Treatment strategies in axial spondyloarthritis: what, when and how?

Fragoulis, G.; Siebert, Stefan

doi:10.1093/rheumatology/keaa435

Cited by 45 publications

(31 citation statements)

References 112 publications

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“…Regular exercise improves the results in AS, but this effect is moderate (6). Exercise is still an important building block in the treatment of AS (7).…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of Physical Therapy In Ankylosing Spondylitis: A Randomized Controlled Study

Enginar

Uğurlu

2021

Mustafa Kemal Üniversitesi Tıp Dergisi

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Ankilozan spondilit (AS) hastalarında fizik tedavinin ağrı, fonksiyon, hastalık aktivitesi, emosyonel durum ve yaşam kalitesi üzerine etkisininin değerlendirilmesi. Materyal ve Metod: Çalışmaya AS tanısı alan 31 hasta dahil edildi. Hastalar randomize olarak fizik tedavi grubu ve kontrol grubu olarak ikiye ayrıldı. Fizik tedavi grubuna 15 seans fizik tedavi (sıcak paket, ultrason, transkutanöz elektriksel sinir stimülasyonu (TENS), hidroterapi), ev egzersiz programı verildi. Kontrol grubuna ev egzersiz programı verildi. Her iki gruba tedavi öncesi, 2. ve 6. haftalarda vizüel analog skala (VAS) gece ve günlük, Ankilozan Spondilit Fonksiyon İndeksi (BASFİ), Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAİ), modifiye schober, el parmak zemin mesafesi, lateral fleksiyon, servikal rotasyon, intermalleolar mesafe, tragus duvar mesafesi ve Ankilozan Spondilit Metroloji İndeksi (BASMİ), göğüs eksansiyonu, çene manubrium mesafesi ölçüldü. Tüm hastalara tedavi öncesi ve 6. hafta Beck Depresyon Ölçeği (BDI) ve Kısa Form (SF-36) dolduruldu. Bulgular: Gruplar karşılaştırıldığında tedavi grubunda 2. haftada VAS (günlük), 6. haftada VAS (günlük) ve SF-36'nın genel sağlık parametrelerindeki düzelme istatistiksel olarak anlamlı idi (p<0.05). 0-6. hafta karşılaştırıldığında fizik tedavi grubunda VAS günlük (p<0.01) ve gece (p<0.01), modifiye schober (p<0.05), göğüs ekspansiyonu (p<0.05), BASDAI (p<0.01), BASMI (p<0.05), SF 36'nın genel sağlık, mental sağlık ve sosyal fonksiyon parametrelerinde (p<0.05) düzelme saptandı. Sonuç: Fizik tedavinin AS'li hastalarda ağrı ve yaşam kalitesi üzerine olumlu etkileri vardır.

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“…Regular exercise improves the results in AS, but this effect is moderate (6). Exercise is still an important building block in the treatment of AS (7).…”

Section: Discussionmentioning

confidence: 99%

“…The number of studies conducted with physical therapy modalities in AS is few (6,7,8). The aim of our study is to evaluate the effectiveness of physical therapy modalities and hydrotherapy in patients with AS and to contribute to the literature.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Physical Therapy In Ankylosing Spondylitis: A Randomized Controlled Study

Enginar

Uğurlu

2021

Mustafa Kemal Üniversitesi Tıp Dergisi

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“…More recent data regarding anti-IL23-p19 seem to be very promising, expanding the therapeutic armamentarium furthermore. [39][40][41] Is the endpoint supported by findings from RCTs suggesting that early aggressive treatment approaches would be advantageous?…”

Section: Psoriatic Arthritismentioning

confidence: 99%

Treat to Target in Spondyloarthritis: Myth or Reality?

Nelly

Hamamouchi

2021

EMJ Rheumatol

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A treat-to-target (T2T) strategy is a treatment plan in which the clinician treats the patient aggressively enough to reach and maintain explicitly specified and sequentially measured goals. To apply a T2T strategy, some conditions should be met. First, a proactive, clear endpoint should be used and a threshold should be defined. Second, a choice between several effective therapies must be available. Third, the endpoint should be supported by findings from randomised controlled trials supporting early aggressive treatment. Fourth, the strategy should be cost-effective. Finally, it needs to be acceptable by the stakeholders. The objective of this review was to verify if the conditions for applying the T2T strategy were met in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), using a narrative review. Based on the currently available literature, the conditions for applying the T2T in PsA and axSpA were partially met. First, proactive outcome measures are available; however, there is no clear consensus regarding the optimal one. Second, there is a reasonable choice of approved therapies for both diseases. Third, additional randomised controlled trials demonstrating the effectiveness of a T2T approach are still needed. Fourth, cost-effectiveness studies are needed and should include patients from different healthcare systems. Fifth, the implementation of T2T recommendations in routine care and the adherence to its application in clinical practice should be promoted. In summary, preliminary data suggest that T2T might be beneficial to patients with PsA and axSpA. However, further studies are needed to meet all the criteria before strongly advocating for T2T strategies.

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“…For PsA, additional conventional synthetic (csDMARDs), such as methotrexate, are also recommended as frontline therapies prior to bDMARDs/tsDMARDs ( Ogdie et al, 2020 ). Approved bDMARDS include TNF inhibitors (TNFi) and IL-17 inhibitors (IL-17i) for both AS and PsA, with IL-23 inhibitors (IL-23i) additionally approved for PsA ( Al-Mossawi et al, 2019 ; Fragoulis and Siebert, 2020 ). For PsA, two types of tsDMARDs are approved: the PDE4 inhibitor, apremilast, and the Janus kinase (JAK) inhibitor, tofacitinib ( Al-Mossawi et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

From Science to Success? Targeting Tyrosine Kinase 2 in Spondyloarthritis and Related Chronic Inflammatory Diseases

et al. 2021

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Spondyloarthritis (SpA) is a family of inflammatory arthritic diseases, which includes the prototypes of psoriatic arthritis and ankylosing spondylitis. SpA is commonly associated with systemic inflammatory diseases, such as psoriasis and inflammatory bowel disease. Immunological studies, murine models and the genetics of SpA all indicate a pathogenic role for the IL-23/IL-17 axis. Therapeutics targeting the IL-23/IL-17 pathway are successful at providing symptomatic relief, but may not provide complete protection against progression of arthritis. Thus there is still tremendous interest in the discovery of novel therapeutic targets for SpA. Tyrosine kinase 2 (TYK2) is a member of the Janus kinases, which mediate intracellular signaling of cytokines via signal transducer and activator of transcription (STAT) activation. TYK2 plays a crucial role in mediating IL-23 receptor signaling and STAT3 activation. A plethora of natural mutations in and around TYK2 have provided a wealth of data to associate this kinase with autoimmune/autoinflammatory diseases in humans. Induced and natural mutations in murine Tyk2 largely support human data; however, key inter-species differences exist, which means extrapolation of data from murine models to humans needs to be done with caution. Despite these reservations, novel selective TYK2 inhibitors are now proving successful in advanced clinical trials of inflammatory diseases. In this review, we will discuss TYK2 from basic biology to therapeutic targeting, with an emphasis on studies in SpA. Seminal studies uncovering the basic science of TYK2 have provided sound foundations for targeting it in SpA and related inflammatory diseases. TYK2 inhibitors may well be the next blockbuster therapeutic for SpA.

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Treatment strategies in axial spondyloarthritis: what, when and how?

Cited by 45 publications

References 112 publications

Effectiveness of Physical Therapy In Ankylosing Spondylitis: A Randomized Controlled Study

Effectiveness of Physical Therapy In Ankylosing Spondylitis: A Randomized Controlled Study

Treat to Target in Spondyloarthritis: Myth or Reality?

From Science to Success? Targeting Tyrosine Kinase 2 in Spondyloarthritis and Related Chronic Inflammatory Diseases

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