On the subject of radiographic progression while on treatment, Dr. Deodhar noted that the traditional teaching has been that medications like TNF inhibitors do not prevent structural progression of disease. However, more recent studies have challenged this dogma. Dr. Deodhar noted that structural progression and inflammation are coupled in axial spondyloarthritis, and effective control of inflammation appears to reduce the rate of structural progression, at least as shown by retrospective observational cohort studies.
Prospective randomized clinical trials are the only gold standard method by which to confirm a cause-and-effect relationship between the use of biologics and inhibition of structural damage, and head-to-head clinical trials would be helpful in comparing the effects of different biologics against one another.
In Sum
This lecture on ankylosing spondylitis and nr-axSpA was thought-provoking and clarified common misconceptions about these conditions.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
References
- Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis. 2009 Jun;68(6):777–783.
- Garg N, van den Bosch F, Deodhar A. The concept of spondyloarthritis: Where are we now? Best Pract Res Clin Rheumatol. 2014 Oct;28(5):663–672.
- Weber U, Lambert RGW, Østergaard M, et al. The diagnostic utility of magnetic resonance imaging in spondyloarthritis: An international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum. 2010 Oct;62(10):3048–3058.
- Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2019 Oct;71(10):1599–1613.