RWCS: What's New in Psoriatic Arthritis and Spondyloarthritis?

Arthur Kavanaugh, MD, explains the recent developments in psoriatic arthritis and spondyloarthritis, as well as what rheumatologists should look forward to in 2022.

Rheumatology Network: What are some of the recent developments in the field of psoriatic arthritis?

Arthur Kavanaugh, MD: Psoriatic arthritis just exploded over the past few years, and this year has been no exception, for example, the approval of the new JAK inhibitor and the approval of the IL-23 inhibitor. It’s very exciting because the more choices we have, the more we like it as clinicians. There’s a lot of interest in the hypothetical, since most people with arthritis had psoriasis first, often 8 or 10 years before. So, if you treated psoriasis very aggressively from the start, can you prevent the development of psoriatic arthritis? There are a handful of papers out this year trying to address that question. But indirectly, they're not controlled studies. And they did not reach a firm conclusion. Some data suggests yes, other data suggests maybe not. But they're great for discussions about how providers need to get information from medical literature, which requires a thorough understanding of clinical epidemiology, methods, limitations of different data sources, and limitations of different analysis. One KOL is going to do kind of a tutorial on clinical epidemiology using cases. It's gotten to be where you may not want to be deeply into clinical epidemiology, but you must understand it to understand how different papers and different analyses can have the opposite conclusions.

RN: What’s new in spondyloarthritis?

AK: My colleague and friend, Dr. Eric Ruderman, and I will be covering spondyloarthritis (SpA). I think of course, the big excitement is the approval JAK inhibitor for Ankylosing Spondylitis or axial spondyloarthritis. It’s very exciting to have an entire new class of agent approved. Ankylosing spondylitis, purely considering the axial manifestations, has been an unmet need. We have we have passed nonsteroidals and we have TNF inhibitors, which were fantastic, but not everybody. They're not ideal for everyone. And IL-17 inhibitors again, fantastic, but not ideal for everyone. So the more choices the better. That’s very exciting.

RN: What should rheumatologist be looking forward to regarding upcoming research in spondyloarthritis?

AK: In spondyloarthritis, there's now that we know and consider more people who have the disease, but don't have damage from it, so-called non-radiographic axial SpA. Not all of those people progress, but they can be very symptomatic. So, it's a question of who is the best candidate for treatment and then, as in all of rheumatology, personalized medicine, i.e. which individual person should get which mechanism of action? We just don't know, as not everybody tolerates nor responds necessarily to a single drug.

RN: What should rheumatologist be looking forward to in 2022?

AK: Biosimilars may come, although I've also heard 2023, but the forces that govern that are not medical or scientific. Rheumatologists should still be on the lookout for that because that's going to impact the treatment group about which medication you are going to be encouraged to use first or in what order, sequencing, and such. That's something to look out for. The biggest unmet need is which medicine for which patients with these different diseases. Lupus has had a number of recent approvals lately. Like psoriatic arthritis, lupus can be very heterogeneous, so it's a real challenge. And we're looking for more data since we have newer therapies and more data about when we should use which therapy for a particular patient. I think that'll be coming. That's why this is really taken off. We also have a presentation by Dr. Anisha Dua, a vasculitis expert from Northwestern, to discuss some very exciting new mechanisms, such as IL-17, and some newer understandings of uses of our current medications. That's been a field of tremendous interest.