RNL 26 Report: Spondyloarthritis Save
Audrey Gibson, PA-C, reports from RheumNow Live 2026 in Dallas, Texas, about lectures presented during the "Staying Ahead of Spondyloarthritis" session.
Transcription
Good morning. I'm Audrey Gibson reporting from day two from RheumNow Live. One of the most clinically impactful sessions today focused on something we don't always think about early enough in axial spondyloarthritis: musculoskeletal complications, especially large joint disease, joint deformity, and fractures.
Dr. Walsh gave a wonderful presentation on these complications. A key takeaway was how common hip involvement really is in axial SpA. Depending on the cohort, 10 to 50% of patients develop hip disease, often bilaterally, and not uncommonly with minimal symptoms early on. What's striking is that many patients already have radiographic damage before pain becomes prominent. That matters because our axial SpA patients undergo hip replacement at younger ages than the general population, with a lifetime risk around 5%, three to four times higher than controls.
Knee involvement follows a similar theme. While less common than hip disease, axial SpA patients, especially younger adults, have a significantly higher relative risk of knee replacement, and risk appears to rise after hip arthroplasty, likely reflecting both biomechanical stress and higher underlying disease activity.
There was encouraging news on the treatment front. Observational data suggests that biologics and conventional synthetic DMARDs are associated with a lower risk of joint replacement, reinforcing the importance of early and effective disease control, not just for pain, but for long-term structural outcomes. That said, when patients do need joint replacement, outcomes are generally good. Implant survival at 10 years exceeds 85 to 90% with substantial pain relief. However, axial SpA patients do face higher rates of perioperative complications including infection and non-orthopedic complications, risks that are not fully explained by comorbidities alone.
Medication management matters. Data consistently show higher infection rates when biologics are continued through surgery, supporting current guidance to withhold biologics perioperatively and restart once the wound has healed, typically around 2 weeks.
Then Dr. Bakewell followed up with advances in axial SpA. She referenced the new 2025 axial SpA classification criteria. These criteria place greater weight on imaging and have significantly improved specificity, now exceeding 90%. Importantly, this doesn't just refine classification, it sharpens how we think about diagnosis in real-world practice.
Extra-articular or extra-axial manifestations also received attention, especially uveitis. Lifetime risk approaches 40% in axial SpA. Several FDA-approved therapies including adalimumab, secukinumab, and ixekizumab have demonstrated reduction in uveitis flares, but only adalimumab and methotrexate currently have randomized trial data in non-infectious posterior uveitis.
On the treatment front, the ASAS-EULAR algorithm remains the backbone of care. NSAIDs and physiotherapy are foundational, but for patients with persistent disease activity, biologic or targeted synthetic DMARDs should not be delayed. TNF inhibitors, IL-17 inhibitors, and JAK inhibitors all have defined roles, with therapy selection guided by comorbidities such as uveitis, IBD, or psoriasis.
There was also excitement around what's coming next. Novel agents including IL-17 fusion proteins, nanobodies, and TYK2 inhibitors promise comparable efficacy with potentially lower cost or improved tissue penetration. Combination targeted therapy remains investigational, but early registry data suggests that it may be an option for highly refractory disease with careful patient selection.
Finally, obesity emerged as a modifiable but underappreciated driver of disease burden. High BMI is associated with worse pain, function, and new bone formation. Comprehensive management — lifestyle, physiotherapy, and even bariatric surgery when appropriate — may be meaningful in improving outcomes in SpA.
Takeaway points from this section: axial spondyloarthritis care in 2026 is earlier, more precise, and increasingly personalized. With better classification, smarter imaging, expanding therapeutic options, attention to comorbidities, and thoughtful perioperative planning, we really have an opportunity to change the long-term trajectory of this disease. Thanks for tuning in, and stay tuned for more conference highlights.
Dr. Walsh gave a wonderful presentation on these complications. A key takeaway was how common hip involvement really is in axial SpA. Depending on the cohort, 10 to 50% of patients develop hip disease, often bilaterally, and not uncommonly with minimal symptoms early on. What's striking is that many patients already have radiographic damage before pain becomes prominent. That matters because our axial SpA patients undergo hip replacement at younger ages than the general population, with a lifetime risk around 5%, three to four times higher than controls.
Knee involvement follows a similar theme. While less common than hip disease, axial SpA patients, especially younger adults, have a significantly higher relative risk of knee replacement, and risk appears to rise after hip arthroplasty, likely reflecting both biomechanical stress and higher underlying disease activity.
There was encouraging news on the treatment front. Observational data suggests that biologics and conventional synthetic DMARDs are associated with a lower risk of joint replacement, reinforcing the importance of early and effective disease control, not just for pain, but for long-term structural outcomes. That said, when patients do need joint replacement, outcomes are generally good. Implant survival at 10 years exceeds 85 to 90% with substantial pain relief. However, axial SpA patients do face higher rates of perioperative complications including infection and non-orthopedic complications, risks that are not fully explained by comorbidities alone.
Medication management matters. Data consistently show higher infection rates when biologics are continued through surgery, supporting current guidance to withhold biologics perioperatively and restart once the wound has healed, typically around 2 weeks.
Then Dr. Bakewell followed up with advances in axial SpA. She referenced the new 2025 axial SpA classification criteria. These criteria place greater weight on imaging and have significantly improved specificity, now exceeding 90%. Importantly, this doesn't just refine classification, it sharpens how we think about diagnosis in real-world practice.
Extra-articular or extra-axial manifestations also received attention, especially uveitis. Lifetime risk approaches 40% in axial SpA. Several FDA-approved therapies including adalimumab, secukinumab, and ixekizumab have demonstrated reduction in uveitis flares, but only adalimumab and methotrexate currently have randomized trial data in non-infectious posterior uveitis.
On the treatment front, the ASAS-EULAR algorithm remains the backbone of care. NSAIDs and physiotherapy are foundational, but for patients with persistent disease activity, biologic or targeted synthetic DMARDs should not be delayed. TNF inhibitors, IL-17 inhibitors, and JAK inhibitors all have defined roles, with therapy selection guided by comorbidities such as uveitis, IBD, or psoriasis.
There was also excitement around what's coming next. Novel agents including IL-17 fusion proteins, nanobodies, and TYK2 inhibitors promise comparable efficacy with potentially lower cost or improved tissue penetration. Combination targeted therapy remains investigational, but early registry data suggests that it may be an option for highly refractory disease with careful patient selection.
Finally, obesity emerged as a modifiable but underappreciated driver of disease burden. High BMI is associated with worse pain, function, and new bone formation. Comprehensive management — lifestyle, physiotherapy, and even bariatric surgery when appropriate — may be meaningful in improving outcomes in SpA.
Takeaway points from this section: axial spondyloarthritis care in 2026 is earlier, more precise, and increasingly personalized. With better classification, smarter imaging, expanding therapeutic options, attention to comorbidities, and thoughtful perioperative planning, we really have an opportunity to change the long-term trajectory of this disease. Thanks for tuning in, and stay tuned for more conference highlights.
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