L.C. Coates, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
G. Schett, MD, Uniklinikum Erlangen, Department of Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
J Rheumatol. 2024 Dec 1;51(12):1254-1258. doi: 10.3899/jrheum.2024-0939.
A program focused on pathogenesis, clinical trial design, and nonpharmacologic mind-body therapy for spondyloarthritis (SpA) was presented at the Spondylitis Association of America Unmet Needs Conference IV. SpA pathogenesis is incompletely understood but involves a complex set of drivers, including genetics, biomechanical stress, and microbial factors. Affected tissues may include axial and peripheral joints, entheses, skin, uvea, and intestines. The specific role of key cytokines like interleukin (IL)-23, IL-17, and tumor necrosis factor in the phases of this inflammatory process remains unclear. New insights into pathogenesis will continue to generate targets for novel therapeutics. How to optimally evaluate those therapeutics in clinical trials, and for the various manifestations of SpA, remains less clear. Future trials need better generalizability, robust subgroup analyses to assess differential responses for distinct disease manifestations, a focus on comparative efficacy, and outcomes relevant to the clinician and the patient. Additionally, study designs need to leverage available technology to facilitate subject participation in trials. In view of the interplay between biologic, physical, and psychological aspects of disease, there is increasing attention to nonpharmacologic agents, with the aim of maximizing long-term health-related quality of life through the control of symptoms and inflammation. Recent studies provide encouraging evidence that mind-body interventions such as tai chi, qigong, yoga, and meditation have benefits for patients with SpA, particularly those with pain. The advances in our understanding of pathogenesis, novel therapeutics, and nonpharmacologic interventions have revolutionized the management of SpA, but numerous questions around optimal management remain.
一个专注于脊柱关节炎（SpA）发病机制、临床试验设计和非药物身心治疗的项目在美国脊柱关节炎协会未满足需求会议 IV 上进行了介绍。SpA 的发病机制尚不完全清楚，但涉及一系列复杂的驱动因素，包括遗传、生物力学应激和微生物因素。受影响的组织可能包括轴性和外周关节、附着点、皮肤、葡萄膜和肠道。关键细胞因子（如白细胞介素[IL]-23、IL-17 和肿瘤坏死因子）在这一炎症过程的各个阶段中的具体作用仍不清楚。对发病机制的新见解将继续为新型治疗方法提供靶点。如何在临床试验中优化评估这些治疗方法，以及针对 SpA 的各种表现，仍然不太清楚。未来的试验需要更好的普遍性、强大的亚组分析以评估不同疾病表现的差异反应、关注比较疗效以及与临床医生和患者相关的结果。此外，研究设计需要利用现有技术来促进受试者参与试验。鉴于疾病的生物学、物理和心理方面相互作用，人们越来越关注非药物治疗方法，旨在通过控制症状和炎症来最大限度地提高长期健康相关生活质量。最近的研究提供了令人鼓舞的证据，表明身心干预，如太极拳、气功、瑜伽和冥想，对 SpA 患者有好处，特别是那些有疼痛的患者。我们对发病机制、新型治疗方法和非药物干预措施的理解的进步彻底改变了 SpA 的治疗方法，但围绕最佳治疗方法仍存在许多问题。
