Treatment strategies for Spondyloarthritis: Implementation of precision medicine – Or “one size fits all” concept?

IF 9.2 1区 医学 Q1 IMMUNOLOGY Autoimmunity reviews Pub Date : 2024-09-12 DOI:10.1016/j.autrev.2024.103638
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Abstract

Spondyloarthritis (SpA) is a term to describe a group of chronic inflammatory rheumatic diseases, which have common pathophysiological, genetic, and clinical features. Under the umbrella term SpA, two main groups are subsumed: axial SpA (radiographic axSpA and non-radiographic axSpA) and peripheral SpA (with the leading representative being psoriatic arthritis (PsA) but also arthritis associated with inflammatory bowel disease (IBD), reactive arthritis, and undifferentiated pSpA). The key clinical symptom in axSpA is chronic back pain, typically with inflammatory characteristics, which starts in early adulthood, while the leading clinical manifestations of peripheral SpA (pSpA) are arthritis, enthesitis, and/or dactylitis. Furthermore, extra-musculoskeletal manifestations (EMMs) (acute anterior uveitis, psoriasis, and IBD) can accompany axial or peripheral symptoms. All these factors need to be taken into account when making treatment decisions in SpA patients. Despite the major advances in the treatment landscape over the past two decades with the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and most recently targeted synthetic DMARDs (tsDMARDs), a relevant proportion of patients still does not achieve the desired state of remission (=absence of disease activity). With this implementation of new treatment modalities, clinicians now have more choices to make in the treatment algorithms. However, despite generalized treatment recommendations, all factors need to be carefully considered when deciding on the optimal treatment strategy for an individual patient in clinical practice, aiming at an important first step towards personalized treatment strategies in SpA. In this narrative review, we focus on the efficacy of approved and emerging treatment options in axSpA and PsA as the main representative of pSpA and discuss their selective effect on the different manifestations associated with SpA to provide guidance on drivers of treatment decisions in specific situations.

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脊柱关节炎的治疗策略:实施精准医疗--还是 "一刀切 "概念?
脊柱关节炎(Spondyloarthritis,SpA)是描述一组慢性炎症性风湿病的术语,这些疾病具有共同的病理生理学、遗传学和临床特征。在 SpA 这个总括术语下,包括两大类:轴性 SpA(放射学 axSpA 和非放射学 axSpA)和外周性 SpA(主要代表是银屑病关节炎(PsA),但也包括与炎症性肠病(IBD)相关的关节炎、反应性关节炎和未分化的 pSpA)。axSpA的主要临床症状是慢性背痛,通常具有炎症特征,始于成年早期,而外周性SpA(pSpA)的主要临床表现是关节炎、肌腱炎和/或趾关节炎。此外,肌肉骨骼外表现(EMMs)(急性前葡萄膜炎、银屑病和肠道传染病)也可能伴随轴向或外周症状。在对 SpA 患者做出治疗决定时,需要考虑到所有这些因素。尽管过去二十年来,随着生物改良抗风湿药(bDMARDs)和最近的靶向合成DMARDs(tsDMARDs)的引入,治疗领域取得了重大进展,但仍有相当一部分患者无法达到理想的缓解状态(=无疾病活动)。随着新治疗模式的实施,临床医生在治疗算法上有了更多的选择。然而,尽管有了通用的治疗建议,但在临床实践中为个体患者决定最佳治疗策略时,仍需仔细考虑所有因素,以迈出SpA个性化治疗策略的重要第一步。在这篇叙述性综述中,我们将重点关注已获批准的和新出现的治疗方案在作为 pSpA 主要代表的 axSpA 和 PsA 中的疗效,并讨论它们对 SpA 相关不同表现的选择性作用,从而为特定情况下的治疗决策提供指导。
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来源期刊
Autoimmunity reviews
Autoimmunity reviews 医学-免疫学
CiteScore
24.70
自引率
4.40%
发文量
164
审稿时长
21 days
期刊介绍: Autoimmunity Reviews is a publication that features up-to-date, structured reviews on various topics in the field of autoimmunity. These reviews are written by renowned experts and include demonstrative illustrations and tables. Each article will have a clear "take-home" message for readers. The selection of articles is primarily done by the Editors-in-Chief, based on recommendations from the international Editorial Board. The topics covered in the articles span all areas of autoimmunology, aiming to bridge the gap between basic and clinical sciences. In terms of content, the contributions in basic sciences delve into the pathophysiology and mechanisms of autoimmune disorders, as well as genomics and proteomics. On the other hand, clinical contributions focus on diseases related to autoimmunity, novel therapies, and clinical associations. Autoimmunity Reviews is internationally recognized, and its articles are indexed and abstracted in prestigious databases such as PubMed/Medline, Science Citation Index Expanded, Biosciences Information Services, and Chemical Abstracts.
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