Treatment of Axial Spondyloarthritis: What Does the Future Hold?
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SPONDYLOARTHRITIS (M KHAN, SECTION EDITOR)
Treatment of Axial Spondyloarthritis: What Does the Future Hold? Denis Poddubnyy 1,2 & Joachim Sieper 1
# The Author(s) 2020
Abstract Purpose of Review To provide a summary of the recent and expected developments related to the treatment of axial spondyloarthritis. Recent Findings An increasing number of interleukin-17 blocking agents show efficacy in axial spondyloarthritis including both non-radiographic and radiographic forms. Janus kinase inhibitors showed promising results in phase II studies in radiographic axial spondyloarthritis and have, therefore, a potential to become a therapeutic option in this indication in the future. Inhibition of structural damage progression in axial spondyloarthritis seems to be possible in the case of effective and early anti-inflammatory treatment, although there are still open questions related to particular drug classes. Summary Despite major advances in the field and growing therapeutic options, there are still many open questions related to the optimized treatment strategies and to the individual choice of a drug in axial spondyloarthritis. Keywords Axial spondyloarthritis . Ankylosing spondylitis . Treatment
Introduction Axial spondyloarthritis (axSpA) is a term which covers both patients with already obvious structural damage in the sacroiliac joints (SIJ) visible on X-rays, termed radiographic axSpA—r-axSpA (also knowns as ankylosing spondylitis— AS)—and patients who have not yet developed such structural damage in the SIJ, termed non-radiographic (nr)-axSpA [1]. A substantial part of patients with axSpA will move from nraxSpA to rad axSpA over time, but not all of them [2, 3]. The inflammation normally starts in the SIJ but can later on extend to inflammatory and structural changes in the spine. AxSpA is a disease of young people (starting before the age of 45 years, but often beginning in the third decade of life), and men are slightly more frequently affected than women [4].
Current Assessment of Spondyloarthritis International Society (ASAS)–European League Against Rheumatism (EULAR) [5] and American College of Rheumatology (ACR)–Spondylitis Association of America (SAA)– Spondyloarthritis Research and Treatment Network (SPARTAN) [6] management recommendations cover the whole group of axSpA. First line of medical treatment is still non-steroidal anti-inflammatory drugs (NSAIDs) followed by biological disease-modifying anti-rheumatic drugs (bDMARDs) and—potentially in the future—targeted synthetic (ts) DMARDs such as Janus kinase (JAK) inhibitors (JAKi). Based on these current recommendations, we will address in this review open question about current and future treatment possibilities. We discuss this for axSpA although older studies often included only patients with r-axSpA.
This article is part of the Topical Collection on Spondyloarthritis * Denis Poddubnyy [email protected] 1
2
Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité – Universitätsmedizin Ber
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