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The pain that inflammation does not explain in SpA and PsA

Antoni Chan, MD, PhD

Clinicians often come across the scenario of a patient with well-controlled spondyloarthritis where the ASDAS in the low disease activity range, CRP normalised, joints clinically quiet. However, the patient returns to the clinic still reporting significant pain. Their rheumatologist adjusts the biological, waits, returns. The pain persists.

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Over 10 years in the GESPIC cohort, males with #axSpA had lower ASDAS/BASDAI and enthesitis but double the odds of significant spinal radiographic progression vs females (OR 2.08). Symptoms don’t always correlate to structural damage Abstr OP0101 @RheumNow #EULAR2026

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

After TNFi secondary failure: does MOA switch beat TNFi cycling? UK RWD (n=155): yes for #PsA (76% vs 57% drug survival at 12m) and axSpA (80% vs 68%), but not RA. Yet 74% of axSpA pts still got another TNFi. Evidence vs practice gap in plain sight. @RheumNow #EULAR2026 POS0776

Jiha Lee JihaRheum ( View Tweet)

Real-world bimekizumab in SpA/#PsA (BIMPACT, n=223): 76% retention at 12mo, even with 54% having prior IL-17i exposure. Effective after IL-17Ai failure. Oral candidiasis higher in PsA (16.5%) vs SpA (3.3%); led to discontinuation in ~25%. @RheumNow #EULAR2026 POS0798/POS0810

Jiha Lee JihaRheum ( View Tweet)

What defines MRI indicative of axSpA? This systematic lit review show adapting more stringent cutoffs in BME (>=4 SIJ quads, erosion >=3 quads, fat >=5 SIJ quads) & combined BME + structural lesions inc specificity. Time for updated definitions? AbsPOS0866 @RheumNow #EULAR2026 https://t.co/gkVbcOAiD3

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sheila RHEUMarampa ( View Tweet)
#OP0241 FASTLANE phase 4 trial showed TOFA was superior to PBO in early active axSpA, achieving significantly higher ASDAS inactive disease rates at 16 weeks (26.4% vs 7.4%) on background of naproxen. MRI osteitis improvement numerically favoured TOFA. #EULAR2026 @RheumNow https://t.co/dGETjkmfrh

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Mrinalini Dey DrMiniDey ( View Tweet)
Impt pts to consider in D2T CLE by Prof Wittmann: If tx is not working, ask yourself: is the dx correct? adherence? Main message: treat early When damage is present, tx doesn’t really provide considerable improvements Future drxns? Endotype-directed tx @Rheumnow #EULAR2026 https://t.co/hB48aD7jx5

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sheila RHEUMarampa ( View Tweet)
#OP0240 phase 3 data showed that the pan-JAK inhibitor gecacitinib significantly improved disease activity, function, MRI inflammation and quality of life in active radiographic axSpA versus placebo at 16 weeks, with ASAS40 responses of 51.9% vs 12.9%. #EULAR2026 @RheumNow https://t.co/6oojvvFmk0

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Mrinalini Dey DrMiniDey ( View Tweet)
#OP0239: validating 2025 ASAS-SPARTAN axSpA classification criteria in the SPACE cohort. Revised criteria showed high specificity but lower sensitivity than 2009 criteria, reflecting greater emphasis on imaging & less reliance on clinical features alone. #EULAR2026 @RheumNow

Mrinalini Dey DrMiniDey ( View Tweet)

#OP0238: French SNDS cohort found longer exposure to targeted therapies in SpA (>6months) was assoc with a lower overall cancer risk vs shorter exposure, esp for haematologic malignancies. Data add to long-term safety evidence for targeted therapies in SpA. #EULAR2026 @RheumNow

Mrinalini Dey DrMiniDey ( View Tweet)

#OP0237 reports positive phase 3 data for the selective JAK1 inhibitor ivarmacitinib in active nr-axSpA. ASAS40 responses at Week 12 significantly higher vs placebo (39.7% vs 24.8%), with sustained efficacy through Week 24 and no new safety signals observed. #EULAR2026 @RheumNow https://t.co/JZLQ0Ywlio

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Mrinalini Dey DrMiniDey ( View Tweet)
After failure of a first TNFi in axSpA, #OP0235 from ROC-SpA trial found no superiority of switching to an IL-17A inhibitor over cycling to second TNFi. ASAS40 responses at Week 24 similar with both strategies, supporting individualised treatment decisions. #EULAR2026 @RheumNow

Mrinalini Dey DrMiniDey ( View Tweet)

Catching up with the “Optimising care in SpA” at #EULAR2026 #OP0234 Phase 3 OLINGUITO trial showed filgotinib significantly improved ASAS40 responses vs PBO in both radiographic and non-radiographic axSpA by Week 16, with responses maintained through Week 52. @RheumNow #EULARBest https://t.co/axn6Zv52RA

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Mrinalini Dey DrMiniDey ( View Tweet)

FASTLANE study Ph4 RCT on TOFA+NPX vs. PBO+NPX for early active axSpA TOFA arm significantly achieved inactive dse vs. PBO (p=0.006) at wk 16. Similar results seen in secondary efficacy endpts. Interesting results supporting TOFA use AbsOP0241 @RheumNow #EULAR2026 #EULARBest https://t.co/PQYzE1zm0h

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sheila RHEUMarampa ( View Tweet)
Mean disease duration in the tofacitinib arm was just 0.57 years since diagnosis. This is genuinely early #axSpA and JAK1 inhibition achieves near-remission rates above placebo. An oral option for early axSpA Abstr#0241 @RheumNow #EUlAR2026

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

Tofacitinib achieved ASDAS inactive disease in 26.4% of patients with early #axSpA (back pain ≤2 years) vs 7.4% placebo at 16 weeks (p=0.006). First RCT of advanced therapy in very early axSpA Abstr#0241 @RheumNow #EULAR2026

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

Day 2 of #EULAR2026 Studies to look forward today in #axSpA: new classification criteria performance, sex differences in disease progression, early disease treatment data, primary care education to reduce delays to diagnosis @RheumNow

Antoni Chan MD (Prof) synovialjoints ( View Tweet)

Roc-SpA study Active axSpA dse + inad response to TNFi ➡️switch or cycled No significant diff in ASDAS40 at wk24 bet IL-17i & 2nd TNFi Switching to IL-17i not superior to cycling to 2nd TNFi after inad. response to 1st TNFi Shared decision is key AbsOP0235 @RheumNow #EULAR2026 https://t.co/3UP37IEgXv

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sheila RHEUMarampa ( View Tweet)
#OP0236: a look at the revised 2025 ASAS-SPARTAN classification criteria for axSpA from the global CLASSIC cohort. The updated criteria achieved 79.5% sensitivity & 90.4% specificity, with MRI & radiographic sacroiliitis remaining central to classification. #EULAR2026 @RheumNow https://t.co/rVIqyCmB8K

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Mrinalini Dey DrMiniDey ( View Tweet)
📈 Do SIJ lesions progress in #axSpA? DESIR cohort (n=649, 10yrs): Yes, slowly, but bDMARDs reduce erosion progression #OP0102 #EULAR2026 @RheumNow https://t.co/Ap35q9D6B4

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Nelly ZIADE 🍀 Nellziade ( View Tweet)
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