The group of Spondyloarthritides (SpA) comprises of two subgroup of patients who are very similar in their clinical presentation but differ mainly in one parameter, the structural changes in the sacroiliac joints (SIJ). Patients with more advance structural changes can be categorized in the subgroup of so-called established ankylosing spondylitis (AS) or “radiographic axial spondyloarthritis (axSpA)”, while those who present with no structural but only inflammatory SIJ changes on the magnetic resonance imaging (MRI) or have a positive HLA-B27 and more than one other SpA feature are recognized as non-radiographic axSpA (nr-axSpA).
Treatment algorithms can be applied in a similar way in both axSpA subgroups, starting with conventional anti-inflammatory compounds such as non-steroidal anti-inflammatory drugs (NSAIDs) and going over to tumor-necrosis-factor alpha (TNFa) blockers compounds in those patients who fail NSAID treatment.
Despite the well-documented very good clinical efficacy of those compounds, several questions remain open and some of them have been answered in recent clinical studies during the last year.
A topic of interest in the field of axSpA has been the efficacy and safety of biologic treatment beyond TNFa-blockers, such as antagonists the inflammatory pathway at the intracellular level through the blockade of Phosphodiesterase 4 (PDE-4) or at the extracellular level through the blockade of interleukin (IL) 12/23, IL-17 or others.
From the perspective of treatment of the disease, also the role of biosimilars has been a topic of intensive and intense discussions.
On the other hand, research has also focused on the long-term effects of anti-inflammatory treatment, not only with respect to the (sustained?) decrease of disease activity but also on the effect on the function and mobility of the patients. Whether these are not only linked directly to pain and activity parameters but also on environmental and occupational factors has been a matter of debate very recently and will also be the topic of abstract at this year's annual meeting.
Disclosure of Interest X. Baraliakos Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Centocor, Chugai, Janssen, MSD,Novatis, Pfizer, Sandoz, UCB., Consultant for: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Centocor, Chugai, Janssen, MSD,Novatis, Pfizer, Sandoz, UCB.