Notes from the 2015 SPARTAN Meeting Save

The formal meeting of the SpondyloArthritis Research and Treatment Network (SPARTAN) was held September 25-26, 2015 in Denver, Colorado.

The meeting was preceded by a course cosponsored by SPARTAN and The Spondylitis Association of America. This invaluable course taught by both rheumatologists and radiologists focused on teaching in a hands-on manner the different techniques involved in reading MRI in patients with spondyloarthritis. It provided a basic introduction of MRI and provided further instruction and guidance on the use of this imaging modality to define the different anatomic manifestations of this group of diseases. It was well done and most participants felt comfortable although not expert in reading spinal and sacroiliac and spinal MRIs. MRI changes are a critical element in the ASAS Classification Criteria for Axial Spondyloarthritis. Further, it is now being recognized and acknowledged that “non-radiographic” spondyloarthritis may be one of the earliest manifestations of this group of diseases, and may provide an earlier window of opportunity in which to intervene aggressively.

FELLOWS PRESENTATIONS. The meeting included fellow’s presentations that spanned basic science, epidemiologic and clinical concepts in spondyloarthritis. One study, entitled Identifying Spondyloarthritis in US Veterans, used natural language processing, a chart review tool, to identify patients from EMRs that may have spondyloarthritis. In another presentation of a small study of 10 patients, whole blood profiling for analysis of microRNA a 2045p micro RNA signature was identified. A Veterans Administration cross sectional study using the PULSAR registry found that approximately 13% of patients with spondyloarthritis had uveitis. An interesting imaging study attempted to define the significance of “Fatty Metaplasia” in patients with spondyloarthritis and, interestingly, demonstrated that only a minority of these patients progress over 15 years to ankylosis. A final fellow presentation identified autophagy in a rat model as a possible process that reduces the accumulation of misfolded HLA B27.

CLINICAL TRIALS & CRITERIA. There was an entire section on the challenges of spondyloarthritis clinical trials in the United States and a proposal for establishing a Clinical Trial Consortium. These initiatives are in the early stages of discussion. There was a section presented on Classification Criteria for Axial Spondyloarthritis and a debate between Dr. Mohammed Asim Khan, who was in favor of modification of the current criteria, and Dr Van Den Bosh, who argued for maintaining the current classification criteria. The ASAS criteria have been adopted in Europe and indeed some biologic therapies there have been approved for patients with axial spondyoarthritis, whereas in the United States anti-TNF therapies are only approved for ankylosing spondylitis.