Management of Psoriatic Arthritis, Treatment of Axial Spondyloarthritis Addressed at EULAR 2016

“They work; they can actually help you distinguish mechanical from inflammatory back pain,” he said. “But you have to take into account that someone who is really a primary non-responder should be critically reevaluated.” Such patients could have been incorrectly diagnosed, he said.

Evidence shows that a young patient with high disease activity but low functional trouble and who has objective signs of inflammation is the ideal candidate to respond to anti-TNF treatment. The opposite also seems to be true: the older the patient without objective signs of inflammation, the greater the chances of treatment discontinuation, he noted.⁸

Other research has shown which patients tend to have a better chance of having a major response when an anti-TNF is added as opposed to continuing on NSAIDs. Those with low function, high inflammation, age below 40 and who are HLA-B27 positive tend to be the best candidates.⁹ Dr. van den Bosch cautioned clinicians not to “become a computer” but only to use such information as a guide.

He is now working on a trial looking at the value of tight control in spondyloarthritis. Real-life outcomes—not disease-activity scores—should be the guide, he said.

“It doesn’t make sense to say, ‘I’m going to treat you more intensively if your ASDAS is above a certain point,’ and then the endpoint of your trial is, ‘Well, I have more patients with an ASDAS below that point,’” he said. “I think you have to look at other endpoints—ideally structural damage, quality of life, getting back to work.”

Thomas R. Collins is a freelance medical writer based in Florida.

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