Axial Spondyloarthritis: Future Outlook

Atul A. Deodhar, MD: As I look to the future, I’m very hopeful because I’m already seeing that the diagnosis of axial spondyloarthritis is being made more and more. I’m getting more referrals. So as the knowledge percolates among the providers, as the knowledge about this condition percolates among the general public, we are finding already that the prevalence of this condition is going up. This is not because the disease is becoming more common; it’s only because the disease is already getting more and more recognized. Newer treatments have that beneficial effect on the psyche of the general public because they think that there is a new treatment for this. Maybe this might get better with the treatment. And newer treatments also then make providers—primary care physicians, chiropractors, osteopathic physicians, physical therapists, internal medicine providers—apart from rheumatologists, take interest in patients with back pain. And then start looking at the back pain in a different way, that maybe this person has a different type of back pain. This is not the common mechanical back pain.

So looking forward, I’m hoping and I’m already seeing, as I said, an earlier diagnosis. That is number 1. Number 2, looking forward, I’m also looking at the newer understanding about the pathology. Because the more we understand the pathology, the more we understand where to go to find newer drugs to treat the inflammation, where exactly the inflammation is coming from. We have 2 classes of drugs, as I said earlier: TNF [tumor necrosis factor] inhibitors and IL-17 [interleukin 17] inhibitors. Looking at the future, I’m hoping that the JAK [Janus kinase] inhibitors would be the third class of drug that would be coming.

Another important area that we did not cover is the microbiome. There is a large amount of research going on in the microbiome, in the gut bacteria that all of us have, into what effect they have on starting the disease and on progression of the disease. So the treatment of this condition, in the future, might also be dependent on altering or modulating your gut microbiome.