Latest news with #ankylosingSpondylitis
Medscape
2 days ago
- Health
- Medscape
JAK1 Inhibitor Shows Promise for Ankylosing Spondylitis
TOPLINE: Ivarmacitinib, a highly selective Janus kinase 1 (JAK1) inhibitor, tamed ankylosing spondylitis with sustained efficacy through 24 weeks in a phase 2/3 trial. METHODOLOGY: A phase 2/3 trial in China evaluated the efficacy and safety of ivarmacitinib in 504 adults with active ankylosing spondylitis who did not benefit from nonsteroidal anti-inflammatory drugs (NSAIDs). In phase 2, patients were randomly assigned to receive ivarmacitinib (2 mg, 4 mg, or 8 mg) or placebo once daily for 12 weeks; 4 mg was selected as the recommended dose based on an interim analysis. In phase 3, 373 patients (mean age, 33.8 years; 79.6% men) were randomly assigned to receive 4 mg ivarmacitinib (n = 187) or placebo (n = 186) once daily for 12 weeks, after which all patients got ivarmacitinib for 12 weeks. The primary endpoint in both phases was the proportion of patients achieving an Assessment of Spondyloarthritis International Society (ASAS) 20 response at week 12. TAKEAWAY: At week 12, 48.7% of patients who received 4 mg ivarmacitinib achieved an ASAS20 response compared with 29% of those who received placebo (P = .0001). More patients on 4 mg ivarmacitinib vs placebo achieved an ASAS40 response (32.1% vs 18.3%; P = .0011) and an ASAS5/6 response (42.8% vs 15.6%; P < .0001) at week 12, with efficacy sustained at week 24. After 12 weeks of treatment, patients receiving 4 mg ivarmacitinib had greater improvements in disease symptoms, physical function, spinal mobility, and quality of life. During the first 12-week period, treatment-emergent adverse events occurred in 79.7% of patients in the ivarmacitinib group and 65.6% in the placebo group but caused few treatment discontinuations. IN PRACTICE: 'Ivarmacitinib 4 mg once daily provided rapid, sustained, and clinically meaningful improvements in disease activity, signs and symptoms, function, and MRI-detected inflammation in patients with active AS [ankylosing spondylitis] who had an inadequate response to NSAIDs, with a manageable safety profile,' the authors wrote. SOURCE: This study was led by Xu Liu, MD, and Liling Xu, MD, of Peking University People's Hospital in Beijing, China. It was published online on June 12, 2025, in Arthritis & Rheumatology. LIMITATIONS: The 24-week efficacy of ivarmacitinib may not reflect long-term outcomes. The absence of an active comparator limited the comparison of ivarmacitinib with other disease-modifying antirheumatic drugs used for active ankylosing spondylitis. These findings in Chinese patients with radiographic axial spondyloarthritis may not be generalizable to other populations. DISCLOSURES: Jiangsu Hengrui Pharmaceuticals Co. Ltd. sponsored and designed the trial. Two authors reported being employees of the sponsor company while the study was conducted. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Health Line
21-06-2025
- Health
- Health Line
What Is Lumbar Spondylitis?
Lumbar spondylitis is a general term for degenerative changes causing pain in the lower spine. It's a progressive condition that can lead to a limited range of motion in your back. Lumbar spondylitis, also called lumbar spondylolysis, can lead to a limited range of motion in the back and problems with other joints, such as the ribs, shoulders, or hips. Symptoms typically develop in early adulthood, but they can also develop in teens or children. Back trauma, chronic repetitive loading, or hyperextension of the back can cause lumbar spondylitis. Ankylosi ng spondylitis is a type of arthritis that can also cause this condition. Ankylosing spondylitis most commonly affects the lower spine. When it involves your lower back, it's sometimes called lumbar spondylitis. This term can also refer to any degenerative changes in your lower spine, such as those caused by osteoarthritis. Symptoms of lumbar spondylitis Lumbar spondylitis symptoms can vary between people. They tend to onset slowly over months to years. The main symptoms are lower back pain and stiffness. Your upper back or neck may also be affected as the condition progresses. Your pain may: get better with exercise, but stay the same or get worse with rest be worse in the morning and evening wake you up at night be felt around your buttocks improve with warmth, such as in a warm shower Pain can range from mild to debilitating. Symptoms tend to flare up and then go through periods where they're reduced or disappear altogether. Other symptoms Other potential symptoms include: pain, stiffness, and warmth in joints, such as the: ribs, which may cause problems with deep breathing shoulders knees hips enthesitis, pain where a bone connects to a tendon abdominal pain and diarrhea loss of appetite weight loss fatigue uveitis, which can cause: vision changes eye pain light sensitivity Lumbar spondylitis causes and risk factors Researchers do not fully understand why some people develop lumbar spondylitis. It's thought that genetic and environmental factors both play a role. People who have the HLA-B27 gene seem to be at an increased risk. More than 90% of people with lumbar spondylitis have this gene. However, most people with this gene never develop lumbar spondylosis. Other risk factors for lumbar spondylitis include: family history age, with most people developing symptoms before age 45 having Crohn's disease being assigned male at birth, occurring about two times more often in males (however, it's believed that AS has been under-recognized and under-diagnosed in biological females) Lumbar spondylitis complications Lumbar spondylitis can compress your spinal cord and lead to neurological symptoms like chronic lower back or leg: pain numbness tingling weakness In rare cases, it can also cause loss of bowel control or loss of bladder control. Other complications can include: reduced joint mobility increased fracture risk increased risk of cardiovascular disease How is lumbar spondylitis treated? Lumbar spondylitis does not have a cure, but a combination of natural remedies, medications, and sometimes surgery can help you slow its progress. Natural remedies and lifestyle modifications Natural remedies or lifestyle modifications that may help you manage your symptoms include: physical therapy, which may include: posture exercises strengthening exercises stretches and mobility work massage exercising regularly focusing on having good posture using assistive devices like walkers or canes minimizing your stress levels eating a nutritious, balanced diet that includes foods like fruits, vegetables, whole grains, and lean protein quitting smoking (this can be difficult, but a doctor can build a cessation plan that works for you) or not starting Medications A doctor may recommend or prescribe the following types of medications: nonsteroidal anti-inflammatory drugs like ibuprofen or celecoxib biologic medications like TNF inhibitors to modify immune system activity janus kinase inhibitors if your condition does not respond to other treatments corticosteroids to decrease inflammation and help with pain (these are used sparingly due to their cumulative side effects) Surgery Because of potential complications, surgery is performed infrequently. Your doctor may recommend surgery if you have trouble with daily activities or neurological complications. Some of the most commonly performed surgeries include: Laminectomy: A laminectomy involves removing a part of the vertebra called the lamina to decompress your spine. Spinal osteotomy: A spinal osteotomy is a procedure used to correct structural abnormalities in your spine. Spinal fusion: Spinal fusion is a procedure where two or more of your vertebrae are permanently fused together. Hip joint replacement: A hip joint replacement involves replacing the ball, socket, or ball and socket of your hip joint with an artificial replacement. When to contact a doctor It's a good idea to contact your primary healthcare professional if you have persistent symptoms that may be a sign of lumbar spondylitis. If your doctor suspects ankylosing spondylitis, they may refer you to a doctor called a rheumatologist who specializes in joints for further evaluation. It's also a good idea to visit your doctor if you've previously been diagnosed with ankylosing spondylitis and you notice a change in your symptoms. How is lumbar spondylitis diagnosed? Lumbar spondylitis can be difficult to diagnose. Doctors will typically consider your personal and family medical history, conduct tests, and order a number of tests to help them make a diagnosis, including: performing a physical exam, which might include: examining your joints watching your movement checking for rib stiffness by having you breathe deeply blood tests to check for inflammation and to see if you have the HLA-B27 gene imaging, such as: X-rays magnetic resonance imaging (MRI) ultrasound You may receive an ankylosing spondylitis diagnosis if you have inflammation in the joints between your lower back and pelvis and at least one of the following symptoms: lower back pain that improves with exercise and gets worse with rest limited movement in your lower back limited ability to expand your chest compared to what would be expected for your age and sex What is the outlook for people with lumbar spondylitis? Lumbar spondylitis generally has a good outlook. There's no cure, and symptoms tend to progress, but in most instances, the condition responds to conservative treatment. Your doctor may recommend surgery if you have neurological complications.
