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López-Medina C, Molto A, Sepriano A, Ramiro S, Tournadre A, Dougados M. Sensitivity to change of structural outcomes in axial spondyloarthritis after 10 years of follow up. Data from the DESIR cohort. RMD Open 2024; 10:e004400. [PMID: 39059812 DOI: 10.1136/rmdopen-2024-004400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE To evaluate the sensitivity to change in structural imaging outcomes over 10 years of follow-up in patients with axial spondyloarthritis (axSpA). METHODS Patients with axSpA from the Devenir des Spondyloarthropathies Indifferénciées Récentes cohort were included. Radiographs and MRIs of the sacroiliac joints (SIJ) and spine were obtained at baseline and at 1, 2, 5 and 10 years. The yearly rate of change of each structural outcome was analysed using generalised estimating equation models, including all patients with ≥1 score from ≥1 reader from ≥1 reading wave, using the time (years) as an explanatory variable and adjusting for reader and wave. All outcomes were standardised, and the relative standardised rate of change was calculated (ie, the standardised rate of an outcome divided by the rate of a reference outcome). RESULTS A total of 659 patients (46% males and mean age 33.6 years) were included. The most sensitive outcome to change in the SIJ (both MRI and radiographs) was the presence of ≥3 fatty lesions at a specific timepoint, with a relative standardised rate of change per year of 5.28 using the modified New York criteria as reference.Similarly, the most sensitive to change (in both MRI and radiographs) outcome in the spine was the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS; relative standardised yearly change 1.76) using ≥1 syndesmophyte as reference. CONCLUSION MRI structural outcomes in the SIJ (ie, fatty lesions) are more sensitive to change than radiographic outcomes. Conversely, the mSASSS remains the most sensitive method, even when compared with MRI of the spine.
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Affiliation(s)
- Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Anna Molto
- Rheumatology, Cochin Hospital, AP-HP, Paris, France
- CRESS, INSERM U1153, Paris-Cité University, Paris, France
| | - Alexandre Sepriano
- NOVA Medical School, UNL, Lisbon, Portugal
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Anne Tournadre
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Maxime Dougados
- Rheumatology, Cochin Hospital, AP-HP, Paris, France
- CRESS, INSERM U1153, Paris-Cité University, Paris, France
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de Hooge M, van der Heijde D. Disease modification in axial spondyloarthritis - still a controversy? Curr Opin Rheumatol 2024; 36:302-308. [PMID: 38712691 DOI: 10.1097/bor.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
PURPOSE OF REVIEW This review evaluates recent advancements in disease-modifying therapies for axial spondyloarthritis (axSpA). RECENT FINDINGS A recent study could not demonstrate an additional effect of NSAID therapy on golimumab [Tumor Necrosis Factor-α inhibitor (TNFi)] on structural progression; however, this might be due to the fact that the study was underpowered. While DMARDs have shown promise in suppressing inflammation, their impact on structural progression remains uncertain. A well powered trial showed no difference in spinal progression between secukinumab [Interleukin17A inhibitor (IL17Ai)] and adalimumab-biosimilar (TNFi). Preliminary data on Janus kinase inhibitors (JAKi) focus on MRI findings but lack evidence on radiographic spinal progression. While some studies suggest promising outcomes, others reveal limitations and inconclusive findings. SUMMARY Recent studies explore the effectiveness of NSAIDs, biological disease-modifying antirheumatic drugs like TNFi and IL-17i, as well as JAK inhibitors in axSpA. Conflicting evidence surrounds these therapies' ability to impede structural progression, with challenges in study design and interpretation. Moreover, changes in demographics and treatment methods underscore the importance of examining trends over time when assessing disease outcomes. Ultimately, ongoing research could benefit from new imaging tools when evaluating therapeutic strategies for modifying disease progression in axSpA.
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Affiliation(s)
- Manouk de Hooge
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
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Molto A, López-Medina C, Sepriano A, Ramiro S, de Hooge M, van Lunteren M, Navarro-Compán V, Wendling D, Dougados M. Sacroiliac radiographic progression over 10 years in axSpA: data from the DESIR inception cohort. Ann Rheum Dis 2024; 83:858-864. [PMID: 38423758 DOI: 10.1136/ard-2023-225184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To evaluate sacroiliac radiographic progression over a 10-year follow-up and determine the baseline factors associated with such progression in patients with recent-onset axial spondyloarthritis (axSpA, <3 years). METHODS This analysis was performed in the DESIR cohort (NCT01648907). The radiographic status of the patients (radiographic axSpA (r-axSpA) vs non-radiographic axSpA (nr-axSpA)) was based on the modified New York (mNY) criteria. Information on mNY criteria on the pelvic radiographs was obtained in four reading waves over a 10-year period. Images were blinded and centrally read by 3 trained readers. The % of mNY net progressors (ie, number of 'progressors' minus number of 'regressors' divided by the total number of patients) was assessed in completers (ie, pelvic radiographs at baseline and 10 years). The yearly likelihood of mNY+ was estimated using an integrated analysis (ie, including all patients with at least one available mNY score ('intention-to-follow' population) using a generalised estimating equations model and time-varying tumour necrosis factor (TNF) use as a confounder. Baseline predictors of mNY+ during 10 years were evaluated. RESULTS Completers included 294 patients, while intention-to-follow included 659 participants. In the completers, the net % progression (from nr-axSpA to r-axSpA) was 5.8%. In the intention-to-follow population, the probability of being mNY+ was estimated to increase 0.87% (95% CI 0.56 to 1.19) per year (ie, 8.7% after 10 years) while when introducing TNF inhibitors (TNFi) as a time-varying covariate, the probability was 0.45% (95% CI 0.09 to 0.81) (ie, 4.5% after 10 years). Baseline bone marrow oedema (BME) on MRI of the sacroiliac joints (SIJ) was associated with being mNY+ over time OR 6.2 (95% CI 5.3 to 7.2) and OR 3.1 (95% CI 2.4 to 3.9) in HLA-B27+ and HLA-B27-, respectively). Male sex, symptom duration >1.5 years, Axial Spondyloarthritis Disease Activity Score ≥2.1 and smoking (only in HLA-B27 positives) were also associated with being mNY+ over 10 years. BME was not found to be a mediator of the HLA-B27 effect on mNY+ at 10 years. CONCLUSIONS The yearly likelihood of switching from nr-axSpA to r-axSpA in patients after 10 years of follow-up was low, and even lower when considering TNFi use.
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Affiliation(s)
- Anna Molto
- Rheumatology, Hospital Cochin Assistance Publique Hôpitaux de Paris, Paris, France
- INSERM U1153, Center for Research in Epidemiology and Statistics, Université Paris Cité, Paris, France
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- GC05, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Alexandre Sepriano
- CHRC Campus Nova Medical School, Lisboa, Portugal
- Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Manouk de Hooge
- VIB Center of Inflammation Research, Ghent University, Gent, Belgium
| | | | | | | | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes Faculté de Médecine, Paris, France
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Benavent D, Capelusnik D, Ramiro S, Navarro-Compán V. Looking through the window of opportunity in axial spondyloarthritis? Joint Bone Spine 2023; 90:105603. [PMID: 37355203 DOI: 10.1016/j.jbspin.2023.105603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that affects the spine and sacroiliac joints, that can lead to irreversible structural damage. Early detection and timely intervention are crucial for preventing long-term structural damage, improving quality of life, and reducing the burden of the disease. The concept of a window of opportunity suggests that an early intervention in the reversible stage of the disease can lead to improved long-term outcomes. However, it is unclear whether this concept applies in axSpA. Recent advances in axSpA management, including the use of diagnostic techniques such as magnetic resonance imaging as well as the use of advanced therapies, have shown promise in improving outcomes. However, studies investigating the potential window of opportunity in axSpA by assessing the impact of an early treatment on clinical outcomes have yielded inconclusive results. One of the reasons behind this is the lack of a standardized definition of early axSpA. The Assessment of Spondyloarthritis International Society (ASAS)-SPEAR (SPondyloarthritis EARly) project has set the ground for it by working on a consensus definition of early axSpA. Randomized controlled trials specifically focused on the comparison between treating axSpA in the early and late stages of the disease and using the standardised definition of early axSpA are essential to understand better the potential benefits of an early treatment on clinical outcomes. Additionally, it would be relevant to assess the long-term outcomes of early axSpA treatment, especially regarding structural damage, to better grasp the concept of the window of opportunity in axSpA.
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Affiliation(s)
- Diego Benavent
- Department of Rheumatology, La Paz University Hospital, IdiPaz, Madrid, Spain
| | - Dafne Capelusnik
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
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Iyer P, Hwang M, Ridley L, Weisman MM. Biomechanics in the onset and severity of spondyloarthritis: a force to be reckoned with. RMD Open 2023; 9:e003372. [PMID: 37949613 PMCID: PMC10649803 DOI: 10.1136/rmdopen-2023-003372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023] Open
Abstract
Increasing evidence suggests that there is a pivotal role for physical force (mechanotransduction) in the initiation and/or the perpetuation of spondyloarthritis; the review contained herein examines that evidence. Furthermore, we know that damage and inflammation can limit spinal mobility, but is there a cycle created by altered spinal mobility leading to additional damage and inflammation?Over the past several years, mechanotransduction, the mechanism by which mechanical perturbation influences gene expression and cellular behaviour, has recently gained popularity because of emerging data from both animal models and human studies of the pathogenesis of ankylosing spondylitis (AS). In this review, we provide evidence towards an appreciation of the unsolved paradigm of how biomechanical forces may play a role in the initiation and propagation of AS.
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Affiliation(s)
- Priyanka Iyer
- Division of Rheumatology, Department of Medicine, UC Irvine Healthcare, Orange, California, USA
| | - Mark Hwang
- Rheumatology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USA
| | - Lauren Ridley
- Rheumatology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USA
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Webers C, Grimm S, van Tubergen A, van Gaalen F, van der Heijde D, Joore M, Boonen A. The value of correctly diagnosing axial spondyloarthritis for patients and society. Semin Arthritis Rheum 2023; 62:152242. [PMID: 37451047 DOI: 10.1016/j.semarthrit.2023.152242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/30/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To demonstrate the value of diagnosing axSpA, by comparing health and costs associated with available diagnostic algorithms and perfect diagnosis. METHODS Using data from SPACE and other cohorts, a model was developed to estimate health (quality-adjusted life-years, QALYs) and costs (healthcare consumption and work productivity losses) of different diagnostic algorithms for axSpA amongst patients with low back pain referred to a rheumatologist, over a 60-year horizon. The model combined a decision-tree (diagnosis) with a state-transition model (treatment). The three algorithms (Berlin [BER, highest specificity], Modification 1 [M1; less strict inflammatory back pain (IBP) criterion] and Modification 2 [M2; IBP not mandatory as entry criterion, highest sensitivity]) were compared. Changes in sensitivity/specificity were explored and the value of perfect diagnosis was investigated. RESULTS For each correctly diagnosed axSpA patient, up to 4.7 QALYs and €60,000 could be gained/saved, considering a societal perspective. Algorithm M2 resulted in more health and lower costs per patient (24.23 QALYs; €157,469), compared to BER (23.96 QALYs; €159,423) and M1 (24.15 QALYs; €158,417). Hypothetical improvements in M2 sensitivity resulted in slightly more value compared to improvements in specificity. Perfect diagnosis can cost €7,500 per patient and still provide enough value. CONCLUSION Correct diagnosis of axSpA results in substantial health and cost benefits for patients and society. Not requiring IBP as mandatory for diagnosis of axSpA (algorithm M2) provides more value and would be preferable. A considerably more expensive diagnostic algorithm with better accuracy than M2 would still be considered good value for money.
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Affiliation(s)
- Casper Webers
- Department of Internal Medicine, Department of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Sabine Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Astrid van Tubergen
- Department of Internal Medicine, Department of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Floris van Gaalen
- Department of Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Department of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Ensslin C, Micheroli R, Kissling S, Götschi A, Bürki K, Bräm R, de Hooge M, Baraliakos X, Nissen MJ, Möller B, Exer P, Andor M, Distler O, Scherer A, Ciurea A. Impact of sex on spinal radiographic progression in axial spondyloarthritis: a longitudinal Swiss cohort analysis over a period of 10 years. RMD Open 2023; 9:e003340. [PMID: 37507208 PMCID: PMC10387740 DOI: 10.1136/rmdopen-2023-003340] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE To investigate sex differences in spinal radiographic progression in axial spondyloarthritis (axSpA). METHODS AxSpA patients in the Swiss Clinical Quality Management cohort with available spinal radiographs every 2 years were included. Paired radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Progression was defined as an increase of ≥2 mSASSS units in 2 years. The relationship between sex and progression was investigated with binomial generalised estimating equation models, considering baseline spinal damage as an intermediate covariate. Additional analyses included adjustments for explanatory variables and multiple imputations for missingness. RESULTS In a total of 505 axSpA patients (317 men and 188 women), mean±SD radiographic progression over 2 years was 1.0±2.8 years in men and 0.3±1.1 years in women (p<0.001). Male sex was associated with enhanced progression in a small model not including baseline damage (OR 3.41, 95% CI 1.87 to 6.21). Both a direct effect of male sex on spinal progression, and an indirect effect, via enhancement of baseline spinal damage were significant (OR 2.06, 95% CI 1.15 to 3.67 and OR 1.04, 95% CI 1.01 to 1.07, respectively). A significant impact of male sex on spinal radiographic progression was still demonstrated after multiple adjustments for covariates known to potentially affect spinal radiographic progression (OR 1.97, 95% CI 1.04 to 3.71). CONCLUSIONS Spinal radiographic progression in axSpA is more severe in men than in women, with three times higher odds of progression in male patients and an effect that is mediated in part through an increase in baseline radiographic damage.
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Affiliation(s)
- Caroline Ensslin
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Seraphina Kissling
- Statistics Group, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland
| | - Andrea Götschi
- Statistics Group, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland
| | - Kristina Bürki
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - René Bräm
- Swiss Ankylosing Spondylitis Association, Zurich, Switzerland
| | - Manouk de Hooge
- Department of Rheumatology, University Hospital Gent, Gent, Belgium
| | | | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospitals, Geneve, Switzerland
| | - Burkhard Möller
- Department of Rheumatology and Immunology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | | | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Almut Scherer
- Statistics Group, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Braun J, Blanco R, Marzo-Ortega H, Gensler LS, Van den Bosch F, Hall S, Kameda H, Poddubnyy D, van de Sande M, van der Heijde D, Zhuang T, Stefanska A, Readie A, Richards HB, Deodhar A. Two-year imaging outcomes from a phase 3 randomized trial of secukinumab in patients with non-radiographic axial spondyloarthritis. Arthritis Res Ther 2023; 25:80. [PMID: 37194094 DOI: 10.1186/s13075-023-03051-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Radiographic progression and course of inflammation over 2 years in patients with non-radiographic axial spondyloarthritis (nr-axSpA) from the phase 3, randomized, PREVENT study are reported here. METHODS In the PREVENT study, adult patients fulfilling the Assessment of SpondyloArthritis International Society classification criteria for nr-axSpA with elevated CRP and/or MRI inflammation received secukinumab 150 mg or placebo. All patients received open-label secukinumab from week 52 onward. Sacroiliac (SI) joint and spinal radiographs were scored using the modified New York (mNY) grading (total sacroiliitis score; range, 0-8) and modified Stoke Ankylosing Spondylitis Spine Score (mSASSS; range, 0-72), respectively. SI joint bone marrow edema (BME) was assessed using the Berlin Active Inflammatory Lesions Scoring (0-24) and spinal MRI using the Berlin modification of the AS spine MRI (ASspiMRI) scoring (0-69). RESULTS Overall, 78.9% (438/555) of patients completed week 104 of the study. Over 2 years, minimal changes were observed in total radiographic SI joint scores (mean [SD] change, - 0.04 [0.49] and 0.04 [0.36]) and mSASSS scores (0.04 [0.47] and 0.07 [0.36]) in the secukinumab and placebo-secukinumab groups. Most of the patients showed no structural progression (increase ≤ smallest detectable change) in SI joint score (87.7% and 85.6%) and mSASSS score (97.5% and 97.1%) in the secukinumab and placebo-secukinumab groups. Only 3.3% (n = 7) and 2.9% (n = 3) of patients in the secukinumab and placebo-secukinumab groups, respectively, who were mNY-negative at baseline were scored as mNY-positive at week 104. Overall, 1.7% and 3.4% of patients with no syndesmophytes at baseline in the secukinumab and placebo-secukinumab group, respectively, developed ≥ 1 new syndesmophyte over 2 years. Reduction in SI joint BME observed at week 16 with secukinumab (mean [SD], - 1.23 [2.81] vs - 0.37 [1.90] with placebo) was sustained through week 104 (- 1.73 [3.49]). Spinal inflammation on MRI was low at baseline (mean score, 0.82 and 1.07 in the secukinumab and placebo groups, respectively) and remained low (mean score, 0.56 at week 104). CONCLUSION Structural damage was low at baseline and most patients showed no radiographic progression in SI joints and spine over 2 years in the secukinumab and placebo-secukinumab groups. Secukinumab reduced SI joint inflammation, which was sustained over 2 years. TRIAL REGISTRATION ClinicalTrials.gov, NCT02696031.
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Affiliation(s)
- Juergen Braun
- Department of Rheumatology, Ruhr-University Bochum, Bochum, Germany.
- Rheuma Praxis, Berlin, Germany.
| | - Ricardo Blanco
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, LIRMM, University of Leeds, Leeds, UK
| | | | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
| | - Stephen Hall
- Department of Medicine, Monash University, Melbourne, Australia
| | | | - Denis Poddubnyy
- German Rheumatism Research Centre, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marleen van de Sande
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Aimee Readie
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Atul Deodhar
- Oregon Health & Science University, Division of Arthritis and Rheumatic Diseases, Portland, USA
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Maksymowych WP, Baraliakos X, Lambert RG, Landewé R, Sandoval D, Carlier H, Lisse J, Li X, Hojnik M, Østergaard M. Effects of ixekizumab treatment on structural changes in the sacroiliac joint: MRI assessments at 16 weeks in patients with non-radiographic axial spondyloarthritis. THE LANCET. RHEUMATOLOGY 2022; 4:e626-e634. [PMID: 38288892 DOI: 10.1016/s2665-9913(22)00185-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2024]
Abstract
BACKGROUND There is limited understanding regarding the inhibition of structural damage in the sacroiliac joint of patients with non-radiographic axial spondyloarthritis. This study evaluated the effect of the interleukin-17A inhibitor ixekizumab versus placebo on structural lesions in the sacroiliac joints as assessed by MRI at week 16 in patients with non-radiographic axial spondyloarthritis from the COAST-X study. METHODS COAST-X was a 52-week, randomised, double-blind, placebo-controlled, parallel-group study done at 107 sites in 15 countries in Europe, Asia, North America, and South America. Eligible participants were adults (aged ≥18 years) with active axial spondyloarthritis without definite radiographic sacroiliitis (non-radiographic axial spondyloarthritis), objective signs of inflammation (via MRI or C-reactive protein), and an inadequate response or intolerance to non-steroidal anti-inflammatory drugs. Patients were randomly allocated to placebo or double-blind ixekizumab 80 mg every 4 weeks (Q4W) or 2 weeks (Q2W), with an 80 mg or 160 mg starting dose. We report a post-hoc analysis of 266 patients with available MRI scans from baseline and week 16. MRI scans were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint structural score (SSS) method independently by two masked readers. Treatment comparisons used analysis of covariance based on observed cases. Correlations were evaluated among changes in SPARCC SSS for erosion, fat lesions, and backfill, and between changes in SPARCC SSS and sacroiliac joint inflammation scores and clinical measures. COAST-X was registered with ClinicalTrials.gov, NCT02757352. FINDINGS Between Aug 2, 2016, and Jan 29, 2018, 303 patients were enrolled to the COAST-X study. 290 (96%) of 303 participants completed the week 16 visit (95 in the ixekizumab Q4W group, 98 in the ixekizumab Q2W group, and 97 in the placebo group), and MRI scans were available for 266 patients at baseline and week 16 (85 in the ixekizumab Q4W group, 91 in the ixekizumab Q2W group, and 90 in the placebo group). Changes from baseline to week 16 in mean SPARCC SSS for erosion were -0·39 for ixekizumab Q4W (p=0·003 vs placebo), -0·40 for ixekizumab Q2W (p=0·002), and 0·16 for placebo; for fat lesions: 0·16 for ixekizumab Q4W (p=0·013), 0·10 for ixekizumab Q2W (p=0·067), and -0·04 for placebo; and for backfill: 0·21 for ixekizumab Q4W (p=0·011), 0·22 for ixekizumab Q2W (p=0·006), and -0·10 for placebo. Ankylosis did not change. Effects of ixekizumab versus placebo on structural changes were most pronounced in patients with baseline inflammation in the sacroiliac joints. Changes from baseline at week 16 in erosion, fat lesions, and backfill were correlated. INTERPRETATION Although the clinical relevance is not yet clear, patients with non-radiographic axial spondyloarthritis receiving ixekizumab had significant reductions in erosions and increases in fat lesions and backfill in the sacroiliac joints versus placebo at week 16, suggesting an early repair process with ixekizumab treatment. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton, AB, Canada; CARE Arthritis, Edmonton, AB, Canada
| | | | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada; Medical Imaging Consultants, Edmonton, AB, Canada
| | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Xiaoqi Li
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Maja Hojnik
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, and Center of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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10
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Koo BS, Lee JJ, Jung JW, Kang CH, Joo KB, Kim TH, Lee S. A pilot study on deep learning-based grading of corners of vertebral bodies for assessment of radiographic progression in patients with ankylosing spondylitis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221114097. [PMID: 35898565 PMCID: PMC9310199 DOI: 10.1177/1759720x221114097] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Radiographs are widely used to evaluate radiographic progression with
modified stoke ankylosing spondylitis spinal score (mSASSS). Objective: This pilot study aimed to develop a deep learning model for grading the
corners of the cervical and lumbar vertebral bodies for computer-aided
detection of mSASSS in patients with ankylosing spondylitis (AS). Methods: Digital radiographic examination of the spine was performed using Discovery
XR656 (GE Healthcare) and Digital Diagnost (Philips). The disk points were
detected between the bodies using a key-point detection deep learning model
from the image obtained in DICOM (digital imaging and communications in
medicine) format from the cervical and lumbar spinal radiographs. After
cropping the vertebral regions around the disk point, the lower and upper
corners of the vertebral bodies were classified as grade 3 (total bony
bridges) or grades 0, 1, or 2 (non-bridges). We trained a convolutional
neural network model to predict the grades in the lower and upper corners of
the vertebral bodies. The performance of the model was evaluated in a
validation set, which was separate from the training set. Results: Among 1280 patients with AS for whom mSASSS data were available, 5,083
cervical and 5245 lumbar lateral radiographs were reviewed. The total number
of corners where mSASSS was measured in the cervical and lumbar vertebrae,
including the upper and lower corners, was 119,414. Among them, the number
of corners in the training and validation sets was 110,088 and 9326,
respectively. The mean accuracy, sensitivity, and specificity for mSASSS
scoring in one corner of the vertebral body were 0.91604, 0.80288, and
0.94244, respectively. Conclusion: A high-performance deep learning model for grading the corners of the
vertebral bodies was developed for the first time. This model must be
improved and further validated to develop a computer-aided tool for
assessing mSASSS in the future.
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Affiliation(s)
- Bon San Koo
- Division of Rheumatology, Department of Internal Medicine, Inje University Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | | | | | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Kyung Bin Joo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
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11
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Kim JG, Jung JY, Lee J, Kwok SK, Hyeon Ju J, Park SH, Kim WU. Can Whole Spine Magnetic Resonance Imaging Predict Radiographic Progression and Inflammatory Activity in Axial Spondyloarthritis? Joint Bone Spine 2022; 89:105352. [DOI: 10.1016/j.jbspin.2022.105352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
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12
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Lucasson F, Richette P, Aouad K, Ryussen-Witrand A, Wendling D, Fautrel B, Gossec L. Prevalence and consequences of psoriasis in recent axial spondyloarthritis: an analysis of the DESIR cohort over 6 years. RMD Open 2022; 8:rmdopen-2021-001986. [PMID: 35091462 PMCID: PMC8804683 DOI: 10.1136/rmdopen-2021-001986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The consequences of psoriasis associated to axial spondyloarthritis (axSpA) are unclear. The objectives were to determine the prevalence and the consequences of psoriasis in recent axSpA over 6 years of follow-up. METHODS The multicentric prospective cohort DESIR (NCT01648907) of adult patients with recent inflammatory back pain suggestive of axSpA was analysed over 6 years. Psoriasis was recorded at each visit and cumulative prevalence and incidence were calculated. Patients with vs without psoriasis at any time point were compared. Outcomes included disease activity (Ankylosing Spondylitis Disease Activity Score-C reactive protein (ASDAS-CRP), joint and enthesitis count, CRP), patient-reported outcomes for function (Health Assessment Questionnaire for axSpA, HAQ-AS) and quality of life, and treatment use over 6 years. Outcomes were compared through univariable and multivariable analyses, as well as linear mixed effect models. RESULTS In 589 patients, mean age 40.5±8.7 years, 45.8% men and baseline mean symptom duration 1.5±0.9 years, the cumulative prevalence of psoriasis increased from 16.8% (99/589) at baseline to 26.8% (158/589) at 6 years, leading to an incidence of 2.1/100 patient-years. Over 6 years of follow-up, patients with psoriasis developed more synovitis (p=0.008), and received more methotrexate (cumulative use, 25.5% vs 11.8%, p<0.001) and biological disease-modifying drugs (55.7% vs 38.5%, p<0.001). There were no significant consequences of psoriasis on other outcomes, including disease activity (ASDAS-CRP), functional capacity (HAQ-AS) and quality of life. CONCLUSION Psoriasis is frequent in early axSpA. AxSpA patients with psoriasis had more swollen joints over time and received more biologics; they did not have worse outcomes related to axSpA in terms of activity and severity. TRIAL REGISTRATION NUMBER NCT01648907.
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Affiliation(s)
- Florian Lucasson
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Pascal Richette
- Rheumatology Department, APHP, Université de Paris, Hôpital Lariboisière, Paris, France.,INSERM UMR1132 Bioscar, Université de Paris, Paris, France
| | - Krystel Aouad
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Adeline Ryussen-Witrand
- Rheumatology Department, Centre d'Investigation Clinique de Toulouse CIC 1436, Inserm, Paul Sabatier University, Toulouse University Hospital, Toulouse, France
| | - Daniel Wendling
- Department of Rheumatology, University Teaching Hospital, CHRU de Besançon, Besancon, France.,EA 4266 EPILAB, Université Bourgogne Franche-Comté, Besancon, France
| | - Bruno Fautrel
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,Pitié Salpêtrière Hospital, Rheumatology Department, APHP.Sorbonne Université, Paris, France
| | - Laure Gossec
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,Pitié Salpêtrière Hospital, Rheumatology Department, APHP.Sorbonne Université, Paris, France
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13
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Sepriano A, Ramiro S, van der Heijde D, Landewé R. Biological DMARDs and disease modification in axial spondyloarthritis: a review through the lens of causal inference. RMD Open 2021; 7:rmdopen-2021-001654. [PMID: 34253683 PMCID: PMC8276290 DOI: 10.1136/rmdopen-2021-001654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterised by inflammation predominantly involving the spine and the sacroiliac joints. In some patients, axial inflammation leads to irreversible structural damage that in the spine is usually quantified by the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Available therapeutic options include biological disease-modifying antirheumatic drugs (bDMARDs), which have been proven effective in suppressing inflammation in several randomised controlled trials (RCT), the gold standard for evaluating causal treatment effects. RCTs are, however, unfeasible for testing structural effects in axSpA mainly due to the low sensitivity to change of the mSASSS. The available literature therefore mainly includes observational research, which poses serious challenges to the determination of causality. Here, we review the studies testing the effect of bDMARDs on spinal radiographic progression, making use of the principles of causal inference. By exploring the assumptions of causality under counterfactual reasoning (exchangeability, positivity and consistency), we distinguish between studies that likely have reported confounded treatment effects and studies that, on the basis of their design, have more likely reported causal treatment effects. We conclude that bDMARDs might, indirectly, interfere with spinal radiographic progression in axSpA by their effect on inflammation. Innovations in imaging are expected, so that placebo-controlled trials can in the future become a reality. In the meantime, causal inference analysis using observational data may contribute to a better understanding of whether disease modification is possible in axSpA.
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Affiliation(s)
- Alexandre Sepriano
- Rheumatology, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal .,Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | | | - Robert Landewé
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands.,Clinical Immunology and Rheumatology, Amsterdam University Medical Centres, Duivendrecht, Netherlands
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14
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Fauny M, Verhoeven F, Allado E, Albuisson E, Pinzano A, Morizot C, Chary-Valckenaere I, Loeuille D. Relationship between spinal structural damage on radiography and bone fragility on CT in ankylosing spondylitis patients. Sci Rep 2021; 11:9342. [PMID: 33927314 PMCID: PMC8085178 DOI: 10.1038/s41598-021-88838-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
To evaluate whether the risk of bone fragility on computed tomography (CT) (scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1)) is associated with the severity of spine structural involvement (mSASSS) in patients with ankylosing spondylitis (AS). This retrospective study included AS patients, followed from 2009 to 2017, who fulfilled the New York criteria and who underwent thoraco-abdomino-pelvic CT and radiography (spine, pelvis). The structural involvement was retained for mSASSS ≥ 2. The SBAC-L1 was measured in Hounsfield units (HU). A SBAC-L1 ≤ 145 HU was used to define patients at risk of vertebral fracture (VF). A total of 73 AS patients were included (mean age: 60.3 (± 10.7) years, 8 women (11%), mean disease duration: 24.6 years (± 13.9)). Sixty patients (82.2%) had a mSASSS ≥ 2 (mean score 20.7 (± 21.2)). The mean SBAC-L1 was 141.1 HU (± 45), 138.1 HU (± 44.8) and 154.8 HU (± 44.9) in the total, mSASSS ≥ 2 and mSASSS < 2 populations, respectively. Patients with bone bridges had lower SBAC-L1 than mSASSS ≥ 2 patients without ankylosis (p = 0.02) and more often SBAC-L1 ≤ 145 HU (73% vs 41.9%, p = 0.006). A SBAC-L1 ≤ 145 HU was not associated with structural spine involvement, but patients with bone bridges had significantly decreased SBAC-L1 and an increased probability of being under the fracture threshold.
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Affiliation(s)
- Marine Fauny
- Department of Rheumatology, Hôpitaux de Brabois, Nancy University Hospital, 54511, Vandoeuvre les Nancy Cedex, France. .,Saint Charles Hospital, 54200, Toul, France.
| | - Frank Verhoeven
- Department of Rheumatology, Besançon University Hospital, Besançon, France
| | - Edem Allado
- Department of Rheumatology, Hôpitaux de Brabois, Nancy University Hospital, 54511, Vandoeuvre les Nancy Cedex, France.,Department of Pulmonary Function Testing and Exercise Physiology, University Hospital of Nancy, 54000, Nancy, France.,Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, 54505, Nancy, France
| | - Eliane Albuisson
- Faculté de Medecine, InSciDens, Université de Lorraine, 54000, Nancy, France.,Université de Lorraine, CNRS, IECL, 54000, Nancy, France.,CHRU-Nancy, DRCI, Département MPI, Unité de méthodologie, Data management et statistiques UMDS, 54000, Nancy, France
| | - Astrid Pinzano
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), UMR 7365 CNRS - University of Lorraine, Nancy, France.,Contrat d'Interface, Department of Rheumatology, Nancy University Hospital, Nancy, France
| | - Caroline Morizot
- Department of Rheumatology, Hôpitaux de Brabois, Nancy University Hospital, 54511, Vandoeuvre les Nancy Cedex, France
| | - Isabelle Chary-Valckenaere
- Department of Rheumatology, Hôpitaux de Brabois, Nancy University Hospital, 54511, Vandoeuvre les Nancy Cedex, France.,Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), UMR 7365 CNRS - University of Lorraine, Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, Hôpitaux de Brabois, Nancy University Hospital, 54511, Vandoeuvre les Nancy Cedex, France.,Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), UMR 7365 CNRS - University of Lorraine, Nancy, France
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15
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Hirano F, van der Heijde D, van Gaalen FA, Landewé RBM, Gaujoux-Viala C, Ramiro S. Determinants of the patient global assessment of well-being in early axial spondyloarthritis: 5-year longitudinal data from the DESIR cohort. Rheumatology (Oxford) 2021; 60:316-321. [PMID: 32766697 PMCID: PMC7785312 DOI: 10.1093/rheumatology/keaa353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/18/2020] [Indexed: 12/05/2022] Open
Abstract
Objectives To investigate the determinants of patient well-being over time, and the influence of age, gender and education in patients with early axial spondyloarthritis (axSpA). Methods Five-year data from DESIR, a cohort of early axSpA, were analysed. The outcome was the BAS-G over 5 years. Generalized estimating equations (GEE) were used to test the relationship between potential explanatory variables from five outcome domains (disease activity, physical function, spinal mobility, structural damage and axial inflammation) and BAS-G over time. Longitudinal relationships were analysed using an autoregressive GEE model. Age, gender and educational level were tested as effect modifiers or confounders. Results A total of 708 patients were included. Higher BASDAI questions on fatigue [β (95% CI): 0.17 (0.13, 0.22)], back pain [0.51 (0.46, 0.56)], peripheral joint pain [0.08 (0.04, 0.12)] and severity of morning stiffness [0.08 (0.03–0.13)], and higher BASFI [0.14 (0.08, 0.19)] were associated with a higher BAS-G. In the autoregressive model, the same variables except for morning stiffness were associated with a worsening in BAS-G. Age, gender and educational level were neither effect modifiers nor confounders. Conclusion A higher level of back pain is associated with a worsening of patient well-being, as are, though to a lesser extent, higher levels of fatigue, peripheral joint pain and physical disability. Age, gender and educational level do not have an impact on these relationships.
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Affiliation(s)
- Fumio Hirano
- Department of Rheumatology, Leiden University Medical Centre, Leiden
| | | | | | - Robert B M Landewé
- Department of Rheumatology, Amsterdam University Medical Centre, Amsterdam.,Department of Rheumatology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Cécile Gaujoux-Viala
- EA2415, University of Montpellier, Montpellier.,Department of Rheumatology, Nîmes University Hospital, Nîmes, France
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Centre, Leiden.,Department of Rheumatology, Zuyderland Medical Centre, Heerlen, the Netherlands
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16
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Madari Q, Sepriano A, Ramiro S, Molto A, Claudepierre P, Wendling D, Dougados M, van der Heijde D, van Gaalen FA. 5-year follow-up of spinal and sacroiliac MRI abnormalities in early axial spondyloarthritis: data from the DESIR cohort. RMD Open 2021; 6:rmdopen-2019-001093. [PMID: 32396521 PMCID: PMC7046942 DOI: 10.1136/rmdopen-2019-001093] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/13/2019] [Accepted: 01/05/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To study changes on MRI of the spine and sacroiliac joint (SIJ) in early axial spondyloarthritis (axSpA) over time. Methods In the Devenir des Spondyloarthropathies Indifférenciées Récentes cohort, MRI-spine and MRI-SIJ at baseline and 2 and 5 years were scored by central readers for bone marrow oedema (BME), fatty lesions, erosions, sclerosis, ankylosis and spinal bone spurs. The average mean number of lesions was reported or the agreement of ≥2 out of 3 readers for binary outcomes. Net progression was calculated by subtracting the patients that ‘improved’ from those that ‘worsened’ divided by the total number of patients. Results Over 5 years, in 155 patients with axSpA (mean age 33.5 (SD 8.9) years, symptom duration 1.4 (0.8) years, 63% human leucocyte antigen+, 14% modified New York+), BME on MRI-SIJ decreased by a mean Spondyloarthritis Research Consortium of Canada score of 1.4 (SD 6.5) (p=0.009). The largest BME decrease was observed in patients using biological disease-modifying antirheumatic drugs at 5 years. Spinal BME increased by 0.3 (4.6) (p=0.41). Fatty lesions and/or erosions on MRI-SIJ increased by a mean of 1.0 (SD 2.6) (p<0.001). Spinal fatty lesions and/or erosions increased by 0.2 (SD 0.5) (p<0.001). Compared with baseline, at 5 years, 7.3% less patients had BME on MRI-SIJ according to the Assessment of Spondyloarthritis International Society definition, while 6.6% more patients had ≥5 fatty lesions and/or erosions. At 5 years, 0.7% less patients had ≥5 spinal BME lesions and 0.7% less patients had ≥5 spinal fatty lesions. Conclusion Over 5 years, BME on MRI-SIJ decreased and spinal BME remained similar, but numerically, little progression of structural lesions on MRI of the SIJ and spine was seen.
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Affiliation(s)
- Queeny Madari
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna Molto
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Pascal Claudepierre
- Department of Rheumatology, Henri Mondor Hospital, APHP, and Université Paris Est Créteil, EA, 7379 - EpidermE, F-94010, Créteil, France
| | - Daniel Wendling
- Department of Rheumatology, CHRU de BESANCON, University Teaching Hospital, and Université de Franche-Comté, EA4266 EPILAB, F-25030, Besançon, France
| | - Maxime Dougados
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
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17
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Chui ETF, Tsang HHL, Lee KH, Lau CS, Wong CH, Chung HY. MRI inflammation of facet and costovertebral joints is associated with restricted spinal mobility and worsened functional status. Rheumatology (Oxford) 2021; 59:2591-2602. [PMID: 32003811 DOI: 10.1093/rheumatology/kez649] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/29/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the association of spinal inflammation on MRI in patients with various clinical, functional and radiological outcomes in patients with axial spondyloarthritis (SpA). METHODS Three hundred and ninety-seven participants with axial SpA and back pain were recruited from 10 rheumatology centres. Clinical, biochemical and radiological parameters were collected and participants underwent MRI of the spine. MRI features including inflammatory lesions of facet joints and costovertebral joints, corner inflammatory lesions, and spondylitis were assessed. BASFI, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Global Index, BASMI and modified Stoke Ankylosing Spondylitis Spinal Score were measured. Multivariate linear regression models were used to determine the associations between MRI parameters and various clinical, functional and radiological outcomes. RESULTS BASMI and BASFI correlated well with inflammatory features in spinal MRI. Multivariate analysis showed that lumbar facet joint inflammation was independently associated with BASMI (regression coefficient (β) = 0.12, P < 0.001), lumbar spinal flexion (β = 0.13, P = 0.00), lateral spinal flexion (β = 0.09, P = 0.04), tragus-to-wall distance (β = 0.16, P < 0.001) and BASFI (β = 0.14, P = 0.01). Costovertebral joint inflammation was also associated with BASMI (β = 0.08, P = 0.05). CONCLUSION Inflammatory lesions of facet and costovertebral joints in MRI are associated with restriction in spinal mobility and functional impairment. These important yet commonly overlooked lesions should be reviewed in clinical practice in patients with SpA.
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Affiliation(s)
- Eva Tsz Fung Chui
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Helen Hoi Lun Tsang
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Kam Ho Lee
- Department of Radiology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Ching Han Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
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18
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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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19
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Do we believe in non-radiographic axial spondyloarthritis? A debate. Autoimmun Rev 2020; 20:102703. [PMID: 33188919 DOI: 10.1016/j.autrev.2020.102703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 11/20/2022]
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20
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Are the recommendations for the use of anti-TNF drugs during axial spondyloarthritis relevant for non-radiographic forms? Joint Bone Spine 2020; 87:381-383. [DOI: 10.1016/j.jbspin.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/25/2020] [Indexed: 01/18/2023]
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21
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Barnett R, Ingram T, Sengupta R. Axial spondyloarthritis 10 years on: still looking for the lost tribe. Rheumatology (Oxford) 2020; 59:iv25-iv37. [PMID: 33053196 PMCID: PMC7566532 DOI: 10.1093/rheumatology/keaa472] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the publication of various recommendations, quality standards and referral strategies to promote early diagnosis in axial SpA (axSpA) over the last decade, there remains a significant delay to diagnosis, leading to a lost tribe of undiagnosed, untreated patients with persistent back pain and axSpA symptoms. This review discusses the various factors contributing to diagnostic delay in axSpA, while providing recommendations to improve the diagnostic pathway, for example use of the online Spondyloarthritis Diagnosis Evaluation (SPADE) tool (http://www.spadetool.co.uk/). Significant shortcomings exist at both the primary and secondary care level, with healthcare professionals often lacking knowledge and awareness of axSpA. Myths regarding the classical signs and symptoms still prevail, including the perception of axSpA as a male disease, only occurring in individuals who are HLA-B27 positive with raised inflammatory markers. Individuals within this lost tribe of undiagnosed patients are likely lacking adequate treatment and are thereby at risk of worse clinical outcomes. It is therefore vital that public health initiatives are implemented to improve education of healthcare professionals and to ensure early specialist referral, to ultimately improve the lives of patients with axSpA.
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Affiliation(s)
- Rosemarie Barnett
- Axial Spondyloarthritis Service, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust
- Department of Computer Science, University of Bath
| | - Thomas Ingram
- Axial Spondyloarthritis Service, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust
- Department for Health, University of Bath
| | - Raj Sengupta
- Axial Spondyloarthritis Service, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
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Hirano F, Landewé RBM, van Gaalen FA, van der Heijde D, Gaujoux-Viala C, Ramiro S. Determinants of the physician global assessment of disease activity and influence of contextual factors in early axial spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 74:268-273. [PMID: 32986932 PMCID: PMC9303864 DOI: 10.1002/acr.24465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/23/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
Objective To investigate determinants of the physician global assessment (PhGA) of disease activity and the influence of the contextual factors on this relationship in patients with early axial spondyloarthritis (SpA). Methods Five‐year data of DESIR, a cohort of early axial SpA, were analyzed. Univariable generalized estimating equations (GEEs) were used to investigate contributory explanatory effects of various potential determinants of PhGA. Effect modification by contextual factors (age, sex, and educational level) was tested, and if significant, models were stratified. Autoregressive GEE models (i.e., models adjusted for PhGA at the previous time point) were used to confirm a longitudinal relationship. Results A total of 708 patients were included. Higher Bath Ankylosing Spondylitis Disease Activity Index individual questions, swollen joint count in 28 joints (SJC28), tender joint count in 53 joints, Maastricht Ankylosing Spondylitis Enthesitis Score, C‐reactive protein (CRP) level, and Bath Ankylosing Spondylitis Metrology Index score were associated with a higher PhGA. Sex and age were effect modifiers of SJC28; the contributory effect of SJC28 was largest in the younger male stratum (β = 1.07 [95% confidence interval (95% CI) 0.71, 1.43]), and the smallest in the older female stratum (β = 0.13 [95% CI 0.04, 0.22]). Autoregressive GEE models revealed the same determinants as having a longitudinal association with PhGA and the same pattern of effect modification. Conclusion Patients’ subjective symptoms, peripheral arthritis and enthesitis, higher CRP level, and impaired spinal mobility contribute to explaining PhGA in patients with early axial SpA, irrespective of sex and age. Intriguingly, physicians consider the presence of swollen joints as more important in males than in females.
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Affiliation(s)
- Fumio Hirano
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert B M Landewé
- Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Cécile Gaujoux-Viala
- EA2415, University of Montpellier, Montpellier, France.,Department of Rheumatology, Nîmes University Hospital, Nîmes, France
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
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Nikiphorou E, Ramiro S, Sepriano A, Ruyssen-Witrand A, Landewé RBM, van der Heijde D. Do Smoking and Socioeconomic Factors Influence Imaging Outcomes in Axial Spondyloarthritis? Five-Year Data From the DESIR Cohort. Arthritis Rheumatol 2020; 72:1855-1862. [PMID: 32562362 PMCID: PMC7702033 DOI: 10.1002/art.41408] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/07/2020] [Indexed: 01/01/2023]
Abstract
Objective To investigate the relationship between smoking and imaging outcomes over 5 years in axial spondyloarthritis (SpA) and to assess whether socioeconomic factors influence these relationships. Methods Axial SpA patients from the Devenir des Spondylarthropathies Indifferérenciées Récentes cohort were included. The following 4 imaging outcomes were assessed by 3 central readers at baseline, 2 years, and 5 years: spine radiographs (using the modified Stoke Ankylosing Spondylitis Spine Score [mSASSS]), sacroiliac (SI) joint radiographs (using the modified New York criteria), magnetic resonance imaging (MRI) of the spine (using the Spondyloarthritis Research Consortium of Canada [SPARCC] score), and MRI of the SI joint (using the SPARCC score). The explanatory variable of interest was smoking status at baseline. Interactions between smoking and socioeconomic factors (i.e., job type [blue‐collar or manual work versus white‐collar or nonmanual work] and education [low versus high]) were first tested, and if significant, analyses were run using separate strata. Generalized estimating equations models were used, with adjustments for confounders. Results In total, 406 axial SpA patients were included (52% male, 40% smokers, and 18% blue collar). Smoking was independently associated with more MRI‐detected SI joint inflammation at each visit over the 5 years, an effect that was seen only in patients with blue‐collar professions (β = 5.41 [95% confidence interval (95% CI) 1.35, 9.48]) and in patients with low education levels (β = 2.65 [95% CI 0.42,4.88]), using separate models. Smoking was also significantly associated with spinal inflammation (β = 1.69 [95% CI 0.45, 2.93]) and SI joint damage (β = 0.57 [95% CI 0.18, 0.96]) across all patients, irrespective of socioeconomic factors and other potential confounders. Conclusion Strong associations were found between smoking at baseline and MRI‐detected SI joint inflammation at each visit over a time period of 5 years in axial SpA patients with a blue‐collar job or low education level. These findings suggest a possible role for mechanical stress amplifying the effect of smoking on axial inflammation in axial SpA.
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Affiliation(s)
- Elena Nikiphorou
- Leiden University Medical Center, Leiden, The Netherlands, and King's College London, London, UK
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, The Netherlands, and Zuyderland Medical Center, Heerlen, The Netherlands
| | - Alexandre Sepriano
- Leiden University Medical Center, Leiden, The Netherlands, and Universidade Nova de Lisboa, Lisboa, Portugal
| | - Adeline Ruyssen-Witrand
- Hôpital Pierre-Paul-Riquet, Université de Montpellier Research Unit 1027, INSERM, Paul Sabatier University Toulouse III, Toulouse, France
| | - Robert B M Landewé
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands, and Zuyderland Medical Center, Heerlen, The Netherlands
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Sepriano A, Ramiro S, Landewé R, Moltó A, Claudepierre P, Wendling D, Dougados M, van der Heijde D. Inflammation of the Sacroiliac Joints and Spine and Structural Changes on Magnetic Resonance Imaging in Axial Spondyloarthritis: Five-year Data From the DESIR Cohort. Arthritis Care Res (Hoboken) 2020; 74:243-250. [PMID: 32937029 PMCID: PMC9305528 DOI: 10.1002/acr.24449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/08/2020] [Accepted: 09/08/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To test the impact of inflammation on structural changes occurring in the sacroiliac (SI) joints and the spine detected on magnetic resonance imaging (MRI). METHODS Patients with early axial spondyloarthritis (SpA) from the Devenir des Spondylarthropathies Indifferérenciées Récentes (DESIR) cohort were included. MRIs of the SI joints (MRI-SI joints) and spine (MRI-spine), obtained at baseline, 2 years, and 5 years, were scored by 3 central readers. Inflammation and structural damage on MRI-SI joints and MRI-spine were defined by the agreement of ≥2 of 3 readers (binary outcomes) and by the average of 3 readers (continuous outcomes). The effect of inflammation (MRI-SI joints/MRI-spine) on damage (MRI-SI joints/MRI-spine, respectively) was evaluated in 2 models: 1) a baseline prediction model (the effect of baseline inflammation on damage assessed at 5 years); and 2) a longitudinal model (the effect of inflammation on structural damage assessed during a 5-year period). RESULTS A total of 202 patients were included. Both the presence of bone marrow edema on MRI-SI joints and on MRI-spine at baseline were predictive of 5-year damage (≥3 fatty lesions) on MRI-SI joints (odds ratio [OR] 4.2 [95% confidence interval (95% CI) 2.4, 7.3]) and MRI-spine (OR 10.7 [95% CI 2.4, 49.0]), respectively, when adjusted for C-reactive protein level. The association was also confirmed in longitudinal models (when adjusted for Ankylosing Spondylitis Disease Activity Score) both in the SI joints (OR 5.1 [95% CI 2.7, 9.6]) and spine (OR 15.6 [95% CI 4.8, 50.3]). Analysis of other structural outcomes (i.e., erosions) on MRI-SI joints yielded similar results. In the spine, a significant association was found for fatty lesions but not for erosions and bone spurs, which occurred infrequently over time. CONCLUSION We found a predictive and longitudinal association between inflammation detected on MRI and several types of structural damage detected on MRI in patients with early axial SpA, which adds to the evidence for a causal relationship.
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Affiliation(s)
- Alexandre Sepriano
- Leiden University Medical Center, Leiden, The Netherlands, and NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Amsterdam University Medical Center, Amsterdam, and Zuyderland Medical Center, Heerlen, The Netherlands
| | - Anna Moltó
- Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, Université de Paris, INSERM (U1153), CRESS, Paris, France
| | - Pascal Claudepierre
- Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris Créteil, Paris, France
| | - Daniel Wendling
- CHRU de Besançon, University Teaching Hospital, and Université de Franche-Comté, EA4266 EPILAB, Besançon, France
| | - Maxime Dougados
- Paris Descartes University, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, INSERM (U1153), and Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
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Landewé R, van der Heijde D, Dougados M, Baraliakos X, Van den Bosch F, Gaffney K, Bauer L, Hoepken B, de Peyrecave N, Thomas K, Gensler LS. Induction of Sustained Clinical Remission in Early Axial Spondyloarthritis Following Certolizumab Pegol Treatment: 48-Week Outcomes from C-OPTIMISE. Rheumatol Ther 2020; 7:581-599. [PMID: 32529495 PMCID: PMC7410911 DOI: 10.1007/s40744-020-00214-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Achievement of remission is a key treatment goal for patients with axial spondyloarthritis (axSpA). C-OPTIMISE assessed achievement of sustained clinical remission in patients with axSpA, including radiographic (r) and non-radiographic (nr) axSpA, during certolizumab pegol (CZP) treatment, and subsequent maintenance of remission following CZP dose continuation, dose reduction or withdrawal. Here, we report outcomes from the first 48 weeks (induction period) of C-OPTIMISE, during which patients received open-label CZP. METHODS C-OPTIMISE (NCT02505542) was a two-part, multicenter, phase 3b study in adult patients with early axSpA (r-/nr-axSpA), including a 48-week open-label induction period followed by a 48-week maintenance period. Patients with active adult-onset axSpA, < 5 years' symptom duration, and fulfilling Assessment of SpondyloArthritis international Society classification criteria, were included. During the induction period, patients received a loading dose of CZP 400 mg at weeks 0, 2, and 4, followed by CZP 200 mg every 2 weeks (Q2W) up to week 48. The main outcome of the 48-week induction period was the achievement of sustained clinical remission (defined as an Ankylosing Spondylitis Disease Activity Score [ASDAS] < 1.3 at week 32 and < 2.1 at week 36 [or vice versa], and < 1.3 at week 48). RESULTS In total, 736 patients (407 with r-axSpA, 329 with nr-axSpA) were enrolled into the study. At week 48, 43.9% (323/736) of patients achieved sustained remission, including 42.8% (174/407) of patients with r-axSpA and 45.3% (149/329) with nr-axSpA. Patients also demonstrated substantial improvements in axSpA symptoms, MRI outcomes and quality of life measures. Adverse events occurred in 67.9% (500/736) of patients, of which 6.0% (44/736) were serious. CONCLUSIONS Over 40% of patients with early axSpA achieved sustained remission during 48 weeks of open-label CZP treatment. Additionally, patients across the axSpA spectrum demonstrated substantial improvements in imaging outcomes and quality of life following treatment. No new safety signals were identified. TRIAL REGISTRATION NCT02505542.
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Affiliation(s)
- Robert Landewé
- Amsterdam Rheumatology and Clinical Immunology Center, Amsterdam, The Netherlands.
- Zuyderland Medical Center, Heerlen, The Netherlands.
| | | | - Maxime Dougados
- Department of Rheumatology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
- INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Dougados M. Treat to target in axial spondyloarthritis: From its concept to its implementation. J Autoimmun 2020; 110:102398. [DOI: 10.1016/j.jaut.2019.102398] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/23/2022]
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Baillet A, Romand X, Pflimlin A, Dalecky M, Claudepierrec P, Flipo RM, Ruyssen-Witrand A, Gaudin P, Gossec L, Molto A, Lukas C, Pouplin S, Soubrier M, Wendling D, Fayet F, Hudry C, Senbel E, Schwartz M, Hacquard-Bouder C, Dougados M. Data to be collected for an optimal management of axial spondyloarthritis in daily practice: Proposal from evidence-based and consensual approaches. Joint Bone Spine 2020; 87:405-411. [PMID: 32428691 DOI: 10.1016/j.jbspin.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To propose a list of variables to be collected right after the diagnosis has been made and during the follow-up of patients with axial spondyloarthritis (ax-SpA) for an optimal management in daily practice. METHODS The process comprised (1) the evaluation of the interest of 51 variables proposed for the assessment of ax-SpA by means of a systematic literature research; (2) a consensus process involving 78 hospital-based or office-based rheumatologists, considering the collection of each variable in a 4 grade scale from "not very useful/useless" to "mandatory"; (3) a consensus on the minimum interval of time for periodic assessment of the selected variables on a 5 grade scale from "at each visit" to "never to be re-collected". RESULTS The systematic literature research retrieved a total of 14,133 abstracts, of which 213 were included in the final qualitative synthesis. Data to be collected at the initial systematic review comprised 5 patient's self-administered questionnaires, 3 variables of the physician's interview, 2 variables of the physical examination, 2 variables of the specific ax-SpA imaging and 2 other investigations. Two variables were recommended to be systematically collected at each visit, 1 variable twice a year, 6 variables yearly and 1 variable every 2 years. CONCLUSIONS Using an evidence-based and an expert consensus approaches, this initiative defined a core set of variables to be collected and reported right after the diagnosis and during follow-up of patients with ax-SpA in daily practice.
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Affiliation(s)
- Athan Baillet
- University Grenoble Alpes, GREPI TIMC, CNRS UMR 5525, Grenoble, France.
| | - Xavier Romand
- University Grenoble Alpes, GREPI TIMC, CNRS UMR 5525, Grenoble, France
| | - Arnaud Pflimlin
- Rheumatology, R Salengro Hospital, University of Lille, Lille, France
| | - Mickael Dalecky
- University Grenoble Alpes, GREPI TIMC, CNRS UMR 5525, Grenoble, France
| | - Pascal Claudepierrec
- Departement de Rhumatologie, Henri Mondor Hospital, AP-HP, Université Paris Est Créteil, EA 7379 - EpidermE, 94010, Créteil, France
| | - René-Marc Flipo
- Rheumatology, R Salengro Hospital, University of Lille, Lille, France
| | - Adeline Ruyssen-Witrand
- Rheumatology, UMR 1027 Inserm, Paul Sabatier University and Purpan Hospital, Toulouse, France. Sorbonne Universités, UPMC Univ, Paris, France
| | - Philippe Gaudin
- University Grenoble Alpes, GREPI TIMC, CNRS UMR 5525, Grenoble, France
| | - Laure Gossec
- Sorbonne Université, inserm, Institut Pierre-Louis d'épidémiologie et de santé Publique, Paris, France; Pitié Salpêtrière hospital, AP-HP, Rheumatology department, Paris, France
| | - Anna Molto
- Paris Descartes University, Department of Rheumatology - Hôpital Cochin. Assistance publique-Hôpitaux de Paris. inserm (U1153): Clinical epidemiology and biostatistics, Université de Paris, Paris, France
| | - Cédric Lukas
- Department of Rheumatology, CHU Montpellier and UMR5535 CNRS, Montpellier, France
| | | | - Martin Soubrier
- Department of Rheumatology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Daniel Wendling
- Department of Rheumatology, CHRU Besançon, and EA 4266, Université de Franche-Comté, Besançon, France
| | - Françoise Fayet
- Department of Rheumatology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Christophe Hudry
- Department of Rheumatology - Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Senbel
- AP-HM, Rheumatology Department, Sainte Marguerite Hospital, Marseille, France
| | - Marjorie Schwartz
- Departement de Rhumatologie, Henri Mondor Hospital, AP-HP, Université Paris Est Créteil, EA 7379 - EpidermE, 94010, Créteil, France
| | | | - Maxime Dougados
- Paris Descartes University, Department of Rheumatology - Hôpital Cochin. Assistance publique-Hôpitaux de Paris. inserm (U1153): Clinical epidemiology and biostatistics, Université de Paris, Paris, France
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Liew JW, Dubreuil M. Treat to Target in Axial Spondyloarthritis: Pros, Cons, and Future Directions. Rheum Dis Clin North Am 2020; 46:343-356. [PMID: 32340706 DOI: 10.1016/j.rdc.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treat to target describes a management paradigm that involves choosing a clinically relevant target, assessment with validated measures at a prespecified frequency, and a change in therapy if the target is not met. Although guidelines recommend treating to target in axial spondyloarthritis (axSpA), ideal methods to reach this target remain controversial. This review focuses on background for a treat-to-target strategy in axSpA. Potential targets of treatment, association of targets with outcomes, evidence of treatment impact on outcomes, and how treat to target has been incorporated into treatment guidelines are discussed. Treat-to-target trials and the research agenda for studies in axSpA are discussed.
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Affiliation(s)
- Jean W Liew
- Division of Rheumatology, Department of Medicine, University of Washington, 1959 Northeast Pacific Street, BB561, Seattle, WA 98195, USA. https://twitter.com/rheum_cat
| | - Maureen Dubreuil
- Section of Rheumatology, Boston University School of Medicine, 650 Albany Street, X201, Boston, MA 02119, USA.
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Sepriano A, Ramiro S, van der Heijde D, Dougados M, Claudepierre P, Feydy A, Reijnierse M, Loeuille D, Landewé R. Integrated longitudinal analysis does not compromise precision and reduces bias in the study of imaging outcomes: A comparative 5-year analysis in the DESIR cohort. Semin Arthritis Rheum 2020; 50:1394-1399. [PMID: 32209237 DOI: 10.1016/j.semarthrit.2020.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess if an integrated longitudinal analysis using all available imaging data affects the precision of estimates of change in patients with axial spondyloarthritis (axSpA), with completers analysis as reference standard. METHODS Patients from the DESIR cohort fulfilling the ASAS axSpA criteria were included. Radiographs and MRIs of the sacroiliac joints and spine were obtained at baseline, 1, 2 and 5 years. Each image was scored by 2 or 3 readers in 3 'reading-waves' (or campaigns). Each outcome was analyzed: i. According to a 'combination algorithm' (e.g. '2 out of 3' for binary scores); and ii. Per reader. Change over time was analyzed with generalized estimating equations by 3 approaches: (a)'integrated-analysis' (all patients with ≥1 score from ≥1 reader from all waves); (b1)Completers-only analysis (patients with 5-year follow-up, using scores from individual readers); (b2)Completers analysis using a 'combination algorithm' (as (b1) but with combined scores). Approaches (b1) and (b2) were considered the 'reference'. RESULTS In total, 413 patients were included. The 'integrated analysis' was more inclusive with similar levels of precision of the change estimates as compared to both completers analyses. In fact, for low-incident outcomes (e.g.% mNY-positive over 5-years), an increased incidence was 'captured', with more precision, by the 'integrated analysis' compared to the completers analysis with combined scores (% change/year (95%CI): 1.1 (0.7; 1.5) vs 1.2 (0.5; 1.8), respectively). CONCLUSION An efficient and entirely assumption-free 'integrated analysis' does not jeopardize precision of the estimates of change in imaging parameters and may yield increased statistical power for detecting changes with low incidence.
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Affiliation(s)
- Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Maxime Dougados
- Paris Descartes University, France; Department of Rheumatology, Clinical epidemiology and biostatistics, Hôpital Cochin. Assistance Publique - Hôpitaux de Paris, INSERM (U1153), PRES Sorbonne Paris-Cité. PARIS 14, France.
| | - Pascal Claudepierre
- Department of Rheumatology, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris Créteil, France.
| | - Antoine Feydy
- Radiology B Department, Cochin Hôpital Paris Descartes University Paris, France.
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Robert Landewé
- Zuyderland Medical Center, Heerlen, the Netherlands; Amsterdam University Medical Center (ARC), Amsterdam, the Netherlands.
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Spinal radiographic progression in axial spondyloarthritis and the impact of classification as nonradiographic versus radiographic disease: Data from the Swiss Clinical Quality Management cohort. PLoS One 2020; 15:e0230268. [PMID: 32196530 PMCID: PMC7083308 DOI: 10.1371/journal.pone.0230268] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/25/2020] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate whether spinal radiographic progression relates to structural damage at the sacroiliac level in axial spondyloarthritis (axSpA). Methods Patients classified as nonradiographic (nr-) and radiographic (r-) axSpA in the Swiss Clinical Quality Management cohort with radiographs performed every 2 years, scored according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), were included. The relationship between classification status and spinal progression during 2 years was investigated using binomial generalized estimating equations models with adjustment for sex, ankylosing spondylitis disease activity score (ASDAS) and tumour necrosis factor inhibitor treatment. Baseline spinal damage was considered an intermediate variable and included in sensitivity analyses. Results In total, 88 nr-axSpA and 418 r-axSpA patients contributed to data for 725 radiographic intervals. R-axSpA patients were more frequently male, had a longer disease duration and higher structural damage at baseline. Mean (SD) mSASSS change over 2 years was 0.16 (0.62) units in nr-axSpA and 0.92 (2.78) units in r-axSpA, p = 0.01. Nr-axSpA was associated with a significantly lower progression in 2 years (defined as an increase in ≥2 mSASSS units) in adjusted analyses (OR 0.33, 95%CI 0.13; 0.83), confirmed with progression defined as the formation of ≥1 syndesmophyte. Mediation analyses revealed that sacroiliitis exerted its effect on spinal progression indirectly by being associated with the appearance of a first syndesmophyte (OR 0.09, 95%CI 0.02; 0.36 for nr-axSpA vs r-axSpA). Baseline syndesmophytes were predictors of further progression. Conclusion Spinal structural damage is mainly restricted to patients with r-axSpA, leading to relevant prognostic and therapeutic implications.
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Huang JX, Chung HY, Chui ETF, Lee KH, Chan SCW, Tsang HHL, Ng AHY. Intensity of spinal inflammation is associated with radiological structural damage in patients with active axial spondyloarthritis. Rheumatol Adv Pract 2020; 4:rkz049. [PMID: 32016167 PMCID: PMC6991179 DOI: 10.1093/rap/rkz049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/26/2019] [Indexed: 12/17/2022] Open
Abstract
Objective The aim was to investigate the relationship between the intensity of spinal inflammation using the apparent diffusion coefficient (ADC) and radiographic progression in axial SpA. Methods This is a cross-sectional study of participants with axial SpA and back pain. Clinical, biochemical and radiological parameters were collected. The ankylosing spondylitis disease activity score (ASDAS)-CRP was determined. Radiographic progression was represented by the modified Stoke ankylosing spondylitis spine score (mSASSS). MRI with short tau inversion recovery (STIR) and diffusion-weighted imaging sequences were performed simultaneously. Inflammatory lesions on STIR were used for the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI indexes and as references in outlining regions of interest in ADC maps to produce mean (ADCmean) and maximal (ADCmax) ADC values. Univariate and multivariate linear regression analyses were used to determine independent associations between ADC and radiographic progression. Results The 84 participants with identifiable lesions on spinal ADC maps recruited were characterized by a mean (s.d.) age of 45.01 (13.68) years, long disease duration [13.40 (11.01) years] and moderate clinical disease activity [ASDAS-CRP 2.07 (0.83)]. Multivariate regression analysis using ADCmean as the independent variable showed that age (regression coefficient [B] = 0.34; P = 0.01), male sex (B = 0.25; P = 0.04) and ADCmean (B = 0.30; P = 0.01) were positively associated with mSASSS. Multivariate regression analysis using ADCmax as the independent variable showed a tendency for ADCmax to be associated with mSASSS (B = 0.21; P = 0.07). Conclusion The intensity of spinal inflammation as determined by ADC is associated with radiographic progression in participants with active axial SpA.
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Affiliation(s)
- Jin Xian Huang
- Division of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, China
| | - Eva Tze Fung Chui
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, China
| | - Kam Ho Lee
- Department of Radiology, Queen Mary Hospital, Hong Kong, China
| | - Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, China
| | - Helen Hoi Lun Tsang
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, China
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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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