The diagnosis and management of axial spondyloarthritis

Presenter: Dr Lionel Schachna, Rheumatologist, Austin Health, Melbourne

Description: Axial spondyloarthritis (SpA), whether with x-ray change (ankylosing spondylitis) or without x-ray change (non-radiographic axial SpA), is usually diagnosed many years after the onset of symptoms. Chronic back pain is common, and recognition of SpA in primary care requires a high index of suspicion and clinical acumen. MRI may be particularly useful in evaluating early presentations, although the chronic changes of sacroiliitis are often better seen on plain X-rays. First line treatment approaches include regular spinal stretching exercises and nonsteroidal anti-inflammatory drugs (NSAIDs). Particularly helpful for SpA patients are the biologic DMARDs that target tumour necrosis factor (TNF). TNF inhibitors strikingly improve symptoms and quality of life among most patients with axial SpA. A recent addition to the treatment armamentarium is an IL-17 inhibitor, secukinumab. Importantly, recent data suggest that the use of biologics for four years or longer can slow spinal fusion in patients with ankylosing spondylitis. These topics will be elaborated upon in the webinar entitled “Diagnosis and management of axial spondyloarthritis”.

About the Presenter: Dr Lionel Schachna runs the Austin Spondylitis Clinic in Melbourne. After completing rheumatology training at the Alfred Hospital and Monash Health, he completed a post-doctoral fellowship and PhD in clinical investigation at Johns Hopkins University in Baltimore. His research interests include epidemiologic studies in predictors of outcomes in axial spondyloarthritis.