0:03
Hello everyone. This is Adela Castro reporting here from Orlando at ACR 2026 and I want to discuss a little bit about the interesting 2026 management guidelines for AxSpA.
0:15
So first I want to start about diagnosing.
0:19
So it's very important in terms of diagnosis the clinical and the imaging part.
0:23
So the guidelines do recommend incorporating the history of the inflammatory back pain on the patient population along with laboratories including HLA-B27, CRP and of course incorporating imaging.
0:35
This means incorporating first X-ray and the X-ray was very particular about AP view of the pelvis as opposed to the previous one that recommended just sacroiliac joint.
0:47
If that X-ray was negative, the recommendation was obtaining MRI without contrast and it was very specific about the indications and looking for those specific landmarks of the MRI that is suggestive of AxSpA.
1:02
Once a diagnosis is made, it's very important to start treatment and identify potential risk factors for progressions.
1:10
So if patients had high disease activity or high disease factors for progression then these patients would probably be better starting on a biologic as opposed to NSAIDs and of course you know adjunctive therapies which included physical therapy and others also are part of the first line treatments.
1:28
Something that is new on this guideline is that they recommended a specific type of NSAID, particularly the COX-2 NSAIDs, and they recommended of course in a continuous mode as opposed to as needed.
1:41
Also in terms of therapy they are favoring a little bit more aquatic therapy as opposed to land-based therapy.
1:48
In terms of treatment, something that is also new in this guideline is also the recommendation at the same level of TNF inhibitors and IL-17 inhibitors which before they were sequential.
2:00
This time it can be parallel, whichever you have access to, pretty much.
2:04
Something that also was very interesting here is the importance of identifying those potential difficult to treat patients which included patients that may have other comorbidities like IBD, uveitis, psoriasis and it's important to tailor the therapies to having those comorbidities.
2:19
And it's very important also to assess, in patients that you feel are not doing well to therapy, other causes of pain including nociplastic pain or fibromyalgia to make sure that you manage these patients appropriately.
2:32
It was also recommended as far as when to consider stopping therapies if the patients were stable.
2:39
The recommendation number one is if you feel that the patient is stable and you want to start tapering therapy, you do not need to get an MRI to do this.
2:47
But it's also recommended to make sure that the patient is in low disease activity and monitor those patients closely clinically.
2:53
And then the recommendation was specifically if you want to go down on the medication, you want to taper it as opposed to discontinue it completely.
3:01
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