EULAR 2014: Research on Rheumatoid Arthritis, Spondyloarthritis

Dr. Isaacs also noted two editorials on the treat-to-target approach—they said it’s important to keep quality of life in perspective, rather than pursue a target blindly.^5,6

“Make sure we know what the incremental benefit is of pursuing remission—rather than low disease activity,” he said. “Or imaging remission rather than clinical remission.  Don’t forget quality of life, because if you’re pushing lots of pills into your patient, that might be having a negative effect [that] offsets the benefits.”

Spondyloarthritis Research

Dr. Baeten made these observations about the spondylo­arthritis (SpA) literature: Two studies found CD74 autoantibodies in patients with spondyloarthritis, challenging the notion that T cells and B cells may not play a major role in the disease.^7,8

Dr. Baeten said the studies mean the SpA community needs to revise their concept that T cells and B cells “are not important.”

“Clinically, if it holds true, then we have to go back to cohorts with early inflammatory back pain and test whether this would be a useful diagnostic biomarker, which would be obviously very important for this disease,” he said.

Dr. Baeten

Another study found that arthritis, spondylitis and enthesitis levels were all down in an anti-IL-23 mouse model, but with no effect on new bone formation. But the studies did little to shed light on the role of downstream cytokines IL-17 and IL-22, he said.⁹

“Clearly, we have more work to do even in an IL-23-dependent model, to understand which downstream cytokines are really key to the pathology,” Dr. Baeten said.

In a 325-patient, 24-week trial of the anti-TNF certolizumab pegol (CZP), now indicated for RA, CZP rapidly reduced axial SpA signs and symptoms, with a safety profile similar to that seen in RA patients.¹⁰

A trial on infliximab and naproxen shed light on how early, aggressive treatment might allow for treatment withdrawal. Patients with early axial SpA were treated with naproxen and infliximab or with naproxen and placebo. Those getting the combination were twice as likely to meet partial remission criteria.¹¹ When treatment was stopped, 60% lost the partial remission, but many stayed in remission. Keeping patients on naproxen didn’t make a difference.¹²

In a bone formation study on ankylosing spondylitis (AS) patients, researchers found a correlation between disease activity scores and mSASSS scores, an index characterizing radiologic changes in the spine in AS patients. Dr. Baeten stressed that doesn’t mean there’s a causal link, but said it’s a line of inquiry worth pursuing more.¹³