[Axial spondyloarthritis - Update 2021]

Area of Science:

• Rheumatology and Immunology
• Medical Imaging
• Pharmacology

Background:

• Axial spondyloarthritis (axSpA) diagnosis relies on detecting inflammatory changes in sacroiliac joints.
• Recent advancements aim to improve the specificity and sensitivity of diagnostic imaging.
• Current therapeutic strategies include biologics targeting key inflammatory pathways.

Purpose of the Study:

• To review recent data on the diagnostic specificity of active inflammatory changes in sacroiliac joints for axSpA.
• To discuss novel magnetic resonance imaging (MRI) sequences for enhanced erosion detection.
• To summarize the therapeutic landscape, including approved biologics and emerging treatments like Janus kinase (JAK) inhibitors.

Main Methods:

• Review of recent scientific literature and clinical data.
• Discussion of a new MRI sequence designed for improved detection of bone erosions.
• Analysis of clinical trial results for Tumor necrosis factor (TNF) and Interleukin-17 (IL-17) inhibitors, as well as JAK inhibitors.

Main Results:

• New data enhance the understanding of active inflammatory changes in sacroiliac joints for axSpA diagnosis.
• A novel MRI sequence shows potential for improved detection of erosions.
• TNF and IL-17 inhibitors are effective for both radiographic and non-radiographic axSpA.
• JAK inhibitors demonstrate promising results in Phase II/III studies.
• Evidence suggests TNF and IL-17 inhibitors can slow structural spinal progression.

Conclusions:

• Recent data improve diagnostic accuracy for axial spondyloarthritis, particularly regarding sacroiliac joint inflammation.
• Advanced MRI techniques offer better visualization of disease-related erosions.
• Targeted therapies, including TNF, IL-17, and JAK inhibitors, represent significant advancements in managing axSpA and preventing structural damage.