Deep dive into SpA reveals the importance of being collaborative

Wednesday, 28 Jun 2017

Close and effective collaboration between specialists who will likely encounter people with spondyloarthritis (SpA) in their clinical practice is vital for the early and appropriate care of patients, the conference has heard.

At an Abbvie sponsored evening session Deep dive into SpA: The way to an integrative approach delegates learned that the complex and multifaceted nature of SpA meant that people living with the disease were at risk of falling through the gaps and missing out on an early diagnosis of the multiple manifestations of the disease.

Chairing the session that involved a gastroenterologist, an ophthalmologist, and a dermatologist rheumatologist Professor Walter P. Maksymowych from the University of Alberta in Canada told delegates that extra articular manifestations occurred in approximately 40 percent of people living with axSpA1.

Undiagnosed axSpA was also seen in up to 50 percent of patients who presented with extra-articular manifestations such as inflammatory bowel disease and uveitis.2

 “As our therapeutic armentarium improves we’re increasingly interested in the early diagnosis of SpA and its co-morbid conditions,” Professor Maksymowych told delegates.

“But we don’t have the specific training to enhance that care [of comorbid conditions] so we need to focus on integrating management with our specialist colleagues,” he stressed.

The adoption of a collaborative approach to care was aimed at diminishing the burden of disease for patients and society as well as understanding the increasing array of therapeutics that could now be used to treat patients, Professor Maksymowych said.

He noted that the approach had been endorsed in guidelines such as the recently updated ASAS-EULAR management recommendations for axSpA3 which states: AxSpA is a potentially severe disease with diverse manifestations usually requiring multidisciplinary management coordinated by a rheumatologist.

“Some of these manifestations required immediate care and some biologics and other therapeutics have indications for both the musculoskeletal manifestations and the extra articular manifestations,” Professor Maksymowych noted.

GRAPPA4 (see our previous story here) and EULAR5 guidelines also endorsed a multidisciplinary approach to the management of people with axial SpA.

“Collaboration between the relevant specialties has become a major focus of treatment recommendations and highlights that we really need to understand the perspectives of our colleagues to determine the best approach to treatment,” he said.

“Collaborative management is also an opportunity for the personalised medicine strategy that is essential for optimal outcomes in patients with axSpA and extra articular manifestations,” he added.

This article has been commissioned and sponsored by AbbVie Pty ltd. The content and views within the article are based on published studies and the speaker’s opinions. The views within the article do not necessarily reflect those of AbbVie Pty Ltd.


  1. Vander Cruyssen B. et al. Ann Rheum Dis 2007; 66:1072-1077.
  2. Van der Horst-Bruisma IE et al. Ther Adv Musculoskeletal Dis 2012; 4:413-422.
  3. Van der Heijde D et al Ann Rheum Dis 2017; 76:978-99.
  4. Coates L et al Arthritis & Rheumatology2016; 68(5): 1060–71
  5. Gossec L et al. Ann Rheum Dis 2016;75:499-510.

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