Abstract

THE most important new information in this area of rheumatology is ... the name of the disease (e.g. spondyloarthritis). It has been recognized that the term spondyloarthritis preceded by both the main clinical presentation of the disease (e.g. axial versus peripheral) and for both presentation by the presence or not of radiological structural damage (the current proposal is to use the term “radiographic” in case of demonstration of sacroiliac structural changes [e.g. sub-chondral bone osteosclerosis, joint erosions or fusion] for the axial presentation and the term of “erosive” in case of peripheral presentation).

Therefore, in 2012, for example, axial radiographic spondyloarthritis should replace the non appropriate one of “ankylosing spondylitis”.

Several advances have been achieved recently in the field of spondyloarthritis in terms of either recognition of the disease, physiopathology or treatment.

The recently proposed ASAS criteria for both the axial and peripheral presentation of the disease have been evaluated in different sets of patients. All these studies have confirmed the relevance of such sets of criteria and, in particular, have emphasized the relative high frequency of non-radiographic axial spondyloarthritis mainly at an early stage of the disease despite the fact that, at this stage, the burden of the disease is at a similar magnitude than in patients with radiographic axial spondyloarthritis.

In terms of physiopathology, improvement has been achieved in a better knowledge of the role of environmental factors not only in terms of microbial environment but also in terms of smoking habits. The still remaining question is whether ossification is a phenomenon resulting from inflammation or whether inflammation and ossification are two independent processes observed in this disease.

In terms of therapy, there is the debate of the exact role of physiotherapy (which one? Which “route of administration” [e.g. home exercises versus groups of patients supervised by a physiotherapist ...]). There is also the debate of the mode of administration of NSAID (e.g. on demand) based on the level of the patients symptoms versus continuously whatever the level of patients’ symptoms. In case of active disease despite optimal NSAID therapy, TNF blockers have confirmed their short term and long term utility. The possibility to taper or discontinue a TNF blocker in case of persistent remission of the disease is still debated.

Finally, drugs with a different mechanism of action (e.g. bisphosphonates, IL6 inhibitors) have failed to demonstrate their utility. At variance, the drugs such as IL17 inhibitors are very promising.

In conclusion, dramatic improvements have been achieved in the field of spondyloarthritis coming from the recognition of the disease, the physiopathology to the management of the diseases.