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Eye-opening findings cast spondyloarthritis in new light, expert says


 

EXPERT ANALYSIS FROM CCR 18

. – Recent findings have led to eye-opening results in the axial spondyloarthritis (SpA) field, including a surprisingly high number of patients with inflammatory back pain who don’t progress to the disease, healthy people who develop SpA-like details on imaging, and significant gender differences in the efficacy of biologic therapy, said Arthur Kavanaugh, MD, professor of medicine at the University of California, San Diego.

The findings could lead clinicians to see the disease differently and consult with patients in new ways, he said.

Dr. Arthur Kavanaugh Bruce Jancin/Frontline Medical News

Dr. Arthur Kavanaugh

In a Mayo Clinic study published this year (Arthritis Rheumatol. 2018 Feb 22. doi: 10.1002/art.40460), researchers assessed the progress of 124 patients originally seen with what was diagnosed as inflammatory back pain, wondering, what happens to them over time?

Just over 20% of the patients progressed to SpA within 5 years, and about 30% over 15 years. But after 5 years, the condition resolved in over 30% of patients – and after 15 years, it resolved in almost half.

In about 5% of patients, symptoms persisted but the condition remained unidentified.

“A lot of people with inflammatory back pain, it doesn’t continue to be an issue – this goes out a decade and a half,” Dr. Kavanaugh said. “I was surprised with this. I would have guess that over this many years, more people would have developed ankylosing spondylitis, but they don’t.”

He said that clinicians should cite this information in their discussions with patients. They should review their case and evaluate spinal symptoms, but let them know that the condition might not progress and might not be permanent.

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