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The role of LCN2 and LCN2-MMP9 in spondylitis radiographic development: gender and HLA-B27 status differences. Arthritis Res Ther 2022; 24:164. [PMID: 35804445 PMCID: PMC9264538 DOI: 10.1186/s13075-022-02854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Male HLA-B27-positive radiographic-axial spondyloarthritis (r-axSpA) patients are prone to have severe spinal radiographic progression, but the underlying mechanisms are unclear. We recently showed that persistently elevated Lipocalin 2 (LCN2; L) reflects sacroiliac joint (SIJ) inflammation. LCN2 binds to MMP9. Concomitant elevation of L and LCN2-MMP9 (LM) was detected in many inflammatory diseases. We asked whether L and LM play similar roles in r-axSpA pathogenesis. Methods We analyzed 190 axSpA patients (123 radiographic and 67 non-radiographic axSpA) who had no detectable circulating Oncostatin M, to avoid complications due to cross-talk between pathways. L and LM levels from a single blood sample of each patient were measured and were correlated with MRI and modified stoke AS (mSASS) scoring. Association of elevated L (L+) or concurrent L+ and elevated LM (LM+) patterns with B27 status and gender were assessed. Results In L+LM+ axSpA patients, both L and LM levels correlated with MRI SPARCC SIJ scores, but only LM levels correlated with MRI Berlin Spine Scores, suggesting LM is a biomarker for both SIJ and spinal inflammation. Among patients with minimal spinal ankylosis (mSASSS < 10), 65% of male r-axSpA patients are L+LM+, while 30% and 64% of female patients are L+LM+ and L+, respectively, supporting the role of LM with disease progression. In B27+ L+LM+ male patients, both L and LM (but not CRP) levels correlate with mSASSS. B27 positivity and maleness have additive effects on spondylitis progression, suggesting concurrent high L and LM elevations are associated with B27+ male patients having more significant radiographic damage. L+ B27-negative male patients or L+ female patients are more likely to have milder disease. Conclusion L and LM are informative biomarkers for SIJ and spinal inflammation, as well as for ankylosing development in r-axSpA patients. Distinctive L+LM+ or L+ patterns not only could distinguish clinically aggressive vs milder course of disease, respectively, but also provide an explanation for B27-positive male patients being the most susceptible to severe ankylosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02854-2.
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Ahn GY, Koo BS, Joo KB, Kim TH, Lee S. Use of Quantitative Vertebral Bone Marrow Fat Fraction to Assess Disease Activity and Chronicity in Patients with Ankylosing Spondylitis. Korean J Radiol 2021; 22:1671-1679. [PMID: 34402239 PMCID: PMC8484149 DOI: 10.3348/kjr.2020.0953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 11/15/2022] Open
Abstract
Objective We quantitatively measured the fat fraction (FF) in the vertebrae of patients with ankylosing spondylitis (AS) using magnetic resonance imaging (MRI) and investigated the role of FF as an indicator of both active inflammation and chronicity. Materials and Methods A total of 52 patients with AS who underwent spinal MRI were retrospectively evaluated. The FF values of the anterosuperior and anteroinferior corners of the bone marrow in the L1-S1 spine were assessed using the modified Dixon technique. AS activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), AS Disease Activity Score (ASDAS), and serum inflammatory marker levels. AS disease chronicity was assessed by AS disease duration and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Univariable and multivariable regression analyses were conducted to investigate the correlation between FF and other clinical characteristics. Results The mean FF ± standard deviation of the total lumbar spine was 43.0% ± 11.3%. At univariable analysis, spinal FF showed significant negative correlation with BASDAI (β = −0.474, p = 0.002) and ASDAS with C-reactive protein (ASDAS-CRP; β = −0.478, p = 0.002) and a significant positive correlation with AS disease duration (β = 0.440, p = 0.001). After adjusting for patient age, sex, and total mSASSS score, spinal FF remained significantly negatively correlated with BASDAI (β = −0.543, p < 0.001), ASDAS-CRP (β = −0.568, p < 0.001), and ASDAS with erythrocyte sedimentation rate (β = −0.533, p = 0.001). Spinal FF was significantly lower in patients with very high disease activity (ASDAS-CRP > 3.5) than in those with only high disease activity (2.1 ≤ ASDAS-CRP ≤ 3.5) (p = 0.010). Conclusion Spinal FF may help assess both AS disease activity and chronicity.
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Affiliation(s)
- Ga Young Ahn
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Bon San Koo
- Division of Rheumatology, Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Kyung Bin Joo
- Departments of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Tae Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Seunghun Lee
- Departments of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
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Petcharat C, Srinonprasert V, Chiowchanwisawakit P. Association between syndesmophyte and metabolic syndrome in patients with psoriatic arthritis or ankylosing spondylitis: a cross-sectional study. BMC Musculoskelet Disord 2021; 22:367. [PMID: 33879097 PMCID: PMC8056532 DOI: 10.1186/s12891-021-04222-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate the prevalence of and factors associated with metabolic syndrome (MetS) in patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS). Methods This cross-sectional study included PsA or AS patients who attended Siriraj Hospital (Bangkok, Thailand) during March 2014 to October 2017. The Harmonized MetS definition was used to diagnose MetS. Demographic, clinical, and spinal radiographic data were collected. Logistic regression was used to identify factors associated with MetS. Results Among 319 patients, 153 had AS and 166 had PsA. MetS was present in 43% of PsA and 19% of AS (p < 0.001). Multiple regression analysis identified body mass index (BMI) > 23 (odds ratio [OR]: 3.7), female gender (OR range: 3.8–3.9), and the number of syndesmophytes or ankylosis [SynAnk] (OR: 1.1) were associated with MetS among PsA patients. For AS patients, BMI > 23 (OR: 9.1) and age > 40 (OR: 4.3) were associated with MetS. Disease activity index was not associated with MetS. Conclusions MetS was significantly more prevalent in PsA than in AS. Structural change of the spine was associated with MetS in PsA. PsA patients with being female, BMI > 23 or evidence of spinal change should be informed to screen for MetS. AS patients with age > 40 or BMI > 23 should be informed to screen for MetS.
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Affiliation(s)
- Chonachan Petcharat
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Varalak Srinonprasert
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Praveena Chiowchanwisawakit
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Sari I, Lee S, Tomlinson G, Johnson SR, Inman RD, Haroon N. Factors Predictive of Radiographic Progression in Ankylosing Spondylitis. Arthritis Care Res (Hoboken) 2021; 73:275-281. [PMID: 31675169 DOI: 10.1002/acr.24104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/29/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Using a longitudinal observational cohort of ankylosing spondylitis (AS) patients, we sought to identify progression rates and factors predictive of spinal progression. As a secondary aim, we analyzed the effect of tumor necrosis factor inhibitor (TNFi) treatment on radiographic progression. METHODS AS patients who had baseline and follow-up cervical and lumbar radiographs were included in the study. Radiographic damage was assessed by the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). A change of 2 mSASSS units in 2 years was defined as progression. The characteristics of the study group such as demographic, clinical, laboratory, and treatment history were collected. RESULTS There were 350 patients in the study. The mean ± SD mSASSS increased from 9.3 ± 15.8 units at baseline to 17.7 ± 21.7 units by the sixth year. Mean ± SD changes in mSASSS between the years 0 to 2, 2 to 4, and 4 to 6 were 1.23 ± 2.68, 1.47 ± 2.86, and 1.52 ± 3.7 units, respectively. Overall, 24.3% of the group progressed over 2 years. Male sex (hazard ratio [HR] 2.46 [95% confidence interval (95% CI) 1.05, 5.76]), the presence of baseline damage (HR 7.98 [95% CI 3.98, 16]), increased inflammatory markers (log C-reactive protein level HR 1.35 [95% CI 1.07, 1.70]), and TNFi use (HR 0.82 [95% CI 0.70, 0.96]) were predictive of radiographic progression. There was a 20% reduction in the rate of progression with TNFi. CONCLUSION Male sex, the presence of baseline damage, active disease state, and higher inflammatory markers confer a high risk for disease progression. Treatment with TNFi showed a disease-modifying effect by slowing the rate of radiographic progression.
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Affiliation(s)
- Ismail Sari
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada, and Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Seunghun Lee
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada, and Hanyang University Hospital, College of Medicine, Seoul, Korea
| | - George Tomlinson
- University Health Network/Mount Sinai Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Sindhu R Johnson
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Robert D Inman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Nigil Haroon
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
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Aouad K, Maksymowych WP, Baraliakos X, Ziade N. Update of imaging in the diagnosis and management of axial spondyloarthritis. Best Pract Res Clin Rheumatol 2020; 34:101628. [PMID: 33257146 DOI: 10.1016/j.berh.2020.101628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Imaging of the spine and sacroiliac joints has acquired a central role in the diagnosis and classification of axial spondyloarthritis (axSpA) in the earliest phases of the disease. New definitions of specific imaging lesions, particularly in magnetic resonance imaging (MRI), have been recently updated and revised by the ASAS MRI working group to reach a standardized understanding and diagnosis of axSpA among rheumatologists. Recognizing the misleading pitfalls of MRI lesions and differential diagnosis also represents an essential issue in clinical practice to avoid false-positive findings and establish the diagnosis of axSpA with careful regard to the clinical context, clinical signs, and biological tests. This review summarizes the current evidence on the different imaging modalities of the sacroiliac joints and the spine with their application in the clinical setting of SpA and their main pitfalls; it also highlights the newest emerging imaging techniques.
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Affiliation(s)
- Krystel Aouad
- Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon.
| | - Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, 568A Heritage Medical Research Centre, Edmonton, Alberta T6G2R3, Canada.
| | - Xenofon Baraliakos
- Department of Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Claudiusstr. 45, 44649 Herne, Germany.
| | - Nelly Ziade
- Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon; Department of Rheumatology, Hotel-Dieu de France Hospital, Beirut, Lebanon.
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Bilgin E, Bilgin E, Özdemir O, Kalyoncu U. Temporomandibular disorders in ankylosing spondylitis: a cross-sectional, monocentric study. Rheumatol Int 2020; 40:933-940. [PMID: 32239320 DOI: 10.1007/s00296-020-04563-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/21/2020] [Indexed: 12/30/2022]
Abstract
There are contradictory results in the relevant literature about the relationship between objective determinants of craniocervical posture and temporomandibular disorder (TMD), whereas no study has worked on ankylosing spondylitis (AS) and TMD relationship. We conducted this study to test the predictors of TMD in AS patients and its relationship with craniocervical posture. AS patients aged between 18 and 50 years consecutively admitted to our outpatient clinics were recruited. TMD was diagnosed by 'Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)'. Spinal mobility was assessed by BASMI; disease activity by ASDAS-CRP and neck disability by Neck Disability Index. Craniocervical posture was assessed on lateral cervical X-ray by measuring the craniocervical angle, cervical curvature angle, suboccipital distance, atlas-axis distance, and anterior translation distance. A total of 98 (58.2% female) patients with a mean age of 37.4 ± 8.2 years were enrolled in this study. TMD was diagnosed in 58 (59.2%) patients. Spinal mobility and craniocervical posture measurements were similar among the two groups. Smoking, bruxism (in females), neck disability and AS disease activity (in males) were higher in TMD patients. Multivariate analysis revealed active smoking (aOR 6.9; 95% CI 1.8-25.6; p = 0.004), bruxism in females (aOR 17.9; 95% CI 2.0-159.2; p = 0.01), high ASDAS in males (aOR 11.8; 95% CI 1.2-122.5; p = 0.038) and neck disability (aOR 12.7; 95% CI 3.8-42.9; p < 0.001) as independent risk factors for TMD in AS patients. No relationship between the craniocervical posture measurements and TMD was found in AS patients. Active smoking, high disease activity in males, bruxism in females and neck disability were found as predictors of TMD in AS patients.
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Affiliation(s)
- Esra Bilgin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emre Bilgin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Oya Özdemir
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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The role of imaging in the diagnosis and management of axial spondyloarthritis. Nat Rev Rheumatol 2019; 15:657-672. [DOI: 10.1038/s41584-019-0309-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
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Aydin SZ, Kasapoglu Gunal E, Kurum E, Akar S, Mungan HE, Alibaz-Oner F, Lambert RG, Atagunduz P, Marzo Ortega H, McGonagle D, Maksymowych WP. Limited reliability of radiographic assessment of spinal progression in ankylosing spondylitis. Rheumatology (Oxford) 2017; 56:2162-2169. [DOI: 10.1093/rheumatology/kex321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 12/17/2022] Open
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Maksymowych WP, Wichuk S, Chiowchanwisawakit P, Lambert RG, Pedersen SJ. Fat metaplasia on MRI of the sacroiliac joints increases the propensity for disease progression in the spine of patients with spondyloarthritis. RMD Open 2017; 3:e000399. [PMID: 28469937 PMCID: PMC5387982 DOI: 10.1136/rmdopen-2016-000399] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/13/2017] [Accepted: 02/24/2017] [Indexed: 01/06/2023] Open
Abstract
Objective We tested the hypothesis that fat metaplasia on MRI of the sacroiliac joints (SIJ) increases the propensity for new bone formation in the spine of patients with spondyloarthritis. Methods We assessed baseline T1-weighted and short τ inversion recovery SIJ MRIs from patients in the Follow Up Research Cohort in Ankylosing Spondylitis (FORCAST). Radiographic progression was assessed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Structural and inflammatory lesions were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ structural and SPARCC SIJ inflammation scores, respectively. Radiographic progression was compared in cases with and without definite MRI lesions (score ≥2 or <2) and the extent of MRI lesions at baseline was compared in patients with and without radiographic progression. The predictive capacity of MRI SIJ lesions for radiographic progression in the spine was assessed in univariate and multivariate regression analyses. Results The extent of MRI structural lesions in the SIJ at baseline was significantly greater in those patients who had spinal radiographic progression on follow-up (p=0.003, 0.02, 0.003 for fat metaplasia, backfill and ankylosis, respectively). Also, radiographic progression was significantly greater in cases with definite baseline SIJ ankylosis (p=0.008). In multivariate regression that included all types of MRI lesions and was adjusted for age, sex, symptom duration, duration of follow-up, CRP, baseline mSASSS and treatment, the extent of SIJ fat metaplasia and ankylosis at baseline were independently associated with radiographic progression. Conclusions SIJ ankylosis and fat metaplasia but not inflammatory lesions increase the propensity for radiographic progression in the spine.
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Affiliation(s)
- W P Maksymowych
- Department of Medicine, Spondyloarthritis Research Consortium of Canada Center, University of Alberta, Edmonton, Alberta, Canada
| | - S Wichuk
- Department of Medicine, Spondyloarthritis Research Consortium of Canada Center, University of Alberta, Edmonton, Alberta, Canada
| | | | - R G Lambert
- Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada Center, University of Alberta, Edmonton, Alberta, Canada
| | - S J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Jaremko JL, Pitts M, Maksymowych WP, Lambert RG. Development of Image Overlay and Knowledge Transfer Module Technologies Aimed at Enhancing Feasibility and External Validation of Magnetic Resonance Imaging-based Scoring Systems. J Rheumatol 2015; 43:223-31. [DOI: 10.3899/jrheum.141573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Semiquantitative arthritis scoring assesses disease burden by scoring presence/extent of features such as bone marrow lesion (BML) or effusion in multiple anatomic regions at a joint. An image overlay clarifying region borders may enhance feasibility and reliability of these scoring systems. To be scalable for use in large clinical trials, systematic computer-based user training is desirable. We developed an overlay and user training module for magnetic resonance imaging (MRI)-based scoring of hip osteoarthritis (OA).Methods.We designed a semitransparent 2-dimensional image overlay applied to individual MRI slices to facilitate hip OA scoring [HIMRISS (Hip Inflammation MRI Scoring System)], initially using freeware and then in a customized HTML Web browser environment. We developed a systematic knowledge translation package including instructional presentation, fully scored expert consensus cases, and video tutorials for training in the use of these scoring systems with the overlays. Three musculoskeletal radiologists who had not used this scoring system before each performed a scoring exercise with no overlay, then repeated this with overlays after completing the training module. Based on postexercise interviews and a reader survey, we identified and corrected problems in the module. The entire training process was then repeated using 3 new readers.Results.Overlays were considered useful, particularly when integrated into a Web browser. The knowledge translation module was considered conceptually valuable, but as initially implemented was too lengthy and not sufficiently interactive.Conclusion.Semitransparent image overlays and standardized knowledge translation modules for reader training show promise to facilitate reader calibration using MRI-based scoring systems. Based on our experience, knowledge translation modules should emphasize close feedback evaluating performance and reader time efficiency.
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The effect of tumor necrosis factor-blockade on new bone formation in ankylosing spondylitis. Curr Opin Rheumatol 2014; 26:389-94. [DOI: 10.1097/bor.0000000000000077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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