Gareth Jones (Aberdeen) began proceedings on the first evening with an update on the BSRBR AS study. His report included analysis of baseline smoking data and from the FOMAxS study on the co-occurrence of spondyloarthritis and fibromyalgia, which identified development of management approaches to address the unmet needs of SpA patients with co-morbid fibromyalgia.
NASS Director Debbie Cook gave an update on a busy year – NASS’s 40 th . While responders to their ‘2016 State of the Nation’ patient questionnaire indicated that 82% of AS patients were under the care of a Rheumatologist, a recent study from the University of Aberdeen shows just one third of patients under the care of a rheumatologist. Debbie announced AS One, a new initiative for young people (18 – 35) with AS, to be formally launched in 2017.BRITSpA are contributing to two NASS projects working with RGCP on two e-learning modules, with the potential to reach 50,000 HCPs. Phase one of Back Pain Plus is complete, an awareness campaign aimed at Ophthalmologists, Dermatologists, Gastroenterologists, hoping to address the delay to diagnosis which remains at 8.5 years.
Karl Gaffney (Norfolk & Norwich) highlighted the impact for our practice on updates from BSR (Aug 2016) and NICE (Feb 2016), including Secukinumab for active AS following NSAIDS/Biologics. A wider range of TNF inhibitors is now available with multiple NSAIDs and BASDAIs no longer required pre-treatment, sequential therapy permitted and access for nr-axSpA patients if +ve MRI and/or raised CRP.
The first day ended with Professor Dennis McGonagle’s (Leeds) lecture on MHC-1- Opathy – common Immunopathogenesis in different diseases, with implications for T cell therapy in anti-Cytokine resistant cases and indicating a move towards an immunological SpA classification.
Prof Maya Buch (Leeds) gave a comprehensive talk on Biosimilars documenting their definition, frequently held concerns and the current regulatory pathway;and challenges still to consider: immunogenicity and interchangeability. careful post-marketing pharmacovigilance is importantfor both biosimilar and reference products. Early transition data from the PLANETAS extension study and long-term extension of a Japanese study of CI-P13 were discussed. It was concluded that appropriate use of biosimilars will drive greater competition which in turn brings value and opportunity to widen access for patients in some circumstances, as well as significant savings.
Richard Cuthbert (Leeds) delivered an interesting lecture on IL-23 in the human enthesis: implications for a better understanding of SpA, reporting that IL-23 acts on various cell types causing the release of the potent inflammatory cytokines IL-17 and IL-221; that IL-22 may also play a role in the aberrant bone formation often observed in human spondyloarthropathies; and that recent mouse studies suggest a role for resident IL-23 responsive cells at the enthesis
Allan Wailoo (Sheffield) gave an illuminating talk on Health economics and spondyloarthritis: what health care professionals need to know, discussing long-term costs, the relationship between long-term disease state and costs incurred to the health service and potentially to other non-NHS costs (productivity, family carers, etc). He summarised that registries – data collection, tracking patients and recording their quality of life – are critical for the future, and may answer yet unforeseen questions.
Delegates were treated to a lively debate, with Pedro Machado (UCL)proposing: This house believes BASDAI is now obsolete: we need a more objective, composite measure to assess disease activity in axSpA, with Andrei Calin (retired) putting up a spirited defence. Delegates were then asked to vote and Dr Machado narrowly won the day.
Stefan Siebert (Glasgow) discussed: Is there really an increased cardiovascular risk in axSpA? He critically appraised data from meta-analysis of CVD risk in AS and reviewed the EULAR 2010 guidelines regarding increased risk CVD as part of extra-articular manifestations and comorbidity, finally recommending a common sense approach for clinic, reducing established risk factors.
Rheumatology Consultant Nurse Trish Cornell then reported on the thoughts and perceptions of patients on anti TNF therapy, discussing the role of the nurse in initiation, effective communication methods and virtual ax SpA clinics. She highlighted the aging workforce of rheumatology nurses.
his year BRITSpA was pleased to run its first abstract competition, with twelve submissions considered and four delegates asked to present. The winner of the certificate and cheque for £500 was Steven Zhao (Aintree) who gave an excellent presentation of his work: Autoantibodies to Osteoprotegerin in Axial Spondyloarthritis. Exploring whether prevalence of OPG-Ab in axSpA is higher than in a healthy population and whether they were associated with measures of bone health in axSpA, he concluded OPG-Ab may be biomarker for accelerated bone loss in axSpA and emphasised the need to explore this in a prospective study.
UCL radiologist Margaret Hall-Craggs delivered an abstract on data on the natural history of sacroiliitis in young people with enthesitis-related arthritis on biologic therapy. Her data suggest that ERA patients undergo a reduction in inflammation but a substantial increase in fusion and fat metaplasia after biologic treatment, concluding that Biologic therapy has not prevented fusion in these patients, although it is unclear whether fusion is a consequence of the inflammation itself or biologic treatment.
Paul Bowness (Oxford) presented Hussein Al-Mossawi’s abstract: is GM-CSF a therapeutic target in spondyloarthritis? This asked whether GM-CSF an important cytokine in human ‘type 17′ driven diseases (AS) and concluded it may be a good therapeutic target in AS/SpA.
Marie Therese McDonald’s abstract (Glasgow) ‘The association of physical activity and sedentary behaviour with disease measures in axial spondyloarthritis’ aimed to assess whether physical activity and sedentary behaviour of people with AxSpa are associated with disease measures.In this small sample, sedentary time was associated with poorer quality of life. Physical activity was not associated with disease activity, suggesting physical activity interventions are essential to all AxSpa patients, independent of their disease activity.
The final presentation was from John Ioannou and Corinne Fisher (UCL): What adult rheumatologists need to know about juvenile spondyloarthritis, reporting on low remission rates in adulthood compared to other subtypes of JIA and high rates of hip disease associated with poor prognosis. Three case studies were given, highlighting the complex changes in the immune system and skeleton occurring during adolescence.