Spartan annual meeting: Denver, Colorado.

The annual meeting of SPARTAN (Spondyloarthritis Research and Treatment Network) was held in Denver, Colorado on July 25 and 26, 2015, and it was preceded by a combined SPARTAN-SAA (Spondylitis Association of American) MRI workshop held on July 24th. SPARTAN is a growing network of health care professionals in North America, Mexico, and other Latin American countries dedicated to foster research, education, awareness, and therapy of spondyloarthritis. This group of arthritides characteristically involves the axial skeleton, although peripheral joints and extra-articular manifestations may also be exhibited; it is highly prevalent among younger individuals in whom it constitutes a frequent cause of long-standing lower back pain leading to a significant impact in quality of life, functional impairment, and disability if left untreated [1, 2]. The pathogenesis of spondyloarthritis remains to be elucidated, although considerable progress has been made in recent years in terms of early diagnosis and newer and highly effective therapeutic modalities. This issue of Clinical Rheumatology highlights 6 papers presented at the annual meeting. It was an intense 3-day affair devoted to basic, clinical, diagnostic, and therapeutic discussion concerning spondyloarthritis by a group of experts. Drs. Khan and Akkoc in the opening article present a provocative proposal to modify existent ASAS classification criteria for axial spondyloarthritis (AS). They provide an overview of the classification criteria of AS beginning with the first criteria set developed at the rheumatic disease conference in Rome in 1961 and thoroughly describe the newer classification criteria introduced by the Assessment of Spondyloarthritis International Society (ASAS) that have had a significant impact on the terminology of this group of arthritides, with the terms axSpA that includes ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA). They suggest that the multi-arm construct of the ASAS criteria is a potential source of heterogeneity that thus reduces their utility. They provide evidence suggesting that it is time to modify the ASAS criteria for axSpA and also propose steps that may improve the validity of these criteria. The next 3 topics present and discuss important basic mechanistic aspects in the development of spondyloarthritis that provide newer insights into their pathogenesis. First, Smith discusses the potential role of the unfolded protein response in axial spondyloarthritis. HLA-B27 MHC class I allele remains the strongest genetic risk factor identified in the great majority of AS patients. In addition to its role in antigen presentation, HLA-B27 possesses unique biochemical characteristics that may contribute to disease pathogenesis. HLAB27 folds slowly and misfolds during its biosynthesis in the endoplasmic reticulum (ER), and this unfolded protein response (UPR) might lead to ER stress and may also increase inflammatory cytokines and affect autophagy. Evidence for the relevance of anHLA-B27-relatedUPR to the development of spondyloarthritis in animal models and humans is discussed. Next, Ciccia and Haroon introduced us to a newer concept, autophagy, and how it might relate to the pathogenesis of SpA, and as such it closely interacts with the previous discussion of the role on unfolded protein response. First, they introduce the concept, discussed the types and its mechanism of action. Then, they briefly present an overview of the role of autophagy in health and disease and conclude by discussing autophagy in rheumatic diseases and particularly AS. Findings discussed appeared to suggest that autophagy could * Luis R. Espinoza luisrolan@msn.com