Discuss the early diagnosis and treatment of axial spondyloarthritis, and optimize the whole-process management of the disease | Famous doctor Kung Fu tea, approach CRA

*Only for medical professionals to read and refer to the big coffee talks, the cutting-edge trends are all in one go.
From May 20th to 22nd, the 25th National Rheumatology Conference (CRA) of the Chinese Medical Association was grandly held in Shenzhen, Guangdong Province.

The meeting was attended by a large number of people, the participants were enthusiastic, and the atmosphere on site was warm.

During the conference, the experts conveyed to us the Chinese voice in the field of rheumatism and immunity through academic discussions and exchanges.

At the CRA meeting site, we are honored to invite Professor Zhu Ping from Xijing Hospital of Air Force Military Medical University and Professor Wu Huaxiang from the Second Affiliated Hospital of Zhejiang University School of Medicine to be a guest in the medical field [Famous Doctor Kung Fu Tea, Approach CRA] Live Interview Room, to deliver to millions of doctors trick.

Professor Zhu Ping: The further breakdown of axial spondyloarthritis is helpful for early diagnosis and treatment of the disease.
Professor Zhu Ping interview video Axial spondyloarthritis (axSpA) is a group of chronic inflammatory diseases that mainly affect the spine and the sacroiliac joints.

Current studies believe that the natural course of axSpA varies widely, and it can be further subdivided according to the radiological progress of the course-ankylosing spondylitis (AS) and radiological negative axSpA (nr-axSpA), the difference lies in the sacroiliac Whether there are radiographic changes in arthritis.

Professor Zhu Ping believes that nr-axSpA is very likely to be the early stage of AS, and some nr-axSpA may progress to AS during the development of the disease.

The proposal of nr-axSpA not only gives us a new understanding of axSpA, it is also conducive to our early diagnosis and treatment of diseases.

In the past, due to the limitations of imaging technology and the lack of meticulous pathological research on the imaging changes of the disease, we did not pay enough attention to sacroiliac arthritis.
In clinical practice, only rough imaging examination methods (such as shooting X Line plain film) to diagnose the disease, so the early development stage of the disease and the best time for treatment are missed.Now, the development of advanced imaging technology, such as the application of magnetic resonance technology (MRI), enables us to clearly observe the active inflammation of the sacroiliac joints and spine before structural changes occur, helping to identify and diagnose nr-axSpA.
Out.

When talking about the treatment strategy of axSpA, Professor Zhu Ping said that the discovery and proposal of nr-axSpA made the axSpA treatment window move forward.

When considering its treatment plan, we need to consider various factors, such as whether the patient has extra-articular manifestations, comorbidities, or high-risk factors for structural progression.
These factors will affect our treatment decisions and also affect the patient's treatment.
Response and prognosis.

For patients with high-risk factors, Professor Zhu Ping said that earlier and more aggressive treatment strategies should be adopted to help them control the condition and delay the progression of the disease.

With the development of biomedical technology, axSpA clinical treatment options are becoming more and more abundant, especially the emergence of biological agents, which has made a revolutionary progress in the axSpA/AS treatment field.

Professor Zhu Ping pointed out that many biological agents used to treat AS have been included in the scope of medical insurance reimbursement, which greatly reduces the economic burden of patients and enables patients to choose biological agents with good curative effects for treatment within their affordable price range.

Professor Zhu Ping also introduced that among the existing biological agents, interleukin-17A (IL-17A) inhibitors are a new generation of biological agents in the treatment of AS.
Good results have been achieved in clinical studies at home and abroad.
The clinical application has not disappointed, and it has played a significant effect on the disease control of patients.

Professor Zhu Ping particularly emphasized that the current treatment of axSpA/AS is no longer simply to control inflammation.
From a long-term perspective, inhibiting new bone formation and imaging progress has become a higher standard of treatment needs and requirements.

IL-17A inhibitors may be expected to help us achieve this goal, and we hope that in the future longer-term clinical applications and observations, there will be more evidence to help us summarize our experience.

Professor Wu Huaxiang: Early diagnosis, standardized treatment, and full-process management of the disease.
Professor Wu Huaxiang’s interview with video The early diagnosis of disease is very important to the prognosis of patients. How to better achieve the early diagnosis of axSpA/AS, Professor Wu Huaxiang explained for us from two aspects, “On the one hand, it is the patient factor, which enables patients to find the disease early, so that they can find the right department and the right doctor.
We need to do a good job of early communication and popular science; on the other hand, doctors, whether specialists or grassroots doctors, need to understand the basis for scientific diagnosis of diseases.

"In addition to early diagnosis, standardized treatment is also a key factor in improving patient prognosis.

Professor Wu Huaxiang gave a detailed introduction on the significance of the guidelines recommendations in standard treatment.

"The formulation of the guidelines is mainly to delineate a general principle for us.

According to the recommendations of the guidelines, we can diagnose and treat diseases in a more standardized way.
This is very important for clinicians, especially primary doctors or non-specialist doctors.
.

"recommendations guide often requires a lot of evidence to support evidence-based medicine, revise and adjust based on expert opinion, it has a strong clinical guidance value.

Professor Wu Huaxiang also pointed out that “the individualized treatment we are now emphasizing is also a treatment plan
based on the general principles of the guidelines and the specific conditions of the patient.
” At present, all major international guidelines on the diagnosis and treatment of axSpA/AS Highlight the therapeutic status of biological agents.

In this regard, Professor Wu Huaxiang said that the arrival of biological agents has indeed greatly improved the level of AS treatment and improved the prognosis of most AS patients, which is of revolutionary significance.

For the clinical application of biological agents, Professor Wu Huaxiang puts forward the following three suggestions: A.
Accurately select the appropriate patient population.

In view of the actual conditions of different patients and the different characteristics of various biological agents, clinicians should promptly choose appropriate treatment drugs for patients.

For example, IL17-A inhibitors are more effective in relieving enthesitis and inhibiting the progress of imaging.
It may be more suitable for patients with these requirements to choose IL-17A inhibitors; and if the patient has inflammatory bowel disease And other diseases, the efficacy of TNF-α inhibitors will be more significant.

B.
Pay attention to the evaluation and management of the safety of the use of biological agents. Before using biological agents, patients should undergo preliminary screening, especially tuberculosis, hepatitis B and tumor screening.

C.
Pay attention to the evaluation and monitoring of curative effect during the treatment process.

In the process of using biological agents for treatment, we should regularly evaluate the effectiveness of their treatment.

If the curative effect is definite, priority should be given to maintenance treatment.
After long-term stability is achieved, the drug can be reduced or stopped.

Finally, Professor Wu Huaxiang also fully expressed his views on the research directions that may be worthy of further exploration in the AS research field.

She believes that the following three directions are currently the most promising research directions: 1.
AS Chronic Disease Management System.

AS is a chronic disease that requires long-term treatment to control the condition.

How to improve the compliance of patients in the treatment process so that they can better manage themselves while cooperating with doctors is the direction we need to continue to explore in the future.

At present, it seems that WeChat, app or public account mini programs may help advance the research in this field; 2.
AS structure progress mechanism and its treatment.

Although AS is not a fatal disease, it is a disease with a high disability rate.

Studying the mechanism of its structural progress will help us find effective prevention and treatment options; 3.
Looking for biomarkers that can predict the efficacy of biological agents.

The field of biologics is developing rapidly, and how to use biomarkers to achieve precise targeted therapy is the focus of our next research.

Expert Profile Professor Zhu Ping, Chief Physician, and Doctoral Supervisor, Chief Physician, Department of Clinical Immunology, Xijing Hospital, Air Force Military Medical University (Fourth Military Medical University), Director, Institute of Rheumatology and Immunology, and President of the Rheumatology and Molecular Immunity Branch of the National Health Administration, China Vice Chairman of the Clinical Immunization Branch of the Society of Immunology; Vice Chairman of the Rheumatology and Immunology Branch of the Chinese Medical Promotion Association; Chairman of the Rheumatology and Immunology Branch of the Shaanxi Physician Association; Vice Chairman of the Ninth Rheumatology Branch of the Chinese Medical Association Outstanding young and middle-aged technical expert of the first and second vice presidents of the branch, winner of the "Silver Award" and "Chinese Physician Award" of the Army Education Award, enjoying the special government allowance of the State Council, and successively won the National Science and Technology Progress Second Prize and the provincial and ministerial level A number of first and second prizes, 9 invention patent authorizations, successively undertook 20 national and military major/key projects, published more than 200 papers, edited 4 postgraduates of the Ministry of Higher Education, 4 undergraduate textbooks, and cultivated 96 PhD/Master graduate students.
Introduction of 3 post-doctoral experts Professor Wu Huaxiang, Chief Physician, PhD supervisor, Director of Rheumatology Department of the Second Affiliated Hospital of Zhejiang University School of Medicine, Chairman of Rheumatology and Immunology Branch of Zhejiang Medical Association, First Director of Rheumatology Branch of Zhejiang Medical Association Member Zhejiang Medical Association Chairman, Chinese Medical Doctor Association Rheumatology and Immunology Branch Standing Committee Member, Chinese Medical Doctor Association Immunosorbent Academic Committee Deputy Chairman, Cross-Strait Medical and Health Exchange Association Rheumatology and Immunology Professional Committee Gout Group Deputy Group Leader, Chronic Disease Management Associate group leader, "Chinese Journal of Rheumatology", "Zhejiang Medicine" editorial board This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's position