Thread by @rheum_cat

#ACR22 #ReviewCourse

Dr Jose Scher on #Spondyloarthritis

Getting on the same page: our current understanding of pathogenesis

#ACR22 #ReviewCourse

And here are the CLASSIFICATION criteria for spondyloarthritis (which are NOT diagnostic criteria)

❗️Gaps in knowledge remain:
-lack of biomarkers
-expert rheumatologist opinion as gold std
-MRI findings have low Sp

#ACR22 #ReviewCourse

nr-axSpA progression to r-axSpA?

In the PROOF study, slow and low %
@DrPoddubnyy
pubmed.ncbi.nlm.nih.gov/34897381/

#ACR22 #ReviewCourse

NSAIDs remain first line for axSpA

#ACR22 #ReviewCourse

What biologics are FDA approved for nr-axSpA?

FYI UPA approved ~3 wks ago for nr-axSpA (approval for r-axSpA came during the last @SPARTAN_Updates meeting)

#ACR22 #ReviewCourse

Coming soon: bimekizumab (inhibition of IL-17A and F), efficacious for both nr-axSpA and r-axSpA

Plenty of data on this med during this meeting as well

#ACR22 #ReviewCourse

Updates on the guidelines from @Official_ASAS @eular_org, presented at #EULAR2022

👉Re-evaluate the dx when treatments fail!
👉Tapering can be considered when low dz activity

Publication here: pubmed.ncbi.nlm.nih.gov/36270658/

#ACR22 #ReviewCourse

@Official_ASAS @eular_org Clinical overview of #PsA all on one slide

#ACR22 #ReviewCourse

@Official_ASAS @eular_org The studies that established efficacy for IL-17A inhibitors in PsA tx

Secukinumab - FUTURE 2

Ixekizumab - SPIRIT-P1 (adalimumab was not compared head to head, nb)

#ACR22 #ReviewCourse

The studies that established efficacy for JAK inhibitors in PsA tx

Tofa - OPAL Broaden
Upa - SELECT PsA

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IL23 inhibitors for PsA

guselkumab - DISCOVER 1
risankizumab - KEEPsAKE 2

Note the skin responses

#ACR22 #Reviewcourse

PsA, other lessons learned from trials

👉MTX may be good in early, bio-naive PsA

👉IL-17i > TNFi for combined outcomes (e.g., ACR50 + PASI100) though in H2H study of ADA vs SEC primary outcome showed no difference

#ACR22 #REviewcourse

Biologic persistence is modest in PsA and cycling (switching thru biologics) is the norm in real world data

#ACR22 #Reviewcourse

IL17i withdrawal in PsA: SPIRIT P3: relapse common but 96% of those with flare after w/d regained response

TNFi taper? Could be a feasible strategy in some with PsA

#ACR22 #ReviewCourse

Updated @GrappaO guidelines. A lot not new, still have the domains, and still don't have data to guide recs on sequence of treatments

#ACR22 #ReviewCourse

Do you crave a treatment algorithm for PsA based on practical, expert center experience?

#ACR22 #ReviewCourse

Upcoming oral option, deucravacitinib, TYK2 inhibitor recently approved for PsO

#ACR22 #Reviewcourse

And, currently recruiting, AFFINITY

Combo TNFi & IL23i (guselkumab) being tested

#ACR22 #ReviewCourse