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Objective: To determine the prevalence of sacroiliac joint variants in patients with axial spondyloarthritis (axSpA) using MRI-based synthetic CT images and to evaluate their relationships with the presence of bone marrow edema, as this may potentially complicate diagnosing active sacroiliitis on MRI in patients with suspected axSpA., Methods: 172 patients were retrospectively included. All patients underwent MRI because of clinical suspicion of sacroiliitis. The diagnosis of axSpA was made by a tertiary hospital rheumatologist. Two readers independently determined the presence of bone marrow edema and the presence of one or more of the nine known sacroiliac joint (SIJ) variants., Results: SIJ variants were common in axSpA patients (82.9%) and the non-SpA group (85.4%); there were no significant differences in prevalence. Bone marrow edema was frequently found in axSpA (86.8%) and non-SpA patients (34%). AxSpA patients with SIJ variants (except for accessory joint) demonstrated 4 to 10 times higher odds for bone marrow edema, however not statistically significant. The more variants were present in this group, the higher the chance of bone marrow edema. However, some multicollinearity cannot be excluded, since bone marrow edema is very frequent in the axSpA group by definition., Conclusion: SIJ variants are common in axSpA and non-SpA patients. SIJ variants were associated with higher prevalence of bone marrow edema in axSpA patients, potentially due to altered biomechanics, except for accessory joint which may act as a stabilizer., (© 2023. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Introduction: Dysbiosis is an environmental factor that affects the induction of axial spondyloarthritis (axSpA) pathogenesis. In the present study, we investigated differences in the gut microbiota of patients with axSpA and revealed an association between specific gut microbiota and their metabolites, and SpA pathogenesis., Method: Using 16S rRNA sequencing data derived from feces samples of 33 axSpA patients and 20 healthy controls (HCs), we examined the compositions of their gut microbiomes., Results: As a result, axSpA patients were found to have decreased α-diversity compared to HCs, indicating that axSpA patients have less diverse microbiomes. In particular, at the species level, Bacteroides and Streptococcus were more abundant in axSpA patients than in HCs, whereas Faecalibacterium (F). prausnitzii , a butyrate-producing bacteria, was more abundant in HCs. Thus, we decided to investigate whether F. prausnitzii was associated with health conditions by inoculating F. prausnitzii (0.1, 1, and 10 μg/mL) or by administrating butyrate (0.5 mM) into CD4 + T cells derived from axSpA patients. The levels of IL-17A and IL-10 in the CD4 + T cell culture media were then measured. We also assessed osteoclast formation by administrating butyrate to the axSpA-derived peripheral blood mononuclear cells. The CD4 + IL-17A + T cell differentiation, IL-17A levels were decreased, whereas IL-10 was increased by F. prausnitzii inoculation. Butyrate reduced CD4 + IL-17A + T cell differentiation and osteoclastogenesis., Discussion: We found that CD4 + IL-17A + T cell polarization was reduced, when F. prausnitzii or butyrate were introduced into curdlan-induced SpA mice or CD4 + T cells of axSpA patient. Consistently, butyrate treatment was associated with the reduction of arthritis scores and inflammation levels in SpA mice. Taken together, we concluded that the reduced abundance of butyrate-producing microbes, particularly F. prausnitzii , may be associated with axSpA pathogenesis., Competing Interests: Authors HS, T-SS, and Y-KK were employed by MD Healthcare Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Min, Na, Jhun, Lee, Choi, Park, Lee, Um, Lee, Seo, Shin, Kim, Lee, Kwok, Cho and Park.)

Objectives: To assess the impact of joint shape variations on inflammatory lesions on SI joint MRIs in patients with axial spondyloarthritis (axSpA)., Methods: A total of 1194 patients from four different prospective cohorts were evaluated, with 684 (57.3%) having sufficient imaging data for inclusion (379 axSpA, 305 controls). All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. Logistic regression analyses were used to assess the association of joint form and lesions on imaging for axSpA patients and controls., Results: Atypical joint forms were common in both axSpA (43.5% [154/354]) and control patients (44.2% [134/303]); both intra-articular variants and a crescent joint shape were significantly more common in axSpA patients (18.4% vs 11.6% and 11.0% vs 5.3.%, respectively; P < 0.001). The axSpA patients with intra-articular joint form variants had 2-fold higher odds of exhibiting erosions [odds ratio (OR) 2.09 (95% CI 1.18, 3.69)] and BMO [OR 1.79 (95% CI 1.13, 2.82)]; this association was not observed in controls. Accessory joints increased the odds for sclerosis in axSpA patients [OR 2.54 (95% CI 1.10, 5.84)] and for sclerosis [OR 17.91 (95% CI 6.92, 46.37)] and BMO [OR 2.05 (95% CI 1.03, 4.07)] in controls., Conclusions: Joint form variations are associated with the presence of inflammatory lesions on SI joint MRIs of axSpA patients. This should be taken into consideration in future research on the interplay of mechanical strain and inflammation in axSpA., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To determine (1) the prevalence of central obesity in axial spondyloarthritis (axSpA) and its effect on disease-related outcomes and (2) how this differs between sexes., Methods: Data were extracted from the Ankylosing Spondylitis Registry of Ireland. Patients with physical measurements for the calculation of anthropometric measures were included. BMI and waist-to-hip ratio (WHR) were used to compare classifications of obesity. Comparison analyses based on sex and central obesity were carried out. Multivariate analysis examined the effects of these factors on the following patient-reported outcomes: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, and the Health Assessment Questionnaire (HAQ)., Results: In total, 753 patients were included in the analysis. Of these patients, 29.6% (n = 223) were classified as obese based on their BMI, and 41.3% (n = 311) were classified as centrally obese according to the WHR. The prevalence of central obesity was significantly higher among women with axSpA compared to men (71.6% vs 29.9%, P < 0.01). Central obesity had a clear effect on patient outcomes, regardless of sex. Presence of central obesity was associated with significantly worse BASFI scores ( P < 0.01), HAQ scores ( P < 0.01), and ASQoL questionnaire scores ( P = 0.01), with a nonsignificant trend toward worse BASDAI scores ( P = 0.07)., Conclusion: There was a high prevalence of central obesity as assessed by the WHR in axSpA, most notably among women with axSpA. This modifiable comorbidity was significantly associated with worse quality of life, greater impairment of functional ability, and a trend toward worse disease activity. Regular use of the WHR to screen for central obesity as part of an axSpA assessment would provide an opportunity for prompt identification and intervention for at-risk patients., (Copyright © 2022 by the Journal of Rheumatology.)

Objective: Advances in the field of axial spondyloarthritis (axSpA) and the methodology to develop core sets have led the Assessment of SpondyloArthritis international Society (ASAS) group to update the ASAS-Outcomes in Rheumatology (OMERACT) core set. An important aspect was to ensure it would be applicable to the entire spectrum of axSpA. The first step was to define the most relevant disease domains., Methods: A 3-round Delphi survey was conducted to gather opinions of 188 patients and 188 axSpA experts to define the most relevant disease domains to be included in the core set. The Delphi survey evaluated 2 separate research settings: (1) studies assessing symptom-modifying therapies; and (2) studies evaluating disease-modifying therapies. Importance of the domains was rated on a 1-9 Likert scale. A domain was considered for inclusion if, for both stakeholder groups, ≥ 70% of participants scored the domain as critical (7-9) and ≤ 15% scored it as not important (1-3) after 3 rounds., Results: A total of 132 (70%) patients and 135 (72%) experts completed at least 1 round. After 3 rounds, 7 domains (pain, physical function, stiffness, disease activity, mobility, overall functioning and health, peripheral manifestations) were selected for the symptom-modifying therapies setting. For the disease-modifying therapies setting, 6 domains (physical function, disease activity, mobility, structural damage, extramusculoskeletal manifestations, peripheral manifestations) were selected. All domains selected by experts were also selected by patients. Patients selected all offered domains except emotional function., Conclusion: This study provides the domains selected by patients and axSpA experts that should be considered for the core set for axSpA., (Copyright © 2021 by the Journal of Rheumatology.)

Objectives: To estimate the prevalence of late-onset axial spondyloarthritis (lo-axSpA) and to identify clinical, laboratory, and imaging features associated with this phenotype. Methods: This single-center, observational study included patients diagnosed with axSpA from the "Reuma-check" SpA program. Patients with a symptom onset ≥ 45 years were classified as lo-axSpA, as opposed to early-onset axSpA (eo-axSpA, onset < 45 years). The prevalence of lo-axSpA was calculated, and lo-axSpA and eo-axSpA were compared in terms of clinical, laboratory and imaging characteristics. Factors associated with lo-axSpA were analyzed with univariable followed by multivariable logistic regression. Results: A total of 126 patients were included, 35 (28%) were lo-axSpA. Comparing lo-axSpA vs. eo-axSpA, significant differences were observed: higher female prevalence in lo-axSpA vs. eo-axSpA (51% vs. 29%), lower NSAID response (52% vs. 73%), increased skin psoriasis prevalence (42% vs. 17%,), and shorter diagnosis delay (40 vs. 93 months). In the multivariable analysis, male sex and diagnosis delay were independently and inversely associated with lo-axSpA (OR 0.2, 95% CI 0.06–0.8 and OR 0.9, 95% CI 0.96–0.99, respectively), while psoriasis was associated with a higher odds for lo-axSpA (OR 4.8, 95% CI 1.1–29). Conclusion: lo-axSpA was present in more than a quarter of the patients. Although recall bias in the symptom duration cannot be excluded, the presentation with lo-axSpA seems to be associated with distinct features, being more frequent in females and more associated with psoriasis and with a shorter diagnostic delay. Key Points • Late-onset axSpA (≥ 45Y) is observed in 28% in our cohort, a higher frequency than previously reported. • Female sex and psoriasis are associated with a higher likelihood for late-onset axSpA. [ABSTRACT FROM AUTHOR]

Purpose: To determine the performance of T2* cartilage mapping in diagnosing and assessing disease activity in early axial spondyloarthritis (axSpA), and to investigate the interaction of cartilage damage with clinical characteristics, sacroiliitis MRI scorings, and diffusion metrics. Materials and methods: This prospective study included 83 axSpA patients and 37 no-axSpA patients. Clinical characteristics, the Assessment of SpondyloArthritis International Society-defined active sacroiliitis on MRI, and T2* SIJs values were recorded. In axSpA, disease activity was evaluated using the ankylosing spondylitis disease activity score-C-reactive protein; active sacroiliitis was evaluated using Spondyloarthritis Research Consortium of Canada, intravoxel incoherent motion, and diffusion kurtosis imaging; chronic sacroiliitis was assessed using composite structural damage score (CSDS) and structural score fat. Mann–Whitney U-test, Kruskal–Wallis test with false discovery rate (FDR), ROC curve, and linear regression were used for statistical analysis. Results: AxSpA patients had significantly higher T2*SIJs values than no-axSpA patients. (22.86 ± 2.42 ms vs 20.36 ± 1.30 ms, p < 0.001). The combination of T2*SIJs values and active sacroiliitis on MRI had the highest AUC for identifying axSpA. T2*SIJs values were significantly different between the inactive and very high, moderate and very high, high and very high, as well as inactive and high disease activity groups (all pFDR < 0.05). Dk (β = 0.48) and CSDS (β = 0.48) were independently associated with T2*SIJs values. Conclusion: T2* values may be a promising biomarker for diagnosing and differentiating disease activity in early axSpA. Both acute and chronic sacroiliitis influence cartilage properties. Clinical relevance statement: Sacroiliac joint cartilage abnormalities can be quantified with T2* relaxation time and allow better characterization of early axSpA. Key Points: T2* mapping may have value in evaluating axSpA. The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA. Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage. [ABSTRACT FROM AUTHOR]

Introduction: Pain in both peripheral and axial joints is a major symptom in patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). Emerging evidence demonstrates pain mechanisms, beyond those related to inflammation or joint damage, based on aberrant processing of nociceptive stimuli peripherally as well as centrally. The Janus kinase/signal transducers and activators of transcription (JAK-STAT) signaling pathway has been implicated in the processing of pain beyond its role in mediating inflammation and inhibitors of this pathway approved for the treatment of axSpA and PsA have been shown to alleviate a broad array of pain outcomes in both axial and peripheral joints. Areas covered: We review recent definitions and standardization of the nomenclature for categorizing chronic pain according to causality, assessment tools to evaluate nociplastic pain, the pathophysiologic role of JAK-STAT signaling in nociplastic pain, evidence for the presence of nociplastic pain in axSpA and PsA, and the impact of JAK inhibitors (JAKi) on pain outcomes in clinical trials (PubMed: 01/01/2019-04/01-2024). Expert opinion: Nociplastic pain assessment has been confined almost entirely to the use of a limited number of questionnaires in cross-sectional studies of these diseases. Though effective for alleviating pain, it is unclear if JAKi specifically impact nociplastic pain. [ABSTRACT FROM AUTHOR]

Background: Patients with Rheumatic and Musculoskeletal Diseases, including axial spondyloarthritis (axSpA), may suffer from stressors like pain and functional impairments leading to limitations in their self-perceived health status. The COping with Rheumatic Stressors (CORS) questionnaire was developed to analyze how patients cope with these stressors. The CORS is currently not available in German. Objective: First, to translate, cross-culturally adapt and to linguistically validate the original Dutch CORS into German. Second, to test the pre-final German translation through cognitive debriefing in patients with axSpA. Methodology: The original Dutch CORS underwent a multistep cross-cultural adaptation process, as described by Beaton. It was first independently translated into German by bilingual Dutch-German lay and expert translators. Subsequently, it was translated back from the German version into Dutch. Remaining discrepancies were resolved by a scientific committee, resulting in a pre-final German version. This version was then tested through cognitive debriefing by 10 patients with axSpA across a broad spectrum of sociodemographic backgrounds. Results: Forward and backward translations of the CORS revealed minor discrepancies, mainly based on the degree of formal versus informal language usage, minor semantic errors or unusual syntax, which led to minor modifications in the wording. Reviewed by the scientific committee, the pre-final consensus German version was linguistically validated by cognitive debriefing by 10 patients with axSpA. Cognitive debriefing confirmed and ensured closest linguistic validity for German in Germany and highest equivalence to the Dutch original version. Conclusion: The German CORS was shown to have high cross-cultural and face validity for the assessment of coping with rheumatic stressors. Key messages: • Cognitive debriefing revealed that the German CORS is highly relevant for patients with axSpA. • The German CORS has high cross-cultural validity to assess coping with rheumatic stressors. • The German CORS has closest linguistic validity and highest equivalence to the Dutch original version [ABSTRACT FROM AUTHOR]

Objective To investigate which factors are associated with treatment intensification (TI) in axial SpA (axSpA) patients with high disease activity (HDA). Methods Patients with axSpA and HDA [Ankylosing Spondylitis Disease Activity Score (ASDAS) ≥2.1] from the Dutch SpA-Net registry were included. TI was defined as: (i) higher dose or shorter interval of the same drug, (ii) switch from current drug to another due to inefficacy or (iii) addition of a new drug. Only anti-inflammatory drugs were considered. Primary determinants considered were ASDAS, Assessment of SpondyloArthritis international Society Health Index (ASAS HI) and physician global assessment (PhGA). Acceptable symptom state according to patient (PASS-patient) or physician (PASS-physician) were included in sensitivity analyses. Patient-centred and physician-centred logistic regression models were used to investigate the association between potential determinants and TI. Results In total, 121 patients with HDA were included. TI was conducted in a minority (41/121, 33.9%), and mainly involved a switch or addition of a drug. In multivariable regression analyses, a higher ASDAS was associated with TI in the patient-centred model [odds ratio (OR)ASDAS = 1.94 (95% CI 1.00–3.74)]. However, in the physician-centred model, this association attenuated, and PhGA or PASS-physician were the primary factors associated with TI [ORPhGA = 1.71 (1.24–2.34); ORPASS-physician = 94.95]. Interestingly, patient-centred factors (ASAS HI/PASS-patient/education level) did not contribute to TI. Conclusion In practice, treatment is intensified in a minority of axSpA patients with HDA. Physician-centred factors are associated with the decision to change treatment, independently of disease activity or patient perspective. Further research is needed to better understand these decisions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the health status and functional impairments in patients with axial spondyloarthritis (axSpA) using the Assessment of SpondyloArthritis International Society Health Index (ASAS-HI) and Environmental Factors (ASAS-EF) Index, and to evaluate the correlation of these indices with established clinical parameters. METHODS: This cross-sectional study included 91 patients diagnosed with axSpA at the Rheumatology Department between November 2017 and July 2018. Participants were evaluated using ASAS-HI, ASAS-EF, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, and Health Assessment Questionnaire (HAQ). Descriptive statistics and correlation analyses were performed to examine relationships between these indices and various clinical and demographic variables. RESULTS: The study found that 49.5% of patients had a BASDAI score >4, indicating high disease activity. The mean ASASHI score was 6.8, reflecting moderate to severe functional impairment in the study population. Significant positive correlations were observed between ASAS-HI and BASFI, BASDAI, spinal pain, and HAQ scores (p<0.05). However, no significant correlations were found between ASAS-HI and ASQoL, disease duration, CRP, or ESR. ASAS-EF was also positively correlated with BASFI, BASDAI, spinal pain, and HAQ scores. CONCLUSION: The ASAS-HI and ASAS-EF indices effectively evaluate health status and functional impairments in patients with axSpA. The significant correlations with established clinical parameters highlight the indices' utility in capturing the multifaceted impact of axSpA, emphasizing the importance of comprehensive disease assessment in guiding targeted interventions. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of Crohn’s disease (CD) and axial spondyloarthritis (axSpA) is challenging, with CD refractory to anti-TNF antibodies. Here, we present for the first time a case treated with dual-targeted therapy (DTT) using the anti-IL-23 monoclonal risankizumab and the anti-TNF antibody certolizumab pegol. Case Presentation: Our patient initially presented with axSpA at the age of 27. Nine years later, CD was diagnosed by the age of 36. One year after the diagnosis of CD, a spontaneous ileal perforation occurred as part of a disease course refractory to multiple anti-TNF antibodies and intolerance to immunomodulators. However, the axSpA showed a response to the anti-TNF certolizumab pegol. After stopping certolizumab pegol, we enrolled the patient into the M15-991 induction trial (MOTIVATE) and the maintenance trial (FORTIFY) testing the anti-IL-23 antibody risankizumab versus placebo in CD with failure to prior biological therapy. As a result, risankizumab induced a CD response but failed to control the axSpA. Considering the CD refractory and the axSpA responding to anti-TNFs, we initiated a DTT with risankizumab and certolizumab pegol. Risankizumab and certolizumab pegol together improved both CD and axSpA. As adverse events, there were only two episodes of spontaneously resolving common colds during the 19-month reviewed period. Conclusion: DTT using risankizumab and certolizumab pegol is effective in CD and axSpA without serious adverse events in our patient. Combining biologicals that target specific pathways in immune-mediated diseases promises excellent potential in CD associated with extraintestinal manifestations. [ABSTRACT FROM AUTHOR]

Background: Gabapentinoids are increasingly prescribed in inflammatory arthritis (IA), despite no trial evidence for efficacy at managing pain in this population. Observational studies in non-IA populations suggest gabapentinoids are associated with fractures but are limited by methodological heterogeneity/potential residual confounding. Patients with IA generally have an increased risk of fracture so may be particularly vulnerable. We examined the relationship between fractures and gabapentinoids in patients with IA who had all been prescribed a gabapentinoid at some point (to minimise confounding by indication). Methods: Our matched case–control study used linked national data from English primary care (Clinical Practice Research Datalink Aurum) and Hospital Episode Statistics. A cohort was constructed of adults with IA, contributing data 01/01/2004–31/03/2021, and ever prescribed oral gabapentinoids. Cases with an incident fracture post-cohort inclusion were ascertained and 1:5 risk set-matched (on age/gender/gabapentinoid type) with controls. Gabapentinoid prescription exposure was categorised as follows: (a) current (overlapping with fracture date); (b) recent (ending 1–60 days pre-fracture); and (c) remote (ending > 60 days pre-fracture). Conditional logistic regression models determined ORs with 95% CIs for fractures with current or recent vs. remote gabapentinoid use, adjusting for confounders. Results: A total of 2485 cases (mean age 63.0 years; 79.4% female) and 12,244 controls (mean age 62.7 years; 79.6% female) were included. Of cases: 1512 received gabapentin, 910 pregabalin, and 63 both drugs; 65.6% were remote, 5.5% recent, and 28.9% current users. In adjusted models, current gabapentinoid use had an increased risk of fracture (OR vs. remote: 1.36 [95% CI 1.22, 1.51]). Similar associations were seen with gabapentin (OR 1.38 [1.19, 1.60]) and pregabalin (OR 1.40 [1.18, 1.66]). Similar or higher levels of association were seen for all gabapentin/pregabalin doses except moderate/very high dose gabapentin. Associations were strongest in those starting gabapentinoids more recently. Conclusions: Our study suggests a modest association between current gabapentinoid use and fractures in patients with IA, after accounting for measured and time-invariant unmeasured confounding. Whilst other unmeasured confounding remains possible, given the absence of evidence for gabapentinoid efficacy in patients with IA who are particularly vulnerable to fractures, this highlights a need for efforts to deliver safer gabapentinoid prescribing in this population. [ABSTRACT FROM AUTHOR]

Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the musculoskeletal system, skin and nails. In addition to peripheral joints, inflammation of the spine and sacroiliac joints may occur. Yet, research into this axial phenotype has lagged behind partly because of the challenge in its clinical identification with a lack of specific clinical, molecular or imaging biomarkers. In the absence of a validated definition of what constitutes axial PsA (axPsA), guidelines for the management of axial involvement in PsA in clinical practice are scarce. On the basis of a literature review and their clinical expertise, a group of rheumatology experts provide their opinion to aid the diagnosis and management of axial PsA in clinical practice. [ABSTRACT FROM AUTHOR]

Axial involvement in psoriatic arthritis (PsA) has been a major feature of the disease since the original description by Wright and Moll. However, despite over 50 years of study, there is still no accepted definition of axial PsA, nor validated classification criteria. Numerous observational studies have described a phenotype of axial involvement that differs from classical ankylosing spondylitis (AS or axial spondyloarthritis) both clinically and radiographically, and in the frequency of the HLA-B27 antigen. These differences are important clinically, as axial PsA may be less prominent than AS, and in terms of treatment. This short review discusses these issues and offers some clarification for clinicians. [ABSTRACT FROM AUTHOR]

Background: To assess gender differences in a large sample of patients included in the International Map of Axial Spondyloarthritis (IMAS) study from around the globe. Method: IMAS is a cross‐sectional online survey (2017–2022) of 5557 unselected axSpA patients from 27 countries. The current analysis assessed differences between males and females for: sociodemographic, health behaviors, disease characteristics, patient‐reported outcomes, mental comorbidities, and treatments. Univariable and multivariable logistic regression analysis was used to evaluate the relationship between gender and disease characteristics, patient‐reported outcomes, comorbidities, and treatments. Results: Data from 5555 patients reporting gender were analyzed: 3492 from Europe, 769 from North America, 600 from Asia, 548 from Latin America, and 146 from Africa. Globally, 55.4% were females, with higher proportions in South Africa (82.2%) and lower in Asia (20.8%). Compared to males, a lower percentage of females smoked and consumed alcohol. The diagnostic delay was significantly longer (+2.4 years) in females, while the frequency of HLA‐B27 positivity of axSpA was lower in females. The use of axSpA pharmacological treatment was more common in females with a higher proportion having ever taken nonsteroidal anti‐inflammatory drugs (NSAIDs), conventional synthetic DMARDs (csDMARDs), and biologic DMARDs (bDMARDS). Conclusions: Identifying the specific disease characteristics associated with gender in patients with axSpA may help to improve the diagnosis and management of the disease, and thereby reduce the disease burden for patients around the world. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the sociodemographic characteristics and disease‐related factors associated with diagnostic delay in Canadian patients with axial spondyloarthritis (axSpA). Methods: Data from 542 Canadian patients who participated in the International Map of Axial Spondyloarthritis online survey were analysed. Diagnostic delay was calculated as the difference between age at diagnosis and age at onset of the first symptoms reported by participants. Univariate and multivariate analyses were used to evaluate possible factors associated with diagnostic delay. Results: The mean age (± SD) of the surveyed participants was 44.3 ± 13.9 years and 63.1% were female. The average diagnostic delay was 9.0 ± 10.5 years (median, 5.0 years; interquartile range, 1.0–13.8). In the multivariate regression analysis, the three variables most strongly associated with longer diagnostic delay were use of nonsteroidal anti‐inflammatory drugs (NSAIDs) (B = 2.991; 95% CI = 1.075–4.909), medium or high functional limitation (B = 1.541; 95%CI = 0.186–2.896), and number of HCPs seen before diagnosis (B = 1.524, 95%CI = 1.072–1.977). Conclusion: Diagnostic delay continues to be a barrier to optimal care for Canadian axSpA patients. Significant diagnostic delay, associated with a high number of HCP visits prior to diagnosis, high use of NSAIDs, and marked functional limitation in daily life, illustrate the convoluted axSpA patient journey. [ABSTRACT FROM AUTHOR]

There are still controversies about the efficacy of cycling to a second tumor necrosis factor inhibitor (TNFi) in patients with inflammatory arthritis. The aim of this study was to evaluate survival, persistence and effectiveness of golimumab (GLM) in patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) with previous experience with other TNFi and to compare these results with TNFi naive patients. Observational cohort of consecutive patients with RA, PsA and axSpA who had started treatment with GLM according to medical indication. bDMARD naive and TNFi experienced patients were selected. A total of 147 (62.3%) bDMARD naive and 45 (19.1%) TNFi experienced patients were included. Patients were followed up for a total of 441.5 patients/year, 55 (28.6%) discontinued GLM, 42 (28.6%) and 13 (28.9%) in each group, respectively (p = 0.967). The majority (63.6%) suspended due to inefficacy, followed by lack of access (23.6%) and adverse events (9.1%). Median GLM survival was 74.0 months (95% CI 57.0, 91.0) and 71.0 months (95% CI 37.0, 105.0), in the bDMARD naive and TNFi experienced patients, respectively (p = 0.695). Drug persistence at 6, 12, 24 and 36 months was 92.8%, 88.1%, 76.1%, 65.4% and 93.1%, 77.4%, 74.2%, 68.5%, respectively. In the multivariable analysis, having public health insurance was associated with higher risk of drug discontinuation (HR 2.56, 95% CI 1.28–5.00, p = 0.008). TNFi experienced patients did not show significantly higher risk of GLM suspension (HR 1.35, 95% CI 0.70–2.57, p = 0.370). In this cohort, TNFi experienced patients had comparable survival and persistence of treatment with GLM. Having public health insurance was associated with lower drug retention rates. [ABSTRACT FROM AUTHOR]

To assess the prevalence of clinically active disease in axial spondyloarthritis (axSpA) and its associated factors in a large global sample of patients from the International Map of Axial Spondyloarthritis (IMAS) study. IMAS is a cross-sectional online survey (2017–2022) of 5557 axSpA patients. Patients were divided between those with active disease (BASDAI ≥4) and without active disease (BASDAI <4). The factors evaluated were sociodemographic, lifestyle, patient-reported outcomes, employment, disease characteristics, extra-musculoskeletal manifestations, and treatment. Logistic regression analysis stratified by gender were used to evaluate the relationship between investigated factors and active disease. In the present study, 5295 patients who had responded to the BASDAI scale were included in the present study: 3231 were from Europe, 770 from North America, 600 from Asia, 548 from Latin America, and 146 from Africa. The mean age was 43.8 ± 12.9 years and 55.4% were females. Patients reported a mean BASDAI of 5.4 (±2.1) with 75% having active disease (BASDAI ≥4). In South Africa, 87.0% of patients reported having active disease, compared to 68.5% in Asia. Multivariable logistic regression showed an association of active disease with higher functional limitation, greater spinal stiffness, difficulty finding a job due to axSpA and worse mental health in both genders. For males, younger age and shorter diagnostic delay, and for females, no physical activity and presence of inflammatory bowel disease were associated with active disease. Three quarters of patients with axSpA reported clinically active disease, with higher proportion of patients with active disease in South Africa and lower proportion in Asia. Our results underline the complexity of the clinical disease activity concept in axSpA and the need for a holistic approach in the patient management, care and treatment. [ABSTRACT FROM AUTHOR]

This review examines the efficacy, safety, and pharmacokinetics of upadacitinib (UPA) for treating rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA). This review analyzes the results of multiple clinical trials and provides a comprehensive overview of UPA's effectiveness in improving disease activity, reducing symptoms, and preventing joint damage. The review also highlights the safety profile of UPA, including the increased risk of herpes zoster, non-melanoma skin cancer, and elevated creatine phosphokinase levels. In addition, the review discusses the pharmacokinetics of UPA, emphasizing its rapid absorption and limited plasma protein binding. Overall, UPA appears to be a promising therapeutic option for patients with RA, PsA, and axSpA, particularly those with inadequate response to other therapies. [ABSTRACT FROM AUTHOR]

Imaging biomarkers in axial spondyloarthritis (axSpA) are currently the most specific biomarkers for the diagnosis of this condition. Despite advances in imaging, from plain radiographs--which detect only damage--to magnetic resonance imaging (MRI)--which identifies disease activity and structural change--there are still many challenges that remain. Imaging in sacroiliitis is characterized by active and structural changes. Current classification criteria stress the importance of bone marrow edema (BME); however, BME can occur in various diseases, mechanical conditions, and healthy individuals. Thus, the identification of structural lesions such as erosion, subchondral fat, backfill, and ankylosis is important to distinguish from mimics on differential diagnosis. Various imaging modalities are available to examine structural lesions, but computed tomography (CT) is considered the current reference standard. Nonetheless, recent advances in MRI allow for direct bone imaging and the reconstruction of CT-like images that can provide similar information. Therefore, the ability of MRI to detect and measure structural lesions is strengthened. Here, we present an overview of the spectrum of current and cutting-edge techniques for SpA imaging in clinical practice; namely, we discuss the advantages, disadvantages, and usefulness of imaging in SpA through radiography, low-dose and dual-energy CT, and MRI. Cutting-edge MRI sequences including volumetric interpolated breath-hold examination, ultrashort echo time, zero echo time, and deep learning-based synthetic CT that creates CT-like images without ionizing radiation, are discussed. Imaging techniques allow for quantification of inflammatory and structural lesions, which is important in the assessment of treatment response and disease progression. Radiographic damage is poorly sensitive to change. Artificial intelligence has already revolutionized radiology practice, including protocolization, image quality, and image interpretation. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) is the most important modifiable risk factor for the development of cardiovascular events (CVEs). Patients with axSpA are also associated with an increased risk of future CVE. Objectives: To ascertain whether baseline early-stage HTN is a predictor of future CVE in addition to inflammation in patients with axial spondyloarthritis (axSpA). Design: A retrospective cohort study. Methods: Patients with axSpA were recruited from 2001 to 2017. Patients with at least 2 years of follow-up and without prior CVE were divided into three groups according to the calculated mean blood pressure (BP) over the first 2-year follow-up period (adjusted mean BP) (⩾140/90, 130–139/80–89, and <130/80 mm Hg). They were followed from baseline until the end of 2020 or the occurrence of a first CVE. Multivariate Cox regression analyses adjusting for baseline and time-varying variables were used to assess the relationship between mean BP and CVE. Results: Out of the 437 patients fulfilling the inclusion criteria, 49 (11.2%) and 132 (30.2%) had an adjusted mean BP ⩾ 140/90 and 130–139/80–89 mm Hg, respectively, and 256 (58.6%) were pre-HTN. After a median follow-up of 12 (7–18) years, 56 (12.8%) CVEs were documented. The incidence rates were 21.4, 14.2, and 5.9 per 1000 patient-years for the three groups, respectively. Baseline adjusted mean BP of 130–139/80–89 mm Hg was independently associated with the occurrence of CVE after adjusting for the baseline covariates as well as time-varying high inflammatory burden. Conclusion: Baseline-defined early-stage HTN carries excessive risk of developing CVE which may be due to untreated inflammatory burden. Early antihypertensive therapy should target this BP level to minimize their future risk of CVE. [ABSTRACT FROM AUTHOR]

Background/Objectives: Obesity and smoking have been related to increased disease activity in axial spondyloarthritis (axSpA), but these associations might vary depending on the composite index chosen to assess disease activity. We aimed to check this possibility. Methods: Three hundred and thirty consecutive patients were recruited from the monographic axSpA unit of a university center. To assess disease activity, BASDAI and ASDAS-CRP measurements were collected. The factors associated with the different disease activity thresholds of these instruments were analyzed using univariate and multivariate logistic regression models. Results: This study included 127 women and 203 men, with a mean age of 47.6 (SD 12.9) years, median disease duration of 8 years [IQR: 4–16], and 63% on biologic therapies. Most patients met the therapeutic goals, with a BASDAI < 4 in 187 (56.7%) and ASDAS inactive/low category in 182 (55.2%). Being male was associated with BASDAI remission (OR 2.63), but smoking reduced this likelihood (OR 0.28). Similar findings were found for ASDAS inactive disease (male: OR 2.09; smoking: OR 0.39). The variables associated with BASDAI ≥ 4 in the multivariate logistic model were the male gender (OR 0.36), age (OR 1.02), smoking (OR 2.39), and obesity (OR 2.94), whereas those associated with active/very active ASDAS categories were the male gender (OR 0.49), age (OR 1.02), and smoking (OR 2.34). However, obesity was not associated with these higher ASDAS categories (p = 0.183). Conclusions: While the association between smoking and increased disease activity was consistent across all composite activity indices, the obesity–activity relationship was only apparent through the BASDAI. [ABSTRACT FROM AUTHOR]

Objective: To develop a guideline for selecting biomarkers in the diagnosis and assessment in patients with axial spondyloarthritis (axSpA). Method: A joint effort was carried out by the core team, the literature review team and the multidisciplinary voting panel to formulate recommendations regarding biomarkers in axSpA, using an evidence-based and consensus-based strategy. Certainty of evidence and strength of recommendation were determined, and levels of agreement within the voting panel were calculated. Results: A total of 20 recommendations were formulated in this guideline, with levels of agreement ranging from 6.48 to 9.71. The two strong recommendations, HLA-B27 testing in patients suspected of axSpA and regular-interval monitoring of CRP/ESR represent the status quo of axSpA evaluation, while the 13 conditional recommendations represent the promising biomarkers with clinical utility in diagnosis, disease activity assessment, prediction of radiographic progression and therapeutic responses. This guideline does not dictate clinical choices of tests on axSpA, and decisions should be made based on comprehensive consideration of costs, accessibility, patients' values and willingness as well as the objective of testing in the local context. Conclusion: This guideline addresses the interpretation of the clinical significance of biomarkers in axSpA, and the biomarkers endorsed in this guideline composed a clinical toolkit for healthcare professionals to choose from. [ABSTRACT FROM AUTHOR]

Objective To study the therapeutic variations of biologic and targeted synthetic DMARDs (b/tsDMARDs) between genders and across age stages in axial SpA (axSpA) patients through meta-analysis. Methods Randomized controlled trials published by PubMed, Scopus and Embase before 10 August 2023, testing the efficacy of b/tsDMARDs in axSpA, were searched and systematically reviewed. The Assessment of Spondyloarthritis International Society ≥40% improvement (ASAS40) was used as the primary outcome of treatment response. Results Only one study meet the inclusion criteria related to tsDMARDs, which was excluded from further analysis. Nine studies of bDMARDs, with 4127 patients, were included for the final analysis. When compared with placebo, both males [odds ratio (OR) 3.14 (95% CI 2.66, 3.70)] and females [OR 2.32 (95% CI 1.82, 2.82)] and younger [OR 4.00 (95% CI 2.50, 6.40)] and older [OR 2.21 (95% CI 1.15, 4.22)] patients presented significantly better responses to bDMARDs. Also, the efficacies were more evident in males [OR 1.89 (95% CI 1.56, 2.30)] and younger [OR 2.07 (95% CI 1.42, 3.02)] patients. Subgroup analysis revealed that the gender difference in efficacy was more obvious in non-radiographic axSpA (nr-axSpA) patients (P heterogeneity = 0.03, I 2 = 78.1%). Moreover, males with radiographic axSpA (r-axSpA) and nr-axSpA shared similar responses to bDMARDs (P heterogeneity = 0.87, I 2 = 0%), while females with r-axSpA showed greater response than those with nr-axSpA (P heterogeneity = 0.005, I 2 = 87.4%). Conclusions The bDMARDs were efficacious in all axSpA patients regardless of gender or age. However, the treatment responses were more evident in male and younger patients. Also, females with r-axSpA had greater responses than those with nr-axSpA, whereas no relevant difference was observed in males, indicating that the gender difference on efficacy was greater in nr-axSpA patients. [ABSTRACT FROM AUTHOR]

Objectives The aim of our study was to identify the potential distinct phenotypes within a broad SpA population. Methods We conducted a cross-sectional study using the REGISPONSER registry, which has data from 31 specialist centres in Spain, including patients with SpA who have fulfilled the ESSG criteria. A latent class analysis (LCA) was performed to identify the latent classes underlying SpA according to a set of predefined clinical and radiographic features, independently of expert opinion. Results In a population of 2319 SpA patients, a five-classes LCA model yielded the best fit. Classes named 'Axial with spine involvement' and 'Axial with isolated SI joint involvement' showed a primarily axial SpA phenotype defined by inflammatory back pain and high HLA-B27 prevalence. Patients in class 'Axial + peripheral' showed a similar distribution of manifest variables to previous classes but also had a higher likelihood of peripheral involvement (peripheral arthritis/dactylitis) and enthesitis, therefore representing a mixed (axial and peripheral) subtype. Classes 'Peripheral + psoriasis' and 'Axial + peripheral + psoriasis' were indicative of peripheral SpA (and/or PsA) with high likelihood of psoriasis, peripheral involvement, dactylitis, nail disease, and low HLA-B27 prevalence, while class 'Axial + peripheral + psoriasis' also exhibited increased probability of axial involvement both clinically and radiologically. Conclusion The identification of five latent classes in the REGISPONSER registry with significant overlap between axial and peripheral phenotypes is concordant with a unifying concept of SpA. Psoriasis and related features (nail disease and dactylitis) influenced the phenotype of both axial and peripheral manifestations. [ABSTRACT FROM AUTHOR]

Objective: To estimate objective cut‐off values for Bath ankylosing Spondylitis Disease Activity Index (BASDAI) corresponding to Ankylosing Spondylitis Disease Activity Score with CRP (ASDAS) cut‐off values (1.3, 2.1, and 3.5), and for interval changes (ΔBASDAI) corresponding to ΔASDAS (1.1 and 2). Methods: In this multicentric study, adult patients with active axial spondyloarthritis (axSpA) treated with either tofacitinib 5 mg twice daily or adalimumab 40 mg subcutaneously fortnightly were recruited. Available paired data on BASDAI and ASDAS and paired interval change of these parameters (taken at least 3‐months apart) were analyzed. Cut‐off values for BASDAI were determined from a multinomial logistic regression and that for ΔBASDAI were determined with ordinal logistic regression with predicted probabilities. Diagnostics were assessed with correct classification rate (CRR), polychoric correlations (PCC), Goodman and Kruskal Gamma (GKG), and Matthew's correlation coefficient (MCC). Results: Total 962 observations of paired data and 670 interval change data were available from 266 patient (mean age 35 years, mean disease duration 7 years, mean BASDAI 2.7, and mean ASDAS 2.1). Following ASDAS classes were observed: inactive disease 131 (13.6%), moderate disease activity 322 (33.5%), high disease activity 420 (43.65%), and very high disease activity 89 (9.25%). The three cut‐offs generated for BASDAI were 0.8, 2.5, and 6 for BASDAI and those for ΔBASDAI were 2 and 4. The CRR for BASDAI cut‐offs was 65.59 and that for ΔBASDAI was 54.9. For the BASDAI cut‐offs, both PCC and GKG showed high values (> 0.85) and the MCC was 0.471. Conclusion: In patients with axSpA, without any clinical or serological confounders, BASDAI values 0.8, 2.5, and 6 corresponded to ASDAS‐CRP values 1.3, 2.1, and 3.5, respectively, and ΔBASDAI values of 2 and 4 correspond to ΔASDAS cut‐offs of 1.1 and 2. [ABSTRACT FROM AUTHOR]

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition with an increased risk of cardiovascular disease (CVD). Diabetes is a well-established risk factor for CVD and stroke. The objective of this study was to conduct a systematic review to: (i) identify the prevalence of diabetes in axSpA and (ii) compare the risk of diabetes in patients with axSpA and without. A comprehensive literature search was performed for articles published between 1 January 2000 and 15 November 2023 using Medline, Embase and Scopus (PROSPERO: CRD42023482573). Observational studies reporting prevalence, incidence or risk of diabetes in axSpA were included. Search results were independently screened by at least two reviewers. Quality of included studies were assessed using the JBI critical appraisal tool. Study-specific proportions and odds ratios (OR) were combined in a random-effects meta-analysis. 2257 articles were identified from database searching from which 23 studies were included for analysis amounting to a combined sample size of 65 025 patients. The pooled prevalence of diabetes in people with axSpA was 7.0% (95% CI 5.9–8.0%; predictive interval 2.4–12.9%; p < 0.001). The funnel plot was symmetric suggesting no small-study effects (I2 = 98.1% (95% CI 0.05–0.08), τ2 = 0.02; p < 0.001). Comparing patients with axSpA to those without, the pooled OR was 1.29 (95% CI 1.10–1.52; predictive interval 0.76–2.22; p = 0.001) for diabetes. The study suggests an increased prevalence and probably an increased risk of diabetes in people with axSpA. Routine screening for diabetes and lifestyle modifications should be encouraged in this cohort. [ABSTRACT FROM AUTHOR]

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily involves the axial skeleton but may also present with peripheral joint involvement and extra-articular involvement. The present study aims to quantitatively analyze posture, balance, and gait parameters in patients with axSpA and and assess associated factors. This cross-sectional case-control study included 51 axSpA patients (30 males, 21 females; mean age 40.94 ± 10.48 years) and 51 age- and sex-matched healthy controls. In patients with axSpA, the Ankylosing Spondylitis Disease Activity Score CRP, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Maastrich Ankylosing Spondylitis Enthesitis Score (MASES), and the Ankylosing Spondylitis Quality of Life (ASQoL) scale were used. For postural analysis, DIERS formetric (Diers GmbH, Schlangenbad, Germany) videoraster- stereography device was utilized. HUR SmartBalance BTG4 (HUR-labs Oy, Kokkola, Finland) balance platform was used for postural balance and limit of stability (LOS) measurement. Participants were evaluated using Berg Balance Scale (BBS), Functional Reach Test (FRT) and Timed Up and Go Test (TUG). The Zebris FDM type 3 (Zebris Medical GmbH, Germany) walking platform was used to measure the spatiotemporal parameters of the participants. Comparison of postural parameters showed that sagittal imbalance and cervical depth distance were increased in the axSpA group than in the healthy participants (p < 0.004). Comparison of functional balance parameters showed that BBS and FRT scores were significantly lower (p < 0.001) in the axSpA group than in the control group, while TUG scores were significantly higher (p < 0.001). The LOS values, which evaluate dynamic balance were significantly lower, indicating impairment, in the axSpA group. In the measurement of postural sway, which indicates static balance, all 23 subparameters were found to be similar. When analyzing the spatiotemporal gait parameters, in the axSpA group compared with those in the control group; Foot angles (p= 0.028) and stride width (p = 0.004) were increased, whereas step lengths (p = 0.004) and stride lengths (P = 0.004) were decreased. In the axSpA group the gait speed was decreased (p = 0.004). When axSpA was analyzed separately as radiographic and nonradiographic axSpA, similar findings were observed in posture, balance, and gait parameters. No significant difference was observed. We found that the clinical assessments most closely associated with posture, balance, and gait analyses were BBS, FRT, TUG, and BASFI. [ABSTRACT FROM AUTHOR]

Introduction: Axial spondyloarthritis (AxSpA) is a chronic inflammatory condition primarily affecting the axial skeleton. Peripheral features such as peripheral arthritis (PA) and dactylitis are common in AxSpA disease. This study aimed to investigate the independent impact of these manifestations on patient presentation and disease outcomes within an Irish AxSpA cohort. Methods: 912 Irish AxSpA patients were analyzed in this study. Disease outcomes in patients with and without peripheral arthritis or dactylitis were compared using univariate and multivariate methods. The prevalence of extra-spinal manifestations was further assessed in relation to AxSpA disease duration. Results: 30.2% of patients reported PA, while 6.6% had dactylitis. PA and dactylitis were strongly linked, with 70% of patients presenting with dactylitis also showing features of PA. Psoriasis was more common in both patients with PA (OR 2.2, P < 0.001) and dactylitis (OR 3.38, P < 0.001). Dactylitis, but not PA was strongly linked to uveitis (OR 2.91, P < 0.001) and inflammatory bowel disease (OR 3.15, P < 0.001), while PA was associated with worse patient functioning and reduced quality of life. PA, but not dactylitis was linked with increased AxSpA disease duration. Discussion: Despite high concurrence of PA and dactylitis in AxSpA patients, each manifestation is independently associated with worse outcomes. While some of these overlapped, several outcomes are specific to either PA or dactylitis. Due to its strong association with uveitis and inflammatory bowel disease, an early presentation of dactylitis may represent a unique subset of patients and serve as a valuable predictive marker for the later onset of these conditions. Key points: Peripheral arthritis and dactylitis are closely correlated but independent manifestations in AxSpA, each uniquely contributing to increased disease severity. Dactylitis is uniquely associated with increased risk of uveitis and inflammatory bowel disease, while peripheral arthritis is uniquely linked with depression. An early presentation of dactylitis in AxSpA patients may be predictive of later uveitis episodes. [ABSTRACT FROM AUTHOR]

Following the market authorization of interleukin (IL)-17 inhibitors, a growing number of cases of IL-17 inhibitor-induced paradoxical psoriasis (PsO) have been reported. Our objectives were to present two cases of IL-17 inhibitor-induced paradoxical PsO and to systematically review the literature for similar cases, summarizing and presenting the relevant data. A systematic literature review of previously presented cases of paradoxical PsO induced by IL-17 inhibitors was conducted. We presented two patients with axial spondyloarthritis (axSpA) and paradoxical PsO induced by secukinumab (SEC). One patient's psoriatic lesions responded well to adjuvant topical treatment, while the other patient required a combination of topical treatment and cyclosporine Α for successful treatment. SEC was continued in both cases. We also identified 35 patients with IL-17 inhibitor-induced paradoxical PsO in the literature review. The most frequent types of paradoxical PsO were palmoplantar pustular and plaque PsO, while the median latency period was 11 weeks. Approximately one-third of patients continued IL-17 inhibitor treatment with adjunctive therapy, primarily topical, which produced satisfactory results in most patients. Almost two-thirds of the patients discontinued the IL-17 inhibitor, with the majority of patients switching to another biological agent with a different mechanism of action or initiating other systemic antipsoriatic treatments, resulting in mainly satisfactory outcomes. Therefore, paradoxical PsO induced by IL-17 inhibitors appears to respond well in both patients who continue IL-17 inhibitors with adjunctive treatment and those who discontinue IL-17 inhibitors while switching to a different class of biological agent or initiating other systemic antipsoriatic treatments. [ABSTRACT FROM AUTHOR]

Introduction: There are several treatment controversies that have emerged in spondyloarthritis and psoriatic arthritis. These are related to the nature of the conditions as well as to the use of medications. Areas covered: This review, which included a search of PubMed database as well as the references within the articles provides an overview of the nature of spondyloarthritis, controversy over the inclusion of psoriatic arthritis (PsA) as a peripheral spondyloarthritis, and a summary of current treatments for both PsA and axial spondyloarthritis (axSpA), with special emphasis on targeted therapy. The review highlights the differences in response to certain medications, particularly biologic therapy and summarizes the randomized controlled trials in psoriatic arthritis and axial spondyloarthritis providing data about the responses in table format. Expert opinion: There is a need for better outcome measures in axSpA. Currently, the measures are subjective. Imaging may be more appropriate but there is a need for research into the reliability and responsiveness of imaging techniques. In PsA, there may also be better response measures and research into the reliability and responsiveness of available measures is underway. There is also a need for novel therapies as well as biomarkers for response in both diseases. [ABSTRACT FROM AUTHOR]

Background: Secukinumab is a monoclonal antibody against interleukin 17 approved for patients with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and psoriasis. Treating axSpA and PsA patients with a history of malignancy is a challenge. While initial results on the applicability of secukinumab in this patient group are positive, the number of studies on this topic remains limited. This study aimed to investigate the drug's survival time and the efficacy and safety of secukinumab treatment in this specific patient group. Methods: This retrospective study included 30 patients with a history of malignancy who were followed up in rheumatology outpatient clinics in 12 centers throughout Turkey and treated with secukinumab between May 2018 and March 2024 with a diagnosis of axSpA and PsA. Results: The mean follow-up time was 29.8 ± 19.3 months. The drug retention rate was 89.7% after 12 months and 80.6% after 24 months. The most common tumor in our study was papillary thyroid carcinoma (n = 5, 16.7%). During follow-up, local tumor recurrence was observed in a patient with urothelial carcinoma of the bladder. Conclusions: In the largest cohort reported to date, treatment with secukinumab in axSpA and PsA patients with a history of malignancy was not shown to cause oncologic recurrence except for one local tumor recurrence. Drug retention rates were also high, and disease activation and function improved compared to baseline. Therefore, secukinumab could be a safe and effective option for this patient group. [ABSTRACT FROM AUTHOR]

Introduction: Real-world data on ixekizumab utilization in axial spondyloarthritis (axSpA) are limited. We evaluated ixekizumab treatment patterns and health care resource utilization (HCRU) in patients with axSpA using United States Merative L.P. MarketScan® Claims Databases. Methods: This retrospective cohort study included adults with axSpA who initiated ixekizumab during the index period (September 2019–December 2021). Index date was the date of the first ixekizumab claim. All patients had continuous medical and pharmacy enrollment during the 12-month pre-index and follow-up periods. Descriptive statistics were used to assess patient demographics (index date); clinical characteristics (pre-index period); treatment patterns (12-month follow-up period); and HCRU (pre-index and 12-month follow-up periods). Results: The study included 177 patients (mean age 45.8 years; females 54.8%) with axSpA who initiated ixekizumab. Overall, 79.1% of patients reported prior biologic use; of these, 70.7% received tumor necrosis factor-alpha inhibitors (TNFi) and 49% received secukinumab. The mean (standard deviation [SD]) Charlson Comorbidity Index score was 1.1 (1.3) and ~ 27% of patients reported ≥2 comorbidities. The median (inter-quartile range [IQR]) number of ixekizumab prescription refills was 7 (4–11). The mean (SD) Proportion of Days Covered (PDC) for ixekizumab was 0.6 (0.3) and adherence (PDC ≥80%) was 34.5% (N = 61). Overall, 26.6% (N = 47) of patients switched to a non-index medication and 54.2% (N = 96) of patients discontinued ixekizumab. Among the patients who discontinued ixekizumab (N = 96), 19.8% (N = 19) restarted ixekizumab and 49.0% (N = 47) switched to a non-index medication. The median (IQR) ixekizumab persistence was 268 (120–366) days. Mean axSpA-related outpatient, inpatient, and emergency room visits were similar between the pre-index and follow-up periods. Treatment patterns were largely similar between biologic-experienced patients (N = 140; 79.1%) and the overall population. Conclusions: Despite high comorbidity burden and majority of the patients being biologic-experienced, patients initiating ixekizumab for axSpA showed favorable persistence profiles during the 12-month follow-up period. Plain Language Summary: Axial spondyloarthritis (axSpA) affects the patients' ability to perform daily activities and can have a major impact on their quality of life. Ixekizumab is approved in the United States for the treatment of axSpA. However, real-world data on utilization of ixekizumab are limited. We used administrative claims databases to evaluate real-world treatment patterns and health care resource utilization in adult patients with axSpA who were receiving ixekizumab in the United States. The study showed that more than a quarter of the patients receiving ixekizumab had at least two comorbidities. A majority of the patients (79%) reported that they had received at least one biologic before initiating ixekizumab. Even with the high comorbidity burden and the previous exposure to biologics, patients showed favorable persistence to ixekizumab. Of the patients who discontinued ixekizumab, subsequently, 20% re-initiated ixekizumab and approximately half of the patients switched to an alternative medication. There was no increase in axSpA-related health care resource utilization following ixekizumab treatment. The study findings suggest that ixekizumab is an effective treatment option for patients with axSpA. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between sacroiliac joint (SIJ) involvement and central sensitization (CS) in patients with axial spondyloarthritis (axSpA). Patients and Methods: Twenty-four patients with axSpA were included in this study. CS was investigated via pressure pain threshold (PPT), temporal summation (TS), conditional pain modulation (CPM), and the central sensitization inventory (CSI). Sacroiliac joint involvement was assessed using the magnetic resonance imaging (MRI)-based Canadian Spondyloarthritis Research Consortium (SPARCC) scoring system. CS-related parameters and SPARCC score correlations were analyzed. Results: The median (IQR) sacroiliac PPT score for the right SIJ was calculated as 17.47 (4.43) and 17.67 (4.57) for the left SIJ. In the TS measurement, the right SIJ TS median (IQR) value was calculated as 4.0 (3.5) and 4.0 (2.75) for the left side. The median (IQR) value was 149.67 (107.5) for CPM and 45.0 (27.75) for CSI. The median (IQR) sacroiliac inflammation score was calculated as 3.0 (8.75), and the median (IQR) structural score was calculated as 7.0 (11.5). No correlation was found between SPARCC scores and PPT, TS, CPM, and CSI values. Conclusion: In axSpA patients, there was no association observed between pain sensitivity measures and sacroiliac involvement. Further comprehensive studies are required, taking into account the complex nature of CS. [ABSTRACT FROM AUTHOR]

Remote monitoring using electronic patient reported outcomes (ePROs) in axial spondyloarthritis (axSpA) may improve self-management and reduce the need for consultations. However, knowledge regarding patients' willingness to use remote care and adherence to reporting ePROs is scarce. The objective of this study was to assess axSpA patients' willingness to use remote care and adherence to reporting of ePROs. The study was part of a three-armed randomized controlled trial testing digital follow-up strategies (The ReMonit study, NCT: 05031767). AxSpA patients in low disease activity were randomized to usual care, remote monitoring, or patient-initiated care. Demographics, clinical data, and patients' willingness to use remote care were collected at baseline. EPROs were reported either monthly or quarterly by the remote monitoring- and patient-initiated care group over 18 months, respectively. Adherence to reporting was calculated as number of ePROs completed divided by the total number requested. Mixed model logistic regression was utilized to assess factors associated with adherence to reporting of ePROs. In total 242 patients (median age 43 years, 75% males) were included. The majority (96%) reported high willingness to use remote care. Adherence to reporting ePROs remained high over 18 months by remote monitoring and patient-initiated care groups [median (IQR): 88% (77–100) vs. 83% (66–100)]. No patient characteristics were significantly associated with adherence to reporting of ePROs. The high degree of willingness and adherence to reporting ePROs over time indicates that the majority of axSpA patients with low disease activity are motivated to use remote care. [ABSTRACT FROM AUTHOR]

To evaluate tumour necrosis factor inhibitor (TNFi) drug-levels and presence of anti-drug antibodies (ADAb) in patients with inflammatory arthritis who taper TNFi compared to TNFi continuation. Patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis on stable TNFi dose and in low disease activity ≥ 12 months were randomised (2:1) to disease activity-guided tapering or control. Blood samples at baseline, 12- and 18-months were evaluated for TNFi drug-levels and ADAb. In total, 129 patients were randomised to tapering (n = 88) or control (n = 41). Between baseline and month 18, a significant shift in TNFi drug-levels were observed in the tapering group resulting in fewer patients with high drug-levels (change: − 14% [95% CI − 27 to − 1%]) and more with low drug-levels (change: 18% [95% CI 5–31%]). Disease activity was equivalent between groups at 18 months, mean difference: RA − 0.06 (95% CI − 0.44 to 0.33), PsA 0.03 (95% CI − 0.36 to 0.42), and axSpA 0.16 (− 0.17 to 0.49), equivalence margins ± 0.5 disease activity points. ADAb were detected in eight patients, all from the tapering group. TNFi drug-level category or ADAb were not predictive for achieving successful tapering at 18 months. TNFi drug-levels decreased during tapering which indicate adherence to the tapering algorithm. Despite the difference in TNFi drug-levels at 18 months, disease activity remained equivalent, and only few tapering patients had detectable ADAb. These data do not support using TNFi drug-level and/or ADAb to guide the tapering decision but future research with larger trials is needed. Trial registration: EudraCT: 2017-001970-41, December 21, 2017. [ABSTRACT FROM AUTHOR]

Axial spondyloarthritis affects 0.1% to 1% of the general population, depending on the source. Unfortunately, despite new diagnostic criteria, also adapted to non-radiographic axial spondyloarthritis, and advances in imaging modalities (widespread use of magnetic resonance imaging), the late diagnosis of the disease and, therefore, a delay in starting therapy still pose a serious problem. On average, the time between the first symptoms of the disease and its diagnosis is several years. Patients’ access to modern treatment methods is also still delayed. This paper presents a practical guide to both the diagnosis and treatment of axial spondyloarthritis in Poland. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of mind-body exercise (MBE) interventions, including Tai Chi, Yoga, Pilates, and Qigong, in patients with axial spondyloarthritis (axSpA), a systematic review and meta-analysis was conducted. Methods: Eight electronic databases were searched from their inception to May 2024. RevMan 5.4 and Stata 16.0 software were used for statistical analysis. Outcome measures included Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analog Scale (VAS), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQoL) Scale, and adverse events. The methodological quality of the included studies was evaluated using the Cochrane risk of bias (RoB) tool (2.0). The certainty of evidence for each outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Of the 330 studies retrieved, 15 studies satisfied the criteria for meta-analysis. Compared with the controls, MBE interventions significantly improved physical function (measured by BASFI, MD = -0.76, 95% CI: -1.01 to -0.50, P < 0.00001), disease activity (measured by BASDAI, MD = -0.76, 95% CI: -0.94 to -0.57, P < 0.00001), pain intensity (measured by VAS, MD = -0.89, 95% CI: -1.21 to -0.57, P < 0.00001), spinal mobility (measured by BASMI, MD = -0.44, 95% CI: -0.70 to -0.19, P = 0.0006), and quality of life (measured by ASQoL, MD = -2.14, 95% CI: -3.54 to -0.75, P = 0.003). Subgroup analyses revealed that Tai Chi appeared to demonstrate a more pronounced effect on pain reduction when compared to Qigong (test for subgroup difference: P = 0.005). The quality of evidence for these outcomes was estimated as moderate to low. Additionally, no serious adverse events related to MBE were identified among the included studies. Conclusions: Overall, MBE may be a promising non-pharmacological treatment to improve physical function, disease activity, pain intensity, spinal mobility, and quality of life in patients with axSpA. To enhance the certainty of the evidence, additional rigorous studies are needed to verify these findings. [ABSTRACT FROM AUTHOR]

Objectives To explore differences in axial spondyloarthritis (axSpA) clinical phenotype around the world in a large sample of patients included in the International Map of Axial Spondyloarthritis (IMAS). Method IMAS was a cross-sectional online survey (2017–2022) of 5557 unselected axSpA patients from 27 countries. We analysed across five geographic regions the age at symptom onset, diagnostic delay, gender, HLA-B27, family history, extra-musculoskeletal manifestations, presence of comorbidities, disease activity (BASDAI), level of spinal stiffness and treatments. Results Of 5557 IMAS participants, 3493 were from Europe, 770 from North America, 600 from Asia, 548 from Latin America and 146 from South Africa. Age at symptom onset ranged between 25 and 30 years and was higher in Latin America. Diagnostic delay was longest in South Africa and lowest in Asia. The lowest HLA-B27 positivity was observed in Latin America and the highest in Asia. Extra-musculoskeletal manifestations were the lowest in Europe. Mean disease activity (BASDAI) was 5.4, with highest values in South Africa and lowest in Asia. Most of the patients had used NSAIDs for their condition and less than half had ever taken conventional synthetic DMARDS; both were more frequent in Latin America and South Africa. Almost half of the patients had ever taken biologic DMARDs, more frequent use being in the Americas. Conclusion There is great heterogeneity of axSpA clinical phenotype presentation around the world. AxSpA manifests differently in different regions, so further understanding of these differences of phenotypes is needed to achieve early diagnosis and initiation of optimal disease treatment in axSpA in the different regions. [ABSTRACT FROM AUTHOR]

Objectives: Bath Ankylosing Spondylitis Patient Global Score (BAS‐G) is a uni‐dimensional scale that enables patients to evaluate the effects of their illness on their health. The aim of this study was to determine the impact of disease related outcomes on the BAS‐G scores in patients with axSpA. Methods: A total of 309 patients (56.6% of whom were male, mean age 44 ± 11) were included in the study. Socio‐demographic characteristics (age, sex and education level) and clinical characteristics such as disease activity (BASDAI and CRP), spinal mobility (BASMI), functional status (BASFI), radiographic structural damage (mSASS, mNY, and BASRI‐hip), and health related quality of life (SF‐36 and ASQoL) of the patients were recorded at baseline. In addition, BASDAI total and each item score, BASFI, BAS‐G, and CRP levels were collected at 6, 12, and 24 months. Results: Female patients had significantly higher BAS‐G scores (p = 0.037). Baseline BASDAI total score (p < 0.001) and all BASDAI item scores (p < 0.001 for each item), BASFI total score (p < 0.001), ASQoL total score (p < 0.001), and SF‐36 PCS sum‐score (p < 0.001) were moderately/highly correlated with BAS‐G. Multivariate analysis revealed that back pain (BASDAI Q2) (p < 0.001) and the severity of morning stiffness (BASDAI Q5) (p < 0.001) were the main determinants of BAS‐G in patients with axSpA. In 2‐year follow‐up, BASDAI Q1, BASDAI Q5, and BASFI scores were independent determinants of BAS‐G in patients with axSpA. Conclusion: According to the results of the present study, patients with axSpA mainly rely on morning stiffness and back pain to determine their global health status. Moreover, fatigue, severity of morning stiffness and function are the determinants of BAS‐G during follow‐up. [ABSTRACT FROM AUTHOR]

Objectives: Axial spondyloarthritis (axSpA) is a chronic rheumatic, musculoskeletal, inflammatory disease with a propensity to present as sacroiliitis, which manifests as low back, buttock, or thigh pain. Effective primary management of axSpA requires a comprehensive approach specific to each patient and disease severity. Non‐pharmacological measures form the cornerstone of treatment. With refractory disease, management also consists of local periarticular and intraarticular injections. The use of sacroiliac joint (SIJ) corticosteroid injections for the treatment of axSpA and localised inflammation, however, is a continuously burgeoning management option. This narrative review aims to present consolidated findings and summarise previously unreferenced or recently available evidence regarding corticosteroid injections to the SIJ for treating sacroiliitis and axSpA. Methods: A comprehensive literary review with the following electronic databases was searched: MEDLINE via PubMed, Web of Science, Cochrane Library, and EMBASE. Results: The initial search yielded a total of 126 references. After duplicates were removed and the remainder analysed for inclusion criteria, 7 studies were included. To stratify each study, injection methodology and characteristics were defined. Discussion: The use of SIJ corticosteroid injections can be an appropriate and effective treatment option for refractory axSpA. The studies presented in this review reported a general trend towards a reduction in pain severity after SIJ corticosteroid injections. Because of the complexity and heterogeneity of the anatomy of the SIJ, image guidance is recommended when performing SIJ injections. Image‐guided injections seem to produce better outcomes when compared to anatomic landmark‐guided injections. [ABSTRACT FROM AUTHOR]

Sacroiliitis is commonly seen in patients with axial spondyloarthritis, in whom timely diagnosis and treatment are crucial to prevent irreversible structural damage. Imaging has a prominent place in the diagnostic process and several new imaging techniques have been examined for this purpose. We present a summary of updated evidence-based practice recommendations for imaging of sacroiliitis. MRI remains the imaging modality of choice for patients with suspected sacroiliitis, using at least four sequences: coronal oblique T1-weighted and fluid-sensitive sequences, a perpendicular axial oblique sequence, and a sequence for optimal evaluation of the bone-cartilage interface. Both active inflammatory and structural lesions should be described in the report, indicating location and extent. Radiography and CT, especially low-dose CT, are reasonable alternatives when MRI is unavailable, as patients are often young. This is particularly true to evaluate structural lesions, at which CT excels. Dual-energy CT with virtual non-calcium images can be used to depict bone marrow edema. Knowledge of normal imaging features in children (e.g., flaring, blurring, or irregular appearance of the articular surface) is essential for interpreting sacroiliac joint MRI in children because these normal processes can simulate disease. Clinical relevance statement: Sacroiliitis is a potentially debilitating disease if not diagnosed and treated promptly, before structural damage to the sacroiliac joints occurs. Imaging has a prominent place in the diagnostic process. We present a summary of practice recommendations for imaging of sacroiliitis, including several new imaging techniques. Key Points: • MRI is the modality of choice for suspected inflammatory sacroiliitis, including a joint-line-specific sequence for optimal evaluation of the bone-cartilage interface to improve detection of erosions. • Radiography and CT (especially low-dose CT) are reasonable alternatives when MRI is unavailable. • Knowledge of normal imaging features in children is mandatory for interpretation of MRI of pediatric sacroiliac joints. [ABSTRACT FROM AUTHOR]

Axial Spondyloarthritis (axSpA) is a chronic, inflammatory, immune-mediated rheumatic disease that comprises two subsets, non-radiographic and radiographic axSpA, and belongs to a heterogeneous group of spondyloarthritides (SpA). Over the years, the concept of SpA has evolved significantly, as reflected in the existing classification criteria. Considerable progress has been made in understanding the genetic and immunological basis of axSpA, in studying the processes of chronic inflammation and pathological new bone formation, which are pathognomonic for the disease. As a result, new medication therapies were developed, which bring more effective ways for disease control. This review presents a brief overview of the literature related to these aspects of disease after summarising the available information on the topic that we considered relevant. Specifically, it delves into recent research illuminating the primary pathological processes of enthesitis and associated osteitis in the context of inflammation in axSpA. The exploration extends to discussion of inflammatory pathways, with a particular focus on Th1/Th17-mediated immunity and molecular signaling pathways of syndesmophyte formation. Additionally, the review sheds light on the pivotal role of cytokine dysregulation, highlighting the significance of the IL-23/17 axis and TNF-α in this intricate network of immune responses which is decisive for therapeutic approaches in the disease. [ABSTRACT FROM AUTHOR]

Objectives Timely diagnosis remains a challenge in axial SpA (axSpA). In addition, data are scarce on the impact of diagnostic delay and disease progression in affected individuals. The British Axial Spondyloarthritis Inception Cohort (BAxSIC) study aims to investigate the impact of newly diagnosed axSpA, the natural history of the disease and the effect of diagnostic delay on disease outcomes. Methods BAxSIC is a prospective, multicentre, observational study. Eligible participants are adults (≥16 years of age), with a physician-confirmed diagnosis of axSpA in the 6 months prior to study entry, recruited from secondary and tertiary rheumatology centres in the UK. Participants will be followed up for 3 years, with in-person visits at baseline and 24 months. In addition, patient self-reported assessments will be recorded remotely via the online electronic case report form (eCRF) at 6, 12, 18, 30 and 36 months. Results The first patient was enrolled in BAxSIC in June 2023. Recruitment is currently ongoing and is planned to end in June 2026. Initial results will be available in 2027. Since opening, the trial has undergone two protocol amendments. Conclusion The BAxSIC study is the first inception cohort designed to investigate the impact of diagnostic delay on clinical presentation and long-term functional outcomes in patients with axSpA in the UK. With an innovative, patient-led virtual longitudinal data collection model, data generated from this study will help inform and improve the care of people newly diagnosed with axSpA. Trial registration ClinicalTrials.gov (http://clinicaltrials.gov), NCT05676775. [ABSTRACT FROM AUTHOR]

Aim: This study examines treatment patterns and preferences among patients diagnosed with Axial Spondyloarthritis (AxSpA) across different age groups. Material and Method: Ankara Bilkent City Hospital registry enabled a comprehensive cross-sectional analysis of 2,811 patients stratified into three age groups: 18-40, 41-55, and over 55 years. These groups were compared in terms of their treatments. Results: Our findings indicate an increasing prevalence of female patients and comorbidities with age. Medication usage patterns showed a trend towards increased use of Methotrexate and Colchicine with age, while Sulfasalazine and Leflunomide were more commonly prescribed in older age groups. Notably, the use of biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs), including anti-Tumor Necrosis Factor (anti-TNF)", "anti-Interleukin (anti-IL) agents, demonstrated a declining trend with advancing age, though not reaching statistical significance. This trend was also reflected in gender-specific treatment distributions, where no significant difference was found in bDMARDs administration among patients over 55 years, contrasting with a higher usage rate in younger male patients. Conclusion: Our study highlights a shift towards more conservative treatment approaches, such as increased conventional synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) use in older patients, likely due to their safety profile and the specific challenges associated with treating older adults, including higher comorbidity rates and medication side effects. These findings emphasize the need for personalized treatment strategies and suggest potential adjustments in clinical practices to better accommodate the aging population, advocating for ongoing research to optimize treatment efficacy and safety for elderly patients with AxSpA. [ABSTRACT FROM AUTHOR]

Background: Fatigue is an important symptom for most patients with axial spondyloarthritis (axSpA). The FACIT-Fatigue is a 13-item patient-reported outcome (PRO) instrument that has been used in axSpA clinical trials to measure fatigue severity and impact on daily activities. However, the psychometric properties of the FACIT-Fatigue are not fully evaluated across the entire spectrum of axSpA including non-radiographic axSpA (nr-axSpA) and radiographic axSpA (r-axSpA). This study determined: (1) the psychometric properties of the FACIT-Fatigue in nr-axSpA, r-axSpA, and the broad axSpA population and (2) FACIT-Fatigue scores representing meaningful within-patient change (MWPC), meaningful between-group differences, and cross-sectional severity bands. Methods: Data from two Phase 3 trials in adults with nr-axSpA (BE MOBILE 1; N = 254) and r-axSpA (BE MOBILE 2; N = 332) were analyzed pooled and separately to assess the psychometric properties of the FACIT-Fatigue. MWPC and meaningful between-group difference estimates were derived using anchor-based and distribution-based methods. Cross-sectional fatigue severity bands were estimated using logistic regression analysis. Results: The FACIT-Fatigue presented good internal consistency, adequate convergent and known-groups validity, and was sensitive to change over time across the full axSpA spectrum. A 5–11-point increase in FACIT-Fatigue score was estimated to represent a MWPC, with an 8-point increase selected as the responder definition. A 2.14–5.34-point difference in FACIT-Fatigue score change over a 16-week period was estimated to represent a small-to-medium meaningful between-group difference. FACIT-Fatigue score severity bands were defined as: none or minimal (>40), mild (>30 to ≤40), moderate (>21 to ≤30), and severe (≤21). Conclusions: These findings support the use of the FACIT-Fatigue as a fit-for-purpose measure to assess fatigue-related treatment benefit in axSpA clinical trials. The proposed score estimates and thresholds can guide FACIT-Fatigue score interpretation across the full axSpA spectrum. Trial registration: ClinicalTrials.Gov, NCT03928704. Registered 26 April 2019—Retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT03928704. ClinicalTrials.Gov, NCT03928743. Registered 26 April 2019—Retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT03928743. Plain English summary: Fatigue is common in patients with axial spondyloarthritis (axSpA)—a painful, chronic disease that mainly affects the joints of the spine. Measuring fatigue in clinical trials is important to see if new treatments for axSpA help reduce this symptom. This study investigated whether a patient-completed measure of fatigue, the 'FACIT-Fatigue', is suitable for use by patients with either of the two main types of axSpA—radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA). This study was needed because we did not know if the FACIT-Fatigue is valid and reliable in both axSpA subtypes and because we are lacking information to interpret the FACIT-Fatigue score in axSpA. Psychometric analysis of clinical trial data showed that the FACIT-Fatigue accurately measures fatigue severity in both types of axSpA. The study additionally pinpointed what change in FACIT-Fatigue score can be used to define whether a treatment has reduced fatigue in a patient, or what constitutes a meaningful between-group difference. It also identified severity score bands that can be used to classify patients into those with no, mild, moderate, or severe fatigue. These findings support using the FACIT-Fatigue in axSpA clinical trials to measure how well treatments reduce fatigue. [ABSTRACT FROM AUTHOR]

Introduction: A previous network meta-analysis established 16-week relative efficacy with bimekizumab, an inhibitor of interleukin (IL)-17F in addition to IL-17A, versus other treatments for patients with radiographic axial spondyloarthritis (r-axSpA; i.e., ankylosing spondylitis), including the IL-17A inhibitors secukinumab and ixekizumab. This matching-adjusted indirect comparison (MAIC) assessed 52-week relative efficacy of bimekizumab versus secukinumab and ixekizumab. Methods: Individual patient data from BE MOBILE 2 (bimekizumab 160 mg; N = 220) were matched to pooled summary data from MEASURE 1/2/3/4 (secukinumab 150 mg), MEASURE 3 (secukinumab 300 mg; escalated dose for inadequate responders), COAST-V (ixekizumab) and COAST-V/-W (ixekizumab). BE MOBILE 2 patients were reweighted using propensity score weights based on age, sex, ethnicity, tumor necrosis factor inhibitor (TNFi) exposure, weight, baseline ASDAS and BASFI (secukinumab) and baseline BASDAI (ixekizumab), and 52-week efficacy outcomes from the trial recalculated. Odds ratios (OR) or mean difference for unanchored comparisons are reported with 95% confidence intervals (CI). Results: At week 52, MAIC demonstrated that patients may have higher likelihood of improvement in key efficacy outcomes with bimekizumab versus secukinumab 150 mg (e.g., ASAS40: [OR (95% CI): 1.48 (1.05, 2.10); p = 0.026]; effective sample size [ESS] = 177). Differences in 52-week efficacy outcomes between bimekizumab and secukinumab 300 mg dose escalation were non-significant (ESS = 120). Bimekizumab versus ixekizumab 80 mg comparisons (COAST-V only; ESS = 84) also suggested that differences were non-significant for most key efficacy outcomes. Other ixekizumab comparisons (COAST-V/-W; ESS = 45) suggested bimekizumab may have higher comparative efficacy for many of the same efficacy outcomes, however ixekizumab analyses were limited by poor population overlap, likely due to the greater proportion of patients with previous TNFi exposure. Conclusions: Patients treated with bimekizumab may have a higher likelihood of achieving improved longer-term efficacy versus secukinumab 150 mg, suggesting bimekizumab may be a favorable therapeutic option for r-axSpA. Differences in efficacy outcomes with bimekizumab versus ixekizumab 80 mg were mostly non-significant, depending on the populations considered. [ABSTRACT FROM AUTHOR]

Introduction: To assess differences in the diagnosis journey and access to care in a large sample of patients with axial spondyloarthritis (axSpA) from around the world, included in the International Map of Axial Spondyloarthritis (IMAS). Methods: IMAS was a cross-sectional online survey (2017–2022) of 5557 unselected patients with axSpA from 27 countries. Across five worldwide geographic regions, the patient journey until diagnosis and healthcare utilization in the last 12 months prior to survey were evaluated. Univariable and multivariable linear regression was used to analyze factors associated with higher healthcare utilization. Results: Of 5557 participants in IMAS, the diagnosis took an average of 7.4 years, requiring more than two visits to HCPs (77.7% general practitioner and 51.3% rheumatologist), and more than two diagnostic tests [67.5% performed human leukocyte antigen B27 (HLA-B27), 64.2% x-ray, and 59.1% magnetic resonance imaging (MRI) scans]. North America and Europe were the regions with the highest number of healthcare professional (HCP) visits for diagnosis, while the lowest number of visits was in the Asian region. In the previous 12 months, 94.9% (n = 5272) used at least one healthcare resource, with an average of 29 uses per year. The regions with the highest healthcare utilization were Latin America, Europe, and North America. In the multiple linear regression, factors associated with higher number of healthcare utilization were younger age (b = – 0.311), female gender (b = 7.736), higher disease activity (b = 1.461), poorer mental health (b = 0.624), greater functional limitation (b = 0.300), greater spinal stiffness (b = 1.527), and longer diagnostic delay (b = 0.104). Conclusion: The diagnosis of axSpA usually takes more than two visits to HCPs and at least 7 years. After diagnosis, axSpA is associated with frequent healthcare resource use. Younger age, female gender, higher disease activity, poorer mental health, greater functional limitation, greater spinal stiffness, and longer diagnostic delay are associated with higher healthcare utilization. Europe and North America use more HCP visits and diagnostic tests before and after diagnosis than the other regions. [ABSTRACT FROM AUTHOR]

To explore the effectiveness and safety of upadacitinib for managing axial spondyloarthritis. Four databases (PubMed, EMBASE, Cochrane, and Web of Science) were applied to search randomized controlled trials (RCTs) for assessing upadacitinib treatment for axial spondyloarthritis published until January 2024. Five RCTs involving 1,246 participants were included. The upadacitinib group had significantly higher percentages of participants achieving Assessment of spondyloarthritis international society (ASAS) 20, ASAS40, ASAS partial remission, Bath ankylosing spondylitis disease activity index (BASDAI) 50, Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, ASDAS inactive disease, ASDAS clinically important improvement, and ASDAS major improvement, except for Work Productivity and Activity Impairment (WPAI) absenteeism. Obvious improvements were observed in the upadacitinib group for ASDAS (CRP), BASDAI, Modified BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI), Canadian Spondyloarthritis Research Consortium (SPARCC) MRI spine, SPARCC MRI sacroiliac joint, Ankylosing Spondylitis Quality of Life (ASQoLS), ASAS Health Index, Bath Ankylosing Spondylitis Metrology Index (BASMI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Total Back Pain, Nocturnal Back Pain, WPAI overall work impairment, WPAI presenteeism, and WPAI activity impairment. Adverse events (AEs) and serious adverse events (SAEs) incidence rates showed no significant difference differ between upadacitinib and placebo groups. Subgroup analysis revealed that disease subtype and age did not significantly affect efficacy, and upadacitinib demonstrated comparable efficacy to adalimumab for axial spondyloarthritis. Upadacitinib exhibited satisfactory efficacy in treating axial spondyloarthritis, reducing disease activity and significantly enhancing patients' physical function, emotional well-being, and social engagement. This meta-analysis offers robust evidence supporting upadacitinib as a new treatment for axial spondyloarthritis patients. [ABSTRACT FROM AUTHOR]