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Axial Spondyloarthritis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
The very concept of axial spondyloarthritis has evolved over the last ten years. Advances in our understanding of the pathophysiology, clinical characteristics, epidemiology, and imaging of the condition have improved our ability to assess and care for these patients. Historically, the disease entity of ankylosing spondylitis was characterized by sacroiliitis on radiographs, vertebral fusion via syndesmophytes leading to “bamboo spine,” and progressive loss of range of motion of the spine and chest wall. This was reflected by the 1984 Modified New York Criteria, which required at least one clinical criterion, including chronic low back pain improved by exercise and not relieved by rest, limitation of lumbar spine range of motion in sagittal and frontal planes, or limitation of chest expansion, along with either bilateral grade 2–4 sacroiliitis or unilateral grade 3–4 sacroiliitis on radiographs.1
Blood-based biomarkers of chronic inflammation
Published in Expert Review of Molecular Diagnostics, 2023
As the twentieth century progressed, inflammation was seen to involve reactions, both extracellularly within the connective tissue matrix, and intracellularly within adjacent local parenchymal cells. The sequence of these reactions came to be described in exquisite biochemical and cell physiologic detail with specific adaptations for particular tissues [9]. Notably, in some conditions, inflammation occurred entirely within connective tissues only, giving rise to the concept of ‘collagen diseases’ [18,19]. Less well recognized because historically inflammation was associated with blood vessel congestion (redness), and increased permeability, components of inflammation, particularly edema and cellular reaction (secretion of proteoglycan), could occur in avascular connective tissues such as cartilage, and enthesis. These components are particularly prominent in the chronic inflammatory disease, ankylosing spondylitis, now termed with an expanded definition, axial spondyloarthritis [20–24].
Tofacitinib for the treatment of active ankylosing spondylitis in adults
Published in Expert Review of Clinical Immunology, 2022
Raagav Mohanakrishnan, Secia Beier, Atul Deodhar
Spondyloarthritis (SpA) is a group of chronic immune-mediated inflammatory disorders that encompasses many diseases involving joints, entheses, skin, nails, as well as extra-musculoskeletal organs such as eyes and gastrointestinal tract. Axial spondyloarthritis (axSpA), a member of the SpA family of diseases, is an inflammatory arthritis that involves the spine including sacroiliac joints, and often manifests as chronic back pain [1,2]. AxSpA can further be differentiated into ankylosing spondylitis (AS), also known as radiographic axial spondyloarthritis, and non-radiographic axial spondyloarthritis (nr-axSpA) based on the presence or lack of definitive sacroiliitis on imaging, respectively [2]. There have been many treatment options developed for axial spondyloarthritis, focusing primarily on symptom management and the inflammatory cascade. These treatments include physical therapy, non-steroid anti-inflammatory drugs (NSAIDs), and biologics such as anti-tumor necrosis factor alpha (anti-TNF-alpha) inhibitors, and Interleukin 17 (IL-17) inhibitors [3]. Janus kinase inhibitors (JAKi) are the latest class of agents to have undergone successful clinical trials in the treatment of axSpA [4]. While this article specifically focuses on the use of tofacitinib in adults with active AS, we have included a brief review on the pathogenesis of AS, since it is germane to the discussion on why JAK inhibitors would be useful in the management of AS.
Disease activity trajectories in rheumatoid arthritis: a tool for prediction of outcome
Published in Scandinavian Journal of Rheumatology, 2021
M Leu Agelii, MLE Andersson, BL Jones, C Sjöwall, A Kastbom, I Hafström, K Forslind, I Gjertsson
Trajectories have been used to describe evolution in various diseases including RA (11, 15, 20, 21), but to our knowledge, the contribution of the different DAS28 components and a comparison to EULAR response have not previously been shown. The multi-trajectory approach accounts for the interrelationship between multiple outcomes, which is very useful in our setting as we simultaneously illustrate the trajectories for DAS28 and each component (28). We identified three significantly different trajectories for patients with early RA in BARFOT, and validated these in TIRA-2 with respect to DAS28 evolution. A Canadian study (11) found a similar evolution and percentage of participants in the top (worst) DAS28 trajectory (11%) over 24 months after diagnosis, as in TIRA-2. The percentage is lower than the 19% belonging to the top DAS28 trajectory found in BARFOT. This is not surprising; the time of enrolment was very similar to that in TIRA-2, while BARFOT is an older cohort that was collected earlier. Another cohort study of early RA participants enrolled slightly earlier than BARFOT (1986–1997) found that, in term of psychological distress, 23% of the participants were on a high–stable or low–increasing stress trajectory over the course of 10 years (14). In a relatively small study of 370 patients with early axial spondyloarthritis followed for 3 years, 34% were on a high persistent disease activity trajectory (19).