AS/Spondyloarthritis

Should we start considering therapeutic drug monitoring when prescribing TNFi for treatment of our rheumatologic conditions?

Uveitis is the most frequent extra-musculoskeletal manifestation (EAM) in Axial Spondyloarthritis (axSpA). The prevalence of uveitis in axSpA is between 25-30%. Up to 50% of patients with an acute episode of uveitis develop recurrent anterior uveitis or iritis. Being such a prevalent EAM in axSpA, we should focus on this condition. There have been some updates on uveitis in SpA at #ACR21 which I will share here.

PsA commonly affects peripheral joints. In up to a quarter of PsA patients, the spine may be involved and this is known as psoriatic spondylitis (PsSpA). An important research question is whether PsSpA and Axial Spondyloarthritis (AxSpA) with psoriasis are separate conditions or not. 

Differentiation between a flare of disease and infection in patients with autoinflammatory (AI) conditions, where fever is the hallmark, can be extremely difficult. Few studies have evaluated potential differentiators; and having such tools would meet a huge unmet need. 

A remaining challenge for clinicians is the ability to delay, if not completely stop, structural progression in patients with axSpA, whether they are diagnosed with radiographic (r-axSpa) or non-radiographic (nr-axSpA) disease.

Delay in the diagnosis of axial spondyloarthritis (axSpA) has been a huge challenge and is associated with poor outcomes.

Who wouldn't like to predict the future? 

The RheumNow faculty have been glued to their monitors all day, watching video, and running down abstract presentations to find the best – several of these stood out as #ACRBests. Here is a listing of “Best” they saw on Day 1.

Patients with axial spondyloarthritis (axSpA) often have increased absence from work as well as reduced productivity at work, which can have profound impacts for not only the affected individual and their families, but also lead to wider economic and social burden.

Despite the increasing scientific knowledge on axSpAs, a substantial gap still remains. Delay in diagnosis continues to pose a threat in the early identification of patients and those already on treatment may deal with additional issues such as work productivity or quality of life.

The opening of ACR2 Convergence was a hit for all who signed up and viewed in. The day included the presidential address by outgoing president Dr. David Karp (UT Southwestern) and a keynote talk and interview with Dr. Seema Yasmin (Stanford). The Year in Review featured a clinical vs basic science Brigham and Women’s Hospital faceoff between its two faculty, Dr. Karen Costenbader and Dr. Michael Brenner.

Growing awareness of spondyloarthropathies over the last two decades has led to a better understanding of the pathophysiology of spondyloarthritis, and subsequently increased interest in more distinct, disease state specific treatment options.

Mysteries behind polyautoimmunity have confounded rheumatologists for decades. One such association, the co-existence of Familial Mediterranean Fever (FMF) and axial spondyloarthritis (axSpA), remains rare. In fact, we believe the rate to be between 0.5% and 7.5%. Two abstracts looking at axSpA and FMF were highlighted during ACR Convergence 2021. 

The pharmaceutical companies will feature the results of their pivotal clinical trials and data analyses at ACR Convergence 2021.  Below is a listing of some of their best studies for you to review and look for in the meeting. Often these become the pivotal studies for regulatory approval and the annual congresses are their first look. Aurinia