Laurent, o-once you have, you know, a patient that, that either you think has failed a trial of methotrexate or are at high risk, how do you choose among the various different options for treatment, including biologics, targeted synthetic DMARDs, and does the fact that they have psoriasis or uveitis, how does that play into your selection of medications?

Well, just to be clear, patients for axial disease, at least we're, we're not recommending the use of conventional synthetic DMARDs.

But the scenario in the way that you describe it, where someone is on those medications, presumably it would be because of the initial presence, let's say, of uveitis or psoriasis, and then the discovery of axial disease.

And in that circumstance, we're going to make a recommendation first for TNF and TNF inhibitors and, uh, IL-17 inhibitors first, with targeted synthetic DMARDs, specifically JAK inhibitors, as a subsequent therapy to consider.

And the catering and tailoring of therapies, as you alluded to, really does depend on the co-occurrence of comorbidities or disease manifestations.

So in folks with, for example, psoriasis, particularly severe psoriasis, one may consider perhaps IL-17.

But for the purpose of these guidelines, TNF inhibitors and IL-17s, for the general patient, they're considered equivalent.

Liran, can you talk a little bit about what the process was like and, and your reflections after completing this awesome document?