Spondyloarthritis (SpA) are a group of chronic inflammatory rheumatic diseases that affects the spine. Axial SpA is a subtype of the disease that primarily involves joints, tendons and bones around the pelvis. SpA is predominantly a genetically determined condition that has a strong association with a type of gene called HLA B27. The term non-radiographic axial SpA refers to a new group of diseases that can be identified before structural changes of the joints can be detected. Non-radiographic axial SpA usually starts in late adolescence or early adulthood. Onset after the age of 45 is rare. Symptoms include lower back pain with predominant night pains, morning stiffness and impaired physical function as well as chest pain, pain and swelling of peripheral joints and extra-articular tenderness.
First line treatment options for SpA normally include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, however, these are only effective in approximately half of patients. Secukinumab (Cosentyx) is a new treatment option that acts by inhibiting the processes that leads to bone loss and inflammation, thereby reducing the symptoms of the disease. It is administered by injection under the skin (subcutaneous). If licenced, secukinumab could provide an additional treatment option for patients who are intolerant or do not respond adequately to NSAIDs.
Ixekizumab is an engineered antibody designed to bind and obstruct the pro-inflammatory interleukin-17A (IL-17A) signalling molecule. It has been suggested that IL-17 may be a crucial mediator of inflammation in the pathway that leads to the development and progression of axial spondyloarthritis. By blocking this pathway, ixekizumab may help prevent joint inflammation, bone erosion, and bone fusion in a patient population where few alternative therapies exist in instances of previous treatment failure.