Current Rheumatology Reports

, 21:43 | Cite as

Current Unmet Needs in Spondyloarthritis

  • Denis PoddubnyyEmail author
  • Joachim Sieper
Spondyloarthritis (M Khan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Spondyloarthritis


Purpose of Review

There was a substantial progress in the field of spondyloarthritis (SpA) in terms of understanding disease mechanisms, early diagnosis, and improved treatment. Nonetheless, several unresolved questions and unmet needs do remain.

Recent Findings

Although the diagnostic delay in axial SpA is decreasing, it remains one of the longest in rheumatology. Application of referral strategies, as well as correct application and interpretation of imaging finding in the clinical context, is the main key to early diagnosis of axial SpA. Tumor necrosis factor (TNF) alpha and interleukin (IL)-17 represent currently two major treatment targets in SpA, while other promising targets such as IL-23 or IL-6 failed in clinical trials. There is an unmet need for strategy trials to optimize and to individualize treatment in SpA. The role of Janus kinases and their blockade in SpA is still to be explored. TNF blockade showed efficacy in peripheral SpA, and other targets (IL-17 and IL-23) should be investigated in clinical trials. Early, effective, and long-term suppression of inflammation is currently the best method to prevent structural damage progression in the spine in axial SpA, while specific effects of IL-17 blockade and of nonsteroidal anti-inflammatory drugs on new bone formation are still being investigated.


This review summarizes the recent advances in diagnosis and treatment of SpA and discusses the current unmet needs in the field.


Spondyloarthritis Diagnosis Imaging Pathophysiology Treatment Radiographic progression Unmet needs 


Compliance with Ethical Standards

Conflict of Interest

Joachim Sieper reports grants and personal fees from Abbvie, Janssen, MSD, and Pfizer and personal fees from Lilly, Novartis, Roche, UCB, and Sun Pharma.

Denis Poddubnyy reports grants and personal fees from Abbvie, MSD, Novartis, and Pfizer, and personal fees from BMS, Lilly, Roche, UCB, and Celgene.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology, Infectious Diseases, and Rheumatology, Campus Benjamin FranklinCharité—Universitätsmedizin BerlinBerlinGermany
  2. 2.Epidemiology UnitGerman Rheumatism Research CentreBerlinGermany

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