(Part 1) Living with axial spondyloarthritis (axSpA) – … — Transcript

[Music] Hello and welcome to the first episode of a two-part conversation series taking a closer look at the arthritis condition axial spondyloarthritis, or axSpA. I'm Granulary, Chief Executive of Arthritis Ireland. AxSpA is a painful chronic inflammatory disease that primarily affects the spine and sacroiliac joints. While much is understood about axSpA, it can sometimes be difficult to find accurate and reliable information. During these conversations, we will speak with medical consultants and specialists, providing you with some well-researched answers to common questions asked by those diagnosed with axSpA. I'm delighted today to be joined by Dr. Barry O'Shea, Consultant Rheumatologist from St. James's Hospital in Dublin, who has a special interest in axSpA. Hi Barry, and thank you so much for joining us today. Hi Granulary, thanks very much and thanks for inviting me to talk about my favorite condition. Yes, and I'm going to start off by asking you, you know, what exactly is axial spondyloarthritis, or what we'll refer to in this interview as axial SpA just for short? Yeah, well, and it's sometimes hard to explain this accurately, what exactly that is, but in its simplest form, axial SpA is a form of inflammatory arthritis. It predominantly affects the spine and sacroiliac joints, and that results in a lot of pain and stiffness that can affect any part of the spine right down over your sacroiliac joints, and people feel that a lot over their buttocks. In addition to that, they can get a lot of peripheral symptoms, so joints may be involved away from their spine, so it might be ankles or even their knees or feet, but it's mostly spine symptoms that is the major issue. Frequently, also get a number of other, what we call extra-spinal, so away from the spine symptoms. They're at increased risk of getting conditions like psoriasis or maybe inflammatory bowel problems and even an unusual eye inflammation condition called uveitis. Okay, and in terms of, I know that it can sometimes be seen as sort of an umbrella term for a number of different conditions that fall under this term of axial SpA. Can you tell us a little bit more about that? Yeah, you're absolutely right. So the kind of, we try and think of it now as, you say, axial, axial SpA as an overarching term to describe every phase of this condition. People might be familiar with an older term, ankylosing spondylitis or AS, and that refers to people that have established spinal involvement. The ankylosing part of it, you know, stands for fusion, so it's people that have had symptoms for many, many years. But that term really let us down when we were trying to find earlier people, people that didn't have the fusion in their spine, so people in the first few years of their conditions. So we took a step back and said there's a phase where people before their x-rays become abnormal, and sometimes you might refer to that as pre-radiographic, so the pre-radiographic phase. And frequently, we use MRIs and different methods of assessing those people to show up inflammation. So the pre-radiographic phase is the earlier phase, and there is then a progression over time to what we classically would have referred to as ankylosing spondylitis or the radiographic or the x-ray phase. But if we take a step back and just want to include early and late disease, axial SpA or axial SpA covers all of that. Okay, and for people who might be watching this, and you know, in your introduction you mentioned some of the signs and symptoms of the disease, but can you just let us know, are there any other signs and symptoms, you know, for people that are maybe experiencing back pain out there who are watching this and wonder, do I have this? Like, what are the traditional signs and symptoms of axSpA? Yeah, you're absolutely right. I mean, back pain is so common, and sure, the vast majority of people that have back pain don't have axSpA, and most people will experience back pain at some stage of their life. So really, I think it's the most common reason to present to your primary care or family doctor. So, but yeah, it's a very, it's remember it's an inflammatory condition, and inflammatory joint conditions, whether they're in your back or any other joint, have a particular pattern. So if you've got a lot of early morning stiffness, like that, not just a little bit stiff in the morning, but significant early morning stiffness where it can take 30 minutes or 60 minutes or 90 minutes to get going in the morning, and if you've got back pain that improves with activity, you're the person that's better moving around. You hate staying still, you hate sitting in the car for a long drive, you hate sitting in the bus, you even hate sitting in the waiting room because you're much better off moving around. So if you're the sort of back pain that gets better with movement, gets worse with rest, and that might go down into the buttocks, remember I mentioned those, so that's where the sacroiliac joints are, and we think that that's where things start. So if it's those or that sort of pain, and that's very different to more standard back pain. People that have more standard back pain, maybe from disc problems or strain, they love to stay still because it helps them, and they hate moving around, it makes things worse. So it's really the opposite of that. So that's what we call inflammatory back pain, and that what we think of as the cardinal symptom of people that have axial SpA. Okay, and how common is it and who gets it? You're right, it's not common. As we said, there are a lot, a lot of other causes of back pain that are much more common. In fact, there's research saying that of all the back pain patients that go to GPs, go to see primary care, maybe only five percent, so that's only one in 20 of those back pain patients turn out to have axial SpA. So it is rare. And then we look at how common is it in the population in general, again, it's hard to get very detailed information, but it's less than 0.5 percent of the population at large will end up having axial SpA as well. Okay, and do we know what actually causes it? You know, and are there known risk factors for it, for instance? So like a lot of our conditions, there is a genetic tendency in them, so people are predisposed by their genes. But not everyone in a family, even though they would have the same genes, would get the condition. So something else must come along to trigger it. A lot of our inflammatory conditions, our autoimmune conditions, are frequently triggered by, we think, maybe a viral infection might be what triggers someone that's predisposed. And, but we never know for sure because sometimes it's so hard to date back to when the symptoms actually really start. So then it's even harder to remember, was I unwell in those few months beforehand? But basically, the bottom line is people are genetically predisposed, and then some environmental trigger is enough to tip them over at the edge and to start to develop inflammation, and that inflammation builds up in their spine, and they start to get back pain. And I mean, sometimes people, I tend to have a belief that this form of arthritis has more of a genetic component than other types. Is that fair to say, or is it just a myth? No, no, that is fair to say. I mean, compared to some of our conditions, it would definitely have a stronger genetic component. You're even able to follow it more closely to various family members. It's not a condition that's passed directly generation to generation consistently, but if you look, you're able to plot out even kind of family tree, you'd be able to see different family members that are affected with the condition. What's interesting is some of the related conditions that I mentioned at the start, like maybe psoriasis or inflammatory bowel problems, they are all genetically linked. They're not the exact same, but they're very similar. So you might be able to trace back going that it was an uncle that had inflammatory bowel problems or a...

and sacroiliac joints while much is understood about axeva it can sometimes be difficult to find accurate and reliable information during these conversations we will speak with medical consultants and specialists providing you with some well-researched answers to common questions asked by

those diagnosed with axpa i'm delighted today to be joined by dr barry o'shea consultant rheumatologist from st james's hospital in dublin who has a special interest in axeva hi barry and thank you so much for joining us today hi growingyou thanks

very much and thanks for inviting me to talk about my favorite condition yes and i'm going to start off by asking you um you know what exactly is axial spondyloarthritis or what we'll refer to in this interview of axial spa just for

short yeah well and it's sometimes hard to explain this accurately what exactly that is but in its simplest form um axial spa is a form of inflammatory arthritis it predominantly affects the spine and sacroiliac joints and that results in a lot of

pain and stiffness that can affect any part of the spine right down over your sacroiliac joints and people feel that a lot over their buttocks in addition to that they can get a lot of um peripheral symptoms so joints um

may be involved away from their spine so it might be ankles or even their knees or feet but it's mostly spine symptoms that is the major issue frequently also get a number of other what we call extra spinal so away from the spine symptoms

they're at increased risk getting the conditions like psoriasis or maybe inflammatory bowel problems and even an unusual eye inflammation condition called uveitis okay and in terms of i know that it's can sometimes be seen as sort of an

umbrella term for a number of different conditions that fall under this this term of axial spa can you tell us a little bit more about that yeah you're absolutely right so the kind of we try and think of it now as you say

axial m axial spa as a an overarching um term to describe every phase of this condition people might be familiar with an older term colossians spondylitis or as um and that refers to people that have established spinal involvement the

ankylosing part of its you know stands for you know fusion so it's people that have had symptoms for many many years um but that term really let us down when we were trying to find earlier people people that didn't have

the fusion in their spine so people in the first few years of their conditions so we took a step back and said there's a phase where people before their x-rays become abnormal and sometimes you might refer to that as pre-radiographic so the

pre-radiographic phase um and frequently we use mris and different methods of assessing those people to show up inflammation so the pre-radiographic phase is the earlier phase and there is then a progression over time to what we classically would

have referred to as ankylosing spondylitis or the radiographic or the x-ray phase but if we take a step back and just want to include early and late disease axial spa our axial spa covers all of that okay and for people who

might be watching this and you know in your introduction you mentioned some of the signs and symptoms um of the disease but can you just let us know are there any other signs and symptoms you know for people that are

maybe experiencing back pain out there who are watching this and wonder do i have this like what what are the traditional signs and symptoms of action yeah you're absolutely right i mean back pain is so common and sure and the vast

vast majority of people that have back pain don't have a ham have axial spine and most people will experience back pain at some stage of their life so really i think it's the most common reason to present to your primary care

or family doctor so but yeah it's a very it's remember it's an inflammatory condition and inflammatory joint conditions whether they're in your back or any other joint have a particular pattern so if you've got a lot of early morning

stiffness like that not just a little bit stiff in the morning but significant early morning stiffness where it can take 30 minutes or 60 minutes or 90 minutes to get going in the morning and if you've got back pain that

improves with activity you're the person that's better moving around you hate staying still you hate sitting in the car for a long drive you hate sitting in the bus you even hate sitting in the waiting room um because you're much better off moving

around so if you're the sort of back pain that gets better with movement gets worse with rest and that might go down into the buttocks remember i mentioned those so that's where the sacroiliac joints are and we think that that's

where things start so if it's those or that sort of pain and that's very different to more standard back pain people that have more standard back pain maybe from disc problems or strain they love to stay still because it helps them and they hate

moving around it makes things worse um so it's really the opposite of that so that's what we call inflammatory back pain and that what we think of us is the cardinal symptom of people that have axial spell okay

and how common is it and who gets it you're right it's not common um as we said there are a lot a lot of other causes of back pain that are um much more common in fact there's research saying that of all the back

pain patients that go to cgp's go to see primary care maybe only five percent so that's only one in 20 of those back pain patients turn out to axial spell so it is rare and then we look at how

common is it in the population in general again it's hard to get very detailed information but it's less than 0.5 of the population at large we'll end up having m axial as well okay and do we know what actually causes it

you know and are there known risk factors for it for instance so like a lot of our conditions there is a genetic tendency in them so people are predisposed by their genes um but not everyone in a family even though

they would have the same genes would get the condition so something else must come along to trigger it a lot of our inflammatory conditions our autoimmune conditions are frequently triggered by we think maybe a viral infection might be what

triggers someone that's predisposed and um but we never know for sure because sometimes it's so hard to date back to when though when the symptoms actually really start so then it's even harder to remember was i unwell in those

few months beforehand but basically the bottom line is people are genetically predisposed and then some environmental trigger um is enough to tip them over at the edge and to start to develop inflammation and that inflammation builds up in their spine

and they start to get back pain and i mean sometimes people i tend to have a belief that this form of arthritis has more of a genetic component um than other types is that fair to say or is it

is it just a myth no no that is fair to say i mean compared to some of our conditions it it would definitely have a stronger genetic component you're even able to follow it more closely to various family members

it's not a condition that's passed directly generation to generation generation consistently but if you look um are able to you know plot out even kind of family tree you'd be able to see different family members that are affected with the condition

are interesting is some of the related conditions that i mentioned at the start like maybe psoriasis or are inflammatory bowel problems they are all genetically linked they're not the exact same but they're very similar so you might be

able to trace back going that it was an uncle that inflammatory bowel problems or a grandfather that had psoriasis and so there's the the related conditions all run down through um families that's so i yeah back to your

point i would say it has a strong genetic opponent so um yeah compared to some other conditions definitely and i think just um linked to look at that question around who gets it and how do people get it um i've often heard it

said that this is one of the few types of arthritis where um it's more prevalent in men and but i know that there there's been some sort of further research done on this when you look at the broader axial

spa family so can you tell us a little bit more about that for people watching you're you're absolutely right i mean i suppose classical or what we're trying to think of a historic angst bond um so that version that maybe is more severe

or has that kind of fusion and a lot of spine involvement that um definitely is seen in more men than women now we used to think it was very much tipped in the favor maybe ten to one we

know that that's actually not correct but it's still roughly maybe three times more common in men than women so that's the x-ray phase but as you say we're now starting to step back and look at this group um

so we can capture about early and late disease as a more and better terminology so the axial spa group and the the the gender difference in those is actually it's actually the same so there's likely to men and women are as

likely to get it and this has been with the change in the terminology and the change in our criteria of last years this has been really interesting so a condition that we previously thought of as maybe being very rare in women we

actually know that that's really no longer the case and they're every bit as likely to have um this version of it and that's important our thinking very much has taken us down that this is a predominantly men condition a male

condition so it's certainly important that we start to you know redress that and start to think of it again there and you know historically people were even slower to diagnose it in a woman but we know that there's every you know

every chance that the patient in front of you whether it's a man or woman could have this condition so when it comes to diagnosis and moving on to that can you can you take us through the steps to a diagnosis how

exactly is it diagnosed it's it can be challenging it can certainly be challenging in the early phases at the end of the day it is what we call it's a clinical diagnosis you come into my clinic or anyone else's

clinic and they have to use their clinical skills and clinical judgment to make that diagnosis we have lots of tools that we use whether it's blood tests or x-rays or mri scans but at the end of the day we need to

what is the likelihood that someone coming in has this condition so back to what we started off with describing that pain the first thing i take is a history i want the patients to describe their pain for me and it's so

informative when people start to describe it because you get clues this you know this bad stiffness in the morning even frequently they wake in the second half of the night because remember they've gone to bed and the inflammation has built up as they've

been still they these remember these patients hate staying still so the inflammation has built up in the second half of the night so they from three four five o'clock in the morning frequently have to get out of bed the

pain is that bad so people start to describe that that's a a warning sign that bad stiffness in the morning they tend to you know be better if they're moving around they hate staying still they might have tried various

anti-inflammatories and it is an inflammatory condition so not surprising anti-inflammatories will help and so it's when i listen to the history when people describe their pain i have a suspicion uh that it either is or it isn't and then we start the process of trying

to investigate them and it's relatively easy to get plain x-rays so we frequently start with those and if people have had symptoms for a long amount of time their x-rays may start to show the classical changes of what we've previously called

ankylosing spondylitis and great that's their diagnosis made but as i said earlier those changes don't happen at the start and we would miss them if we only had those plain x-rays some patients that i think might have an

underlying axial spa i am convinced or as convinced as i can be that it might be they're the ones i would at least strongly consider sunny for an mri and mri has helped us a lot and it's really important that we get

the right type of mri because again we are looking for inflammation and there's a specific kind of type of mri that's on it's done in the same machine and all the rest of it but the request needs to specifically

please out rule or confirm inflammatory changes in the spine or sacroiliac joint because the standard mri won't necessarily do that and then once that mri is done and it's the correct one and in the setting of if we can do some routine blood tests

because the inflammation markers can be a pointer and if you're in good health your inflammation marker should be normal if you've got chronic inflammation those those markers that we use the cop and the esor they're called will start to to

raise so it's bringing all those together and then at the end going do i think you have an axial spa yes or no okay and i i know this is one of the diseases within the the rheumatic disease family that can sometimes take a

long time to be diagnosed and you know i think um correct me if i'm wrong but it can take up to eight years i think that's one of the things and it's one of certainly one of the rationales behind doing this campaign

so you know why can it take so long to be diagnosed yeah you're absolutely right and it's so frustrating you know we don't we wouldn't find that acceptable in so many other conditions even in our own field and rheumatoid arthritis you might wait

eight years to get your diagnosis so why is it remember the presenting symptom is back pain yeah and we've said already that only a small percentage of back pain is inflammatory so only a small percentage of back pain patients have an

axial spa um so that we're up against that from the word go so as i said earlier for back pain patients maybe presenting to their gp only five percent of them so one in twenty so a gp you will have to see amongst their busy

busy practice lots and lots of patients but also lots and lots of back pain patients 19 out of 20 before they might stumble across the one that has it so it's hard in that in it you know therefore it gets lost somewhat in

regular back pain yeah not seeing too many cases absolutely and a lot of people even themselves don't necessarily seek out attention with their with their back pain they're like maybe to go directly for physio or start to do some you know you know some

exercise or swimming themselves and stuff so each of those steps delays things a little bit yeah and i suppose the other major reason is that our our older criteria were not very good they were dependent on x-rays and they were

dependent on x-rays showing up classical changes in the spine or the sacroiliac joint and they don't happen early so even if you happen to come to to see me in the first year and that would be good and i just only did a plain x-ray your

x-ray might be normal and i might say oh you don't have an axial spa off you go or go back to your gp and things like that but you could well have done yeah so the advent of newer criteria and the

advent of neuro technology like mri plus just increasing awareness that's why this is so important increasing awareness that every healthcare professional thinks of this condition from gps to physios to um doctors working in the hospital on the general wards and even

rheumatologists the more we think about this condition the more likely we are to diagnosis because we have to work so much better on that you're right it's it's over eight years is the average delay from your symptom onset to coming

in and being told you have the condition so we've covered diagnosis um then let's move on to treatment and how is how is axial spa treated two main broad categories of the way we divide it m is the non-pharmacological

so non-medicine side and the medicine side the pharmacology side and the non-pharmacological side is really really important i think of all the conditions that i look after in rheumatology it's the most important it is so important remember this is a

condition that's potentially going to involve you're at the full length of your spine and we've seen in the very severe versions of it going to fuse your spine so we want to do all in our power to reduce or eliminate that as much as

possible and i work really closely with physiotherapists in in my clinic and anyone that has a new diagnosis they automatically get get referred to the physiotherapist because it's so important that they have a specific kind of tailored program for them and their

back that they keep moving it they keep stretching it they keep strengthening it working on their core strength all these things that are really really important and what's falls into that as well is um keeping your weight under control and

the more pressure that's put on your spine the the the worse it is and just educating yourself about your condition and all the things that you can do non-pharmacologically we don't always have to depend on medicine um it's only a small percentage but i've

some patients who don't need any medicine at all but they have a very strict exercise program there the patients that might go swimming three or four or five times a week and that's enough to keep their inflammation under

control so that side is important and in crucial and then we move on and then i'm more responsible than i'm purely in the pharmacology or the medicine side like the first line treatment for this group of conditions are anti-inflammatory medications

and it is really important that you try different anti-inflammatories there's lots of them out there some across the counter some of them are on prescription i always get people to try different ones because everyone is a little bit

different in terms of how they will respond to um a medication and anti-inflammatories aren't the cure for everyone by any means but there's a court patients maybe about a quarter patients and they will be enough whether they need to take them regularly

or maybe on demand but that will be enough to control their inflammation now we don't necessarily like people being on those anti-inflammatories long term day in day out they're not without their side effects um so we are conscious of that and i

suppose how things have changed in the last 10 or 15 years as the advent of the biologic medications that's another group of medications they work against inflammation in a different way than anti-inflammatory they're much more targeted they're much more specific

um classically they block a central cytokine called tnf or tumor necrosis factor and this seems to be so important in the inflammation your spine so if you come in and you block it and it has a significant impact on people's

level of pain and stiffness and inflammation they're normally able to reduce or even drop their anti-inflammatories completely and they say on these medications they're slightly different to the anti-inflammatories that they're not given by tablet they're an injection that people normally give themselves but

people get used to that very quickly and thankfully they're not very frequent there's different versions you might take your injection once a week or once every two weeks or maybe even once a month so that works um very well and

they've really been a game changer in terms of how we treat this group of conditions and so that's broadly how i start to kind of come up with a treatment plan for any patient that comes into my clinic okay

and like we know with any form of inflammatory arthritis flares and flare management can be you know a really part important part of the i suppose as the disease develops or as people live longer with it you know it just seems to

be part and parcel of the whole process can you explain first to to people watching you know exactly what a flare is and then how it might be managed yeah so i suppose this condition isn't any different than any other condition

that you know that will go through flares or attacks and people call it different ways and it's just for whatever reason a significant increase in their level of symptoms people may already be on an effective treatment that's controlling them 90 of the time

but something happens and they get an escalation in their level of symptoms we don't really understand that like why why why would you might get a flare you know is it if our body comes under some form of stress and that can be physiological

stress you might be you know having another illness and that might be triggered or even psychological stress it might be enough to actually trigger an attacker flare and just their level of symptoms will increase um so they might have been doing fine

but all of a sudden they wake up one day and they they nearly get a reminder of what their symptoms were like before they started treatment it's important that patients know that this is common um and it is manageable and that we can

you know very easily come up with a plan for that um if people are on an established treatment say they're already on one of their biological injections it just means as a short-term measure we need to escalate things

um to bring that information back under control so i would frequently put people back on their anti-inflammatory medication maybe for a couple of weeks just so things settle down it's totally safe to take your regular biological injection and to come in with an

anti-inflammatory they work in a totally different way they are safe to use together um and i get them to re-engage with their physio or their exercise program um i get them if possible if there's something not too bad to say get into a

pool because it's so much easier it's going to ease out the kind of the tightness a lot of patients when the inflammation builds up they get their muscles almost going to spasm and they can get a lot of symptoms throughout

their spine and and the warm water of a pool does wonders for that and stuff so it happens hopefully not too frequently that people get a flare if they're on um effective medication but if it does happen people need to know that we have

a plan for that and it's normally reverting to anti-inflammatory medications would be the most common okay um is surgery often needed not that often is the short answer that i suppose you need to remember that this is a condition

um it affects really the length of your spine it starts right down of your sacroiliac joints and where we think things actually go wrong are surrounding our spine and our vertebrae are a series of kind of tendons and ligaments up and

down the length and keep keep us upright keep it together but keep us flexible and it's where those tendons insert and attach to those vertebrae that each of those little points becomes inflamed i think then we'd have 30 40 50 of those

points that potentially become inflamed and that's why the symptoms can be so severe during a flare but operating on that really isn't an option there are multiple multiple levels so in terms of for the active inflammation we just don't send patients for surgery

surgery on their spine we do need to remember though as i said it's a condition that predominately affects the spine but it can affect other joints like hips even or knees so there may be an increased risk of getting

more wear and tear on those joints so um exhale spa patients may end up getting you know a hip replacement or a knee replacement at maybe a slightly younger age than someone who didn't have that condition and so that's the sort of surgery that i

most frequently would end up sending my patients for rather than directly on their spine okay um when it comes to the person themselves getting involved in you know how they manage their condition you know what what can a person do

to help manage their their axial spa and what can they do to manage their pain i suppose the first thing i would say is you need to be knowledgeable you know it's your condition and you need to learn about it become educated about and

know it and know and also listen to your body in terms of how your symptoms are and certainly if you've got a certain level of symptoms and all of a sudden they change that's important and not just automatically going oh this is just

the way things should be you know if your pattern of symptoms change that you know something needs to be done about that so uh learning about your condition is crucial from that point of view as i said earlier um the the the work in some

sense that you put in in terms of um exercise um really pays dividends it's uh you know exercise and those things are good for all of us on our both our mental well-being and our physical well-being particularly for um um axial spa

patients and it keeps their weight under control so everything that you can anything you can do keep your weight under control the less amount of weight that the spine is carrying the better things are going to be um

so that's the things that i always say um if patients happen to be smokers hopefully they're not but i strongly strongly emphasize that that smoking needs to to go all the data out there shows us that patients and

axial spa patients do worse of their smokers and they're less responsive to treatments they're more likely to progress at a quicker rate than the non-smokers so that is something that they can directly take control of it if at all possible um and address

is smoking also a trigger a potential trigger for the development of accessible in the first place it is i mean smoking is bad for um a lot of different reasons we all know that but in the in the

rheumatology world in different forms of arthritis um back to the what i mentioned earlier on about what potentially is a trigger again if you're genetically predisposed smoking can be one of those triggers that kind of pushes you over the age and starting to

develop the symptoms we know that for definite and rheumatoid arthritis um but certainly in axial spa as well that that is likely to be the case and it just all the data would show that you're going to be less less responsive to treatment and

so that's so why that is so important okay and i'll move on to asking you about sort of diet and nutrition because obviously this is a um you know a pet subject for lots of people with arthritis um and certainly

in relation to actual axials bad this would be a question a lot of people ask as well in terms of um you know are there certain foods that a person should exclude from their diet or anything like that so

as the expert uh you know what research is out there to support you know the influence of diet yeah like you're absolutely i get that's probably the question i get asked yes because i mean in lots of ways it seems like a great um

thing going oh if i take tomatoes yeah well it's something you can proactively engage with and make changes unfortunately well back to your point the research on it has been poor so you know there's not great research on

um on the role of diet but what we do know is that um you know the standard of ice but a healthy balanced diet is crucial because that will have such a role in keeping you at a healthy weight

and being overweight is again because of just the physical impact um on your spine isn't good but carrying around extra and weight is not good in itself that tissue is very what we call pro-inflammatory so it's another stimulation for inflammation so lots of

reasons to follow a healthy balanced diet to get your weight under control specific things then that we're starting to learn about now is the role of processed foods and particularly processed carbohydrates and so the more processed a diet is and the

more processed our carbohydrates so very much if it's a white bread white rice is white pastas and stuff that that sort of processed food stimulates inflammation itself so if you've got an underlying condition or in any way predisposed there's another

trigger that's going to come along and now we're not saying for any mean you cut out your carbides all together it's all about moderation and mean stuff but trying to cut back the process in taking your diet just into a healthier

diet it's going to remove some of that stimulus for inflammation and so that can that is something that you know patients themselves can take control of not easy but at least if they do it the majority of the time i think

they'll see a benefit from it okay and i suppose just looking to you know the future i know you don't have a crystal ball or anything but you know in your opinion you know what does the future hold for um for axial spa and can

you tell us a little bit about the research that's going on in this area as well yeah i mean i i think personally it's it's very exciting there's a lot happening um but there's a lot still to be done and a lot of

deficiencies in our knowledge about it this that the number one thing is cracking the diagnosis and reducing that time that people are waiting and not having them wait eight years um to get their formal diagnosis because that's you know we need to get

people started on their treatment plan and their their goal and all the evidence that does show us that where you are able to identify people earlier so early disease in the first few years and get them identified and on to affect the

treatment that they do the best in the long term we know that without a doubt so that is crucial that we focus on reducing the time um to diagnosis and what do you think are the elements of that

i think things like this are important i mean i think educating patients about back pain and that there's a chance that their back pain might be caused by something different healthcare professionals have a role in this we need all across the board

to improve our awareness and to think about it if we don't think about this condition we'll never diagnose it um so i think all those things are important you know the the change in terminology you know not ideal

and it's all a bit of a mouthful at least you know you know dropping angst bond enclosing spondylitis to some degree and replacing with axial spa this is the same letter so a s so sometimes people refer to the condition of a s

they get to keep their letters yes yes um and so that's that's that's all all part of it and stuff because but there are still as i said kind of deficiencies in our knowledge if and particularly i suppose the the

the gender difference is is so important uh our females patients have been poorly researched because i suppose it was poorly or rarely thought of this condition didn't really affect females why would we why would we think about pregnancy it hardly ever happens

happens a lot half of the patients now diagnosed with axial spa are women so uh what about the effects of pregnancy and and all those other things so they're they're really important they're a focus of ongoing research but

there's a lot more work to be done in that area um going forward so there are the main areas that i i see changes happening hopefully in the in the next few years i suppose something in the same way the

treatments have changed usually over the last 10 or 15 years with the advent of biologics like that whole field is changing hugely as as well um and if you told me like i started in rheumatology 20 years ago we'd have all these very

much targeted treatments i would have said because that's kind of crazy talk but it's switched to you know it's just moved hugely in terms of you know we have a repertoire of treatment now which is brilliant and i suppose what

will come back the next or the next phase hopefully will be just getting better at picking what treatments what treatment do you go on if you come in to me yeah and our female patients respond better to drug a versus drug b um

should we you know if you've got you know family history should we target drugs differently we're we're not there yet you know this idea of a personalized medicine approach but you know the changes that we made you know

so much in the last 10 years that's where we're going so i don't necessarily waste too much time i just will start you in the drug that i've always used and give you a trial and then wait and

bring you back three or six months later and if you know better i keep on moving whereas being able to make that decision on day one or in those early days would be crucial and i think that's the more

research we do about it and the more likely we are to make good decisions about about treatment yeah okay on that positive note um i will finish things for today and thank you very much for being with us here today

thank you very much and thank you very much for watching this video for more information on axial spa please log on to our website arthritis ireland dot ie you can also get further support via our online facebook groups

or via our helpline zero eight one eight two five two eight four six thank you very much again to dr barry o'shea consultant rheumatologist for joining us and for sharing his insights and experiences we look forward to seeing you again soon

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