Axial Spondyloarthritis: Reshape the Future—From the “2022 GISEA International Symposium”
, Giulia Cassone 4, Salvatore D’Angelo 5, Serena Guiducci 6, Ennio Giulio Favalli 7,8, Fabrizio Conti 9, Elisa Gremese 10, Florenzo Iannone 11, Roberto Caporali 7,8, Marco Sebastiani 4,*, Gian Franco Ferraccioli 12, Giovanni Lapadula 11 and Fabiola Atzeni 2
Hung-Pin Tu
Round 1
Reviewer 1 Report
This review discusses the main mechanisms and therapeutic approaches in axSpA, which is of great significance, especially introduces the clinical effects of several new therapeutic drugs in recent years and provides practical guidance for clinicians. Several innovative points are proposed: 1. IL-23 and IL-17 play a key role in the pathogenesis of axSpA; 2. Clinical trials have shown that IL-17 inhibitors, but not IL-23 inhibitors, are effective in axSpA patients, and their divergent effects are unique in immune-mediated diseases. Decoupling of IL-17 and IL-23 may be a possible explanation for this effect. However, recent exploratory data from PsA patients with axial symptoms suggest that improvement may occur, but it needs to be confirmed in dedicated axSpA trials, so more corresponding basic research and clinical trials may be needed to explore in the future; 3. This article puts forward the importance of central sensitization, a new concept, in axSpA. At present, various central action drugs have been proved to activate inhibitory downward pain control and desensitize the central nervous system. Second, peripherally acting drugs have been demonstrated in clinical trials to have the ability to reduce central sensitization by reducing peripheral inputs. Whether such drugs can also be used in the treatment of axSPA is worth looking forward to in the future.
Author Response
We thank the reviewer for his contribution and for the attention shown in reviewing our manuscript. His suggestions contributed to a significant scientific growth of our paper and of the Authors.
Reviewer 2 Report
The authors present a review article that aims to discuss the main pathogenetic mechanisms, therapeutic approaches, and the role of pain in axial spondyloarthritis (axSpA) from the 2022 International GISEA/OEG Symposium.
Comments:
The article is well organized.
No further comment
Author Response
We thank the reviewer for his contribution and for his kindness in reviewing our manuscript. His opinion was very important for our work.
