The paper briefly describes the history of spondyloarthritis  studies from the works of the outstanding Russian neurologist V.M. Bekhterev up to the present time. Special emphasis is laid on the results of the representatives of the scientific school of Professor E.R. Agababova, an organizer of the first laboratory of spondyloarthritis  in Russia. The major areas of the investigations that are currently under way in Russia are shown.

The literature virtually lacks the results of investigations aimed to study the clinical picture of ankylosing spondylitis (AS) in the real practice of rheumatologists  in Russia. At the same time, these investigations may give information  on not only the epidemiological aspects of the disease, but also a variety of its clinical presentation, its social importance, allow evaluation of the efficiency of therapy, and plan a system of further health care costs.

Subjects and methods. In early 2015, the cross-sectional multicenter  non-interventional trial EPICA2 was conducted to refine the clinical picture of AS in the real practice of a rheumatologist. The trial involved 402 patients with AS from 10 centers of Russia. The patients were examined using the international standards accepted for this disease. Results and discussion. 180 out of the 402 patients were treated in hospital; the others were examined during outpatient visits. The patients' mean age was 40.8±11.5 years; there were 292 (72.6%) men; 82.6% were HLA-B27 positive. The average age of onset was 27.6 years; the interval between symptom onset and diagnosis was 85.2 months. The rheumatologists  established the diagnosis in 87.3% of the cases. BASDAI and BASFI averaged 4.3±2.1 and 4.1±1.8, respectively. At the trial, there was peripheral arthritis in 33.1% of the patients, enthesitis in 37.1%, and dactylitis in 1.2%. Joint endoprosthesis was carried out in 4.7% of the patients. The most common  comorbidities were hypertension (25.1%), gastric ulcer (9.7%), coronary heart disease (4.0%), and diabetes mellitus (3.0%).

Conclusion. AS is diagnosed in real practice more than 7 years after its onset mainly by rheumatologists.The delay of the diagnosis is mostly associated with the fact that specialists of other medical specialties are unaware of the clinical presentation  of the disease. The examined group of patients with AS shows a relatively high activity and obvious functional impairments, which is primarily related to the specific features of patient selection in this trial.

Objective: to optimize the diagnosis of spinal column involvement in early psoriatic arthritis (ePsA).

Subjects and methods. 40 ePsA patients (17 men and 23 women) fulfilling the respective CASPAR criteria were examined. Their median age was 36.5 [28.5; 49.5] years; median PsA duration  – 13.5 [5; 24] months. The activity of ePsA was assessed using DAS and DAS28. Presence of inflammatory back pain (IBP) according to ASAS criteria and HLA-B27 was evaluated in all the patients; 38 of them underwent  pelvic X-ray to reveal significant sacroiliitis (SSI) (Stage II bilateral or Stage III–IV unilateral SSI) and 37 had magnetic resonance imaging (MRI)  of sacroiliac joints. A radiologist determined  blindly the presence of active sacroiliits (ASI) as bone marrow edema/osteitis.

Results and discussion. In ePsA, median DAS and DAS28 were 3.99 [2.99; 4.92] and 4.22 [3.37; 4.8], respectively. IBP was detected in 22 (55%) patients; it was prolonged in 12 (54.5%); IBP episodes were noted in 10 (45.5%). MRI revealed ASI n 15 (40.5%) of the 37 patients; SSI in 11 (28.9%); 17 (42.5%) patients were HLA-B27 positive. In ePsA, there was a very high association of ASI and SSI with IBP (Q = 0.91, р<0.002 and Q=0.83,  р<0.002). No significant relationship was found between ASI and HLA-B27. There was no correlation  between ASI and DAS (Q=0.06,  р>0.9) and SSI and DAS (Q=0.42,  р>0.3). A significant association was revealed between ASI and SSI (Q=0.67,  р<0.002). Conclusion. In ePsA, ASI and SSI are identified in 40.5 and 28.9% of cases, respectively. ASI and SSI are closely related to IBP rather than to HLA-B27. The activity of peripheral arthritis does not affect the rate of ASI detected on MRI and SSI in patients with ePsA.

Metabolic syndrome (MS) is a cluster of metabolic disorders giving rise to atherosclerotic  cardiovascular diseases (CVD). The combination  of inflammatory activity and a high spread of traditional  risk factors (RF) for CVD in patients with psoriatic arthritis (PsA) permits them to be referred to as a higher cardiovascular risk group as compared to the general population.

Objective: to estimate the spread of MS and its association with inflammation and subclinical atherosclerosis in patients with PsA.

Subjects and methods. This investigation enrolled 128 patients with PsA (61.7% women and 38.3% men); their median age was 43 [34; 49.5] years; the duration of PsA and psoriasis – 7 [3; 13] and 15 [6; 26] years, respectively). There was a preponderance of patients with moderate (3.7 ≥ DAS > 2.4) and high (DAS > 3.7) disease activity: 33 (25.8%) and 74 (57.8%), respectively. MS was diagnosed on the basis of the 2011 National  Guidelines of the Russian Cardiology Society for Cardiovascular Prevention.  All the patients underwent carotid Doppler ultrasound (CDU) for the diagnosis of subclinical atherosclerosis.

Results and discussion. MS was diagnosed in 49 (38.3%) patients with PsA. The most common  MS criteria were abdominal  obesity in 72 (56.3%) and dyslipidemia [an elevation of low-density lipoproteins (LDL)  level in 101 (78.9%), and a decrease in high-density lipoproteins (HDL)  level in 65 (50.8)]. Hypertension was diagnosed in 32 (25%). 65 (50.8%) patients were found to have subclinical atherosclerosis,  as evidenced by CDU.

The patients with MS were older than those without this condition  (46 [43; 52] and 39 [31; 46] years, respectively; p < 0.0001). These groups did not differ in PsA duration (15 [7; 29] and 15 [5.5; 25] years respectively; p = 0.47). The patients with MS had higher DAS values (4.4 [3.2; 5.6] and 3.6 [2.5; 4.7], respectively; p = 0.02); mean intima media thickness (IMT)  (0.78 [0.72; 0.86] and 0.73 [0.66; 0.77] mm; p < 0.0001) and maximal IMT (0.94 [0.84; 1.03] and 0.84 [0.75; 0.94] mm; p < 0.01). They were found to have significantly more often signs of subclinical carotid atherosclerosis than those without MS (33 (67.3%) and 32 (40.5%) patients, respectively; p = 0.003).

There was a statistically significant relationship between IMT and RF for CVD (MS components, such as waist circumference  (R = 0.41; p <0.0001), systolic blood pressure (R = 0.41; p < 0.0001), LDL (R = 0.44; p < 0.0001), and triglycerides (R = 0.36; p < 0.0001). There was also a correlation between IMT and PsA duration (R = 0.18; p < 0.03).

Conclusion. Thus, the patients with PsA had a high prevalence of MS that was detected in almost 40% of them. There was a relationship of PsA activity to MS. In the PsA patients with MS, IMT was greater than in those without MS. An association was established between IMT and traditional  RF for CVD (MS components), PsA duration,  suggesting that both traditional  RF for CVD and PsA duration may affect the development process of CVD in patients with PsA.

Objective: to study clinical presentations, disease activity, and functional impairments  in patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis  (nr-axSpA).

Subjects and methods. A total of 153 patients were examined in the period 2010 to 2013. They were divided into two groups: 1) 119 patients with a valid diagnosis of AS; 2) 34 with nr-axSpA. BASDAI, BASFI, BASMI, MASES, erythrocyte sedimentation rate, and HLA-B27 antigen were determined  in both groups. The mean age of the patients was 36.5±0.7 years and 27.0±1.2 years and the disease duration 14.7±0.6 and 4.1±0.5 years in Groups 1 and 2, respectively.

Results and discussion. Among the patients with AS and those with nr-axSpA, men accounted  for 68.9 and 70.6%, respectively. The axial type was predominant in both groups (53.7% in Group 1 and 67.6% in Group 2). The mean visual analogue scale (VAS) pain score was 40.6±1.6 mm in Group 1 and 31.6±2.4 mm in Group 2 (p < 0.01). High BASDAI was seen in 51.2% of the patients with AS and 41.1% of those with nr-axSpA. Group 2 had significantly lower mean BASDAI values (3.4±0.2)  than Group 1 (4.0±0.1).  Functional impairments  by BASFI were more obvious in the patients with AS ((3.2±0.2) than in those with nr-axSpA (1.5±0.2).  BASFI >4 was not noted in Group 2. Higher BASMI scores were found in the patients with AS (1.9±0.1)  than in those with nr-axSpA (0.5±0.1). Conclusion. The ASAS criteria for axSpA enable one to establish its diagnosis in the early stage until stable functional impairments  emerge. In the pre-radiographic stage, the patients have lower disease activity and pain.

The rate of osteoporosis (OP) and the mechanism  of its development in patients with ankylosing spondylitis (AS) and other spondyloarthrititides (SpA) have not been sufficiently investigated. Steady-state  inflammatory disease activity is anticipated  to be the leading factor of OP in AS.

Objective: to investigate lumbar spine (LS) and femoral neck (FN)  bone mineral density (BMD)  in patients with early axial SpA (axSpA) and to reveal its association with inflammatory disease activity.

Subjects and methods. A total of 150 patients (59 men and 91 women) aged 18 to 45 years with inflammatory back pain for ≥3 months and ≤5 years were examined. The diagnosis of axSpA was established in accordance  with the 2009 ASAS criteria. BASDAI and ASDAS-CRP were used to assess activity and functional status was evaluated with BASFI. The examination  included determination of HLA-B27, X-ray of the pelvis and LS, magnetic resonance imaging (MRI)  of the sacroiliac joints, LS, and hip joints (in the presence of clinical signs of their involvement),  and densitometry of LS (LI–IV)  and FN. By taking into account the patients’ young age, the Z score was used to estimate BMD. The Z-score -2 SD or lower in at the least one of the regions examined is considered to be diminished BMD. Results and discussion. The median Z-score was -0.7 [-1.3; -0.2] SD for FN and -0.9 [-1.6; -0.6] SD for LS. Reduced BMD in at the least one of the regions examined was diagnosed in 27 (18.0%) patients. There was lower BMD in LS in 21 (14.0%) patients and in FN in 8 (5.3%). Two (1.3%) patients were diagnosed as having osteopenia in the two examined regions. There was no association between diminished BMD and age, gender, disease activity assessed with BASDAI, ASDAS-СRP, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An association was found between inflammatory LS changes, as evidenced by MRI (MRI spondylitis), and reduced BMD in at least one of the examined regions. MRI spondylitis was detected in 27 (18.0%) patients. Decreased BMD in any of the examined skeletal regions was seen in 9 (33.3%) of the 27 patients having MRI spondylitis; the remaining 18 (66.7%) patients had normal BMD values. In the absence of MRI spondylitis, osteopenia was identified in 18 (14.6%) patients; normal BMD values were noted in 105 (85.4%); p = 0.03).

There was also a relationship  between the presence of MRI spondylitis and diminished  BMD in the same region. LS osteopenia  was found in 7 (25.9%) patients with MRI spondylitis and LS BMD remained  within the normal range in 20 (74.1%). In the absence of MRI spondylitis, LS osteopenia  was observed in 14 (11.4%) patients and LS BMD was normal in 109 (88.6%) (p < 0.05).

Conclusion. There was an association between inflammatory LS changes, as evidenced by MRI,  and reduced BMD in the same region. Our findings confirm the hypothesis that bone mass loss in the vertebral bodies in early axSpA results from local inflammation.

Relapsing uveitis is a serious problem for patients with ankylosing spondylitis (AS). Tumor necrosis factor-α  inhibitors significantly reduce the frequency of uveitis attacks in AS patients, but they are not always available. In this connection, it is appropriate  to evaluate the effect of traditional  disease-modifying antirheumatic drugs on the course of uveitis in AS.

Objective: to compare the frequency of uveitis attacks in AS during combined therapy using sulfasalazine (SULF)  and nonsteroidal  anti-inflammatory drugs (NSAIDs)  versus monotherapy with NSAIDs.

Subjects and methods. A total of 111 patients with significant AS who had at least one uveitis attack during the disease were examined. 49 subjects received combined therapy including SULF 2 grams daily and NSAIDs for at least 1 year. Six of the 49 patients were noted to have frequently relapsing uveitis (above 3 episodes yearly); 43 had no more than 3 ones per year. The remaining 62 patients took NSAIDs only throughout  the follow-up period. Nine of them had an average of 3 uveitis attacks per year; 53 had no more than 3 ones per year. Out of the 49 patients receiving combined therapy with NSAIDs and SULF,  23 took NSAIDs only at least 1 year before SULF use; 10 of them were observed to have frequent relapses in that period and 13 had three or fewer episodes.

Results and discussion. The entire group showed an average of 2.06±2.04 uveitis attacks per year during monotherapy with NSAIDs and 1.41±1.83 attacks yearly during combined therapy with NSAIDs and SULF (p = 0.08). Among the patients with less than 3 uveitis attacks per year, the mean number of episodes was significantly fewer during combined therapy than during NSAID monotherapy: 0.99±0.87 and 1.37±0.91,  respectively (p = 0.04). Among those with frequently relapsing uveitis (more than 3 attacks per year), the mean number of episodes yearly was not significantly different during NSAID monotherapy and combined therapy: 5.7±2.5 and 5.5±2.7,  respectively (p = 0.9). In a subgroup of patients receiving sequentially NSAID monotherapy and combined therapy with NSADs and SULF,  13 patients with three or fewer baseline attacks per year displayed a significant reduction  in the frequency of episodes from 1.92±0.96 to 0.4±0.44 (p = 0.00003). During combined therapy versus monotherapy, 10 patients with frequently relapsing uveitis (over 3 episodes yearly) exhibited an insignificant reduction  in the number of relapses from 5.9±3.02 to 5.33±1.1 (p = 0.6).

Conclusion. Combined therapy with SULF and NSAIDs does not substantially affect the frequency of uveitis episodes in AS patients with frequently relapsing uveitis (above 3 attacks per year), but significantly reduces the number of episodes among patients with its mild course (less than 3 attacks yearly).

Guidelines for the treatment of ankylosing spondylitis (AS) lack muscle relaxants. At the same time, the latter are used for combined therapy using nonsteroidal  anti-inflammatory drugs (NSAIDs)  in 53.1% of patients in an outpatient  setting. No clear recommendations make the administration of these agents uncontrolled, on the one hand, and substantially restrict therapeutic  possibilities, on the other.

Objective: to investigate the short-term effect and safety of using tolperisone hydrochloride  (THC,  Mydocalm®)  in patients with AS during group therapeutic  exercise (TE).

Subjects and methods. The investigation included 40 patients aged over 18 years with a valid diagnosis of AS who had been treated at the Clinic of the V.A. Nasonova Research Institute of Rheumatology and agreed to participate  in the study. All the patients were randomized  in a 1:1 ratio into two groups: 1) 20 patients used NSAIDs in combination with TE; 2) 20 patients received NSAIDs,  TE, and THC 450 mg/day. The groups were matched for age, gender, disease duration,  and functional impairments. Before and after completion  of the investigation, the investigators estimated BASDAI, BASFI, patient-rated numerical pain rating scale (NPRS), patient-rated TE performance  scores (NPRS, where 0 (very effective), 10 (ineffective), THC tolerance monitoring  (consideration of adverse events). Spinal motility was evaluated using BASMI and chest excursion measurement.

Results and discussion. During TE, both groups showed a significant increase in the volume of movements (p < 0.03), when measuring chest excursion and carrying out modified Schober's test, a decrease in BASDAI (p < 0.01) and BASFI (p < 0.009), as well as a reduction  in patient-rated overall disease activity assessment (p < 0.02) as compared to the baseline values. At the same time the modified Schober test revealed that the increase in motility was significantly higher in Group 2 than in Group 1 (p < 0.05). During the follow-up, the patient-rated evaluation of TE efficiency remained significantly unchanged  in Group 1 whereas at the end of the study it significantly increased in Group 2 as compared to the baseline values (p < 0.01). There were no significant differences between the groups in the time course of changes in BASDAI and BASFI. When performing the BASMI tests, there was an intensive increment  in the volume of movements after the third TE lesson. The increment  occurred saltatorily in Group 1, but more rapidly and evenly in Group 2. No serious adverse events were recorded in Group 2 during the investigation.

Conclusion. Incorporation of THC into the treatment of patients with AS contributes to the enhanced  efficiency of TE. There is a need for further investigations to study the use of muscle relaxants, including THC,  in AS in order to elaborate recommendations on how to administer this class of drugs for this disease.

At present, there are a number of unsolved problems associated with unawareness of the causes and ways to prevent the inefficacy of tumor necrosis factor-α  inhibitors.

Objective: to study the causes of secondary inefficacy of infliximab (INF), by analyzing its concentrations and antidrug antibody levels in the serum of ankylosing spondylitis (AS) patients receiving long INF,  as well as a possibility to overcome its secondary inefficacy through plasmapheresis.

Subjects and methods. 54 patients with active AS (BASDAI > 4) underwent regular long-term  (1-to-10-year) treatment with INF 5 mg/kg according to the standard scheme. During the therapy blood samples were taken before a regular INF infusion to quantify the levels of antibodies to the drug and its concentration. According to the efficiency of the drug, two groups were formed: 1) 27 (50%) patients with INF inefficacy (an exacerbation occurred 2–4 weeks after infusion); 2) 27 patients with drug efficacy. The levels of anti-double stranded DNA antibodies and antinuclear factor were estimated in 27 patients to investigate a relationship between the immunogenicity of INF and the presence of autoantibodies in its secondary inefficacy. A plasmapheresis session was carried out in 5 patients before a regular IFN infusion.

Results and discussion. Anti-INF antibodies were found in 28 (52%) patients, these being more common  in the patients with drug inefficacy than in the others (67 and 37%, respectively; p < 0.05). In the patients with INF inefficacy, anti-INF antibody levels were significantly higher than in those with preserved drug effect (18.33 and 4.67 U/ml, respectively; р < 0.05). Moreover, the serum concentration of INF was not significantly different in these groups (1.6 and 2.96 μg/ml). There was an inverse correlation  between INF concentrations and anti-INF antibodies (r = -0.7; p < 0.05). The level of autoantibodies  did not correlate with that of anti-INF antibodies. Following plasmapheresis, the level of anti-INF antibodies dropped in all the patients and the concentration of the drug increased in only three of the five patients; in two of them anti-INF antibody levels were initially low (p < 0.05). Plasmapheresis promoted  a short-term restoration  of INF efficacy no matter what the baseline level of anti-INF antibodies.

Conclusion. The secondary inefficacy of INF may be associated with not only the emergence of its neutralizing antibodies and the reduction  in serum drug concentration, but also with other yet unknown causes. There is a need for further investigation of the causes of secondary INF insufficiency and methods for its overcoming.

In accordance  with the Ankylosing Spondylitis Assessments (ASAS) International Working Group guidelines, tumor necrosis factor-α  inhibitors are recommended in patients with ankylosing spondylitis (AS) refractory to at least two nonsteroidal  anti-inflammatory drugs (NSAIDs)  and in those with the peripheral form of the disease. Previous investigations suggest that when long used, infliximab (INF) shows a steady-state efficacy in the vast majority of patients with active AS. Works evaluating the efficiency of combined therapy using NSAIDs and INF are scarce. Objective: to evaluate the efficiency of therapy with NSAIDs and INF in patients with AS from the results of a prospective study.

Subjects and methods. A total of 72 men with a valid diagnosis of AS were followed up. All the patients were allocated to two groups according to the option of basic therapy: 1) 29 patients received combined therapy with INF and NSAIDs; 2) 43 had NSAID monotherapy. Clinical, laboratory, and instrumental  examinations were performed every 12 months. Results and discussion. At 12 months of INF therapy, there were significant reductions in the values of BASDAI, BASFI, back pain, fatigue, and patient-rated global activity assessment. High BASDAI values remained in only 10 patients.

At 24-month follow-up, the above measures did not significantly change as compared to the results obtained at 12 months and remained stable at 36 months. At 12 months of NSAID therapy, there were significant reductions in the values of BASDAI, back pain, fatigue, and patient-rated global activity assessment (p < 0.05). The reduction in BASFI values was insignificant. At 24 months of treatment all the measures versus those obtained after 12 months did not significantly change, except pain in the examined region of the spine, which became significantly severer than that at the 12-month follow-up. These results were also preserved at 36 months. There were more patients achieving 20% and 40% improvements and remission according to the ASAS criteria, and those with a 50% BASDAI improvement after 36 months of INF + NSAID therapy versus NSAID monotherapy (p < 0.05).

Conclusion. The highest clinical effect of INF + NSAID therapy was observed within the first year and the measures in question remained stable at the 36-month follow-up after both treatments. 

Until recently there is no clarity in the nosological independence of non-radiographic axial spondyloarthritis  (nraxSpA). Cohort studies can assist in solving this problem. In 2013, the V.A. Nasonova Research Institute of Rheumatology started to form a Cost and Resource utilization Study in Antiretroviral treated patients (CoRSaR) cohort to investigate the evolution of nr-axSpA and treatment policy for this condition.  This communication deals with the preliminary results of a 12-month follow-up study of the CoRSaR  cohort.

Subjects and methods. The cohort was recruited  from all consecutive patients with a < 5-year history of nr-axSpA who sought for medical advice and treatment. The patients were examined in accordance  with the Ankylosing Spondylitis Assessments (ASAS) International Working Group  guidelines at inclusion and after 12 months.

A total of 94 patients with axSpA were enrolled; 54 patients out of them were included into a preliminary analysis of the evolution of axSpA; their mean age at inclusion was 27.1±5.5  years and the mean disease duration  was 22.4±15.1 months;  49 (90.7%) patients were HLA-B27 positive. 31 of the 54 patients had ankylosing spondylitis(AS) and 23 had nr-axSpA.

Results and discussion. The patients with AS and those with nr-axSpA showed virtually no difference in main clinical parameters,  such as the presence of arthritis, enthesitis, BASDAI, ASDAS-CRP, and BASFI. By the end of the 12month follow-up, both groups virtually displayed almost a double reduction  in all inflammatory markers but erythrocyte sedimentation rate. Nine (39%) patients with nr-axSpA developed radiographic sacroiliitis over 12 months and the diagnosis of AS was confirmed.

Conclusion. 39% patients with nr-axSpA developed radiographic sacroiliitis at the 12-month follow-up. Nr-axSpA should be regarded as an early stage of AS.

Therapy for ankylosing spondylitis (AS) is a challenge for a physician, primarily because of a small number of therapeutic alternatives. Interleukin-17 (IL17), a novel promising therapeutic  target, has been recently disclosed. The first representative of the new group of drugs – anti-IL17A monoclonal  antibodies (secukinumab)  has emerged, which allows expanding therapeutic  opportunities  for this disease. Trials have shown that secukinumab is effective in treating AS, has low immunogenicity and its safety profile does not virtually differ from that of placebo.

Diffuse idiopathic skeletal hyperostosis, or Forestier's disease (FD), is a rare non-inflammatory disease of the locomotor apparatus,  which is associated with ligament and tendon ossification that gradually results in ankylosis. In a number of cases, the clinical and radiographic patterns of FD are similar to those of ankylosing spondylitis (AS), which requires a differential diagnosis.

The paper describes two clinical cases demonstrating  difficulties in the differential diagnosis of FD and AS.

The paper gives the draft guidelines elaborated  by the Expert Spondyloarthritis  Diagnosis and Treatment Group  by order of the Association of Rheumatologists  of Russia. The guidelines include the essentials of how to use nonsteroidal  anti-inflammatory drugs in axial spondyloarthrititides, including ankylosing spondylitis, contain  instructions  for how long they should be administered, and describe possible patient  management tactics in the most common  clinical situations and a preferential  algorithm for evaluating the efficiency and safety of treatment.

The paper provides guidelines for the use of tumor necrosis factor-α  (TNF-α) inhibitors in the treatment of patients with axial spondyloarthritis  (axSpA), including ankylosing spondylitis. It gives data on the efficacy of TNF-α inhibitors in patients with non-radiographic axSpA. By using international and Russian guidelines, the authors lay down indications for this therapy and criteria for evaluation of its efficiency and safety.

The Congress considered the issues pertinent  to the latest approaches to therapy for axial spondyloarthritis  (axSpA), as well as the problems associated with a search for axSpA-modifying anti-rheumatic drugs. Reports on the results of therapy with nonsteroidal  anti-inflammatory drugs and biological agents (tumor necrosis factor-α  and interleukin 17/23 inhibitors) were of the most relevance.

The European  League Against Rheumatism (EULAR)  Congress (EULAR-15) was held in Rome on 10–13 June 2015. One of the most important  aspects of the Congress was the problem of spondyloarthritis  (SpA). Reports on the pathogenesis of SpA, including a relationship between the inflammatory processes and the mechanisms  of bone proliferation, occupied a prominent place in the program of the Congress. The fundamental  importance  of proinflammatory cytokines, such as interleukin 17 (IL17)/IL23, for SpA was the subject of wide speculation. As in previous years, many reports were dedicated to the early diagnosis of SpA, the comparison of different SpA classification criteria, and the progression of non-radiographic axial SpA to ankylosing spondylitis. Much time was devoted to the results of the latest studies visualizing sacroiliitis and spondylitis.