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Zouris G, Evangelopoulos DS, Benetos IS, Vlamis J. The Use of TNF-α Inhibitors in Active Ankylosing Spondylitis Treatment. Cureus 2024; 16:e61500. [PMID: 38952586 PMCID: PMC11216526 DOI: 10.7759/cureus.61500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/03/2024] Open
Abstract
Ankylosing spondylitis (AS) is a challenging disease, characterized by chronic inflammation and structural damage primarily affecting the axial skeleton, while extra-articular manifestations may also appear. This results in the deterioration of patients' quality of life. Over the past few decades, tumor necrosis factor-α (TNF-α) inhibitors have revolutionized the management of AS, offering substantial relief from symptoms and improving patient outcomes. The aim of this review is to assess the efficacy of TNF-α inhibitors in patients with active AS. A search was performed in the PubMed database using the following keywords: ("TNF alpha inhibitors" OR "anti TNF-a" OR "TNF-a inhibitors" OR "anti TNF-alpha" OR "Etanercept " OR "Golimumab" OR "Infliximab" OR "Certolizumab pegol" OR "Adalimumab") AND "ankylosing spondylitis". The search was completed in February 2024, and 35 studies were included in this review following PRISMA guidelines. The findings reveal evidence supporting the efficacy of TNF-α inhibitors in reducing inflammation, preventing structural damage, and enhancing overall well-being in AS patients. Overall, TNF-α inhibitors have emerged as a cornerstone in the therapeutic algorithm against AS with a very satisfactory safety profile.
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Affiliation(s)
- Georgios Zouris
- 5th Orthopaedic Department, General Hospital "Asklepieio" Voulas, Athens, GRC
- Postgraduate Training Program, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Dimitrios Stergios Evangelopoulos
- 3rd Orthopaedic Department, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Postgraduate Training Program, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Metabolic Bone Diseases Department, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Ioannis S Benetos
- 3rd Orthopaedic Department, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Postgraduate Training Program, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - John Vlamis
- 3rd Orthopaedic Department, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Postgraduate Training Program, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Mihai IR, Burlui AM, Rezus II, Mihai C, Macovei LA, Cardoneanu A, Gavrilescu O, Dranga M, Rezus E. Inflammatory Bowel Disease as a Paradoxical Reaction to Anti-TNF-α Treatment-A Review. Life (Basel) 2023; 13:1779. [PMID: 37629636 PMCID: PMC10455403 DOI: 10.3390/life13081779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
TNF-α inhibitors (TNFis) have revolutionized the treatment of certain chronic immune-mediated diseases, being widely and successfully used in rheumatic inflammatory diseases, and have also proved their efficacy in the treatment of inflammatory bowel disease (IBD). However, among the side effects of these agents are the so-called paradoxical effects. They can be defined as the appearance or exacerbation of a pathological condition that usually responds to this class of drug while treating a patient for another condition. A wide range of paradoxical effects have been reported including dermatological, intestinal and ophthalmic conditions. The causal mechanism of occurrence may implicate an imbalance of cytokines, but is still not fully understood, and remains a matter of debate. These paradoxical reactions often show improvement on discontinuation of the medication or on switching to another TNFi, but in some cases it is a class effect that could lead to the withdrawal of all anti-TNF agents. Close monitoring of patients treated with TNFis is necessary in order to detect paradoxical reactions. In this study we focus on reviewing IBD occurrence as a paradoxical effect of TNFi therapy in patients with rheumatological diseases (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis).
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Affiliation(s)
- Ioana Ruxandra Mihai
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.A.M.); (A.C.); (E.R.)
| | - Alexandra Maria Burlui
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.A.M.); (A.C.); (E.R.)
| | - Ioana Irina Rezus
- Department of Dermatovenerology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Cătălina Mihai
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.M.); (O.G.); (M.D.)
| | - Luana Andreea Macovei
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.A.M.); (A.C.); (E.R.)
| | - Anca Cardoneanu
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.A.M.); (A.C.); (E.R.)
| | - Otilia Gavrilescu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.M.); (O.G.); (M.D.)
| | - Mihaela Dranga
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.M.); (O.G.); (M.D.)
| | - Elena Rezus
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.A.M.); (A.C.); (E.R.)
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Wang CR, Tsai HW. Seronegative spondyloarthropathy-associated inflammatory bowel disease. World J Gastroenterol 2023; 29:450-468. [PMID: 36688014 PMCID: PMC9850936 DOI: 10.3748/wjg.v29.i3.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/18/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Seronegative spondyloarthropathy (SpA) usually starts in the third decade of life with negative rheumatoid factor, human leukocyte antigen-B27 genetic marker and clinical features of spinal and peripheral arthritis, dactylitis, enthesitis and extra-articular manifestations (EAMs). Cases can be classified as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, or juvenile-onset spondyloarthritis. Joint and gut inflammation is intricately linked in SpA and inflammatory bowel disease (IBD), with shared genetic and immunopathogenic mechanisms. IBD is a common EAM in SpA patients, while extraintestinal manifestations in IBD patients mostly affect the joints. Although individual protocols are available for the management of each disease, the standard therapeutic guidelines of SpA-associated IBD patients remain to be established. Nonsteroidal anti-inflammatory drugs are recommended as initial therapy of peripheral and axial SpA, whereas their use is controversial in IBD due to associated disease flares. Conventional disease-modifying anti-rheumatic drugs are beneficial for peripheral arthritis but ineffective for axial SpA or IBD therapy. Anti-tumor necrosis factor monoclonal antibodies are effective medications with indicated use in SpA and IBD, and a drug of choice for treating SpA-associated IBD. Janus kinase inhibitors, approved for treating SpA and ulcerative colitis, are promising therapeutics in SpA coexistent with ulcerative colitis. A tight collaboration between gastroenterologists and rheumatologists with mutual referral from early accurate diagnosis to appropriately prompt therapy is required in this complex clinical scenario.
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Affiliation(s)
- Chrong-Reen Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan
| | - Hung-Wen Tsai
- Department of Pathology, National Cheng Kung University Hospital, Tainan 70403, Taiwan
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Chung HY, Huang JX, Lee KH, Tsang HHL, Lau CS, Chan SCW. MRI lesions in SpA: a comparison with noninflammatory back pain using propensity score adjustment method. Ther Adv Musculoskelet Dis 2022; 14:1759720X221119250. [PMID: 36051632 PMCID: PMC9425894 DOI: 10.1177/1759720x221119250] [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: 04/07/2022] [Accepted: 07/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Magnetic resonance imaging (MRI) is important in the management of axial spondyloarthritis (SpA). However, many MRI lesions are not exclusive to axial SpA. Further characterization of these lesions may lead to better clinical decisions. Objective: The objective of this study was to compare the frequency of individual spinal MRI lesions between axial SpA and noninflammatory back pain. The factors associated with individual lesions in participants with axial SpA were also determined. Design: This was a cross-sectional observational study. Methods: MRI lesions in 447 participants with axial SpA and 122 participants with noninflammatory back pain were compared using the propensity score adjustment method. Individual lesions included discovertebral lesions (DVL), Modic type 1 lesions, DVL without Modic type 1 lesions, facet joint lesions, costovertebral joint lesions, corner inflammatory lesions (CIL), and fatty corner lesions (FCL). The factors associated with the lesions were determined using regression analyses. Results: Among participants with axial SpA, 81.9% were HLA-B27-positive, 55.0% had radiographic axial SpA, and 60.5% had radiographic features of spinal damage (mSASSS >2). Almost half (48.6% in axial SpA versus 31.1% in noninflammatory back pain) had inflammatory lesions on spinal MRI. In propensity score matching with noninflammatory back pain, axial SpA had an increased occurrence of DVL without Modic type 1 lesion (OR = 3.43, p = 0.01), costovertebral lesion (OR = 11.89, p = 0.02), number of CIL (B = 1.19, p < 0.001), and number of FCL (B = 3.33, p < 0.001). Similar associations were found in the regression models in the radiographic axial SpA subgroup: DVL without Modic type 1 lesion (OR = 2.46, p = 0.001), costovertebral lesion (OR = 3.86, p < 0.001), number of CIL (B = 1.13, p < 0.001), and FCL (B = 2.29, p < 0.01). Conclusion: MRI lesions including DVL without Modic type 1, costovertebral joint lesions, CIL, and FCL were more specific in axial SpA.
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Affiliation(s)
- Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Jin Xian Huang
- Division of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kam Ho Lee
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Helen Hoi Lun Tsang
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong
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Hammoura I, Fiechter RH, Bryant SH, Westmoreland S, Kingsbury G, Waegell W, Tas SW, Baeten DL, van de Sande MGH, van Tok MN, van Duivenvoorde LM. Dual Blockade of TNF and IL-17A Inhibits Inflammation and Structural Damage in a Rat Model of Spondyloarthritis. Int J Mol Sci 2022; 23:ijms23020859. [PMID: 35055042 PMCID: PMC8776047 DOI: 10.3390/ijms23020859] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 12/20/2022] Open
Abstract
The tumor necrosis factor (TNF) and IL-23/IL-17 axes are the main therapeutic targets in spondyloarthritis. Despite the clinical efficacy of blocking either pathway, monotherapy does not induce remission in all patients and its effect on new bone formation remains unclear. We aimed to study the effect of TNF and IL-17A dual inhibition on clinical disease and structural damage using the HLA-B27/human β2-microglobulin transgenic rat model of SpA. Immunized rats were randomized according to arthritis severity, 1 week after arthritis incidence reached 50%, to be treated twice weekly for a period of 5 weeks with either a dual blockade therapy of an anti-TNF antibody and an anti-IL-17A antibody, a single therapy of either antibody, or PBS as vehicle control. Treatment-blinded observers assessed inflammation and structural damage clinically, histologically and by micro-CT imaging. Both single therapies as well as TNF and IL-17A dual blockade therapy reduced clinical spondylitis and peripheral arthritis effectively and similarly. Clinical improvement was confirmed for all treatments by a reduction of histological inflammation and pannus formation (p < 0.05) at the caudal spine. All treatments showed an improvement of structural changes at the axial and peripheral joints on micro-CT imaging, with a significant decrease for roughness (p < 0.05), which reflects both erosion and new bone formation, at the level of the caudal spine. The effect of dual blockade therapy on new bone formation was more prominent at the axial than the peripheral level. Collectively, our study showed that dual blockade therapy significantly reduces inflammation and structural changes, including new bone formation. However, we could not confirm a more pronounced effect of dual inhibition compared to single inhibition.
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Affiliation(s)
- Ihsan Hammoura
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (I.H.); (R.H.F.); (S.W.T.); (D.L.B.); (M.N.v.T.); (L.M.v.D.)
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Renee H. Fiechter
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (I.H.); (R.H.F.); (S.W.T.); (D.L.B.); (M.N.v.T.); (L.M.v.D.)
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Shaughn H. Bryant
- AbbVie Bioresearch Center, Worcester, MA 01605, USA; (S.H.B.); (S.W.); (G.K.); (W.W.)
| | - Susan Westmoreland
- AbbVie Bioresearch Center, Worcester, MA 01605, USA; (S.H.B.); (S.W.); (G.K.); (W.W.)
| | - Gillian Kingsbury
- AbbVie Bioresearch Center, Worcester, MA 01605, USA; (S.H.B.); (S.W.); (G.K.); (W.W.)
| | - Wendy Waegell
- AbbVie Bioresearch Center, Worcester, MA 01605, USA; (S.H.B.); (S.W.); (G.K.); (W.W.)
| | - Sander W. Tas
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (I.H.); (R.H.F.); (S.W.T.); (D.L.B.); (M.N.v.T.); (L.M.v.D.)
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Dominique L. Baeten
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (I.H.); (R.H.F.); (S.W.T.); (D.L.B.); (M.N.v.T.); (L.M.v.D.)
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Marleen G. H. van de Sande
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (I.H.); (R.H.F.); (S.W.T.); (D.L.B.); (M.N.v.T.); (L.M.v.D.)
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
| | - Melissa N. van Tok
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (I.H.); (R.H.F.); (S.W.T.); (D.L.B.); (M.N.v.T.); (L.M.v.D.)
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Leonie M. van Duivenvoorde
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (I.H.); (R.H.F.); (S.W.T.); (D.L.B.); (M.N.v.T.); (L.M.v.D.)
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Garcia-Montoya L, Emery P. Disease modification in ankylosing spondylitis with TNF inhibitors: spotlight on early phase clinical trials. Expert Opin Investig Drugs 2021; 30:1109-1124. [PMID: 34842481 DOI: 10.1080/13543784.2021.2010187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is a chronic inflammatory disease whose main hallmark is involvement of the axial skeleton. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line treatment; however, their use is limited because of side effects. Tumor necrosis factor inhibitors (TNFi) are a safe and effective therapy, and they have been approved for the management of AS. AREAS COVERED This is a review of the efficacy of TNFi in disease modification in AS. It is focused on results from early-phase clinical trials; however, it also discusses the most relevant findings in order to optimize anti-TNF treatment. A literature search was done using PubMed, Medline, Embase, Google Scholar, and Cochrane library, looking for scientific publications from inception to August 2021. Further information was retrieved from ClinicalTrial.gov and Clinicaltrialsregister.eu. EXPERT OPINION TNFi have demonstrated short- and long-term improvements in all aspects of disease activity, as well as physical function in patients with AS. They have drastically revolutionized the management of the disease; and even though new drugs have become available in the market, TNFi has not been displaced for the treatment of AS, and still constitute the best alternative when NSAIDs are no-longer an option.
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Affiliation(s)
- Leticia Garcia-Montoya
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Early Improvements in Disease Activity Indices Predict Long-Term Clinical Remission Suggested by the Treat-to-Target Strategy in Patients with Ankylosing Spondylitis Receiving TNF-α Inhibitor Treatment. J Clin Med 2021; 10:jcm10184279. [PMID: 34575390 PMCID: PMC8469764 DOI: 10.3390/jcm10184279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/29/2021] [Accepted: 09/16/2021] [Indexed: 01/12/2023] Open
Abstract
This study evaluated the possibility of clinical remission suggested by the treat-to-target strategy and identified predictors of clinical remission in 139 patients with ankylosing spondylitis (AS) receiving tumor necrosis factor-α inhibitors (TNFi). Clinical remission criteria selected were AS Disease Activity Score Inactive Disease (ASDAS-ID) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) < 2 with normal C-reactive protein (CRP) levels (BASDAI-CRP). The longitudinal relationship between clinical parameters and clinical remission was assessed using generalized estimating equations (GEEs). Responders to ASDAS-ID and BASDAI-CRP increased from 32.4% to 68.9% and from 39.9% to 75.2% at months 3 and 33, respectively. Responders to ASDAS-ID and BASDAI-CRP almost overlapped. In the univariable GEE model, age and 3-month improvement in BASDAI, ASDAS-CRP, physician and patient global assessments, and spinal pain predicted clinical remission achievement, while the presence of syndesmophytes predicted ASDAS-CRP achievement, and normalized CRP at 3 months was associated with BASDAI-CRP achievement. Multivariable GEE analysis revealed age (odds ratio (OR): 0.67; 95% confidence interval (CI), 0.49–0.93) and 3-month BASDAI improvement (OR: 1.70; CI, 1.19–2.41) as independent predictors of ASDAS-ID achievement and age (OR: 0.69; CI, 0.54–0.89), 3-month BASDAI improvement (OR: 2.00; CI, 1.45–2.76), and normalized CRP at 3 months (OR: 3.72; CI, 1.39–9.95) as independent predictors of BASDAI-CRP achievement.
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Yu T, Zhang J, Zhu W, Wang X, Bai Y, Feng B, Zhuang Q, Han C, Wang S, Hu Q, An S, Wan M, Dong S, Xu J, Weng X, Cao X. Chondrogenesis mediates progression of ankylosing spondylitis through heterotopic ossification. Bone Res 2021; 9:19. [PMID: 33731675 PMCID: PMC7969928 DOI: 10.1038/s41413-021-00140-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/17/2020] [Accepted: 12/12/2020] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis (AS) is chronic inflammatory arthritis with a progressive fusion of axial joints. Anti-inflammatory treatments such as anti-TNF-α antibody therapy suppress inflammation but do not effectively halt the progression of spine fusion in AS patients. Here we report that the autoimmune inflammation of AS generates a microenvironment that promotes chondrogenesis in spine ligaments as the process of spine fusion. Chondrocyte differentiation was observed in the ligaments of patients with early-stage AS, and cartilage formation was followed by calcification. Moreover, a large number of giant osteoclasts were found in the inflammatory environment of ligaments and on bony surfaces of calcified cartilage. Resorption activity by these giant osteoclasts generated marrow with high levels of active TGF-β, which induced new bone formation in the ligaments. Notably, no Osterix+ osteoprogenitors were found in osteoclast resorption areas, indicating uncoupled bone resorption and formation. Even at the late and maturation stages, the uncoupled osteoclast resorption in bony interspinous ligament activates TGF-β to induce the progression of ossification in AS patients. Osteoclast resorption of calcified cartilage-initiated ossification in the progression of AS is a similar pathologic process of acquired heterotopic ossification (HO). Our finding of cartilage formation in the ligaments of AS patients revealed that the pathogenesis of spinal fusion is a process of HO and explained why anti-inflammatory treatments do not slow ankylosing once there is new bone formation in spinal soft tissues. Thus, inhibition of HO formation, such as osteoclast activity, cartilage formation, or TGF-β activity could be a potential therapy for AS.
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Affiliation(s)
- Tao Yu
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Wei Zhu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Xiao Wang
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Yun Bai
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Bin Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Qianyu Zhuang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Chang Han
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Shengru Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Qimiao Hu
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Senbo An
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Mei Wan
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Shiwu Dong
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Jianzhong Xu
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730, Beijing, China.
| | - Xu Cao
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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Fragoulis GE, Siebert S. Treatment strategies in axial spondyloarthritis: what, when and how? Rheumatology (Oxford) 2021; 59:iv79-iv89. [PMID: 33053192 PMCID: PMC7566463 DOI: 10.1093/rheumatology/keaa435] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
There have been major advances in the management of axial spondyloarthritis (axSpA) with the introduction of effective biologic agents targeting TNF and IL-17A. Clinicians now have more choice but, despite treatment recommendations, are still faced with significant uncertainty when deciding on the optimal treatment strategy for an individual patient in clinical practice. Management of axSpA typically requires both non-pharmacological and pharmacological interventions. NSAIDs remain the first line drug therapies for axSpA with proven efficacy for symptomatic management but uncertainty remains regarding their optimal long-term use relating to radiographic progression and safety in axSpA. To-date there are no head-to-head trials of biologics in axSpA. Clinicians need to consider other factors, including extra-articular manifestations, comorbidities, safety and radiographic progression when deciding on which biologic to recommend for an individual patient. This article will explore the evidence relating to these factors and highlight areas of unmet need.
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Affiliation(s)
- George E Fragoulis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, 'Laiko' General Hospital, Athens, Greece
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Alahmari ASA, Qari SK, Asiri RI, Almohammadi TA, Alalawi MA, Aljahdali HM, Alnasser AH, Alaqeel FA, Kazim OA, Qasem HAO. An Overview on the Role of Surgical Management in Ankylosing Spondylitis. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/9azbvu4zlt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Achievement of Remission Endpoints with Secukinumab Over 3 Years in Active Ankylosing Spondylitis: Pooled Analysis of Two Phase 3 Studies. Rheumatol Ther 2020; 8:273-288. [PMID: 33351179 PMCID: PMC7991028 DOI: 10.1007/s40744-020-00269-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/05/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Clinical remission in patients with ankylosing spondylitis (AS) has been determined using composite indices such as the AS Disease Activity Score inactive disease (ASDAS-ID), Assessment of SpondyloArthritis international Society criteria partial remission (ASAS-PR), and low Bath AS Disease Activity Index (BASDAI) scores. The objective of this exploratory analysis was to evaluate the proportion of secukinumab-treated patients with AS achieving remission defined based on the ASDAS-ID (score < 1.3), ASAS-PR or BASDAI score ≤ 2. Methods The analysis pooled data from the MEASURE 1 and 2 studies over 3 years. The proportion of patients who achieved ASDAS-ID, ASAS-PR, or BASDAI ≤ 2 with secukinumab was compared with placebo at week 16; results for secukinumab-treated patients were summarized through week 156. Sustainability of each criterion was assessed from week 16 to 156 using shift analysis. The association between each of these criteria and specific patient-reported outcomes (PROs), such as health-related quality of life, function, fatigue, and work impairment, was also explored. Results At week 16, a higher proportion of secukinumab-treated patients versus placebo achieved ASDAS-ID (17.6 vs. 3.5%), ASAS-PR (15.4 vs. 4.1%), or BASDAI ≤ 2 (22.3 vs. 6.4%) criteria (all P < 0.0001), which were sustained through 156 weeks. Shift analysis showed that the majority of secukinumab-treated patients achieving remission at week 16 maintained their status at week 156 (ASDAS-ID, 57.1%; ASAS-PR, 68.0% and BASDAI ≤ 2, 74.3%). Remission was also associated with improved PROs over 156 weeks. Conclusions Secukinumab-treated patients maintained ASDAS-ID, ASAS-PR, or BASDAI ≤ 2 from week 16 up to 3 years. Patients who achieved at least one of the three responses/states, reported improvement in PROs, which suggests an association of clinical remission/ID with PROs in patients with active AS. Trial registration ClinicalTrials.gov: NCT01358175, NCT01863732, and NCT01649375 Supplementary Information The online version contains supplementary material available at 10.1007/s40744-020-00269-6.
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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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Aouad K, De Craemer AS, Carron P. Can Imaging Be a Proxy for Remission in Axial Spondyloarthritis? Rheum Dis Clin North Am 2020; 46:311-325. [DOI: 10.1016/j.rdc.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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Baraliakos X, Braun J. [Imaging in patients with axial spondylarthritis with focus on new bone formation]. Z Rheumatol 2019; 79:33-39. [PMID: 31822992 DOI: 10.1007/s00393-019-00732-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To summarize, the currently available imaging procedures have various possibilities to visualize or sometimes to predict the osteogenesis pathognomonic for axial spondylarthritis (axSpA). The individual imaging techniques of X‑rays, computed tomography (CT) and magnetic resonance imaging (MRI) all have strengths and weaknesses in the diagnostics of axSpA. The generally easily available X‑ray imaging rapidly provides information on the condition of large sections of the skeleton. In particular, it can depict the chronic stages with various structural alterations of the sacroiliac joint and syndesmophytes and ankylosis of the spine. The CT technique, which principally has the same contrast as X‑rays, also shows pathological ossifications but without superimpositions, with better resolution of details and a higher dimensionality. The MRI technique has a superior soft tissue contrast so that acute inflammatory stages, such as bone marrow edema and erosion of the edges of vertebrae of the spine (shiny corners, Romanus lesions) or erosions and bone marrow edema of the sacroiliac joint are easily visible. Bony reconstruction processes can be visualized better in X‑ray imaging and particularly in CT, which increases the evidential value of X‑ray, CT and MRI techniques. The positions of conventional radiography and MRI are well-established in the diagnostic algorithm; however, low-dose CT of the spine is still in the experimental stage but the initial results look promising.
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Affiliation(s)
- X Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
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16
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Ren J, Zhu J, Li D, Li W, Liu F. The value of contrast-enhanced ultrasonography to detect the sacroiliac joint for predicting relapse after discontinuation of anti-tumor necrosis factor therapy in patients with ankylosing spondylitis. Quant Imaging Med Surg 2019; 9:1110-1117. [PMID: 31367565 PMCID: PMC6629574 DOI: 10.21037/qims.2019.06.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/06/2019] [Indexed: 08/29/2023]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by high relapse. Therefore, the present study aimed to investigate the ultrasonographic features of contrast-enhanced ultrasonography (CEUS) in the sacroiliac joint (SIJ) in patients with AS in remission after discontinuation of anti-tumor necrosis factor (TNF) therapy, and also examined the role of CEUS in predicting relapse. METHODS In this prospective observational study, 130 SIJs in 65 patients with AS (according to modified New York criteria) satisfying Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease after discontinuation of anti-TNF therapy were investigated on color Doppler ultrasonography (CDUS) and CEUS. Vascularization and the resistive index (RI) of the SIJ were observed and measured. We defined no blood flow, high RI of arterial blood flow (RI ≥0.7), the reversed phase in the diastolic phase or venous blood flow in the bilateral SIJs, as negative CDUS/CEUS; meanwhile, low RI of arterial blood flow (RI <0.7) in the unilateral or bilateral SIJs was defined as positive CDUS/CEUS. All the patients were followed up for 52 weeks until relapse. Relapse was defined as an increase of two or more items in comparison with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at the time of anti-TNF withdrawal. RESULTS After 52 weeks, 46 of the 65 patients (70.8%) had relapse. The mean time to relapse was 31.4 weeks (±8.4 weeks, range 20 to 52). After discontinuation of anti-TNF therapy, positive CEUS accounted for 61.5%; this was significantly more than positive CDUS (13.8%). The vascularization detected by CEUS for patients of relapse was significantly different from that of patients with remission (P<0.05). In addition, patients with negative CEUS had a longer duration of remission than the patients with positive CEUS (P=0.005). A Cox proportional hazards regression analysis found that the disease duration could also be regarded as a factor predictive of relapse in patients with AS. CONCLUSIONS The use of CEUS distinctly improved the detection of vascularization in the SIJ in patients with AS in remission after anti-TNF withdrawal. The presence of vascularization in the SIJ detected by CEUS at the time of anti-TNF withdrawal could yield a valuable predictor of relapse in patients with AS. A significant limit of this study is the lack of magnetic resonance imaging (MRI) as the standard reference.
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Affiliation(s)
- Jiayu Ren
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Diancheng Li
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Fang Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
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17
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Wink F, Arends S, Maas F, Bootsma H, Griep EN, Bruyn GAW, Spoorenberg A. High prevalence of hip involvement and decrease in inflammatory ultrasound lesions during tumour necrosis factor-α blocking therapy in ankylosing spondylitis. Rheumatology (Oxford) 2019; 58:1040-1046. [PMID: 30624693 DOI: 10.1093/rheumatology/key382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 10/03/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Freke Wink
- 1Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Suzanne Arends
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fiona Maas
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ed N Griep
- Rheumatology, Antonius Hospital, Sneek, The Netherlands
| | | | - Anneke Spoorenberg
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Etanercept-induced Crohn’s disease in ankylosing spondylitis: a case report and review of the literature. Rheumatol Int 2018; 38:2157-2162. [DOI: 10.1007/s00296-018-4165-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/25/2018] [Indexed: 01/14/2023]
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19
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BARALIAKOS XENOFON, BERENBAUM FRANCIS, FAVALLI ENNIOGIULIO, OLIVIERI IGNAZIO, OSTENDORF BENEDIKT, PODDUBNYY DENIS, DE VLAM KURT. Challenges and Advances in Targeting Remission in Axial Spondyloarthritis. J Rheumatol 2018; 45:153-157. [DOI: 10.3899/jrheum.170222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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Yahya F, Gaffney K, Hamilton L, Lonsdale E, Leeder J, Brooksby A, Cavill C, Berry-Jenkins J, Boyle C, Bond D, Sengupta R. Tumour necrosis factor inhibitor survival and predictors of response in axial spondyloarthritis—findings from a United Kingdom cohort. Rheumatology (Oxford) 2017; 57:619-624. [DOI: 10.1093/rheumatology/kex457] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Fariz Yahya
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Louise Hamilton
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Ellie Lonsdale
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Jane Leeder
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Alan Brooksby
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Charlotte Cavill
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Joshua Berry-Jenkins
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Cathal Boyle
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Debbie Bond
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Raj Sengupta
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacology, University of Bath, Bath, UK
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21
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Wang CR, Weng CT, Lee CT, Huang KY, Hsu SM, Liu MF. Rare occurrence of inflammatory bowel disease in a cohort of Han Chinese ankylosing spondylitis patients- a single institute study. Sci Rep 2017; 7:13165. [PMID: 29030592 PMCID: PMC5640612 DOI: 10.1038/s41598-017-13573-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023] Open
Abstract
Despite a high prevalence of ankylosing spondylitis (AS) in Han Chinese, the clinical experience remains very limited in the extra-articular presentation of inflammatory bowel disease (IBD). A monocentric retrospective study was performed for the AS-associated IBD manifestation. This study analyzed AS patients fulfilling the 1984 revised New York diagnostic criteria, excluding those who had the onset of IBD before or concurrently with the diagnosis of AS, for their demographic, clinical, laboratory, radiological, pathological and medication data, particularly in the usage of anti-TNF monoclonal antibody. Among 988 AS patients with 19.8% female, 4 (0.4%) had the overt IBD presentation, one female and 3 male aged 28 to 47 years (38.8 ± 4.6), all ulcerative colitis with the characteristic histopathological findings. At the onset of colitis, all had a long-term disease duration of 10 to 25 years (17.5 ± 6.5) and high BASDAI 7.5 to 8.8 (8.2 ± 0.5) with the hip joint involvement. There were recurrent flares of colitis despite the treatment with corticosteroids and messalazopyrin/salazopyrin, and no relapses of IBD were observed for 6.0 ± 1.1 years after the adalimumab (ADA) therapy. In this retrospective cohort, we demonstrate the rarity of AS-associated IBD manifestation in Han Chinese with a beneficent effect from the ADA therapy.
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Affiliation(s)
- Chrong-Reen Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Chia-Tse Weng
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chung-Ta Lee
- Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Kuo-Yuan Huang
- Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Min Hsu
- Opthalmology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Fei Liu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Guillot X, Prati C, Sondag M, Wendling D. Etanercept for treating axial spondyloarthritis. Expert Opin Biol Ther 2017; 17:1173-1181. [PMID: 28682112 DOI: 10.1080/14712598.2017.1347156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Axial spondyloarthritis is an inflammatory rheumatic disease causing back pain, functional impairment and potential ankylosis in the advanced stage. In this context, TNF blockers have been a major therapeutic advance. Etanercept is a soluble recombinant TNF receptor fusion protein in this vain. Areas covered: The aim of this review is to summarize the current published data concerning the efficacy and tolerance of etanercept in axial spondyloarthrits. The authors performed a systematic review on PubMed, using 'etanercept' and 'spondyloarthritis', 'axial spondyloarthritis' or 'ankylosing spondylitis' keywords. Expert opinion: Etanercept showed clinical efficacy on the axial (non-radiographic and radiographic) and peripheral manifestations (peripheral arthritis and enthesitis) of axial spondyloarthritis (Ax-SpA). Among the extra-articular manifestations, it works on psoriasis but not on inflammatory bowel disease, with a lack of efficacy data in anterior uveitis. Etanercept also demonstrated an interesting tolerance profile and good drug survival rates after 5 years. Etanercept was also shown to reduce MRI inflammation on the spine and the sacroiliac joints. However, like other TNF blockers, its impact on radiographic progression could not be fully demonstrated. In the context of upcoming new biologic targeted treatments, head-to-head and longer-term randomized controlled trials are now required to further define the role of etanercept in spondyloarthritis treatment strategies.
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Affiliation(s)
- Xavier Guillot
- a Rheumatology Department , Besançon University Hospital, CHRU de Besançon , Besançon , France.,b PEPITE EA4267, FHU INCREASE , Bourgogne-Franche-Comté University , Besançon , France
| | - Clément Prati
- a Rheumatology Department , Besançon University Hospital, CHRU de Besançon , Besançon , France.,b PEPITE EA4267, FHU INCREASE , Bourgogne-Franche-Comté University , Besançon , France
| | - Maxime Sondag
- a Rheumatology Department , Besançon University Hospital, CHRU de Besançon , Besançon , France
| | - Daniel Wendling
- a Rheumatology Department , Besançon University Hospital, CHRU de Besançon , Besançon , France.,c EA 4266, Bourgogne-Franche-Comté University , Besançon , France
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Abstract
Psoriatic arthritis (PsA) is a chronic, progressive, inflammatory spondyloarthropathy that affects approximately one-third of patients with all types of psoriasis. Dermatologists are in a unique position to recognize early symptoms of PsA, initiate appropriate therapy, and prevent development of further disability. The course of PsA can be modulated by immunosuppressive therapy; patients with moderate-to-severe disease require aggressive management with medications proven to halt disease progression. It is essential for the dermatologist to understand the safety, tolerability, efficacy, cost, and potential to halt disease progression with available medications for this relatively common and potentially disabling disease.
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Affiliation(s)
- Suzanne J Tintle
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA.
| | - Alice B Gottlieb
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA
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van den Berg R, de Hooge M, Bakker PAC, van Gaalen F, Navarro-Compán V, Fagerli KM, Landewé R, van Oosterhout M, Ramonda R, Reijnierse M, van der Heijde D. Metric Properties of the SPARCC Score of the Sacroiliac Joints - Data from Baseline, 3-month, and 12-month Followup in the SPACE Cohort. J Rheumatol 2015; 42:1186-93. [PMID: 25934824 DOI: 10.3899/jrheum.140806] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate metric properties of the SpondyloArthritis Research Consortium of Canada (SPARCC) score of the sacroiliac (SI) joints. METHODS Patients with back pain (≥ 3 months, ≤ 2 years, onset < 45 years) were included in the SPACE cohort (SpondyloArthritis Caught Early). Patients with (possible) axial spondyloarthritis had followup visits after 3 and 12 months and were treated according to clinical practice. Magnetic resonance imaging (MRI) of the SI joints (MRI-SI) was scored in 2 independent campaigns (campaign 1: at baseline and 3 months; campaign 2: at baseline, 3 months, and 12 months) by 2 different blinded reader pairs, applying the Assessment of Spondyloarthritis International Society (ASAS) definition (MRI-SI+ vs MRI-SI-; discordant cases were adjudicated by a third reader) and SPARCC score (mean of 2 agreeing readers). Calculations were made for agreement between SPARCC score cutoff values and a consensus judgment of MRI-SI+ (ASAS definition) as external standard, change in SPARCC score, and smallest detectable changes (SDC) over 3 and 12 months. RESULTS SPARCC score ≥ 2 showed best agreement with MRI-SI+ in both campaigns. Regarding observed changes in relation to SDC, SPARCC score changed in 70/151 patients; 26/70 patients changed > SDC (3.4), of whom 20 patients received stable treatment over 3 months in campaign 1. Over 3 months, 20/68 patients showed changes in SPARCC score; 11/20 > SDC (2.1), of whom 8 patients received stable treatment. Over 1 year, 23/74 patients changed their SPARCC score; 14/23 changed > SDC (2.4), of whom 7 received stable treatment in campaign 2. CONCLUSION SPARCC score ≥ 2 can be used as surrogate for a consensus judgment of MRI-SI+ (ASAS definition) in clinical trials. The SDC ranged from 2.1-3.4 dependent on reader pair and were close to the proposed minimum important change of 2.5.
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Affiliation(s)
- Rosaline van den Berg
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center.
| | - Manouk de Hooge
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Pauline A C Bakker
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Floris van Gaalen
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Victoria Navarro-Compán
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Karen Minde Fagerli
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Robert Landewé
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Maikel van Oosterhout
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Roberta Ramonda
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Monique Reijnierse
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
| | - Désirée van der Heijde
- From the Department of Rheumatology, and the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, University Hospital La Paz, Madrid, Spain; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Amsterdam Rheumatology Center, Amsterdam; Department of Rheumatology, Groene Hart Ziekenhuis (GHZ) hospital, Gouda, the Netherlands; Rheumatology Unit, Department of Medicine, DIMED University of Padua, Padua, Italy.R. van den Berg, PhD; M. de Hooge, MSc; P.A. Bakker, MD; F. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center; V. Navarro-Compán, MD, Department of Rheumatology, Leiden University Medical Center, and Department of Rheumatology, University Hospital La Paz; K.M. Fagerli, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Landewé, MD, PhD, Amsterdam Rheumatology Center; M. van Oosterhout, MD, PhD, Department of Rheumatology, GHZ hospital; R. Ramonda, MD, Rheumatology Unit, Department of Medicine, DIMED University of Padua; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center
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van der Heijde D, Breban M, Halter D, DiVittorio G, Bratt J, Cantini F, Kary S, Pangan AL, Kupper H, Rathmann SS, Sieper J, Mease PJ. Maintenance of improvement in spinal mobility, physical function and quality of life in patients with ankylosing spondylitis after 5 years in a clinical trial of adalimumab. Rheumatology (Oxford) 2014; 54:1210-9. [PMID: 25541333 PMCID: PMC4473764 DOI: 10.1093/rheumatology/keu438] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Chronic pain and progressive loss of physical function with AS may adversely affect health-related quality of life (HRQoL). The objective of this study was to assess the 5-year data regarding spinal mobility, physical function and HRQoL in patients with AS who participated in the Adalimumab Trial Evaluating Long-term Efficacy and Safety for AS (ATLAS) study. METHODS Patients received blinded adalimumab 40 mg or placebo every other week for 24 weeks, then open-label adalimumab for up to 5 years. Spinal mobility was evaluated using linear BASMI (BASMIlin). BASDAI, total back pain, CRP, BASFI, Short Form-36 and AS quality of life (ASQoL) were also assessed. Correlations between BASMIlin and clinical, functional and ASQoL outcomes after 12 weeks and after 5years of adalimumab exposure were evaluated using Spearman's rank correlation. Associations were further analysed using multivariate regression. RESULTS Three hundred and eleven patients received ≥1 dose of adalimumab; 125 of the 208 patients originally randomized to adalimumab received treatment for 5 years. Improvements in BASMIlin were sustained through 5 years, with a mean change of -0.6 from baseline in the population who completed 5 years of treatment with adalimumab. Improvements in disease activity, physical function and ASQoL were also sustained through 5 years. BASMIlin was significantly correlated with all evaluated clinical outcomes (P < 0.001). The highest correlation was with BASFI at 12 weeks (r = 0.52) and at 5 years (r = 0.65). Multivariate regression analysis confirmed this association (P < 0.001). CONCLUSION Treatment with adalimumab for up to 5 years demonstrated sustained benefits in spinal mobility, disease activity, physical function and HRQoL in patients with active AS. Spinal mobility was significantly associated with short- and long-term physical function in these patients. TRIAL REGISTRATION Clinicaltrials.gov; https://clinicaltrials.gov/NCT00085644.
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Affiliation(s)
- Désirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Maxime Breban
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Dale Halter
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Gino DiVittorio
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Johan Bratt
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Fabrizio Cantini
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Sonja Kary
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Aileen L Pangan
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Hartmut Kupper
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Suchitrita S Rathmann
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Joachim Sieper
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Phillip J Mease
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Rheumatology Division, Hôpital Ambroise Paré, AP-HP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Cedex, France, Houston Institute for Clinical Research, Houston, TX, Coastal Clinical Research, Inc., Mobile, AL, USA, Department of Rheumatology, Karolinska University Hospital, Huddinge, Sweden, Department of Rheumatology, Nuovo Ospedale S. Stefano, Prato, Italy, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany, Pharmaceutical Development, AbbVie, Data and Statistical Sciences, AbbVie, North Chicago, IL, USA, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany and Rheumatology and Internal Medicine, Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA
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Baraliakos X, Haibel H, Fritz C, Listing J, Heldmann F, Braun J, Sieper J. Long-term outcome of patients with active ankylosing spondylitis with etanercept-sustained efficacy and safety after seven years. Arthritis Res Ther 2014; 15:R67. [PMID: 23786760 PMCID: PMC4060369 DOI: 10.1186/ar4244] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 01/29/2013] [Accepted: 06/20/2013] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Data from clinical studies on the long-term efficacy and safety of anti-tumor necrosis factor (TNF)-α therapy in patients with ankylosing spondylitis (AS) are scarce. This is the first report on continuous treatment with the TNFα fusion protein etanercept over seven years (y). METHODS Overall, 26 patients with active AS were initially treated with etanercept 2 × 25 mg s.c./week with no concomitant disease modifying anti-rheumatic drugs (DMARDs) or steroids. The clinical response was assessed by standardized parameters. The primary outcome was the proportion of patients in the Spondyloarthritis International Society (ASAS) partial remission at seven years. AS disease activity scores (ASDAS) for status and improvement were compared to conventional outcome measures. RESULTS Overall, 21/26 patients (81%) completed two years of treatment and 16/26 patients (62%) completed seven years. In the completer analysis, 31% patients were in ASAS partial remission at seven years, while 44% patients showed an ASDAS inactive disease status. Mean Bath AS activity index (BASDAI) scores, which were elevated at baseline (6.3 ± 0.9), showed constant improvement and remained low: 3.1 ± 2.5 at two years and 2.5 ± 2.2 at seven years, while ASDAS also improved (3.9 ± 0.7 at baseline, 1.8 ± 0.9 at two years, 1.6 ± 0.8 at seven years), all P <0.001. From the 10 dropouts, only 5 patients discontinued treatment due to adverse events. Patients who completed the study had lower baseline Bath AS function index (BASFI) scores vs. patients who discontinued. No other clinical parameter at baseline could predict any long-term outcome. CONCLUSIONS This study confirms the clinical efficacy and safety of etanercept in patients with active AS over seven years of continuous treatment. After seven years, more than half of the initially treated patients remained on anti-TNF therapy, and one-third were in partial remission. TRIAL REGISTRATION ClinicalTrials.gov: NCT01289743
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[German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 6 Diagnostics]. Z Rheumatol 2014; 73 Suppl 2:49-65. [PMID: 25181974 DOI: 10.1007/s00393-014-1431-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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McArthur MA, Birt L, Goodacre L. “Better but not best”: a qualitative exploration of the experiences of occupational gain for people with inflammatory arthritis receiving anti-TNFα treatment. Disabil Rehabil 2014; 37:854-63. [DOI: 10.3109/09638288.2014.946156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Song IH, Hermann KG, Haibel H, Althoff CE, Poddubnyy D, Listing J, Weiß A, Buß B, Freundlich B, Lange E, Alten R, Rudwaleit M, Sieper J. Consistently Good Clinical Response in Patients with Early Axial Spondyloarthritis After 3 Years of Continuous Treatment with Etanercept: Longterm Data of the ESTHER Trial. J Rheumatol 2014; 41:2034-40. [DOI: 10.3899/jrheum.140056] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective.In patients with early active axial spondyloarthritis (axSpA) with a disease duration of < 5 years, the longterm efficacy of 3 years of continuous etanercept (ETN) treatment was assessed.Methods.In a previously reported ESTHER trial, patients with axSpA were randomized to treatment with ETN (n = 40) versus sulfasalazine (SSZ; n = 36) in the first year. We analyzed the clinical, laboratory, and magnetic resonance imaging (MRI) response in the pooled dataset of patients (study population; n = 61), including patients with ankylosing spondylitis (AS, n = 31) and nonradiographic axSpA (nr-axSpA, n = 30) who were continuously treated with ETN for 3 consecutive years. Data were analyzed using the last observation carried forward and completer analysis.Results.In the entire group of patients in the study population (n = 61), the mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) decreased from 5.7 (± 1.3) at baseline to 2.6 (± 2.4) at Year 3. The Ankylosing Spondylitis Disease Activity Score (ASDAS) decreased from 3.4 (± 0.8) to 1.5 (± 1.0). Also, mean values for MRI spine and sacroiliac joint scores showed a significant decrease. Response rates in the nr-axSpA group were similar and at least as good compared to the AS group for all outcome measures. When comparing remission stages, we found that ASDAS inactive disease correlated better with C-reactive protein and MRI remission than with Assessment of SpondyloArthritis international Society partial remission.Conclusion.There was a consistent and sustained clinical response in patients with early axSpA treated with ETN over 3 years. ClinicalTrials.gov registration number NCT00844142.
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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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Yoo IK, Choung RS, Hyun JJ, Kim SY, Jung SW, Koo JS, Lee SW, Choi JH, Kim H, Lee HS, Keum B, Kim ES, Jeen YT. Incidences of serious infections and tuberculosis among patients receiving anti-tumor necrosis factor-α therapy. Yonsei Med J 2014; 55:442-8. [PMID: 24532516 PMCID: PMC3936648 DOI: 10.3349/ymj.2014.55.2.442] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Anti-tumor necrosis factor-alpha (TNF-α) medications represent a major advancement in the management of chronic inflammatory diseases. However, these agents are associated with increased risks of tuberculosis (TB) and other serious infections. The aim of this study was to evaluate the incidences of such disease among tertiary hospitals in Korea. MATERIALS AND METHODS We retrospectively studied patients who received anti-TNF-α therapy; we reviewed serious infections including TB that developed within 6 months after initiation of anti-TNF-α therapy. Data concerning patient demographics, types of anti-TNF-α agents, concomitant immunosuppressive drugs use, and infection details were collected. RESULTS A total 175 patients treated with infliximab (n=72) or adalimumab (n=103) with the following conditions were enrolled: Crohn's disease, 34 (19.4%); ulcerative colitis, 20 (11.4%); ankylosing spondylitis, 82 (46.9%); and rheumatoid arthritis, 39 (22.2%). There were 18 cases (6.0%) of serious infections. The most common site of serious infection was the intra-abdomen (n=6), followed by TB (n=3), skin and soft tissue (n=3), bone and joints (n=2), ocular neurons (n=2), lower respiratory tract (n=1), and urinary tract (n=1). Of the 175 patients, only 3 cases showed development of TB. Furthermore, of all those who developed TB, none had taken anti-TB chemoprophylaxis prior to treatment with an anti-TNF agent due to negative screening results. CONCLUSION Serious infections with anti-TNF-α therapy were uncommon among tertiary hospitals in Korea; TB was the second most frequent infection. Nevertheless, there were no TB reactivations after anti-TB chemoprophylaxis. Accordingly, physicians should be aware of TB in subjects undergoing anti-TNF-α therapy, especially in countries with a high prevalence of TB.
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Affiliation(s)
- In Kyung Yoo
- Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea.
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Baraliakos X, Braun J. Anti-TNF-α therapy with infliximab in spondyloarthritides. Expert Rev Clin Immunol 2014; 6:9-19. [DOI: 10.1586/eci.09.61] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chou CT, Tsai CY, Liang TH, Chang TM, Lai CH, Wei CC, Chen KH, Lin SC, Yu CL, Liou LB, Luo SF, Lee CS, Hsue YT, Huang CM, Chen JH, Lai NS, Cheng HH, Cheng TT, Lai HM, Tsai WC, Yen JH, Lu LY, Chang CP. Better short-term clinical response to etanercept in Chinese than Caucasian patients with active ankylosing spondylitis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0334-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Schiotis R, Sánchez A, Escudero A, Bartolomé N, Szczypiorska M, Font P, Martínez A, Tejedor D, Artieda M, Mulero J, Buzoianu A, Collantes-Estévez E. Candidate's single-nucleotide polymorphism predictors of treatment nonresponse to the first anti-TNF inhibitor in ankylosing spondylitis. Rheumatol Int 2013; 34:793-801. [PMID: 24337767 DOI: 10.1007/s00296-013-2913-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/26/2013] [Indexed: 12/22/2022]
Abstract
The objective of this study is to identify single-nucleotide polymorphisms (SNPs) predictors of treatment nonresponse to the first anti-TNF-alpha agent in ankylosing spondylitis (AS). Patients were classified as "nonresponders" if they failed to achieve improvement ≥50 % of the initial BASDAI. We selected candidate SNPs previously reported, associated with susceptibility or pathogenesis of AS and with other spondylarthropaties (SpAs). The predictors of nonresponse were modeled with multiple logistic regression. The predictive power of the genetic model of nonresponse to treatment was tested with AUC-ROC. One hundred and twenty-one (121) AS patients fulfilled the inclusion criteria. Of the candidate SNPs tested for association with treatment effectiveness, five independent predictors were identified: rs917997, rs755622, rs1800896, rs3740691, and rs1061622. The genetic model of nonresponse to treatment had a predictive power of 0.77 (95 % CI 0.68-0.86). Our study identified several polymorphisms which could be the useful genetic biomarkers in predicting nonresponse to anti-TNF-alpha therapy.
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Affiliation(s)
- Ruxandra Schiotis
- Department of Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania,
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Baraliakos X, Listing J, Haibel H, Sieper J, Braun J. Vertebral erosions associated with spinal inflammation in patients with ankylosing spondylitis identified by magnetic resonance imaging: changes after 2 years of tumor necrosis factor inhibitor therapy. J Rheumatol 2013; 40:1891-6. [PMID: 23908444 DOI: 10.3899/jrheum.120533] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Spinal inflammation and erosions have been described in magnetic resonance imaging (MRI) examinations of patients with ankylosing spondylitis (AS). MRI scoring systems have implemented these observations. METHODS MRI scans (T1 or short-tau inversion recovery) from tumor necrosis factor-α blocker (anti-TNF) trials with patients with active AS (n = 22) were analyzed at baseline and after 2 years based on vertebral units (VU). The analysis was based on the prevalence of spinal erosions in relation to inflammation (active erosions) or without it (inactive erosions) as an outcome measure on MRI and their course under anti-TNF therapy. The results of MRI scoring systems that include (ASspiMRI) or exclude (Berlin score) erosions were also compared. RESULTS At baseline, there were more VU with inflammation (33.7%) than with erosions irrespective of activity (10.6%). After 2 years, active erosions decreased to 3.7% while inflammation was seen in a total of 12% of VU - a reduction of 58.9% and 64.5%, respectively (both p < 0.02). The overall extent of erosions decreased from 10.6% at baseline to 5.6% at 2 years. At the patient level, 73% and 32% of patients showed active erosions (p = 0.002), while 100% and 64% of patients showed inflammation (p = 0.029) at baseline and 2 years, respectively. Both scoring systems showed similar improvement, independent of inclusion or exclusion of erosions. CONCLUSION Inflammation with erosions was observed in the spine of most patients with AS but their contribution to changes observed upon anti-TNF therapy was small, indicating that erosions do not need to be included in quantitative scoring systems of inflammation. Spinal inflammation was still present after 2 years of anti-TNF therapy in two-thirds of patients.
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Affiliation(s)
- Xenofon Baraliakos
- From the Rheumazentrum Ruhrgebiet, Herne, Ruhr-University Bochum; German Rheumatism Research Center, Berlin; and Department of Rheumatology, University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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McArthur M, Birt L, Goodacre L. A Narrative Literature Review of the Impact of Anti-TNFα Treatment on the Occupational Performance of People with Rheumatoid Arthritis or Ankylosing Spondylitis. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13807217284260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Anti-TNFα treatment has revolutionised the disease pathway for some people with rheumatoid arthritis and ankylosing spondylitis, although physiological improvements do not always readily translate into re-engagement in occupational activities. This review explores the evidence base for the impact of anti-TNFα on occupational performance. Method: Literature was searched from 2000–11. A four-stage process resulted in the review of 19 articles. The Weight of Evidence framework was used to assess quality and relevance to the review question. Findings: People on anti-TNFα treatment experience increased engagement in functional, psychological and social domains. Most studies focused on employment issues, with conflicting evidence about how well anti-TNFα protected against work disability and very limited evidence that anti-TNFα enabled return to paid work. The increase in productivity was to the detriment of other occupational domains, with resulting occupational imbalance. Conclusion: The assumption that clinical improvement is relatively trouble free is incorrect, as some people on anti-TNFα treatment continue to experience difficulties in all occupational domains, particularly work. People on anti-TNFα treatment do not routinely have access to occupational therapy services. Further research needs to explore the nuanced experiences of treatment and the role of occupational therapy in maximising the treatment potential of anti-TNFα.
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Affiliation(s)
- Margaret McArthur
- Honorary Fellow, University of East Anglia, School of Rehabilitation Sciences, Norwich
| | - Linda Birt
- Research Associate, University of East Anglia, School of Rehabilitation Sciences, Norwich
| | - Lynne Goodacre
- Research Fellow, Lancaster University, School of Medicine and Health Sciences, Lancaster
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Baraliakos X, Haibel H, Listing J, Sieper J, Braun J. Continuous long-term anti-TNF therapy does not lead to an increase in the rate of new bone formation over 8 years in patients with ankylosing spondylitis. Ann Rheum Dis 2013; 73:710-5. [DOI: 10.1136/annrheumdis-2012-202698] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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MRI in Seronegative Spondyloarthritis: Imaging Features and Differential Diagnosis in the Spine and Sacroiliac Joints. AJR Am J Roentgenol 2013; 200:149-57. [DOI: 10.2214/ajr.12.8858] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Thalidomide reduces recurrence of ankylosing spondylitis in patients following discontinuation of etanercept. Rheumatol Int 2012; 33:1409-13. [PMID: 23143621 DOI: 10.1007/s00296-012-2571-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 10/21/2012] [Indexed: 12/15/2022]
Abstract
A previous study showed that most ankylosing spondylitis (AS) patients presented recurrence within 6 months post-discontinuation of etanercept. How to reduce recurrence following discontinuation of etanercept should be further researched. In this study, 111 ankylosing spondylitis patients meeting the Assessment in AS 20 % response (ASAS20) criteria after 12-week administration of etanercept were randomized into three groups: Group I, 150 mg thalidomide once/day; Group II, 1 g sulfasalazine, twice/day; Group III, NSAIDs for the maintenance treatment. The patients were regularly followed up once a month, and AS recurrence was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the patient global assessment (PGA), and rachialgia. The follow-up lasted for 1 year, and AS recurrence was considered as the end of a visit. Finally, 100 patients completed the follow-up study, of whom 30 were in Group I, 33 in Group II, and 37 in Group III. The average follow-up period was 5.1 ± 3.9 months and the longest lasted for 12 months. At the end of the follow-up study, the recurrence rates in Groups I, II, and III were, respectively, 60.0 % (18/30), 84.8 % (28/33), and 89.2 % (33/37). The recurrence rates of Group I were statistically significantly lower than that of Group II and III (P = 0.0265; P = 0.0053), while there was no significant difference between Group II and Group III. In addition, we found that PGA, C-reactive protein (CRP), and spinal inflammation could be regarded as predictive factors for AS recurrence by analysis with the Cox proportional hazard model. This study points to a new way for maintenance therapy of AS following discontinuation of etanercept and reveals several useful indicators for prediction of AS recurrence.
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MAKSYMOWYCH WALTERP, LAMBERT ROBERTG, BROWN LSTEVEN, PANGAN AILEENL. Defining the Minimally Important Change for the SpondyloArthritis Research Consortium of Canada Spine and Sacroiliac Joint Magnetic Resonance Imaging Indices for Ankylosing Spondylitis. J Rheumatol 2012; 39:1666-74. [DOI: 10.3899/jrheum.120131] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective.To define the minimally important change (MIC) in the SpondyloArthritis Research Consortium of Canada (SPARCC) spine and sacroiliac (SI) joint magnetic resonance imaging (MRI) indices in patients with ankylosing spondylitis.Methods.MRI scans were performed during a placebo-controlled trial of adalimumab (no. NCT00195819). Two independent readers, blinded to treatment and sequence, determined SPARCC scores for the spine and SI joints and a global evaluation of change (GEC; “much worse,” “worse,” “no change,” “better,” or “much better”; categories other than “no change” were pooled together as “change”) between baseline–Week 12, baseline–Week 52, and Weeks 12–52. Mean absolute changes in SPARCC scores (95% CI) were calculated for each interval, treatment group, and GEC. Receiver-operating characteristic (ROC) curves were used to identify the MIC. Relationships of MIC to clinical responses were examined.Results.Reader agreement on GEC evaluations was > 70%. Changes in SPARCC scores were generally comparable between time intervals and treatment groups for “change” and “no change” categories and were combined for each category; change in score was significantly associated with GEC of “change” (area under ROC curves: spine 0.839; SI joints 0.960). ROC curves peaked at values of 5.0 for the spine and 2.5 for SI joints. Placebo-treated patients achieving > 2.5 unit improvement in SI joint score had significantly better clinical responses than placebo-treated patients who did not achieve such improvement. MRI and clinical responses were uncoupled in adalimumab-treated patients.Conclusion.We propose that changes of 5.0 for the spine and 2.5 for SI joints define the MIC for the SPARCC MRI indices.
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Li ZH, Zhang Y, Wang J, Shi ZJ. Etanercept in the treatment of ankylosing spondylitis: a meta-analysis of randomized, double-blind, placebo-controlled clinical trials, and the comparison of the Caucasian and Chinese population. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23:497-506. [PMID: 23412168 DOI: 10.1007/s00590-012-1035-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 06/18/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Ankylosing spondylitis (AS) is a kind of rheumatic disease, leading to pain, fatigue, stiffness, and functional impairment, which seriously affects the quality of life. Etanercept, a fully human recombinant protein, has been applied for the treatment of AS. However, there has not been a systematic analysis for its efficacy and safety. METHODS This meta-analysis of fourteen randomized, double-blind, placebo-controlled clinical trials with 1,570 participants was performed to investigate the efficacy and safety of etanercept, by means of calculating the overall relative risk, and to compare the different responses between the Caucasian population and the Chinese population. RESULTS Generally, there was sufficient evidence to prove that etanercept has its advantages in both disease activity controlling and symptoms relieving, especially for axial joints compared with peripheric joints, without higher incidence of serious adverse events. INTERPRETATION Our preliminary analysis provided that the Caucasian population has better response to etanercept treatment, with more treatment-emergent adverse events. Further specially designed clinical trials need to be performed to investigate the different responses between axial and peripheric joints, also between different races.
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Affiliation(s)
- Zhi-han Li
- Department of Orthopaedic Surgery, Nanfang Hospital, Guangzhou, Guangdong Province, China
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Imaging and Clinical Measurements. Am J Med Sci 2012; 343:345-9. [DOI: 10.1097/maj.0b013e3182513fb4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Verstappen SMM, Fautrel B, Dadoun S, Symmons DPM, Boonen A. Methodological issues when measuring paid productivity loss in patients with arthritis using biologic therapies: an overview of the literature. Rheumatology (Oxford) 2012; 51:216-29. [DOI: 10.1093/rheumatology/ker363] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Mohamed Said MS, Shaharir S, Rajalingham S, Abdullah SA, Bin Hassanudin A, Soon NC, Shahid MS. Etanercept in the treatment of recalcitrant enteropathic arthritis: a case report. J Med Case Rep 2012; 6:10. [PMID: 22236863 PMCID: PMC3398294 DOI: 10.1186/1752-1947-6-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 01/11/2012] [Indexed: 01/06/2023] Open
Abstract
Introduction Enteropathic arthritis is one of the recognized extraintestinal manifestations of inflammatory bowel disease and affects up to 25% of patients. The treatment options for refractory disease were rather limited and ineffective until the arrival of biologic therapy in the last few years. The use of etanercept was unique for this disease. Case presentation In this case report, a 58-year-old Malay woman with a 17-year history of ulcerative colitis had persistent left knee effusion and synovitis for seven years, despite remission of the primary disease. She had had multiple courses of systemic and intra-articular steroid that caused significant systemic side effects such as impaired fasting glucose, hypertension, cataract, and weight gain. She also had a total left knee replacement for secondary osteoarthritis. But the left knee synovitis and effusion recurred a month after the total knee replacement, and she was subjected to a total synovectomy the following year. In view of failure of remission despite multiple immunosuppressants (100 mg of azathioprine daily, 1 g of sulfasalazine twice a day, 10 mg of prednisolone daily, and 10 mg of methotrexate weekly), 25 mg of subcutaneous etanercept twice weekly was started. After 5 weeks of treatment, complete resolution of left knee effusion and normalization of the inflammatory markers were shown. This continued up to 12 months of follow-up while our patient was on etanercept and 10 mg of methotrexate weekly. No relapse or serious side effects were noted. Conclusions This case demonstrates the efficacy of etanercept in recalcitrant enteropathic arthritis with no relapse of the underlying colitis while on treatment. The usage of this tumor necrosis factor inhibitor was unique in this case of rheumatology and gastroenterology.
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Baraliakos X, Braun J. Spondyloarthritides. Best Pract Res Clin Rheumatol 2011; 25:825-42. [PMID: 22265264 DOI: 10.1016/j.berh.2011.11.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/14/2011] [Indexed: 12/17/2022]
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Braun J, Baraliakos X, Hermann KGA, van der Heijde D, Inman RD, Deodhar AA, Baratelle A, Xu S, Xu W, Hsu B. Golimumab reduces spinal inflammation in ankylosing spondylitis: MRI results of the randomised, placebo- controlled GO-RAISE study. Ann Rheum Dis 2011; 71:878-84. [PMID: 22128083 PMCID: PMC3371220 DOI: 10.1136/annrheumdis-2011-200308] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective To evaluate golimumab's effect on MRI-detected spinal inflammation in ankylosing spondylitis (AS). Methods Patients were randomly assigned to subcutaneous injections of placebo (n=78), golimumab 50 mg (n=138), or golimumab 100 mg (n=140) every 4 weeks. An MRI substudy comprising 98 patients (placebo n=23, 50 mg n=37, 100 mg n=38) at eligible MRI substudy sites had serial spine MRI scans (sagittal plane, 1.5T scanners, T1 and short tau inversion recovery sequences) at baseline and weeks 14 and 104. Two blinded (treatment, image order) readers independently evaluated MRI spinal inflammation using AS spine MRI-activity (ASspiMRI-a) scores; reader scores were averaged. Changes from baseline to weeks 14 and 104 were compared among treatment groups using analysis of variance on van der Waerden normal scores both with (post-hoc) and without (prespecified) adjustment for baseline ASspiMRI-a scores. Results Median baseline ASspiMRI-a scores were lower in the 100 mg (3.5) than placebo (6.8) and 50 mg (7.8) groups. Median decreases in activity scores from baseline to week 14 were −0.5 for placebo, −3.5 for 50 mg (p=0.047 vs placebo), and −1.5 for 100 mg (p=0.14 vs placebo). After adjusting for baseline ASspiMRI-a score imbalance, significant improvements were observed with both 50 mg (p=0.011) and 100 mg (p=0.002) versus placebo. ASspiMRI-a scores improvement achieved with golimumab was maintained at week 104. Improvement in ASspiMRI-a scores correlated with improvement in the recently developed AS disease activity score (ASDAS) and C-reactive protein (CRP) levels but not with other key AS clinical outcomes. Conclusion Golimumab significantly reduced MRI-detected spinal inflammation of AS; improvements were sustained to week 104 and correlated with improvement in ASDAS and CRP.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Ruhr-University, Bochum, Germany.
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Kerensky TA, Gottlieb AB, Yaniv S, Au SC. Etanercept: efficacy and safety for approved indications. Expert Opin Drug Saf 2011; 11:121-39. [DOI: 10.1517/14740338.2012.633509] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Braun J, van der Horst-Bruinsma IE, Huang F, Burgos-Vargas R, Vlahos B, Koenig AS, Freundlich B. Clinical efficacy and safety of etanercept versus sulfasalazine in patients with ankylosing spondylitis: A randomized, double-blind trial. ACTA ACUST UNITED AC 2011; 63:1543-51. [PMID: 21630245 DOI: 10.1002/art.30223] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Juergen Braun
- Rheumatology Medical Center, Ruhr District, Herne, Germany
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Documento SER de consenso sobre el uso de terapias biológicas en la espondilitis anquilosante y otras espondiloartritis, excepto la artritis psoriásica. ACTA ACUST UNITED AC 2011; 7:113-23. [DOI: 10.1016/j.reuma.2010.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 12/10/2010] [Accepted: 12/10/2010] [Indexed: 12/17/2022]
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