This edition of the newsletter was revised to include the CLASSIC study update that was inadvertently omitted in the prior version.
  Fall 2020                                                                   Volume 6 Issue 3

We are coming to the end of a very unusual, eventful year and gearing up for the imminent virtual ACR conference. Regardless of format, this conference remains an invaluable way to keep abreast of the scientific advances made in Rheumatology. This edition of the newsletter aims to highlight the Spondyloarthritis sessions at ACR and aid in navigating the marathon 4-day ACR virtual meeting.

I would also like to put in a plug for the post-ACR SPARTAN-GRAPPA-ASAS educational symposium on November 10th. We are very excited to offer an excellent group of distinguished speakers and look forward to their talks. Register today!

Best Wishes,


Judy Smith


We are pleased to announce that we have activated half of the planned investigative sites, for a total of 12 active sites; We now have active sites in all 3 participating countries: USA, Mexico and Canada. 

Despite COVID-19 related challenges, we currently have 6 sites actively recruiting patients for a total of 60 patients enrolled. We would like to congratulate Dr. Deodhar, Dr. Aydin and Dr. Reveille, along with their teams, for recruiting their first patient this month!

We thank all sites for their continued efforts, and we look forward to activating our remaining sites over the coming months.

SPARTAN referral recommendations for patients with chronic back pain who may have axial spondyloarthritis.

Delayed diagnosis of axial spondyloarthritis (axSpA) continues to be a problem. One approach to improve this situation is to facilitate the early recognition of symptoms and signs of axSpA by non-rheumatology health care providers followed by referral for rheumatology evaluation. While ASAS-endorsed recommendations for the early referral of patients with a suspicion of axSpA were published in 2015, differences in healthcare environment suggest that there is a need for referral recommendations specifically developed for North America. 

As a first step in this direction, the SPARTAN Board of Directors has issued a request for proposals to identify SPARTAN members interested in leading the development of SPARTAN referral recommendations. Letters of intent are due tomorrow 10/30/20. 

Next steps will be determined by the board upon review of the received letters. We anticipate that the recommendations will be based on the existing scientific literature. However, the identification a research agenda is an important aspect of the project, which we hope will lead to new collaborations and follow-up research projects.

World Arthritis Day

We observe World Arthritis Day every October 12th to increase awareness of the prevalence and impact arthritis imparts on patients, reminding all that rheumatologic diseases continue to be a leading cause of disability worldwide. It provides a great opportunity to honor the hard work of scientists and the sacrifices of patients and physicians who have participated in research and clinical trials. As members of SPARTAN we are aware of the challenges faced by both patients and physicians in treating spondyloarthritis. Patient-led organizations like the Arthritis Foundation, the National Psoriasis Foundation, and Spondylitis Association of America,  as well as our professional societies SPARTAN, ACR, EULAR, and GRAPPA have been at the forefront in promoting educational and advocacy initiatives. As a SPARTAN member, you are encouraged to help promote the ideals of World Arthritis Day on this date and throughout the year.

Gopi Penmetsa MD

ACR Convergence 2020

Mark Asquith Study Group on IBD-associated SpA.
Friday Nov 6, 1 pm EST


IL17, IL23, and other cytokine targets.  
Saturday Nov 7, 11am EST


Nomenclature: Classification around AS, Axial Spondyloarthritis, and non-radiographic AxSpA.
Saturday Nov 7, 1 pm EST


Controversies in the Diagnostic Evaluation of axSpA.
Monday Nov 9, 3pm EST


Complete list of SpA Related sessions >>  here


Regula Neuenschwander 1, Monika Hebeisen1,2, Raphael Micheroli1, Kristina Bürki1, Pascale Exer3, Karin Niedermann4, Michael J. Nissen5, Almut Scherer2 and Adrian Ciurea1* 

Differences between men and women with nonradiographic axial spondyloarthritis: clinical characteristics and treatment effectiveness in a real-life prospective cohort. Arthritis Research & Therapy (2020) 22:233

Peer review by Michael Weisman, MD
This carefully done observational cohort study provides another piece of the puzzle that examines potential gender differences between men and women with axSpA.  What does it tell us?  The cohort examined is unique since much of the previously proposed gender differences (women have more pain, less radiographic damage, later disease onset, more fibromyalgia, take longer to diagnose, and often respond differently to treatment) have been observed in long standing disease.  This cohort is defined carefully by the (unfortunate) use of the regulatory term non-radiographic ax-SpA (nr-AxSpA), which means in the broadest sense that these are SpA patients whose x-rays do not meet the old NY-classification standard of, at a minimum, bilateral erosions on pelvis x-rays.   All of the above issues were examined in this cohort including a real-world collection of observational data on individual patients' responses to the initiation of their first biologic, a TNFi agent.

They observed that the women with nr-AxSpA, at their baseline evaluation, took longer to diagnose despite having onset of symptoms at similar ages to men.  This finding actually does bridge an important gap - it is likely that diagnostic slant or prejudice created this particular distinction rather than actual age-related disease onset.  It was interesting (and revealing) that self-reported disease activity, fibromyalgia, and presence of enthesitis was reported higher in women, along with a lower proportion of B-27 positivity, but actual arthritis and dactylitis and objective measures of disease activity such as CRP were not different.  Women's BMI were lower than men; how this relates to current theories about body composition causing differences in inflammation and treatment response is not addressed.  Although enthesitis differences have been shown by others in early cohorts to aggregate more to women who have peripheral SpA, some of the more subjective measures of disease activity might be a victim of diagnostic bias.  Finally, the authors suggest, and they might be correct here, that the small B-27+ difference in frequency between men and women in their cohort might reflect misclassification distortion rather than true genotypic differences.

However, the real bottom line of the study (at least from the authors' perspective) is that response to TNFi were significantly lower in women compared to men.  They could not exclude channeling bias (more women would be started on a TNFi if they had a positive B-27) since the proportion of subjects starting TNFi had the same B-27+ proportion between men and women.  Nevertheless, this finding needs further examination and documentation.  Was it really gender, or B-27+, or even the fault of the study design itself that created these differences?  The authors clearly adjusted for all possible confounders and effect modifiers they could find, including a sensitivity analysis of why people stopped their TNFi, and the differences remained.  It is likely real.  From a practical standpoint in the general care of our early disease patients and when we initiate therapy, does this mean we should back-off from TNFi in this subset of patients and use other biologics with different mechanisms of action?  Let us not jump to that conclusion yet, and we should examine this question with more research into why these differences occur in an individual patient as well as on a molecular level. 
ACR annual conference ACR Convergence 2020: The ACR's All-Virtual Annual Meeting November 5-9, 2020
SpA related sessions
SPARTAN GRAPPA ASAS Symposium on axSpA and PsA will be a virtual event with ACR Convergence. November 10, 4:00 pm Eastern. Learn more >> here
Annual ASAS Workshop January 15-16, 2021. Location/format TBD.
SPARTAN Annual Meeting
May 22-24, 2021
Madison, Wisconsin

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