ACR 2025 SpA Topic Podcasts Compilation 2 Save

This is an ACR twenty twenty five podcast coming to you from Chicago. Hope you enjoy it.

I'm Anthony Chan reporting here for RheumNow at ACR twenty twenty five in Chicago. And today, there was a presentation, abstract number o eight five four, which is the revision of the axial spondyloarthritis classification criteria, and this came from the classic study. This was a joint project between ASAS and Spartan and presented today here at ACR twenty twenty five. The aim of this study was to refine the classification criteria for Axos par, which was first developed by ASAS in 2009. The 2009 ASAS XSPAR criteria offered a sensitivity of eighty three percent and specificity of eighty four percent for rheumatologists confirmed diagnosis.

It's important to note that these are classification criteria, not diagnostic criteria. While there was a strong starting point, the high prevalence of back pain in a commune in the general population meant that we were looking for a greater specificity in this round in the classic study where that was the focus. The focus was to try to get to above 75% sensitivity, but higher specificity at 90 greater than 90%. And that was the goal of the classic study. The classic study recruited over 1,000 patients from 61 centers across 27 countries, and these patients had back pain for more than three months, and the age of onset was below the age of 45.

The diagnosis was assessed very stringent in the five stages, and stage five had a reference standard. This includes centralized imaging review by two primary readers and also an adjudicator. The cohort was split into testing and training sets and validation sets, and they used regression techniques, including LASSO and multivariable logistic regression. And the team identified the key SPA features that's strongly associated with a stage five diagnosis. And then following that, ex expert consensus was refined to, to refine the criteria further, and the final proposal was put to vote from both the ASUS and SPARTAN members.

The results of the classic study was, three hundred seventy patients, about thirty six point five percent of patients finally met the stage five diagnosis of XBA. And from this, they achieved a sensitivity of 79.5 and also specificity of 90.4, which met the original target for the specificity and sensitivity. What is different from the 2,009 criteria is there's a greater weighting on MRI imaging of the sacroiliac joints, both in terms of active and also structural lesions, radiographic sacroiliitis, and then the clinical features, HLAB 27, presence of inflammatory back pain, inflammatory bowel disease, uveitis, heel antisitis, and elevated CRP. Notably, they have added in psoriasis, and also dactylitis was replaced by CRP based on expert consensus. The conclusion I've taken away from the classic study is that this revised ASA spartan criteria hopefully will try to improve the the specificity, in the classification criteria and also to emphasize that the central role of imaging, and to streamline the clinical variables to improve diagnostic precision.

So I think this is one further step for us to try to improve the accurate identification of XBAW, particularly for clinical trials and research studies where these classification criterias will help us to identify these patients more accurately. I'm Anthony Chen reporting here for RheumNow at ACR twenty twenty five in Chicago.

Hello, everyone. I'm Richard Conway from Dublin, Ireland reporting for RheumNow from ACR twenty twenty five. I wanna talk to you today about abstract number two three five nine, which was a poster presentation. This was by Consta et al. It was a study in radiographic axial spondyloarthritis or ankylosing spondylitis.

And this looked at the question of, do NSAIDs, non steroidal anti inflammatory drugs, add anything extra in terms of inhibiting radiographic progression? So they had two sixty two patients. All of them were on TNF inhibitors. And then they had one hundred of that two sixty two who were also on NSAIDs, and the other one hundred and sixty two who were just on the TNF inhibitor. And what they found was that there were new syndesmophytes in thirty six percent of those who were on the nonsteroidals, compared to fifty eight percent of those who weren't.

And the change in the modified stoke and closing spondylitis spinal score was 0.1 compared to 0.7. So again, favoring the group who were on the nonsteroidal anti inflammatory drugs. And then the other nice thing they did is kind of had an internal control almost for this, where they looked at hip changes and they found no difference in the hip changes between the two groups. So this suggests that potentially non steroidal anti inflammatories have a specific effect on the spinal radiographic changes, probably because these are more osteoporotic in nature. So this is an interesting study.

It adds to kind of the ongoing debate in this area. They've kind of gone back and forth about what effect nonsteroidals have and is there any such effects potentially beneficial? I think it's still very much an open question, but I thought this was an intriguing, study. So I'm Richard Conway. Follow me on Twitter, Richard p a Conway, and do tune in to RheumNow for all the updates, from ACR twenty twenty five in Chicago.

Hello, my name is Atul Devdar. I'm a professor of medicine at Oregon Health and Science University. I'm going to speak about biomarker discovery in axial spondyloarthritis. One of the issues we have in the field, one of the big unmet need that we have in the field of axial spondyloarthritis is lack of biomarkers. Beyond C reactive protein and HLA B27 and MRI of the sacroiliac joint or spine.

We don't have any other biomarkers. I found there were three studies presented here, two posters, one oral presentation, and they are on fourteen thirty three ETA, which is a protein, and the autoantibodies to that protein in external spondyloarthritis. Rheumatologists know about fourteen thirty three ETA as a blood test in patients with rheumatoid arthritis, and this is known for over a decade now. And the levels, high levels of fourteen thirty three ETA correlate with the disease severity in rheumatoid arthritis. It's also helpful in diagnosis of rheumatoid arthritis, etc.

During the investigation of this, protein, further, it was found out that the antibodies two fourteen-three-three eta might be a biomarker for axial spondyloarthritis. It's a very exciting, or interesting, story how that was found out. But in any case, fourteen thirty three eta is a intracellular protein. It's a chaperone protein, and it lives inside the cell. But if it is externalized, then the body can make autoantibodies against this protein.

It was found that patients with axial spondyloarthritis have high levels of this particular autoantibody. There was one poster at this meeting which compared the autoantibody levels of fourteen thirty three eta in patients with radiographic axial spondyloarthritis, or what we used to call ankylosing spondylitis, with normal controls, and it was found out that the levels were high. They also found out that if you combine this biomarker of autoantibodies to fourteen thirty three with c reactive protein and age and sex and HLA B27, then the ROC area under the curve becomes point nine three, so it becomes a pretty strong diagnostic test. Second poster compared the autoantibody levels of this fourteen thirty three eta in axial spondyloarthritis, radiographic axial spondyloarthritis with patients with mechanical back pain because that is the closest differential diagnosis we have. And they found that the levels are high in radiographic axial SPA, but not so in mechanical back pain.

So it works as a differential test. And the third, which was an oral presentation, they actually looked at these levels in radiographic and non radiographic excess spondyloarthritis, compared with controls, mechanical back pain patients, and found out that even in non radiographic excess spondyloarthritis, the levels are high. So this is an interesting development in the field of, axial spondyloarthritis. Also, in the SPARTAN meeting, which was along with the ACR, it was declared that, SPARTAN might be embarking on a study called Basis biomarker investigation in axial So I'm happy to report that, the field is moving and probably within a few years we might actually have more biomarkers for axial spondyloarthritis.

I'm Anthony Chen reporting here for RheumNow in in ACR twenty twenty five in Chicago. And today, I want to talk to you about a subject that we probably don't talk very much about in our clinics, is the assessment of sexual function in axial spondyloarthritis. It appears that it's one of the important outcome measures that we should add to the many other outcome measures that we use to assess our patients with ankylosing spondylitis or excess spondyloarthritis. And there are two abstracts today presented that I wanted to talk to you. Firstly is two three four six.

This is a check study where they looked at the sexual function in patients who receive biologic treatment. And in this study, they focus on men. And the patients who are about to start biologics, assess their sexual function using the IIEF score, which is a validated score to check for sexual function at zero and then at six months. And the study objective was to see the impact of the the biologics on these outcomes on top of the standard outcome, which is the disease activity scores. There were fifty two male patients who were randomised into the study.

They had ankylosing spondylitis and the mean age was around 40 years. Around ninety two percent of them were HLEB27 positive. The majority of them, around ninety six percent, received anti TNF and around four percent had IL-seventeen inhibitors. They assessed sexual function but also they looked at traditional outcome scores, the CRP, STES, health assessment questionnaires, SF thirty six, and also the EuroQOL. The overall improvement at six months was significant in terms of the traditional outcomes, ESR, CRP, and STES, but also the improvement in quality of life, including the HAC and the Eurocall.

When they stratified these patients based on their baseline IIEF, erectile dysfunction scores, they found that there was a difference. In the group that had received the biologics, There was an improvement in the score at the end of six months in those who were treated with biologics. There was also significant gains in many other aspects of their sexual function which was assessed. And this was maintained over the period of the of the study. In those patients who did not have any sexual dysfunction, then what the biologics did is they maintained their score.

So what we're seeing is that in patients who had a low baseline score, we signify poorer sexual function, there was an improvement. But if they did not have sexual dysfunction, then that was maintained throughout the whole six months. These were quite important studies that this shows that not only does our biologic DMARC treatments advance the improvement in terms of their health outcomes, their quality of life, their physical scores like the ESR and S test, but also sexual function. This highlights the importance of maybe addressing sexual health on top of other outcomes that we assess. Similar to this in abstract two three one six, this is from a Brazilian study where they did a meta analysis in women this time with XPAR.

They also found that sexual dysfunction and sexual health issues were were higher compared to age matched healthy controls. Again, highlighting that incorporating sexual health evaluation is is probably something we need to start to consider in, in assessing our patients with, axial spondyloarthritis. I'm Anthony Chan reporting here for RheumNow in the ACR twenty twenty five. I'm Anthony Chen reporting here for RheumNow at ECR twenty twenty five in Chicago. And one of the interesting abstracts that was presented today was abstract number two three three one.

And this talks about something that we probably don't talk very much about, which is coping strategies for our patients in axial spondyloarthritis. And this comes from the OASIS cohort where they have analyzed patients with axial spondyloarthritis. We know that our patients with axial spondyloarthritis, have physical, emotional, and also social, changes that can often affect how they feel and how they respond to the treatments that we are giving them. So they have coping strategies that to help manage chronic disease, including pain. This study looked into how these coping strategies are being utilized by the patients, and secondly, what happens over a period of time whether these patients maintain their coping strategy or whether they change strategies as time went on.

And also whether these coping strategies are somewhat related to disease activity. So the data came from the OASIS study, and they look at something called CORS, which is coping with rheumatic stressors. And these evaluation which looks at three main components. Firstly, pain, secondly, limitation, and third, dependence. It is quite a comprehensive assessment with 61 items across eight strategies, and patients then were scored between one to four.

And then they evaluated this according to the demographics of the patient, including their age, sex, and education, their health scores, including ESTI, BESFI, SF thirty six, and also to long detainee follow them over a period of time. So they had 116 patients who were included in this study, and they looked at the coping strategies. The most often used coping strategy was pain. For pain, there was comforting cognitions, and for limitations, they use pacing, and for dependence showing consideration. For associations, they they looked at how these things then coped how these patients cope with these many challenges.

Patients who use a lot of comforting cognitions, this was linked to those who had lower educational attainment and also higher BMI. For pacing, this was used more by older individuals. And for showing consideration, this was used less with people with more comorbidities. What was surprising was these methods or coping strategies that were being used were not necessarily direct, related to the, outcome measures. So it looks like the disease scores, including s test, BESV, s f thirty six, had very minor effect on which coping strategies that the patients use.

And also, the coping strategies did not really change over the two years of of the study. So this study really showed that these coping strategies are being utilized by our patients, and this is a very comprehensive way of analyzing it. And patients use different ways to to cope with their chronic disease. The important thing is that this is not necessarily related to disease activity, and this is down to the individual, person itself. So these are personal characteristics such as age, education, body mass index, and these are thought to be more important rather than the actual disease activity that determines how our patients use these coping strategies.

This again highlights to us that when we care for our patients with XBA in the personalization of this care, we should also try to tailor these coping strategies or coping styles in order for us to manage our patients with XBA better. I'm Anthony Chan reporting here for RheumNow at twenty twenty five.

Hi. I'm Sheila Reyes from The Philippines, and I'm here in Windhoek, Chicago reporting live for RheumNow for ACR convergence twenty twenty five. In this video, I will be talking about one of the late breaking abstracts that were presented in the poster sessions this afternoon. It's abstract number l b zero nine entitled rotation or change of biologic after TNF blocker treatment failure for axial spondyloarthritis or the RUXPA study from the group of doctor Daleks. So this study is a prospective randomized open label superiority trial.

It's a phase four study, which was conducted in France and in Monaco between 2018 and 2023 that enrolled patients with spondyloarthritis who developed inadequate response or treatment failure with their first TNF inhibitors for at least three months. And so the group wanted to identify whether what would be the most effective treatment after these patients get an adequate response from their first TNF inhibitors by either getting or switching to an IL-17A inhibitor or a second TNF alpha inhibitor. And so the primary outcome was achievement of ASAS 40 at week twenty four, and secondary outcomes were achievement of ASAS 40 at different time points. Now as I mentioned earlier, also, were randomized to either switching to an IL seventeen a inhibitor or rotating to a second TNF inhibitor. And for those given or being switched or being changed to an IL seventeen inhibitor during this study, only secukinumab and execizumab were the available IL seventeen a inhibitors at the time of of the study.

So what there what are the results? Well, the primary outcome was not achieved because there was really no significant statistically significant difference between the ASAS 40 rates of the IL seventeen a inhibitor group and the second TNF inhibitor groups. And this means that well, this means that the IL seven or changing to an IL seventeen inhibitor was not superior to compared with shifting or rotating to a second TNF inhibitor. Now how can these results help in clinical practice? I think it informs us of the options that we can give our patients and that it also aligns with what the current recommendations say about either switching or rotating to biologic DMARDs in our patients who fail an initial an initial treatment for axSpA.

But it's also interesting to watch out for newer data as the trial may progress or probably addition of addition of other newer IL seventeens. Follow me on x at RheumNow for more updates of the ACR 2025.

Hello, this is Atul Devdar from Portland, Oregon. Has it ever occurred to you that why do patients stay in long term clinical trials like three years, four years, five years, even when they have not received the minimal outcome. Case in point, in axial spondyloarthritis, as DAS, inactive disease or as DAS low disease activity is a good endpoint for the patients to be. Why would patients stay in a clinical trial after three years if they have not even received as does low disease activity and they're still at the end of three years in high disease activity? And we generally don't think about it.

Case in point here is there is an abstract here two, three, four, seven where bimekizumab patients stayed in clinical trial of axial spondyloarthritis. There were two phase three studies done. These are pooled results. And eighty percent of the patients in that clinical trial at the end of three years were in ASDAS, low disease activity, which means twenty percent of the patients were in high disease activity. And you think why were these patients even they stayed?

And there was this abstract number two, three, four, seven poster which actually had heat maps. Heat maps is a great way of showing what happens to individual patient over time. In the heat map, if it is a green line, that means the patient is in low disease activity or inactive disease. If it is orange, is high disease activity and red would be very high disease activity. If you look at the figure, you will find out that patients who at the end of three years were in high disease activity.

But if you look back, they were in low disease activity before. And that brings an important point that just cutting the data at one particular time point, say three years, doesn't really give you the full picture. You need to see what happened to the patient over entire three year period. And the heat map is the only heat map is the only way you can get that those data. A couple of other points I want to make here is if we really follow treat to target.

Treat to target means that you see the patient and the patient is not doing so well, you have to change the therapy. Here, these patients did intermittently very well and then intermittently had flares. If trick to target was applied on every time they did badly, they would have changed the therapy, which really was not essential. Another point that comes out of this is that maybe the outcome measures that we have for axial spondyloarthritis are not really measuring why the patient stays into clinical trial. There is something that is making them happy.

One of those things could be that compared to what they were at baseline, they are so much better now. Even though they were high disease activity, they were in very high disease activity, and their ASDAS has dropped. So it made me think that if somebody is not doing so well at one particular time point, it doesn't necessarily tell you that the therapy has failed. That could be a blip in their long journey. All our diseases are chronic and there is something else that we are not really measuring in our measurements that is missing which actually in fact makes the patients stay into the clinical trials.

Hello, everyone. Today is day three of ACR twenty twenty five, and a lot of data being presented about patients with axial spondyloarthritis. And I found these few abstracts which are very clinically relevant for our patients, is those patients with axial spondyloarthritis that have inadequate response to first TNF, what to do in them next. There was a prospective study that was presented from 31 centers. The study looked at whether those patients with Axial SpA have inadequate response to TNF inhibitors should switch to a different TNF inhibitor or completely switch the class, like to an IL-17A inhibitor.

The study showed that the primary endpoint at twenty four weeks was ASAS40 response, and the study showed there was no significant difference between the two groups. That ASAS40 response at twenty four weeks was similar between the IL-17A, switch or switch to a second TNF. The take home message from this abstract was that, you know, this, switching is an individualized decision, shared decision making between the physician and the patient to decide where to switch next patient, where to switch to the next medication. Another abstract on the same line was from a Spanish registry which also looked at switching for patients to a different TNF inhibitor or to IL-17A inhibitor, and that registry also showed that the retention and survival was much longer on patients that switched from one TNF inhibitor to another TNF inhibitor, suggesting that switching maybe within the same family may be better than switching to a different class. We did a real world study using TriNetX database where we looked at initial start, what should be their first start of biologic in these patients, and whether it should be a TNF inhibitor or an IL-17A inhibitor or a JAK inhibitor.

We found that the odds of survival were much higher in TNF inhibitors than in patients with IL-seventeen and JAK inhibitors. These data need to be looked into further, maybe giving us some idea about what to start first in these patients with axial spondyloarthritis. Thank you.