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EULAR update: Talking ’bout a therapy evolution (spondyloarthritis)

EULAR BannerFrom this year’s EULAR annual conference comes major news for people living with spondyloarthritis (SpA). Based on recommendations from a task force of European and North American patients, rheumatologists, dermatologists, and health professionals, new treat-to-target (T2T) guidelines for SpA were announced that emphasize the importance to set a target in shared decision making between a specialist and patient and carefully monitor the disease in order to improve a patient's health outcome.

"The T2T recommendations are following the principle that you have to define a target you want to reach and adapt management to reach this target. This is independent of the treatment you use to reach the target," said Professor Desiree van der Hejde, a professor at Leiden University Medical Centre in the Netherlands.

SpA is a group of diseases characterized by chronic inflammation of the pelvic joints and spine. Often, it is accompanied by arthritis in other joints.

ACE Founder, Cheryl Koehn, is encouraged by the updated recommendations for SpA therapy: "Historically, SpA has not been as well recognized or researched as rheumatoid arthritis (RA). This has occurred despite SpA affecting at least the same number of Canadians as RA (one in 100 people). The EULAR announcement shows the increased attention and new research SpA is receiving here in Canada, in the U.S. and Europe."

The Canadian Spondylitis Association defines spondyloarthritis as follows:

The term Spondyloarthritis (SpA) describes a group of inflammatory arthritis diseases with common features, including inflammation of the spine, eyes, skin and gastrointestinal tract. This group was also sometimes referred to as Spondylitis and Spondyloarthropathies. This group is clinically and genetically related but has distinct entities with several genetic, prognostic and therapeutic differences.

The characteristics of spondyloarthritis are:

  • Spinal arthritis
  • The presence of the gene HLA-B27
  • Peripheral arthritis that differs from Rheumatoid Arthritis
  • Extra articular manifestations of Inflammatory Bowel Disease, Psoriatic Arthritis and Uveitis
  • Seronegative for Rheumatoid Arthritis

The group of diseases includes:

  • Ankylosing Spondylitis (AS)
  • Psoriatic Arthritis (PsA)
  • Enteropathic Arthritis (arthritis associated with Inflammatory Bowel Disease or IBD)
  • Reactive Arthritis (ReA)
  • Juvenile Idiopathic Arthritis that is Enthesitis Related Arthritis (JIA-ERA)
  • Undifferentiated Spondyloarthritis (USpA)

As more is learnt about Spondyloarthritis, the terminology is changing. Today, instead of using the names of the diseases above, we break down Spondyloarthritis into two subsets, Axial Spondyloarthritis and Peripheral Spondyloarthritis.

Axial Spondyloarthritis (AxSpA) affects the spine and sacroiliac joints (the joints between the pelvis and the sacrum or base of the spine). This term is explained as a subheading in the section on Ankylosing Spondylitis.

Peripheral Spondyloarthritis affects areas away from the spine and sacroiliac joint such as finger, arm, foot and leg joints as well as the insertion of muscles and ligaments on bones (enthesis). It includes Psoriatic Arthritis, Reactive Arthritis and Enteropathic Arthritis or Inflammatory Bowel Disease.