0:03
Hello, my name is Marina Magra. I'm professor of medicine at Case Western Reserve University here at ACR 2026 Convergence, and I'm going to recapitulate what were some takeaways for me in spondyloarthritis in this meeting.
0:19
There was a lot presented, and you know the most important thing was the 2026 ACR SPARTAN and ASAS guidelines for treatment of axial spondyloarthritis were presented.
0:31
Some of the key takeaways from that presentation was that some major changes from the previous guidelines from 2019 — both TNFs were preferred over IL-17 and JAK inhibitors in those guidelines.
0:48
There is no preference of TNF or IL-17 now.
0:52
The clinician can either start with a TNF inhibitor or IL-17.
0:55
Although conditionally, JAK inhibitors were recommended to be initiated after TNF and IL-17.
1:00
This was a conditional recommendation because in the United States, the FDA has mandated us to use it after TNF failure.
1:07
So another important change that was made in these guidelines was that tapering of biologics was allowed.
1:13
So if your patient is in sustained remission, you can taper the biologics, and then once you're safely able to taper them, you can withdraw the biologics.
1:23
And if a patient flares, the recommendation was that you can start back the original biologic on which the patient was.
1:30
So that was another takeaway from this meeting.
1:35
Some good practice statements were that you should co-manage your patients with psoriatic arthritis with a dermatologist, uveitis patients with acute anterior uveitis with an ophthalmologist, and with IBD with a gastroenterologist.
1:50
They also conditionally recommended use of combination biologics in certain patients who are difficult to manage.
1:57
Another interesting set of guidelines that were presented in this meeting were about a definition of axial PsA.
2:09
It was meant that those patients who have chronic back pain or inflammatory back pain with psoriatic arthritis, or are HLA-B27 positive, and have radiographic or MRI evidence of inflammation of the SI joints, should be classified as having axial PsA.
2:28
This was based on the AXIS study, and interestingly the study showed that, unlike axial SpA, patients with axial PsA can have spine involvement in about 18% of patients without SI joint involvement.
2:43
So the clinical take-home point from that data is that we should be ordering not only MRIs of the SI joints in axial PsA patients, but also MRIs of the spine.
2:55
Sometimes we may see isolated findings in the spine.
3:00
And these were some two interesting things I liked. Thank you again from RheumNow.
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