A program focused on pathogenesis, clinical trial design, and nonpharmacologic mind-body therapy for of 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.

中文翻译：

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脊柱关节炎未满足的需求：发病机制、临床试验设计和非药物治疗。


在美国脊柱炎协会未满足需求会议 IV 上提出了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计划。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向关节和外周关节、内腔、皮肤、葡萄膜和肠道。白细胞介素 （IL）-23、IL-17 和肿瘤坏死因子等关键细胞因子在该炎症过程阶段的具体作用尚不清楚。对发病机制的新见解将继续产生新疗法的靶点。如何在临床试验中最佳评估这些疗法以及 SpA 的各种表现，目前尚不清楚。未来的试验需要更好的普遍性、稳健的亚组分析来评估不同疾病表现的不同反应、关注比较疗效以及与临床医生和患者相关的结局。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、生理和心理方面之间的相互作用，人们越来越关注非药物，目的是通过控制症状和炎症来最大限度地提高与健康相关的长期生活质量。最近的研究提供了令人鼓舞的证据，表明太极拳、气功、瑜伽和冥想等身心干预对 SpA 患者有益，尤其是那些有疼痛的患者。 我们对发病机制、新疗法和非药物干预的理解的进步彻底改变了 SpA 的管理，但围绕最佳管理仍然存在许多问题。