0:03
I'm Anthony Chan reporting here at ACR 2026 in Orlando, and I'm here joined by Dennis Poddany from University of Toronto, who's presenting today a very interesting abstract, abstract number 0347.
0:18
This is a study from the UPSTAND study where the early identification of a good pain response predicted the longer-term outcome for these patients.
0:27
So Dennis, tell us a little bit about this study.
0:30
So UPSTAND was a phase four study where we looked at the effect of treatment with JAK inhibition on pain and some other outcomes including nociplastic pain and neuropathic pain.
0:50
In the analysis we're presenting in this abstract, we looked at the relationship between the improvement of pain — of back pain — as early as week one, with achieving low disease activity and remission at week 12 and week 52.
1:14
So in other words, we were trying to analyze whether feeling better early is associated with long-term benefits for the patients, and it was indeed the case.
1:31
We saw early improvement of back pain by at least one point in two-thirds of participants, and this early improvement of back pain was associated
1:43
with achieving low disease activity — as in inactive disease — but also with improvement in anxiety, depression, sleep disturbance, signs of nociplastic and neuropathic
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pain, at both week 12 and week 52.
2:01
We also looked in the secondary analysis at the relationship between improvement of back pain by 30% at least at week one and the same outcome parameters after 12 and 52 weeks, with very similar results.
2:19
That's a very fascinating result. Most of the time we only measure people at three months after starting treatment, and maybe we are missing a trick here where we should actually be perhaps calling them or getting them to do a pain score at week one.
2:34
How do you think this might help us in terms of how we can better assess the longer-term outcome for our patients?
2:40
Yeah. For me these results were quite reassuring, because people coming to us with axial spondyloarthritis, but also with other painful rheumatic conditions such as psoriatic arthritis, they do care about how quickly can they get the relief and what would it mean in the long term.
2:59
So with these results, I felt it is quite remarkable that you can feel the difference already at week one — after just one week of treatment — with a disease-modifying anti-rheumatic drug, and you can see that it does matter for long-term outcomes.
3:18
Yeah, I think that's quite important in terms of adherence to the treatment.
3:21
If a drug is working quickly, the patients are more likely to stay on them long term as well.
3:28
Is that your experience as well? No, absolutely.
3:31
It is quite important that people feel that something positive is being done for them, so that the drug is really working.
3:42
So with a relatively quick onset of action, I do believe that adherence is going to become better.
3:50
Was there any difference between biologic-experienced or biologic-inexperienced, or any previous exposure to prior therapies, in your study?
4:01
Not much to talk about, I would say. But in general, as you know, especially in axial spondylitis, the biologic-experienced patient group is a difficult group for a variety of reasons why the previous biologic treatment was stopped.
4:18
So in general we see better improvement in biologic-naive patients, and I think — just a practical point — if we see no response to a biologic in axial spondylitis patients, it is a good idea to check whether the diagnosis is correct and what is behind the patient's symptoms.
4:37
That is also part of the points to consider at this meeting as well, where we should not only look at the inflammatory aspect of disease but also other aspects such as pain.
4:49
So, do we think we should think about this differently in terms of using some of these scores such as the PainDETECT that you measured, to better identify this cohort of patients?
4:59
Yes. We can definitely operationalize assessment of nociplastic or neuropathic pain with screening instruments such as WPISS or PainDETECT.
5:12
But most importantly, I believe, is that the rheumatologist thinks about the possibility that the patient's symptoms may not be related to inflammation, checks for the presence of inflammation, and if inflammation is well under control, then we would need to address other reasons for pain.
5:32
Yeah, I think my takeaway would be: I want to know how patients respond at week one.
5:39
So, in summary, what will be your key takeaways from this study today?
5:43
My key takeaway from this study is that with effective anti-inflammatory treatments such as JAK inhibition in axial spondylitis, we can see the effect as early as after one week of treatment.
5:58
It is not a full effect, but it gives something that people can feel, and this is associated with long-term improvement in those patients.
6:08
Dennis, thank you very much for sharing this very interesting study.
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I'm Anthony Chan reporting here at ACR 2026 in Orlando.
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