Enteropathic Spondyloarthritis

2018 SPARTAN Annual Meeting, “Unmet Needs” Breakout Session

Session leaders:
Sergio Schwartzman, MD, Hospital for Special Surgery, New York, NY, SchwartzmanS(at)HSS.EDU
Joerg Ermann, MD, Brigham and Women’s Hospital, Boston, MA, jermann(at)bwh.havard.edu

Rational:
It is well recognized that Spondyloarthritis (SpA) and intestinal inflammation are closely linked. Reactive arthritis is frequently preceded by an intestinal infection and inflammatory bowel disease (IBD)-associated SpA is a recognized entity. The phenotypic spectrum of this group of diseases is not well defined and indeed the classification criteria for SpA continue to evolve and classification criteria for Ulcerative Colitis (UC) and Crohn’s Disease (CD) have never been formalized or used in clinical trials.
Importantly, many patients with SpA have subclinical intestinal inflammation. This is well defined in axial disease but has not been explored in peripheral spondyloarthritis. The immune mechanisms linking inflammation in the gut, the spine and peripheral joints are poorly understood. The role of the microbiome in these diseases has only recently been addressed and critical gaps remain in our understanding of disease pathogenesis.
SpA and IBD are treated by different subspecialists that frequently manage patients independently and do not communicate or collaborate in patient management. Optimal patient care, therefore is often not attained. Complicating this issue further is the fact that some therapies approved for SpA do not work for IBD (or even result in worsening) and vice versa. These same patients may also have other comorbidities and co-manifestations such as skin and ophthalmic involvement that have not been well characterized.

Goals for the SPARTAN Workshop:

• Discuss the following questions:
  – What are current deficits in the care of patients with IBD and concomitant musculoskeletal problems?
  – What are the most important research questions that need to be addressed?
  – What are the unmet needs in education?
• Identify SPARTAN members with interest in enteropathic SpA.
• Develop a research agenda.
• Promote cross-specialty education and research collaborations.

Methodology:

• The breakout session will include SPARTAN members with interest in IBD-associated SpA. We will also invite gastroenterologists from local academic institutions with clinical expertise and research interest in IBD and IBD comorbidities.
• Questions will be circulated to workshop attendees via email prior to the meeting.
• Answers to each of the above questions will be tallied and summarized before the meeting.
• The workshop will begin with a 10-minute introduction. Each question will then be re-presented and discussed.
• The workshop will conclude with the discussion and endorsement of an action plan.

Action Plan:
The workshop will conclude with the discussion and endorsement of an action plan. Elements of this plan will depend on the answers to the above questions and the discussion during the session – but possible inclusions are:

• Set up a task force of investigators to continue the discussion beyond the workshop.
• Identify mechanisms for cross-specialty education and research collaborations.
• Agree on terminology and develop a classification system for enteropathic arthritis.
• Develop and test a SpA screening tool for patients with IBD.
• Develop and test an IBD screening tool for patients with SpA.
• Devise strategies to promote (and fund) research focused on mechanisms of joint involvement in patients with IBD, immunological differences between IBD and SpA, and biomarkers.
• Initiate discussions with stakeholders (ACR, AGA, SPARTAN, CCFA) to develop treatment recommendations for enteropathic SpA.
• Propose a strategy to develop treatment recommendations for enteropathic SpA.

References:
https://www.ncbi.nlm.nih.gov/pubmed/9577346
https://www.ncbi.nlm.nih.gov/pubmed/21122514
https://www.ncbi.nlm.nih.gov/pubmed/26554932