🚺w/axSpA
✳️GDM, antepartum hem, SMM (severe maternal morbidity) -⬆️ in axSpA
✳️Neonat complications-preterm birth
Factors assoc w/SMM- age, comorbidity, gestational age at delivery
Better strategies for maternal care
#ACR25 @RheumNow Abs2200 https://t.co/LrVzJLnvWe
Links:
sheila RHEUMarampa ( View Tweet)
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)
