Axial & Psoriatic Disease Save
Dr. Peter Nash at Eular 2024 in Vienna, Austria.
Transcription
Peter Nash reporting from EULA, Vienna 2024 for RheumNow. One of the topics of interest, it's a big debate. Graphic had a huge project in it. The axis study is trying to define whether axial involvement in PSA is different to axial SpA with a psoriatic rash. They're putting a huge amount of effort into trying to differentiate the two.
From my point of view, there are two aspects of the same I call it NASH type one and NASH type two. If you're sitting in a clinic that is a back pain AS clinic, you see the first phenotype, bilateral sacroiliitis, high percentage B27 positive, symmetrical, typical AS and nine percent of those people have a psoriasis rash. So you'll think it's just axSpA with a rash. If you sit in the peripheral arthritis clinic like I do, you see a very different phenotype, so called phenotype type two. Asymmetrical sacroiliitis, asymmetrical syndesmophytes.
Half if you're lucky are B27 positive, a lot of cervical involvement. Of course they're the same disease but they're two phenotypic expressions of the same disease and they'll both respond to therapy. They'll have different symptomatology and they'll have different imaging and genetic background. It's like leprosy. Is it granulomatous?
Is it lepromatous? It's still leprosy. It's still axial involvement and it's splitting hairs whether it's axial PSA or axSpA with a rash. X two of the same disease just two different phenotypes. Treatment implications are not going to be that different.
You treat symptoms and you treat inflammation that you can see on imaging and I think we'll find that what are we going to do? Call, PSA dactylitis different to axSpA dactylitis? Are we going to call PSA enthesitis different to axSpA enthesitis. So I think this will come down to splitting hairs that won't make a huge treatment difference. Thanks for your attention.
From my point of view, there are two aspects of the same I call it NASH type one and NASH type two. If you're sitting in a clinic that is a back pain AS clinic, you see the first phenotype, bilateral sacroiliitis, high percentage B27 positive, symmetrical, typical AS and nine percent of those people have a psoriasis rash. So you'll think it's just axSpA with a rash. If you sit in the peripheral arthritis clinic like I do, you see a very different phenotype, so called phenotype type two. Asymmetrical sacroiliitis, asymmetrical syndesmophytes.
Half if you're lucky are B27 positive, a lot of cervical involvement. Of course they're the same disease but they're two phenotypic expressions of the same disease and they'll both respond to therapy. They'll have different symptomatology and they'll have different imaging and genetic background. It's like leprosy. Is it granulomatous?
Is it lepromatous? It's still leprosy. It's still axial involvement and it's splitting hairs whether it's axial PSA or axSpA with a rash. X two of the same disease just two different phenotypes. Treatment implications are not going to be that different.
You treat symptoms and you treat inflammation that you can see on imaging and I think we'll find that what are we going to do? Call, PSA dactylitis different to axSpA dactylitis? Are we going to call PSA enthesitis different to axSpA enthesitis. So I think this will come down to splitting hairs that won't make a huge treatment difference. Thanks for your attention.
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