Difficult Diagnosis the Focus of Spondyloarthritis Congress

Ingrid Hein

September 27, 2018

GHENT, Belgium — Improved tools and techniques that can be used to diagnose spondyloarthritis and predict disease severity are among the highlights that will be discussed here at biennial International Congress on Spondyloarthritides (SPA) 2018.

"We are gradually developing new treatments, but still have a very hard time making a diagnosis," said Walter Maksymowych, MD, from the University of Alberta in Edmonton, Canada, who is a member of the SPA scientific committee.

"And we lack the tools to evaluate disease activity, prognosis, and outcome," he told Medscape Medical News.

Maksymowych said he is looking forward to presentations on new assessment tools, including new biomarker technologies, the suitability of low-dose radiation CT for the assessment of structural progression in spondyloarthritis, and Doppler ultrasound of entheses in patients with an unclear diagnosis of spondyloarthritis from the EchoSpA prospective multicenter French cohort.

Maksymowych himself will be presenting data on MRI lesion definitions of the Assessment in SpondyloArthritis International Society in patients with axial spondyloarthritis from the same cohort.

"We see an emerging story that MRI is not only useful for diagnosis, but also to predict outcomes," he explained.

Long-term Biologics

Ongoing discussions about the long-term results of treatment with biologics will also be in the limelight.

Agents that target interleukin-17 are of increasing interest, said Maksymowych. "We're now generating longer-term data and will be discussing these results. It's a slow-moving process with incremental changes."

"We're moving beyond primary efficacy and end points in remission" with disease-modifying antirheumatic drugs (DMARDs), said Lianne Gensler, MD, from the University of California, San Francisco.

"Now that we have patients, what are the predictors of remission? Can we taper? Can we stop the drug?" she asked.

Insights into the pathogenesis of the disease in men and women will also be addressed at the meeting.

Gensler will be giving a presentation on the myths and facts related to the role of gender in axial spondyloarthritis and will look at clinical phenotype and response to treatment.

Underlying biology related to gender will be addressed by Eric Gracey, MD, from Toronto, and gender-associated risks for spondyloarthritis will be examined by Walter Magerl, MD, from the Center for Biomedicine and Medical Technology in Mannheim, Germany.

The Gut and the Microbiome

The role of the microbiome in health and chronic inflammation will be the topic of the keynote lecture, which will be delivered by Dusko Ehrlich, PhD, from the microbial genetics unit at the INRA Research Centre in Jouy-en-Josas, France.

"The microbiome continues to be a hot topic," Gensler told Medscape Medical News. "We still don't how it relates to hypogenesis, or whether it really is genetic. We're not sure; maybe there's more than one disease."

It is likely that mechano-stress — how physical forces and changes in the mechanical properties of cells and tissues contribute to the disease — will lead basic science discussions, she said.

"This is one of the big areas I'm interested in learning more about, especially from Maxime Breban, MD, copresident of the congress," she added.

Treat-to-Target Debate Anticipated

Conference goers can look forward to a lively debate on the treat-to-target strategy for spondyloarthritis, in which a specific goal signals either remission or low disease state, Maksymowych said. The approach will be championed by Atul Deodhar, MD, from the Oregon Health and Science University in Portland, and Pedro Machado, MD, from University College London ,will speak against it.

I'm "looking forward" to the meeting and learning about our special areas of interest, Maksymowych said. "We tend to have very focused areas of research and it's always compelling to see the totality of new advances over the 2 years" since the 2016 SPA meeting.

Maksymowych and Gensler have disclosed no relevant financial relationships.

Follow Medscape Rheumatology on Twitter @MedscapeRheum and Ingrid Hein @ingridhein


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.