Meet the Professor: Axial Spondyloarthritis

Axial spondyloarthritis (axSpA) is a complex, immune-mediated inflammatory disorder characterized by inflammatory back pain and axial arthritis. Typical of other diseases in the spondyloarthritis family, the clinical phenotypes can be diverse, and an array of comorbidities often accompanies the spinal disease.

“In this Meet the Professor Session at ACR Convergence 2024,” says Christopher Ritchlin, MD, MPH, “I will combine a discussion of key basic science advances in the field with advances in diagnosis and therapy and highlight therapies in the current pipeline.”

Dr. Ritchlin is a professor of medicine in the Allergy, Immunology and Rheumatology Division and the Center for Musculoskeletal Research at the University of Rochester Medical Center. He attended medical school at Albany Medical College and completed his medical residency and chief residency at Mt. Sinai Hospital, New York. He trained as a fellow in rheumatology at the New York University Medical Center and remained as a postdoctoral fellow for two years and then spent an additional year in the lab of Robin Poole in Montreal, Canada. He joined the faculty of the University of Rochester School of Medicine and Dentistry in 1991. In 2009, he earned an MPH degree at the university.

“From a scientific perspective,” he says, “I will highlight the discovery of the TRBV 9 subset of T cells with pathogenetic significance in HLAB27+ axial SpA and describe efforts underway to develop therapeutic antibodies to this cell population. I will also discuss the relevance of the microbiome to the spinal disease.

“From a diagnostic perspective, advances in artificial intelligence hold promise for improving accurate reads of plain radiographs and MRI images of the sacroiliac joints. I will also discuss the therapeutic landscape in axSpA, emphasizing the importance of the diverse phenotypes and comorbidities that can strongly influence therapeutic selections. Another important development that deserves discussion is the lower treatment responses observed in female patients with axSpA.

“I will then present several clinical cases that incorporate challenging differential diagnostic dilemmas and complex treatment decisions. These include how to proceed with a patient with inflammatory back pain when both the plain radiographs and MRI studies are negative. What is the natural history of younger patients who present with inflammatory back pain when viewed over several years? What is the likelihood that a patient with non-radiographic axSpA will develop radiographic changes? What are the differential features between axSpA and axial psoriatic arthritis, and how do these differences translate clinically?