Axial spondyloarthritis: new advances in diagnosis and management

Abstract

Axial spondyloarthritis (axSpA) is an inflammatory disease of the axial skeleton associated with significant pain and disability. Previously, the diagnosis of ankylosing spondylitis required advanced changes on plain radiographs of the sacroiliac joints. Classification criteria released in 2009, however, identified a subset of patients, under the age of 45, with back pain for more than three months in the absence of radiographic sacroiliitis who were classified as axSpA based on a positive magnetic resonance imaging or HLAB27 positivity and specific clinical features. This subgroup was labeled non-radiographic (nr)-axSpA. These patients, compared with those identified by the older New York criteria, contained a larger percentage of women and demonstrated less structural damage. However, their clinical manifestations and response to biologics were similar to radiographic axSpA. The discovery of the interleukin (IL) IL-23/IL-17 pathway revealed key molecules involved in the pathophysiology of axSpA. This discovery propelled the generation of antibodies directed toward IL-17A, which are highly effective and demonstrate treatment responses in axSpA that are similar to those observed with anti-TNF agents. The finding that agents that block IL-23 were not effective in axSpA came as a surprise and the potential underlying mechanisms underlying this lack of response are discussed. New agents with dual inhibition of the IL-17A and F isoforms and some oral small molecule agents that target the Jak-STAT pathway, have also shown efficacy in axSpA.

Anatomical Joint Form Variation in Sacroiliac Joint Disease: Current Concepts and New Perspectives

“…The question of mechanical factors in the development and progression of axial spondyloarthritis (axSpA) is of great interest to the scientific community and inspires ongoing discussion among experts in the field [1,2]. Within this area of research, a special focus lies on the sacroiliac joints (SIJ), which biophysically act as the main transductor of force from the lower extremities to the torso [3] and are also by far the most common site of manifestation of axSpA [4]. Recent studies have found associations between the shape of the joints themselves and both inflammatory and degenerative joint disease [5•].…”

Integrative Single-Cell RNA-Seq and ATAC-Seq Analysis of Peripheral Mononuclear Cells in Patients With Ankylosing Spondylitis

“…We observed abnormal expression of TNF , NFKB , FOS , JUN , and JUNB in CD8+ T cells, and these genes were enriched in the TNF signaling pathway. The abnormal TNF signaling pathway in CD8+T cells plays a role in the pathogenesis of AS ( 37 ). The clinical application of anti-TNF therapy has changed the treatment of chronic inflammatory diseases, such as AS.…”

Etanercept in axial spondyloarthritis – treatment efficacy

“…Социальная значимость аксиальных спондилоартритов (аксСпА) определяется их высокой распространенностью в популяции, дебютом заболевания в молодом возрасте (до 45 лет) и значительным вкладом болезни в потерю трудоспособности [1]. Внедрение в 1998/1999 годах в лечение аксСпА ингибиторов фактора некроза опухоли α (иФНО-α) коренным образом изменило течение аксСпА [2,3]. Первыми иФНО-α, применявшимися для лечения аксСпА, были инфликсимаб и этанерцепт (ЭТ), позднее появились адалимумаб, голимумаб, цертолизумаба пэгол [2,3].…”

“…Внедрение в 1998/1999 годах в лечение аксСпА ингибиторов фактора некроза опухоли α (иФНО-α) коренным образом изменило течение аксСпА [2,3]. Первыми иФНО-α, применявшимися для лечения аксСпА, были инфликсимаб и этанерцепт (ЭТ), позднее появились адалимумаб, голимумаб, цертолизумаба пэгол [2,3].…”