164 research outputs found
Beyond the horizon: Innovations and future directions in axial-spondyloarthritis
No full textAxial spondyloarthritis (axSpA) is a chronic inflammatory disease of the spine and sacroiliac joints. This review discusses recent advances across multiple scientific fields that promise to transform axSpA management. Traditionally, axSpA was considered an immune-mediated disease driven by human leukocyte antigen B27 (HLA-B27), interleukin (IL)-23/IL-17 signaling, biomechanics, and dysbiosis. Diagnosis relies on clinical features, laboratory tests, and imaging, particularly magnetic resonance imaging (MRI) nowadays. Management includes exercise, lifestyle changes, non-steroidal anti-inflammatory drugs and if this is not sufficient to achieve disease control also biological and targeted-synthetic disease modifying anti-rheumatic drugs. Beyond long-recognized genetic risks like HLA-B27, high-throughput sequencing has revealed intricate gene-environment interactions influencing dysbiosis, immune dysfunction, and aberrant bone remodeling. Elucidating these mechanisms promises screening approaches to enable early intervention. Advanced imaging is revolutionizing the assessment of axSpA's hallmark: sacroiliac bone-marrow edema indicating inflammation. Novel magnetic resonance imaging (MRI) techniques sensitively quantify disease activity, while machine learning automates complex analysis to improve diagnostic accuracy and monitoring. Hybrid imaging like synthetic MRI/computed tomography (CT) visualizes structural damage with new clarity. Meanwhile, microbiome analysis has uncovered gut ecosystem alterations that may initiate joint inflammation through HLA-B27 misfolding or immune subversion. Correcting dysbiosis represents an enticing treatment target. Moving forward, emerging techniques must augment patient care. Incorporating patient perspectives will be key to ensure innovations like genetics, microbiome, and imaging biomarkers translate into improved mobility, reduced pain, and increased quality of life. By integrating cutting-edge, multidisciplinary science with patients' lived experience, researchers can unlock the full potential of new technologies to deliver transformative outcomes. The future is bright for precision diagnosis, tightly controlled treatment, and even prevention of axSpA
The management of axial spondyloarthritis with cutting-edge therapies: advancements and innovations
No full textIntroduction: Axial involvement in spondyloarthritis has significantly evolved from the original 1984 New York criteria for ankylosing spondylitis, leading to an improved understanding of axial spondyloarthritis (axSpA) as a disease continuum encompassing non- radiographic axSpA (nr-axSpA) and radiographic axSpA (r-axSpA). A clear definition for early axSpA has been established, underscoring the need for early intervention with biological and targeted synthetic drugs to mitigate pain, reduce functional impairment, and prevent radiographic progression. Areas covered: This review explores therapeutic strategies in axSpA management, focusing on biological and targeted synthetic therapies and recent advancements. Biologics targeting TNFα or IL-17 and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) are primary treatment options. These therapies significantly impact clinical outcomes, radiographic progression, and patient-reported functional improvement. Expert opinion: AxSpA treatment has evolved significantly, offering various therapeutic options. Biological DMARDs, particularly TNFα inhibitors, have transformed treatment, significantly enhancing patient outcomes. However, challenges persist for patients unresponsive or intolerant to existing therapies. Emerging therapeutic targets promise to address these challenges. Comprehensive management strategies and personalized approaches, considering extra-articular manifestations and individual patient factors, are crucial for achieving optimal outcomes in axSpA management
Managing Musculoskeletal Symptoms in Patients With Psoriasis: Who Should Be in the Driver’s Seat?
No full textThe Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting included a lively debate regarding the optimal management of musculoskeletal (MSK) symptoms in patients with psoriasis (PsO) at risk of or with early psoriatic arthritis (PsA). Drs. Fabian Proft and Laura Savage presented comprehensive, evidence-based retrospective arguments from the perspectives of rheumatology and dermatology. Proft advocated for rheumatologists to lead PsA management by highlighting the specialized training that allows rheumatologists to identify inflammatory diseases and use advanced imaging techniques to differentiate PsA from mechanical MSK conditions. In contrast, Savage emphasized the pivotal role of dermatologists, who often serve as the first healthcare providers (HCPs) to encounter emergent PsA in their patients with PsO. Dermatologists are increasingly aware of the importance of early detection and timely intervention, as well as of the new data that support the concept of "treating to intercept" in patients at risk of transition from PsO to PsA. Both experts highlighted systemic barriers hindering collaborative care and underscored the necessity of patient-centered approaches that effectively address skin and joint manifestations. This article summarizes the insightful debate, reinforcing the importance of a multidisciplinary approach to optimize patient outcomes with PsA
Beyond inflammation: the molecular basis of bone remodeling in axial spondyloarthritis and psoriatic arthritis
No full textSpondyloarthritis (SpA) encompasses a group of chronic inflammatory diseases with overlapping genetic, clinical, and radiographic features. Axial spondyloarthritis (axSpA), a subset of SpA, predominantly involves the sacroiliac joints and spine, often progressing to ankylosis, severe disability, and functional impairment. Psoriatic arthritis (PsA), another SpA subtype, is characterized by a heterogeneous phenotype that includes peripheral arthritis, enthesitis, and axial involvement, frequently associated with psoriasis. Bone remodeling in axSpA and PsA is driven by a dynamic interplay between inflammatory cytokines and the uncoupling of anabolic and catabolic processes, resulting in bone erosion, systemic and local bone loss, and pathological new bone formation. In axSpA, tumor necrosis factor-alpha (TNFα) and interleukin-17A (IL-17A) drive osteoclastogenesis via the RANKL pathway while suppressing osteoblast-mediated bone formation through WNT/β-catenin signaling. Mechanical stress, combined with inflammatory mediators, promotes mesenchymal stem cell differentiation and new bone formation, which manifests as syndesmophytes and contributes to progressive ankylosis. Conversely, PsA is distinguished by concurrent bone erosion and neoformation, driven by IL-17A, IL-22, and IL- 23, with axial disease exhibiting asymmetrical, bulky para-syndesmophytes rather than the fine, hair-like syndesmophytes typical of axSpA. Advanced imaging modalities, particularly MRI, have elucidated key mechanisms of disease progression, revealing processes such as fat metaplasia and reparative changes. This review explores the intricate molecular and cellular mechanisms underlying bone remodeling in SpA, emphasizing both shared pathways and disease-specific features. It aims to enhance the understanding of these processes to support the development of more precise and effective therapeutic approaches tailored to axSpA and PsA
sj-docx-1-tab-10.1177_1759720X221085951 – Supplemental material for Validation of the ASDAS with a quick quantitative CRP assay (ASDAS-Q) in patients with axial SpA: a prospective multicentre cross-sectional study
No full textSupplemental material, sj-docx-1-tab-10.1177_1759720X221085951 for Validation of the ASDAS with a quick quantitative CRP assay (ASDAS-Q) in patients with axial SpA: a prospective multicentre cross-sectional study by Fabian Proft, Julia Schally, Henning Christian Brandt, Jan Brandt-Juergens, Gerd Rüdiger Burmester, Hildrun Haibel, Henriette Käding, Kirsten Karberg, Susanne Lüders, Burkhard Muche, Mikhail Protopopov, Judith Rademacher, Valeria Rios Rodriguez, Murat Torgutalp, Maryna Verba, Silke Zinke and Denis Poddubnyy in Therapeutic Advances in Musculoskeletal Disease</p
Factors Associated with Achieving Remission in Patients with Early Peripheral Spondyloarthritis: 10-Year Results from the German Spondyloarthritis Inception Cohort
No full textTorgutalp M, Peng X, Proft F, et al. Factors Associated with Achieving Remission in Patients with Early Peripheral Spondyloarthritis: 10-Year Results from the German Spondyloarthritis Inception Cohort. In: ACR Convergence 2023 Abstract Supplement. Arthritis & Rheumatology . Vol 75. Hoboken: Wiley; 2023: 4380-4381
sj-docx-2-tab-10.1177_1759720X211057975 – Supplemental material for Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)
No full textSupplemental material, sj-docx-2-tab-10.1177_1759720X211057975 for Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) by Denis Poddubnyy, Xenofon Baraliakos, Filip Van den Bosch, Jürgen Braun, Laura C. Coates, Vinod Chandran, Torsten Diekhoff, Floris A. van Gaalen, Lianne S. Gensler, Niti Goel, Alice B. Gottlieb, Désirée van der Heijde, Philip S. Helliwell, Kay Geert A. Hermann, Deepak Jadon, Robert G. Lambert, Walter P. Maksymowych, Philip Mease, Peter Nash, Fabian Proft, Mikhail Protopopov, Joachim Sieper, Murat Torgutalp and Dafna D. Gladman in Therapeutic Advances in Musculoskeletal Disease</p
sj-docx-1-tab-10.1177_1759720X211057975 – Supplemental material for Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)
No full textSupplemental material, sj-docx-1-tab-10.1177_1759720X211057975 for Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) by Denis Poddubnyy, Xenofon Baraliakos, Filip Van den Bosch, Jürgen Braun, Laura C. Coates, Vinod Chandran, Torsten Diekhoff, Floris A. van Gaalen, Lianne S. Gensler, Niti Goel, Alice B. Gottlieb, Désirée van der Heijde, Philip S. Helliwell, Kay Geert A. Hermann, Deepak Jadon, Robert G. Lambert, Walter P. Maksymowych, Philip Mease, Peter Nash, Fabian Proft, Mikhail Protopopov, Joachim Sieper, Murat Torgutalp and Dafna D. Gladman in Therapeutic Advances in Musculoskeletal Disease</p
sj-7z-3-tab-10.1177_1759720X211057975 – Supplemental material for Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)
No full textSupplemental material, sj-7z-3-tab-10.1177_1759720X211057975 for Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) by Denis Poddubnyy, Xenofon Baraliakos, Filip Van den Bosch, Jürgen Braun, Laura C. Coates, Vinod Chandran, Torsten Diekhoff, Floris A. van Gaalen, Lianne S. Gensler, Niti Goel, Alice B. Gottlieb, Désirée van der Heijde, Philip S. Helliwell, Kay Geert A. Hermann, Deepak Jadon, Robert G. Lambert, Walter P. Maksymowych, Philip Mease, Peter Nash, Fabian Proft, Mikhail Protopopov, Joachim Sieper, Murat Torgutalp and Dafna D. Gladman in Therapeutic Advances in Musculoskeletal Disease</p
Diagnostik, Therapie und Verlaufsbeurteilung der axialen Spondyloarthritis
No full textIn den letzten zwei Dekaden haben sich im Feld der Spondyloarthritiden wichtige Neuerungen ergeben. Vordergründig sind das Konzept der axialen Spondyloarthritis als Kontinuum mit zwei Untergruppen – der radiographischen axialen Spondyloarthritis und der nicht-röntgenologischen axialen Spondyloarthritis, die Diagnostik der Erkrankung unter Einbezug der MRT zur Erkennung der Frühformen der Erkrankung sowie direkten Visualisierung entzündlicher Prozesse im Bereich der Wirbelsäule sowie der SIG, die Implementation neuer Klassifikationskriterien sowie die Zulassung diverser hocheffektiver Therapien zu nennen.
Nichtsdestotrotz bleiben weitere wichtige Fragen bestehen. So ist insbesondere die Ätiologie und Pathogenese der axSpA nicht ausreichend verstanden und somit stehen lediglich effektive Behandlungsansätze, jedoch weiterhin keine Heilungsmöglichkeiten dieser chronischen immunvermittelten Erkrankung zur Verfügung stehen. Ein wichtiger Schritt zu einem besseren Verständnis der Erkrankung könnte in der Entdeckung des Zusammenspiels des gastro-intestinalen Microbioms mit den Spondyloarthritiden bestehen. [135, 136] Dessen Einfluss auf Krankheitsentstehung und Krankheitsaktivität muss jedoch noch weiter erforscht werden, um hieraus möglichen Nutzen ziehen zu können.
Auch konnte die Diagnoseverzögerung deutlich verkürzt werden, jedoch ist diese weiterhin mit durchschnittlich 5,7 Jahren in Deutschland [41] inakzeptabel lange und der Fokus zur Frühdiagnose muss beibehalten und nach neuen Möglichkeiten - auch unter Einbezug digitaler Ansätze – gesucht werden. Darüber hinaus erreichen trotz der Zulassung von bDMARDs als neue Therapieoptionen im klinischen Alltag weiterhin weniger als die Hälfte der axSpA Patienten den angestrebten Zustand einer inaktiven Erkrankung. [137, 138] Dies muss als ein klares Signal verstanden werden einerseits die zur Verfügung stehenden Therapien konsequenter einzusetzen und andererseits nach weiteren Therapieoptionen sowie komplementären Maßnahmen zu forschen. Da auf Grund der zum Teil erst kürzlich erfolgten Zulassungen diverser bDMARDs für das gesamte Spektrum der axSpA Langzeiterfahrungen zum Einsatz dieser Medikamente in der Patientengruppe mit axSpA fehlen, ist es von hoher Bedeutung Erfahrungen zu Sicherheit und Wirksamkeit dieser Therapien bei Patienten
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mit axSpA im „echten Leben“ anhand von Registerdaten und Beobachtungsstudien zu sammeln. Um einen Leitfaden für die optimale Versorgung von axSpA Patienten zu haben stellen die kürzlich veröffentlichten Qualitätsstandards der ASAS [67] einen Meilenstein dar. Jedoch müssen Wege identifiziert werden, wie die hier empfohlenen Maßnahmen auch im Rahmen der klinischen Routine unter dem wirtschaftlichen Druck sowie in Anbetracht der aktuellen Versorgungssituation erreicht werden können.
Im Rahmen dieser Habilitationsschrift wurde der aktuelle Stand zu den Themen der Diagnostik, Therapie und Verlaufsbeurteilung bei der axialen Spondyloarthritis erörtert, die eigenen Arbeiten zu dem Thema vorgestellt und deren möglicher Einfluss auf die Versorgungssituation von Betroffenen diskutiert. Darüber hinaus wurden weiterhin bestehende Fragen zur axialen Spondyloarthritis definiert, welche im Rahmen wissenschaftlicher Projekte in der Zukunft bearbeitet werden sollten
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