2014 Update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Treatment Recommendations for the Management of Spondyloarthritis. Part II: Specific Management Recommendations

Rohekar, Sherry; Chan, Justin; Tse, Shirley M. L.; Haroon, Nigil; Chandran, Vinod; Bessette, Louis; Mosher, Dianne; Flanagan, Cathy; Keen, Kevin J.; Adams, Karen E.; Mallinson, M.; Thorne, Carter; Rahman, Proton; Gladman, Dafna D.; Inman, Robert D.

doi:10.3899/jrheum.141001

Cited by 44 publications

(38 citation statements)

References 191 publications

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“…That changed with the approval of the IL-12/IL-23 antagonist ustekinumab, the phosphodiesterase 4 inhibitor apremilast, and the IL-17A inhibitor secukinumab for the treatment of PsA, and with the approval of secukinumab for the treatment of AS. Now, when patients fail to respond to one biologic due to lack of efficacy or poor tolerability, switching to another biologic with a different mechanism of action can be an effective treatment strategy [42, 43]. …”

Section: Methodsmentioning

confidence: 99%

Mechanistic rationales for targeting interleukin-17A in spondyloarthritis

Raychaudhuri

2017

Arthritis Res Ther

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The term spondyloarthritis (SpA) is used to describe a group of inflammatory autoimmune diseases, including ankylosing spondylitis and psoriatic arthritis, with common genetic risk factors and clinical features. SpA is clinically distinct from rheumatoid arthritis and typically affects the spine, sacroiliac joints, entheses, and, less commonly, peripheral joints. Although the pathogenesis of SpA is not fully understood, recent findings have identified the interleukin (IL)-17 pathway as a key mediator of disease pathogenesis. Clinical evidence for the efficacy of IL-17A inhibition by biologic agents was initially shown in patients with chronic plaque psoriasis, another autoimmune disease mediated by the IL-17 pathway. Subsequently, similar positive efficacy for inhibition of IL-17A was seen in patients with ankylosing spondylitis and psoriatic arthritis. Inhibition of IL-17A may also improve cardiovascular and metabolic comorbidities often found in patients with SpA because studies have linked these disorders to the IL-17 pathway. In this review, we will examine key preclinical studies that demonstrated the mechanistic role of IL-17A in the development SpA and discuss how these observations were translated into clinical practice.

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Section: Methodsmentioning

confidence: 99%

Mechanistic rationales for targeting interleukin-17A in spondyloarthritis

Raychaudhuri

2017

Arthritis Res Ther

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“…Guidelines for management have been issued by expert panels in Europe, 69 the United States, 70 and Canada. 71 Each of these guidelines is based on a systematic review of the literature, and there is substantial agreement among the three. Whether spondyloarthritis is active or stable, patients are advised to follow an active exercise program designed to maintain posture and range of motion.…”

Section: Tr E Atmentmentioning

confidence: 99%

Ankylosing Spondylitis and Axial Spondyloarthritis

2016

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C hronic back pain is common worldwide and is cared for by a variety of providers, but specific, satisfactory treatment is often lacking. Ankylosing spondylitis, an inflammatory disorder that in its extreme form can lead to the bony fusion of vertebral joints, is an uncommon but well-established cause of chronic back pain. During the past decade, ankylosing spondylitis has come to be considered as a subset of the broader and more prevalent diagnostic entity referred to as axial spondyloarthritis. The estimated prevalence of axial spondyloarthritis in the United States is 0.9 to 1.4% of the adult population, similar to that of rheumatoid arthritis. 1 Axial spondyloarthritis is generally diagnosed and treated by rheumatologists, and there is specific treatment for it. However, prolonged delay in reaching the diagnosis is common and is usually the result of the failure of recognition by nonrheumatologists. 2 This review is intended to enhance awareness and understanding of axial spondyloarthritis and ankylosing spondylitis -and the relationship between the two -in order to facilitate prompt and accurate diagnosis and proper treatment. Recent advances in our understanding and treatment of these conditions are discussed.Concep t ua l His t or y a nd Cl a ssific ation

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“…Therapies for SpA and IBD overlap, but effectiveness in the gut and joints can differ 10 . Anti-TNF agents, including adalimumab, ETN, and infliximab (IFX), are all effective and cost-efficient in treating SpA and AS 3,37,38 . However, ETN is not effective for IBD 39 .…”

Section: Kopylov Et Al: the Space Capsule Studymentioning

confidence: 99%

“…Clinicians must consider the potential systemic characteristics of both disorders, musculoskeletal and GI manifestations, and the risk/benefit of available therapies 3,37 . Therapies for SpA and IBD overlap, but effectiveness in the gut and joints can differ 10 .…”

Section: Kopylov Et Al: the Space Capsule Studymentioning

confidence: 99%

Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study

Kopylov

Starr²,

Watts³

et al. 2018

J Rheumatol

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Objective.Inflammatory bowel disease (IBD) is generally reported to be associated with spondylarthropathies (SpA) in 5%–15% of cases. Systematic colonoscopic assessment by protocol demonstrated mucosal inflammation characteristic of Crohn disease (CD) in up to one-third of patients with SpA. Video capsule endoscopy (CE) is a superior diagnostic tool to detect small bowel mucosal disease. Our study compared the accuracy of CE to standard colonoscopy for detection of inflammatory bowel lesions in patients with SpA, and to describe predictors of small bowel inflammation (SBI) in this cohort.Methods.Prospective cross-sectional study of adult patients followed for SpA. Patients were evaluated by CE and standard colonoscopy with biopsies. SBI was quantified using the Lewis Score. Additional screening tests included fecal calprotectin (FCP), C-reactive protein (CRP), and a diagnostic panel of serologic, inflammatory and genetic tests (SGI).Results.There were 64 patients recruited (53% female, mean age 42 ± 13 yrs). Chronic gastrointestinal (GI) symptoms were present in 57%. CE revealed significant SBI in 27/64 (42.2%), compared to 7/64 (10.9%) by standard colonoscopy (p = 0.035). Elevated FCP was associated with small bowel CD (OR 4.5, 95% CI 1.01–19.9; p = 0.042). No correlation was observed with presence of GI symptoms, CRP, or SGI results. Finding CD led to a change in management in 65.2% of cases.Conclusion.CE uncovered SBI consistent with CD in 42.2% of patients with SpA, with a significant incremental yield over colonoscopy of 31%. FCP levels were significantly correlated with CE results, while GI symptoms and SGI results were poor predictors of SBI.

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2014 Update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Treatment Recommendations for the Management of Spondyloarthritis. Part II: Specific Management Recommendations

Abstract: These recommendations were developed based on current literature and applied to a Canadian healthcare context. It is hoped that implementation of these recommendations will promote best practices in the treatment of SpA.

Cited by 44 publications

References 191 publications

Mechanistic rationales for targeting interleukin-17A in spondyloarthritis

Mechanistic rationales for targeting interleukin-17A in spondyloarthritis

Ankylosing Spondylitis and Axial Spondyloarthritis

Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study

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