Can Peripheral Spondyloarthritis Be Reversed?

According to an article originally published at The Rheumatologist, a CRESPA (that’s Clinical REmission in peripheral SPondyloArthritis) study recently showed that golimumab, a TNF inhibitor, might be effective in relieving the symptoms of peripheral spondyloarthritis.

What is Peripheral Spondyloarthritis?

Peripheral Spondyloarthritis (or pSpA) is a condition where the smaller peripheral joints, such as those in the elbow, wrist, fingers, feet, or knees.

There are several different kinds of pSpA, and currently there are no treatments available to patients at large other than non-steroidal anti-inflammatory drugs.

TNF inhibitors are known to be effective in treating some pSpA patients, but they can be costly, and patients aren’t typically reimbursed for these drugs unless psoriasis or pelvic inflammation are present. TNF is a substance in the body that can cause inflammation and lead to a number of immune system diseases. TNF inhibitors block their function and lead to a relief in inflammation.

The CRESPA Study

The study, which involved a randomized placebo-controlled study of 60 patients, showed impressive results after a year of treatment with golimumab.

The patients had only recently received pSpA diagnoses, all having experienced symptoms for fewer than 12 weeks.

For the first twenty weeks, 40 patients were given 50mg of golimumab in an injection every four weeks. 20 patients were given a placebo. Those whose pSpA appeared to be in remission after twenty-four weeks were taken off the drug – those whose symptoms persisted would be kept on the same 50mg monthly dose for another twenty-four week period.

In an open-label extension period (during which the golimumab was not disguised by a placebo), those whose symptoms continued or relapsed were given the 50mg monthly dose for another year.

An impressive 49 of the 60 patients showed continued clinical remission after the introduction of the TNF inhibitor. In fact, 30 respondents showed signs of remission only by week 24. Another 19 would be in remission just 16 weeks from then.

After the conclusion of the study, researchers continued to check in with patients for between two and five years. At this time, 26 of the 49 were in drug-free remission – their symptoms gone despite going off golimumab.

Early Detection and Treatment is Key

The fact that the 60 respondents in the CRESPA study had early cases of pSpA appears to be the differentiating factor in the effectiveness of achieving drug-free remission.

Earlier studies showed that patients with more advanced and established cases quickly relapsed when taken off TNF inhibitors. For these people, drug-free remission may never be a possibility.

Dr. Philippe Carron, MD, the first author of the study, noted that this might be due to an inability to reverse autoimmunity in patients where pSpA is firmly established. Receiving adequate therapy provides these patients with some relief, but never the full remission achieved in the patients where the condition was detected early and treated aggressively.

Do you or someone you know have an autoimmune inflammatory disease? Do non-steroid anti-inflammatory drugs adequately treat your condition? Share your story with the Patient Worthy community!

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