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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\n      \u003Ch2\u003ESummary\u003C\/h2\u003E\n      \u003Cp id=\u0022p-1\u0022\u003EThis article discusses current insights into spondyloarthropathies, including TNF inhibition, structural damage progression in ankylosing spondylitis, methotrexate as a disease-modifying agent, and reactive arthritis.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einflammatory disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n      \u003Ch2 class=\u0022\u0022\u003ETNF Inhibition and Structural Damage Progression in Ankylosing Spondylitis\u003C\/h2\u003E\n      \u003Cp id=\u0022p-2\u0022\u003EWalter P. Maksymowych, MD, University of Alberta, Edmonton, Alberta, Canada, discussed the relationship between anti-TNF agents, inflammation, and lesions that demonstrate fat metaplasia in the structural progression of ankylosing spondylitis (AS).\u003C\/p\u003E\n      \u003Cp id=\u0022p-3\u0022\u003EAnti-TNF agents safely and effectively treat signs and symptoms of AS and improve health-related quality of life [Davis JC et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2005; Lambert RG et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2007]. Nonetheless, structural progression in AS has not been shown to be impacted by anti-TNF agents, despite the role of TNF-induced inflammation in the disease [van der Heijde D et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2008]. This question has not been fully answered because of limitations in study design.\u003C\/p\u003E\n      \u003Cp id=\u0022p-4\u0022\u003EQuestions persist over which MRI lesions predict the progression of AS. There is evidence that inflammatory lesions predict new bone formation, although the majority of new syndesmophytes develop at sites without active inflammation [Maksymowych et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2009]. It has now been shown that inflammatory lesions that resolve undergo fat metaplasia and that this is associated with new bone formation. Fat metaplasia, therefore, appears to be an important intermediary in the pathway from inflammation to new bone (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [\u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2011].\u003C\/p\u003E\n      \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\n         \u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\n            \n               \u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/26\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Pathogenesis of New Bone is Ankylosing Spondylitis.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-157105388\u0022 data-figure-caption=\u0022Pathogenesis of New Bone is Ankylosing Spondylitis.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/26\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\n            \n            \n         \u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/26\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/26\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12625\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\n         \u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\n            \u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EPathogenesis of New Bone is Ankylosing Spondylitis.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from W. Maksymowych, MD.\u003C\/q\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\n   \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n      \u003Ch2 class=\u0022\u0022\u003EPsA: Is Methotrexate a Disease-Modifying Agent?\u003C\/h2\u003E\n      \u003Cp id=\u0022p-6\u0022\u003EMethotrexate (MTX) is often used as the primary treatment for psoriatic arthritis (PsA). However, there are limited data to demonstrate its clinical benefit, especially for axial disease [Gottlieb A et al. \u003Cem\u003EJ Am Acad Dermatol\u003C\/em\u003E 2008; Ritchlin CT et al. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2009; Gossec L et al. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2011]. Gabrielle H. Kingsley, MB, PhD, FRCP, Kings College, London, United Kingdom, discussed the role of MTX in the treatment of PsA, with a focus on whether MTX can be considered a disease-modifying antirheumatic drug (DMARD).\u003C\/p\u003E\n      \u003Cp id=\u0022p-7\u0022\u003EAccording to Prof. Kingsley, the aim of DMARD therapy is to improve long-term outcomes, not just symptoms. However, definitive demonstration of DMARD efficacy is difficult to confirm outside of placebo-controlled, randomized, controlled trials.\u003C\/p\u003E\n      \u003Cp id=\u0022p-8\u0022\u003EThe MTX in Psoriatic Arthritis (MIPA) Trial [Kingsley et al. \u003Cem\u003ERheumatology.\u003C\/em\u003E In Press 2011] was a 6-month RCT that compared MTX with placebo to test the hypothesis that the drug improves disease activity and function in PsA. Key findings from the study indicate that MTX improves self-reported symptoms but has no effect on objective joint counts or acute phase reactants, which classifies it as a \u201csymptom-modifying agent\u201d rather than a DMARD. Prof. Kingsley recommends a reconsideration of current guidelines, based on new data [Baranauskaite A et al. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2011; Lie E et al. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2009; Kingsley GH et al. \u003Cem\u003ERheumatology.\u003C\/em\u003E In press 2011].\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n      \u003Ch2 class=\u0022\u0022\u003EReactive Arthritis: Clinical Insights and Treatment Options\u003C\/h2\u003E\n      \u003Cp id=\u0022p-9\u0022\u003EReactive arthritis (ReA) occurs 1 to 6 weeks after exposure to a causative organism, either postdysentery or postvenereal. John D. Carter, MD, University of South Florida, Tampa, Florida, USA, discussed the epidemiology of ReA and the pathophysiology, treatments, and outcomes of \u003Cem\u003EChlamydia trachomatis\u003C\/em\u003E-induced ReA (CiReA) [Carter JD et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2009].\u003C\/p\u003E\n      \u003Cp id=\u0022p-10\u0022\u003EIn the United States, the incidence of ReA is underestimated and underdiagnosed. Dr. Carter concluded that \u003Cem\u003EChlamydia\u003C\/em\u003E might be a common cause of undifferentiated spondyloarthropathies; that ocular serovars appear to be uniquely capable of causing ReA [Gerard HC et al. \u003Cem\u003EMicrob Pathog\u003C\/em\u003E 2010]; that ReA is a Th2-predominant disease; and that combination antibiotics show promise in the amelioration of CiReA symptoms and the elimination of the persistent state of \u003Cem\u003EChlamydia.\u003C\/em\u003E\n         \u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/13\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmwop\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmwop\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}