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Barrett J, Leysen S, Galmiche C, Al-Mossawi H, Bowness P, Edwards TE, Lawson AD. Chimeric antigens displaying GPR65 extracellular loops on a soluble scaffold enabled the discovery of antibodies, which recognized native receptor. Bioengineered 2024; 15:2299522. [PMID: 38184821 PMCID: PMC10773626 DOI: 10.1080/21655979.2023.2299522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024] Open
Abstract
GPR65 is a proton-sensing G-protein coupled receptor associated with multiple immune-mediated inflammatory diseases, whose function is relatively poorly understood. With few reagents commercially available to probe the biology of receptor, generation of an anti-GPR65 monoclonal antibody was desired. Using soluble chimeric scaffolds, such as ApoE3, displaying the extracellular loops of GPR65, together with established phage display technology, native GPR65 loop-specific antibodies were identified. Phage-derived loop-binding antibodies recognized the wild-type native receptor to which they had not previously been exposed, generating confidence in the use of chimeric soluble proteins to act as efficient surrogates for membrane protein extracellular loop antigens. This technique provides promise for the rational design of chimeric antigens in facilitating the discovery of specific antibodies to GPCRs.
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Affiliation(s)
- Janine Barrett
- UK Research Department, UCB Pharma, Slough, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Hussein Al-Mossawi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paul Bowness
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Hansmaennel A, Fakih O, Gerazime A, Prati C, Chouk M, Wendling D, Verhoeven F. Effects of disease-modifying anti-rheumatic drugs on sacroiliac MRI score in axial spondyloarthritis: a systematic review and meta-analysis. Clin Rheumatol 2024; 43:1045-1052. [PMID: 38158505 DOI: 10.1007/s10067-023-06849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Sacroiliac bone marrow edema is an important factor in the diagnosis and management of axial spondyloarthritis (axSpA). The aim of this meta-analysis is to assess the effect of the different bDMARDs and tsDMARDs on the SPARCC score at 12-16 and 48-52 weeks. METHODS A systematic review, performed on PubMed (including Medline), Cochrane (CENTRAL) and DOAJ databases, included randomized controlled studies evaluating the sacroiliac joint (SIJ) SPARCC score at 12-16 or 48-52 weeks in patients with axSpA meeting the ASAS 2009 criteria or the modified New York criteria. We included studies evaluating the effects of the different treatments on the SPARCC score of SIJ in axial spondyloarthritis in comparison to a control group. RESULTS Eighteen studies were included in the meta-analysis. Nine studies evaluated the effect of TNFα inhibitors (TNFi), three for IL-17 inhibitors, and four for JAK inhibitors. At 12 and 16 weeks, SIJ SPARCC score was significantly improved by TNFi (WMD: - 3.29 [95% CI - 4.25; - 2, 34]), by IL-17 inhibitors (WMD: - 4.66 [95% CI - 6.22; - 3.09]), and by JAK inhibitors (JAKi) (WMD: - 3.06 [95% CI - 3.24; - 2.89]). There was no difference between the molecule subgroups. At 48-52 weeks, TNFα inhibitors reduced more SIJ SPARCC, but not significantly (WMD: - 2.26 [95% CI - 4.94; 0.42]), than placebo groups who began a TNFi treatment with delay. CONCLUSION Our meta-analysis shows a comparable improvement of the SIJ SPARCC score regarding TNFi, JAKi, and IL-17 inhibitors at three months and suggests the presence of an opportunity window. Key Points • Anti-TNF Ab, anti-IL17 Ab, and JAK inhibitor treatments reduce the sacroiliac joint SPARCC scores. • There is no difference between the different treatments in the reduction of the sacroiliac joint SPARCC score after 3 months in axial spondyloarthritis.
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Affiliation(s)
| | - Olivier Fakih
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Aurélie Gerazime
- Unité de méthodologie clinique, CHU de Besançon, Besançon, France
| | - Clément Prati
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4267 "PEPITE", Université de Bourgogne Franche Comté, Besançon, France
| | - Mickaël Chouk
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Daniel Wendling
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4266 "EPILAB", Université de Bourgogne Franche-Comté, Besançon, France
| | - Frank Verhoeven
- Service de Rhumatologie, CHU de Besançon, Besançon, France.
- EA 4267 "PEPITE", Université de Bourgogne Franche Comté, Besançon, France.
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Maksymowych W, Hadsbjerg AEFEF, Østergaard M, Micheroli R, Pedersen SJ, Ciurea A, Vladimirova N, Nissen MS, Bubova K, Wichuk S, de Hooge M, Mathew AJ, Pintaric K, Gregová M, Snoj Z, Wetterslev M, Gorican K, Möller B, Eshed I, Paschke J, Lambert RG. Validation of SPARCC MRI-RETIC e-tools for increasing scoring proficiency of MRI sacroiliac joint lesions in axial spondyloarthritis. RMD Open 2024; 10:e003923. [PMID: 38351052 PMCID: PMC10868186 DOI: 10.1136/rmdopen-2023-003923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The Spondyloarthritis Research Consortium of Canada (SPARCC) developers have created web-based calibration modules for the SPARCC MRI sacroiliac joint (SIJ) scoring methods. We aimed to test the impact of applying these e-modules on the feasibility and reliability of these methods. METHODS The SPARCC-SIJ RETIC e-modules contain cases with baseline and follow-up scans and an online scoring interface. Visual real-time feedback regarding concordance/discordance of scoring with expert readers is provided by a colour-coding scheme. Reliability is assessed in real time by intraclass correlation coefficient (ICC), cases being scored until ICC targets are attained. Participating readers (n=17) from the EuroSpA Imaging project were randomised to one of two reader calibration strategies that each comprised three stages. Baseline and follow-up scans from 25 cases were scored after each stage was completed. Reliability was compared with a SPARCC developer, and the System Usability Scale (SUS) assessed feasibility. RESULTS The reliability of readers for scoring bone marrow oedema was high after the first stage of calibration, and only minor improvement was noted following the use of the inflammation module. Greater enhancement of reader reliability was evident after the use of the structural module and was most consistently evident for the scoring of erosion (ICC status/change: stage 1 (0.42/0.20) to stage 3 (0.50/0.38)) and backfill (ICC status/change: stage 1 (0.51/0.19) to stage 3 (0.69/0.41)). The feasibility of both e-modules was evident by high SUS scores. CONCLUSION The SPARCC-SIJ RETIC e-modules are feasible, effective knowledge transfer tools, and their use is recommended before using the SPARCC methods for clinical research and tria.
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Affiliation(s)
- Walter Maksymowych
- Medicine, University of Alberta, Edmonton, Alberta, Canada
- CARE ARTHRITIS Limited, Edmonton, Alberta, Canada
| | - Anna Enevold Fløistrup E F Hadsbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Susanne Juhl Pedersen
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Nora Vladimirova
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Kristyna Bubova
- First Faculty of Medicine, Rheumatology, Charles University, Prague, Czech Republic
| | - Stephanie Wichuk
- Rheumatology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Manouk de Hooge
- Ghent University Hospital, Ghent, Oost-Vlaanderen, Belgium
- Leiden University, Leiden, Netherlands
| | - Ashish J Mathew
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Clinical Immunology and Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
| | | | - Monika Gregová
- First Faculty of Medicine, Rheumatology, Charles University, Prague, Czech Republic
| | - Ziga Snoj
- Radiology, UKC Ljubljana, Ljubljana, Slovenia
| | - Marie Wetterslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karel Gorican
- Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Burkhard Möller
- Rheumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Robert Gw Lambert
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Xie R, Liang X, Zhang X, Morelli JN, Wang J, Liu C, Li X. Whole-joint histogram analysis of different models of diffusion weighted imaging in evaluating disease activity of axial spondyloarthritis. Br J Radiol 2023; 96:20220420. [PMID: 37751218 PMCID: PMC10646629 DOI: 10.1259/bjr.20220420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES To assess whole-joint histogram analysis of mono-exponential and bi-exponential diffusion weighted and diffusion kurtosis imaging in evaluating disease activity of axial spondyloarthritis (axSpA). METHODS A total of 82 patients with axSpA who underwent both DKI and multi b diffusion weighted imaging of the sacroiliac joints were divided into active and inactive disease groups based on clinical activity indices. Another 17 patients with nonspecific low back pain were included as a control group. The SPARCC scoring system was used to assess the level of sacroiliac joint bone marrow edema. Histogram parameters of apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion fraction (f), pseudodiffusion coefficient (D*), mean kurtosis (MK), and mean diffusivity (MD) were calculated. Regions of interest were placed covering the entire sacroiliac joint. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic performance of imaging parameters in distinguishing different groups. Regression analysis was applied to determine the correlation between imaging parameters and clinical activity indices. RESULTS All of the histogram parameters distinguished the active from inactive groups with a low area under the curve (AUC) (max AUCs≤0.71), while the SPARCC score failed to differentiate the two groups (p = 0.08). MD, MK, D, D*, and ADC showed good performance in differentiating active and inactive from control groups (max AUC = 0. 81 ~ 0.98). f50 differentiated the active from control groups with an AUC of 0.72, significantly lower than the maximum AUC for MD, MK, D, ADC, and SPARCC score (all p < 0.05). The max AUC of MD in differentiating inactive from control groups was significantly higher than that of D* and the SPARCC score. MD, D, D*, f, and ADC were positively correlated with BASDAI, while MK was negatively correlated with BASDAI. Only MD was positively correlated with hsCRP. CONCLUSIONS Whole-joint histogram analysis of mono-exponential, bi-exponential diffusion weighted, and diffusion kurtosis imaging showed good diagnostic performance in differentiating active and inactive axSpA from patients with non-specific back pain. All the imaging parameters were correlated with BASDAI except for SPARCC score. Only DKI-derived MD was correlated with an increase in hsCRP, suggesting its potential use as an imaging biomarker for disease activity in axSpA. ADVANCES IN KNOWLEDGE 1. No significant difference was found between the three models of diffusion weighted imaging in evaluating disease activity of axial spondyloarthritis.2. Only DKI-derived MD was correlated with an increase in hsCRP, suggesting its potential use as an imaging biomarker for disease activity in axSpA.
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Affiliation(s)
- Ruyi Xie
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqing Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoli Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - John N Morelli
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jingyi Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chanyuan Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tian H, Li T, Wang Y, Lu H, Lin L, Wu X, Xu H. The correlations between C-reactive protein and MRI-detected inflammation in patients with axial spondyloarthritis: a systematic review and meta-analysis. Clin Rheumatol 2023; 42:2397-2407. [PMID: 37336841 PMCID: PMC10412674 DOI: 10.1007/s10067-023-06658-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 04/14/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA. MATERIALS AND METHODS A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models. RESULTS Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I2=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I2=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I2=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I2=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS. CONCLUSIONS In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.
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Affiliation(s)
- Haoran Tian
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Ting Li
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Yuanqiong Wang
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Hongjuan Lu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Li Lin
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Xin Wu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
- Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, 100084, China.
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China.
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Dubinina TV, Gaidukova IZ, Sableva NA, Sapozhnikov KV, Sokolova VD, Tolkacheva DG. Comparative Pharmacoeconomic Effectiveness of Interleukin-17 Inhibitors for the Treatment of Ankylosing Spondylitis. DOKL BIOCHEM BIOPHYS 2023; 511:173-179. [PMID: 37833603 PMCID: PMC10739179 DOI: 10.1134/s1607672923700291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 10/15/2023]
Abstract
The objective of this study was to compare the clinical efficacy and cost-effectiveness of IL-17 inhibitors (SEC, IXE, NTK) in the treatment of adult patients with ankylosing spondylitis (AS) in the healthcare system of the Russian Federation. Materials and methods. The study is a sub-analysis of a previously published systematic review and network meta-analysis of the comparative efficacy of biologics in adult patients with AS in the Russian Federation. NNT values were calculated for BASDAI 50 and ASAS 20/40 after 16 weeks of therapy for all studied drugs. CpR was estimated for each biologic after 16 weeks and one year of therapy. Additionally, we carried out an assessment of the financial burden of the most cost-effective strategies for the treatment of AS. The use of NTK is characterized by an average of no more than three patients needed to treat to achieve one ASAS 20/40 or BASDAI 50 response, while on IXE and SEC no more than 4-5 patients need to be treated, depending on the estimated effectiveness criterion. According to CpR estimate, NTK is the most cost-effective IL-17 inhibitor for the treatment of AS, both after 16 weeks and after one year of therapy. The obtained results make it possible to compare the effectiveness of IL-17 inhibitors from a clinical and economic points of view and can be used both in decision making on treatment strategies for individual patients and at the population level when deciding on the reimbursement of drugs.
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Affiliation(s)
- T V Dubinina
- Nasonova Research Institute of Rheumatology, Moscow, Russia.
| | - I Z Gaidukova
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
- St. Petersburg Clinical Rheumatology Hospital no. 25, St. Petersburg, Russia
| | - N A Sableva
- Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia
| | - K V Sapozhnikov
- Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia
| | - V D Sokolova
- Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia
| | - D G Tolkacheva
- Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia
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Dubinina TV, Gaydukova IZ, Sableva NА, Sapozhnikov KV, Sokolova VD, Tolkacheva DG. Comparative pharmacoeconomic effectiveness of interleukin-17 inhibitors for the treatment of ankylosing spondylitis. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-594-601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective – to compare the clinical efficacy and cost-effectiveness of IL-17 inhibitors (SEC, IXE, NTK) in the treatment of adult patients with ankylosing spondylitis (AS) in the healthcare system of the Russian Federation.Material and methods. The study is a sub-analysis of a previously published systematic review and network meta-analysis of the comparative efficacy of biologics in adult patients with AS in the Russian Federation. NNT values were calculated for BASDAI 50 and ASAS 20/40 after 16 weeks of therapy for all studied drugs. CpR was estimated for each biologic after 16 weeks and one year of therapy. Additionally, we carried out an assessment of the financial burden of the most cost-effective strategies for the treatment of AS.Results. The use of NTK is characterized by an average of no more than three patients needed to treat to achieve one ASAS 20/40 or BASDAI 50 response, while on IXE and SEC – no more than 4–5 patients need to be treated, depending on the estimated effectiveness criterion. According to CpR estimate, NTK is the most cost-effective IL-17 inhibitor for the treatment of AS, both after 16 weeks and after one year of therapy.Conclusion. The obtained results make it possible to compare the effectiveness of IL-17 inhibitors from a clinical and economic points of view and can be used both in decision making process of treatment strategies for individual patients, and at the population level – when deciding on the reimbursement of drugs
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Affiliation(s)
| | - I. Z. Gaydukova
- North-Western State Medical University named after I.I. Mechnikov; Saint Petersburg Clinical Rheumatology Hospital N 25
| | - N. А. Sableva
- The Russian Presidential Academy of National Economy and Public Administration
| | - K. V. Sapozhnikov
- The Russian Presidential Academy of National Economy and Public Administration
| | - V. D. Sokolova
- The Russian Presidential Academy of National Economy and Public Administration
| | - D. G. Tolkacheva
- The Russian Presidential Academy of National Economy and Public Administration
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Tu L, Zhao M, Wang X, Kong Q, Chen Z, Wei Q, Li Q, Yu Q, Ye Z, Cao S, Lin Z, Liao Z, Lv Q, Qi J, Jin O, Pan Y, Gu J. Etanercept/celecoxib on improving MRI inflammation of active ankylosing spondylitis: A multicenter, open-label, randomized clinical trial. Front Immunol 2022; 13:967658. [PMID: 36091030 PMCID: PMC9458864 DOI: 10.3389/fimmu.2022.967658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the efficacy and safety of clinical, magnetic resonance imaging (MRI) changes in active ankylosing spondylitis (AS) patients with etanercept and celecoxib alone/combined treatment.MethodsA randomized controlled trial was conducted in three medical centers in China. Adult AS patients with BASDAI ≥4 or ASDAS ≥2.1, CRP >6 mg/L, or ESR 28 mm/1st hour were randomly assigned (1:1:1 ratio) to celecoxib 200 mg bid or etanercept 50 mg qw or combined therapy for 52 weeks. The primary outcomes were SPARCC change of the sacroiliac joint (SIJ) and spine and the proportion of patients achieving ASAS20 response at 52 weeks.ResultsBetween September 2014 and January 2016, we randomly assigned 150 patients (mean age, 32.4 years; mean disease duration, 109 months), and 133 (88.6%) completed the study. SPARCC inflammation scores of the SIJ and spine decreased in the three groups, and significant differences were found between the combined group and the celecoxib group [between-group difference: −6.33, 95% CI (−10.56, −2.10) for SIJ; −9.53, 95% CI (−13.73, −5.33) for spine] and between the etanercept group and the celecoxib group [between-group difference: −5.02, 95% CI (−9.29, −0.76) for SIJ; −5.80, 95% CI (−10.04, −1.57) for spine]. The ASAS20 response rates were 44%, 58%, and 84% in the celecoxib, etanercept, and combined groups, respectively, and a significant difference was only found between the combined and the celecoxib groups.ConclusionEtanercept with or without celecoxib decreases inflammation detected by MRI at 1 year compared to celecoxib alone in active AS patients. The combination of etanercept and celecoxib was superior to celecoxib alone for the primary clinical response.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT01934933.
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Affiliation(s)
- Liudan Tu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minjing Zhao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaohong Wang
- Department of Radiography, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingcong Kong
- Department of Radiography, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zena Chen
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiujing Wei
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiuxia Li
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qinghong Yu
- Department of Rheumatology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China
| | - Zhizhong Ye
- Department of Rheumatology, Fourth People’s Hospital of Shenzhen City, Shenzhen, China
| | - Shuangyan Cao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhimin Lin
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zetao Liao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing Lv
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jun Qi
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ou Jin
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunfeng Pan
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Jieruo Gu,
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Evaluating the Impact of High Intensity Interval Training on Axial Psoriatic Arthritis Based on MR Images. Diagnostics (Basel) 2022; 12:diagnostics12061420. [PMID: 35741229 PMCID: PMC9222014 DOI: 10.3390/diagnostics12061420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022] Open
Abstract
High intensity interval training (HIIT) has been shown to benefit patients with psoriatic arthritis (PsA). However, magnetic resonance (MR) imaging has uncovered bone marrow edema (BME) in healthy volunteers after vigorous exercise. The purpose of this study was to investigate MR images of the spine of PsA patients for changes in BME after HIIT. PsA patients went through 11 weeks of HIIT (N = 19, 4 men, median age 52 years) or no change in physical exercise habits (N = 20, 8 men, median age 45 years). We acquired scores for joint affection and pain and short tau inversion recovery (STIR) and T1-weighted MR images of the spine at baseline and after 11 weeks. MR images were evaluated for BME by a trained radiologist, by SpondyloArthritis Research Consortium of Canada (SPARCC) scoring, and by extraction of textural features. No significant changes of BME were detected in MR images of the spine after HIIT. This was consistent for MR image evaluation by a radiologist, by SPARCC, and by texture analysis. Values of textural features were significantly different in BME compared to healthy bone marrow. In conclusion, BME in spine was not changed after HIIT, supporting that HIIT is safe for PsA patients.
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Lems W, Miceli-Richard C, Haschka J, Giusti A, Chistensen GL, Kocijan R, Rosine N, Jørgensen NR, Bianchi G, Roux C. Bone Involvement in Patients with Spondyloarthropathies. Calcif Tissue Int 2022; 110:393-420. [PMID: 35066596 DOI: 10.1007/s00223-021-00933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/24/2021] [Indexed: 11/02/2022]
Abstract
Spondyloarthropathies (SpA) are common systemic inflammatory rheumatic diseases, in which, as in other rheumatic diseases, levels of markers of bone resorption are elevated, leading to bone loss and elevated risk of vertebral fractures. However, the diseases are also associated with new bone formation in the spine, the so-called syndesmophytes. We tried to unravel the pathogenesis of formation and growth of syndesmophytes and evaluated new diagnostic and treatment options. After a successful meeting of the Working Group on Rheumatic Diseases at the ECTS 2020, we (WL and CR) were excited about the quality of the speakers (CM, JH, AG, and GL) and their complimentary lectures. Given the relative lack of reviews on spondyloarthropathies and bone, we decided to work together on a comprehensive review that might be interesting for basic scientists and clinically relevant for clinicians. Radiographic progression in axSpA is linked to several risk factors, like male sex, smoking, HLA-B-27, increased levels of CRP, presence of syndesmophytes, and marked inflammation on MRI. The potential role of mechanical stress in the context of physically demanding jobs has been also suggested to promote structural damages. Different treatment options from NSAIDs to biologic agents like TNF inhibitors (TNFi) or IL-17inhibitors (IL-17i) result in a reduction of inflammation and symptoms. However, all these different treatment options failed to show clear and reproducible results on inhibition on syndesmophyte formation. The majority of data are available on TNFi, and some studies suggested an effect in subgroups of patients with ankylosing spondylitis. Less information is available on NSAIDs and IL-17i. Since IL-17i have been introduced quite recently, more studies are expected. IL-17 inhibitors (Il-17i) potently reduce signs and symptoms, but serum level of IL-17 is not elevated, therefore, IL-17 probably has mainly a local effect. The failure of anti-IL-23 in axSpA suggests that IL-17A production could be independent from IL-23. It may be upregulated by TNFα, resulting in lower expression of DKK1 and RANKL and an increase in osteogenesis. In active AS markers of bone resorption are increased, while bone formation markers can be increased or decreased. Bone Turnover markers and additional markers related to Wnt such as DKK1, sclerostin, and RANKL are valuable for elucidating bone metabolism on a group level and they are not (yet) able to predict individual patient outcomes. The gold standard for detection of structural lesions in clinical practice is the use of conventional radiographics. However, the resolution is low compared to the change over time and the interval for detecting changes are 2 years or more. Modern techniques offer substantial advantages such as the early detection of bone marrow edema with MRI, the fivefold increased detection rate of new or growing syndesmophytes with low-dose CT, and the decrease in 18F-fluoride uptake during treatment with TNFα-inhibitors (TNFi) in a pilot study in 12 AS patients. Detection of bone involvement by new techniques, such as low-dose CT, MRI and 18-Fluoride PET-scans, and bone turnover markers, in combination with focusing on high-risk groups such as patients with early disease, elevated CRP, syndesmophytes at baseline, male patients and patients with HLA-B27 + are promising options for the near future. However, for optimal prevention of formation of syndesmophytes we need more detailed insight in the pathogenesis of bone formation in axSpA and probably more targeted therapies.
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Affiliation(s)
- Willem Lems
- Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.
| | - Corinne Miceli-Richard
- INSERM U 1153, Université de Paris-APHP.Centre, Service de Rhumatologie, Hopital Cochin, Paris, France
- Immunoregulation Unit, Department of Immunology, Institut Pasteur, Paris, France
| | - Judith Haschka
- I Medical Department, Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK & Hanusch Hospital Vienna, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
- Karl Landsteiner Institute for Rheumatology and Gastroenterology, Rheuma-Zentrum Wien-Oberlaa, 1100, Vienna, Austria
| | - Andrea Giusti
- Rheumatology Unit, Department of Medical Specialties, Local Health Trust 3, Via Missolungi 14, 16147, Genoa, Italy
| | | | - Roland Kocijan
- Medical Faculty of Bone Diseases, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Nicolas Rosine
- INSERM U 1153, Université de Paris-APHP.Centre, Service de Rhumatologie, Hopital Cochin, Paris, France
- Sorbonne Université, Service de Rhumatologie Hôpital Pitié Salpêtrière, APHP, Paris, France
| | | | - Gerolamo Bianchi
- Rheumatology Unit, Department of Medical Specialties, Local Health Trust 3, Via Missolungi 14, 16147, Genoa, Italy
| | - Christian Roux
- INSERM U 1153, Université de Paris-APHP.Centre, Service de Rhumatologie, Hopital Cochin, Paris, France
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Atas N, Çakır B, Bakır F, Uçar M, Satış H, Güz GT, Demirel KD, Babaoğlu H, Salman RB, Güler AA, Karadeniz H, Haznedaroğlu Ş, Göker B, Öztürk MA, Tufan A. The impact of anti-TNF treatment on Wnt signaling, noggin, and cytokine levels in axial spondyloarthritis. Clin Rheumatol 2022; 41:1381-1389. [DOI: 10.1007/s10067-022-06070-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 11/27/2022]
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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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Brandon TG, Xiao R, Peterson RG, Chauvin NA, Francavilla ML, Biko DM, Rumsey DG, Stoll ML, Weiss PF. Changes over time in inflammatory and structural lesions at the sacroiliac joint in children with spondyloarthritis exposed and unexposed to tumor necrosis factor inhibitor. Pediatr Rheumatol Online J 2021; 19:167. [PMID: 34857002 PMCID: PMC8638346 DOI: 10.1186/s12969-021-00647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this work was to describe magnetic resonance imaging (MRI) changes over time in inflammatory and structural lesions at the sacroiliac joint (SIJ) in children with spondyloarthritis (SpA) exposed and unexposed to tumor necrosis factor inhibitor (TNFi). METHODS This was a retrospective, multicenter study of SpA patients with suspected or confirmed sacroiliitis who underwent at ≥2 pelvic MRI scans. Images were reviewed independently by 3 radiologists and scored for inflammatory and structural changes using the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ inflammation score (SIS) and structural score (SSS). Longitudinal, quantitative changes in patient MRI scans were measured using descriptive statistics and stratified by TNFi exposure. We used an average treatment effects (ATE) regression model to explore the average effect of TNFi exposure over time on inflammatory and structural lesions, adjusting for baseline lesion scores. RESULTS Forty-six subjects were evaluated using the SIS (n = 45) and SSS (n = 18). Median age at baseline imaging was 13.6 years, 63% were male and 71% were white. Twenty-three subjects (50%) were TNFi exposed between MRI studies. The median change in SIS in TNFi exposed and unexposed subjects with a baseline SIS ≥0 was - 20.7 and - 14.3, respectively (p = 0.09). Eleven (85%) TNFi exposed and 8 (89%) unexposed subjects with a baseline SIS ≥0 met the SIS minimal clinically important difference (MCID; ≥2.5). Using the ATE model adjusted for baseline SIS, the average effect of TNFi on SIS in patients with a baseline SIS ≥2 was - 14.5 (p < 0.01). Unadjusted erosion change score was significantly worse in TNFi unexposed versus exposed subjects (p = 0.03) but in the ATE model the effect of TNFi was not significant. CONCLUSION This study quantitatively describes how lesions in the SIJs on MRI change over time in patients exposed to TNFi versus unexposed. Follow-up imaging in TNFi exposed patients showed greater improvement than the unexposed group by most metrics, some of which reached statistical significance. Surprisingly, a majority of TNFi unexposed children with a baseline SIS≥2 met the SIS MCID. Additional studies assessing the short and long-term effects of TNFi on inflammatory and structural changes in juvenile SpA are needed.
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Affiliation(s)
- Timothy G. Brandon
- grid.239552.a0000 0001 0680 8770Division of Rheumatology and Center for Pediatric Clinical Effectiveness at the Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, USA
| | - Rui Xiao
- grid.25879.310000 0004 1936 8972Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Rosemary G. Peterson
- grid.239552.a0000 0001 0680 8770Division of Rheumatology at the Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, USA
| | - Nancy A. Chauvin
- grid.29857.310000 0001 2097 4281Department of Radiology at Penn State Health Milton S. Hershey Children’s Hospital, Hershey, PA USA
| | - Michael L. Francavilla
- grid.25879.310000 0004 1936 8972Department of Radiology at the Children’s Hospital of Philadelphia and Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - David M. Biko
- grid.25879.310000 0004 1936 8972Department of Radiology at the Children’s Hospital of Philadelphia and Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Dax G. Rumsey
- grid.17089.37Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Matthew L. Stoll
- grid.265892.20000000106344187Division of Pediatric Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL USA
| | - Pamela F. Weiss
- grid.25879.310000 0004 1936 8972Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness at the Children’s Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, 2716 South Street, Room 11121, Philadelphia, PA 19104 USA
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Kasar S, Ozturk M, Polat AV. Quantitative T2 mapping of the sacroiliac joint cartilage at 3T in patients with axial spondyloarthropathies. Eur Radiol 2021; 32:1395-1403. [PMID: 34797385 DOI: 10.1007/s00330-021-08357-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of T2 mapping of sacroiliac joint cartilage in patients with axial spondyloarthropathies (SpA). METHODS Thirty-seven SpA patients and 43 controls (mean age: 36.5 ± 8.2; 20 men) prospectively underwent conventional MRI and T2 mapping of the sacroiliac joints at 3 T. SpA patients and their sacroiliac joints were categorized into active and inactive based on the presence of bone marrow edema on the conventional MRI. T2-relaxation times were measured by drawing six manual ROIs on the cartilaginous part of the joints. T2 values of the bilateral iliac and sacral joint cartilages for each patient (T2subject), iliac and sacral cartilages for each sacroiliac joint (T2joint), iliac cartilage (T2iliac), and sacral cartilage (T2sacral) were calculated and compared between SpA patients and controls, and active and inactive joints. RESULTS The T2subject of SpA patients (50.48 ± 5.32 ms) was significantly higher than the T2subject of the controls (46.33 ± 3.30 ms, p < 0.001). Selecting an optimal T2subject cut-off value of 48.77 to differentiate SpA patients from controls revealed a sensitivity and a specificity of 62.2% and 81.4% respectively (AUC = 0.739). In SpA patients, T2joint, T2iliac, and T2sacral values of the inactive joints were not significantly different from those of the active joints (p = 0.088, p = 0.179, and p = 0.069). T2joint, T2iliac, and T2sacral values of the inactive joints of SpA patients were significantly higher than those of the controls (p = 0.012, p = 0.029, and p = 0.016). CONCLUSIONS T2 values of both active and inactive sacroiliac joint cartilages of SpA patients were increased. Thus, T2 mapping may be used in the diagnosis of SpA. KEY POINTS • Sacroiliac cartilage T2 values of SpA patients increase compared to those of the non-SpA controls. • Sacroiliac cartilage T2 values of active and inactive joints of SpA patients increase compared to those of the non-SpA controls. • Sacroiliac cartilage T2 values of active and inactive joints of SpA patients do not show statistically significant difference.
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Affiliation(s)
- Suleyman Kasar
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Mesut Ozturk
- Radiology Clinic, Samsun Gazi State Hospital, Samsun, Turkey.
| | - Ahmet Veysel Polat
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Deodhar AA, Mease PJ, Rahman P, Navarro-Compán V, Strand V, Hunter T, Bolce R, Leon L, Lauzon S, Marzo-Ortega H. Ixekizumab improves spinal pain, function, fatigue, stiffness, and sleep in radiographic axial Spondyloarthritis: COAST-V/W 52-week results. BMC Rheumatol 2021; 5:35. [PMID: 34538257 PMCID: PMC8451150 DOI: 10.1186/s41927-021-00205-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/19/2021] [Indexed: 01/22/2023] Open
Abstract
Background This analysis assessed improvements in patients with radiographic axial spondyloarthritis (r-axSpA) treated with ixekizumab in the Assessment of Spondyloarthritis International Society (ASAS) treatment response domains and additional patient-reported outcomes at 1 year of treatment. Methods COAST-V and COAST-W were 52-week, phase 3, randomized controlled trials evaluating the efficacy and safety of ixekizumab in biologic disease-modifying antirheumatic drug (bDMARD)-naïve and tumor necrosis factor inhibitor (TNFi)-experienced patients with radiographic spondyloarthritis, respectively. Patients were treated with 80-mg ixekizumab either every 2 weeks or every 4 weeks. Patient-reported outcomes included Patient Global Disease Activity, Spinal Pain, stiffness as measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Questions 5 and 6, function as measured by the Bath Ankylosing Spondylitis Functional Index, fatigue as measured by the Fatigue Numeric Rating Scale and BASDAI question 1, Spinal Pain at Night, and sleep quality as measured by the Jenkins Sleep Evaluation Questionnaire. Mixed-effects models for repeated measures were used to analyze changes from baseline in patient-reported outcomes from weeks 1 to 16, and descriptive statistics were reported from weeks 20 to 52. Analysis of covariance with Scheffé’s method was used for the ASAS response association analyses. Results This study assessed 341 bDMARD-naïve and 316 TNFi-experienced patients in the placebo-controlled blinded treatment dosing period (weeks 1–16) as well as 329 bDMARD-naïve and 281 TNFi-experienced patients in the dose double-blind extended treatment period (weeks 20–52). bDMARD-naïve or TNFi-experienced patients treated with ixekizumab every 2 weeks and every 4 weeks reported improvements in patient global disease activity, spinal pain, function, stiffness, fatigue, spinal pain at night, and sleep quality through week 52. Greater correlations with improvements in all response domains were seen when comparing ASAS40 responders to ASAS20 non-responders (p < 0.001), with up to 10.5-fold greater improvements observed in ASAS40 responses compared with ASAS20 non-responders. Function and fatigue demonstrated the highest values. Conclusions Ixekizumab-treated bDMARD-naïve and TNFi-experienced patients with radiographic axial spondyloarthritis achieving ASAS40 reported sustained and consistent improvement in all ASAS response domains and other patient-reported outcomes though week 52, with spinal pain, function, and stiffness as major drivers of the response. Trial registration NCT02696785 and NCT02696798, March 2, 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00205-3.
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Affiliation(s)
- Atul A Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Philip J Mease
- Swedish Medical Center/ Providence St. Joseph Health and University of Washington, Seattle, WA, USA
| | - Proton Rahman
- Memorial University of Newfoundland, St. John's, NL, Canada
| | | | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | - Luis Leon
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Helena Marzo-Ortega
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds, Leeds, WY, UK
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Almodovar R, Bueno A, Garcia Monco C, De Miguel E, Tornero C, Moreno M, Gratacos J, Zarco P, Mazzucchelli R. Quantification of Bone Marrow Edema by MRI of the Sacroiliac Joints in Patients Diagnosed with Axial Spondyloarthritis: Results from the ESPeranza Cohort. Scand J Rheumatol 2021; 51:374-381. [PMID: 34472387 DOI: 10.1080/03009742.2021.1946995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To evaluate whether the quantification of bone marrow edema (BMO) of the sacroiliac (SI) joints by magnetic resonance imaging (MRI) improves capacity for axial spondyloarthritis (axSpA) classification in comparison with the assessment of sacroiliitis by Assessment of SpondyloArthritis international Society (ASAS) classification criteria.Method: This prospective study from the ESPeranza cohort involved 66 subjects with an available MRI of the SI joints at baseline. This subgroup includes patients with axSpA (n = 28), peripheral spondyloarthritis (n = 10), and other diagnoses that were not spondyloarthritis (n = 28). Measures of diagnostic usefulness [area under the curve (AUC), sensitivity, specificity, Youden's J statistic, positive and negative likelihood ratios (LR+ and LR-)] were calculated for MRI of the SI joints according to ASAS criteria and for MRI quantified by means of SCAISS (Spanish tool for semi-automatic quantification of sacroiliac inflammation by MRI in spondyloarthritis). This analysis was stratified in patients who were human leucocyte antigen (HLA)-B27 positive and negative.Results: The AUC value with BMO quantification was 0.919 [95% confidence interval (CI) 0.799-1] for HLA-B27-positive patients and 0.884 (95% CI 0.764-1) for HLA-B27-negative patients. A SCAISS cut-off point of 80 units obtained a specificity of 94.4% and LR+ 7.5, while assessment by ASAS criteria showed a specificity value of 90% and LR+ 6.4.Conclusion: For patients with suspected axSpA, quantification of BMO improves the predictive capacity of MRI of the SI joints, for both HLA-B27-positive and HLA-B27-negative patients.Axial spondyloarthritis (axSpA) has a dramatic impact on physical function and quality of life (1). Despite its significant impact, patients with axSpA are normally diagnosed several years after presenting symptoms (2). In this respect, magnetic resonance imaging (MRI) of the sacroiliac (SI) joints has gained significance over the past decade, particularly in the early stages of the disease. Nowadays, imaging tests and human leucocyte antigen (HLA)-B27 testing are among the most important diagnostic procedures for patients with suspected axSpA.
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Affiliation(s)
- R Almodovar
- Rheumatology Unit, Hospital Universitario Fundación Alcorcon, Alcorcon, Madrid, Spain.,Department of Epidemiology and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - A Bueno
- Radiology Unit, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - C Garcia Monco
- Radiology Unit, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - E De Miguel
- Rheumatology Unit, Hospital Universitario La Paz, Madrid, Spain
| | - C Tornero
- Rheumatology Unit, Hospital Universitario La Paz, Madrid, Spain
| | - M Moreno
- Rheumatology Unit, Hospital Universitario Parc Taulí, Barcelona, Spain
| | - J Gratacos
- Rheumatology Unit, Hospital Universitario Parc Taulí, Barcelona, Spain
| | - P Zarco
- Rheumatology Unit, Hospital Universitario Fundación Alcorcon, Alcorcon, Madrid, Spain
| | - R Mazzucchelli
- Rheumatology Unit, Hospital Universitario Fundación Alcorcon, Alcorcon, Madrid, Spain.,Department of Epidemiology and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
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Huang ZX, Deng WM, Zheng SL, Guo X, Zeng SQ, Li TW. Magnetic resonance imaging in ankylosing spondylitis: reduction of active sacroiliitis and hip arthritis during treatment with an adalimumab biosimilar. Clin Rheumatol 2021; 40:2099-2101. [PMID: 33559010 DOI: 10.1007/s10067-021-05628-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/11/2021] [Accepted: 01/31/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Zhi-Xiang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wei-Ming Deng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shao-Ling Zheng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xin Guo
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shao-Qing Zeng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tian-Wang Li
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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18
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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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19
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Huang Y, Chen Y, Liu T, Lin S, Yin G, Xie Q. Impact of tumor necrosis factor α inhibitors on MRI inflammation in axial spondyloarthritis assessed by Spondyloarthritis Research Consortium Canada score: A meta-analysis. PLoS One 2020; 15:e0244788. [PMID: 33382842 PMCID: PMC7775088 DOI: 10.1371/journal.pone.0244788] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/16/2020] [Indexed: 02/05/2023] Open
Abstract
Spondyloarthritis Research Consortium Canada (SPARCC) score is an effective magnetic resonance imaging (MRI) evaluation method for inflammation in axial spondyloarthritis. Previously published meta-analyses have shown tumor necrosis factor α inhibitors (TNFi) had great effectiveness on improving disease activity and function in axial spondyloarthritis. However, there still has no one that concentrates on the impact of TNFi on MRI inflammation. We conduct a meta-analysis to summarize the impact of TNFi on MRI inflammation in axial spondyloarthritis using SPARCC score. Comprehensive search was conducted in the databases of OVID Medline, OVID EMBASE, and Cochrane library on November 14, 2020. We investigated the differences in SPARCC score of sacroiliac joint and spine, before and after TNFi treatment in patients with axial spondyloarthritis. SPARCC score was further compared in the subgroup by diagnostic category and TNFi types. In addition, clinical assessment indicators including ankylosing spondylitis disease activity score, bath ankylosing spondylitis disease activity index, bath ankylosing spondylitis functional index, c-reactive protein were also analyzed. Data were pooled by mean differences (MD) with 95% confidence intervals (CI) and publication bias was assessed by Egger's test. Jadad scale was applied to assess the quality of included trials. Compared with control group, TNFi significantly improved SPARCC score of sacroiliac joints (n = 11, MD = 2.86, 95% CI 2.50, 3.23) and spine (n = 5, MD = 1.87,95%CI 1.27, 2.46). This effect was consistent among subgroups by different diagnostic category (ankylosing spondylitis, non-radiographic axial spondyloarthritis) and TNFi types (adalimumab, certolizumab pegol). Analysis of clinical assessment indicators also confirmed the therapeutic effect on axial spondyloarthritis. Egger's test suggested no possibility of publication bias. This meta-analysis shows that TNFi are effective to improve MRI inflammation in patients with axial spondyloarthritis and the treatment effectiveness is not affected by diagnostic category and TNFi types.
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Affiliation(s)
- Yupeng Huang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuehong Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sang Lin
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Geng Yin
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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20
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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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21
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Møller JM, Østergaard M, Thomsen HS, Krabbe S, Sørensen IJ, Jensen B, Madsen OR, Klarlund M, Pedersen SJ. Validation of assessment methods for the apparent diffusion coefficient in a clinical trial of axial spondyloarthritis patients treated with golimumab. Eur J Radiol Open 2020; 7:100285. [PMID: 33204770 PMCID: PMC7649611 DOI: 10.1016/j.ejro.2020.100285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/25/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose To compare three region-of-interest (ROI) settings in the assessment of ADC in a clinical trial, and to evaluate the effectiveness of ADC in assessing therapy-induced changes and predicting clinical outcomes. Methods In a 52-week clinical trial involving patients with axial spondyloarthritis, mean sacroiliac joint (SIJ) ADC measurements using structured, lesion-based, and index-lesion ROI-settings were assessed at baseline and weeks 4, 16, and 52. Variation among the three ROI-settings, correlations with Spondyloarthritis Research Consortium of Canada (SPARCC)-bone marrow edema (BME) SIJ inflammation indices, standardized response means (SRMs), and effectiveness in predicting clinical outcomes were analyzed. Results Forty of the 53 patients had at least one assessable SIJ lesion on ADC at baseline. The mean of the structured ROI ADC (ADCstruc) was 230 μmm2/s (standard deviation [SD] = 120). This was significantly lower (p < 0.01) than the means of the lesion-based ROI ADC (ADClesion = 420 μmm2/s, SD = 210) and index-lesion ROI ADC (ADCindex = 471 μmm2/s, SD = 278), which did not differ. ADC correlated with SPARCC-BME scores at baseline (p < 0.01) as did changes over time in ADC- and SPARCC-BME (p<0.05). At all follow-up time points, responsiveness was high for ADClesion (SRM > 0.92) and ADCindex (SRM > 0.87) while moderate for ADCstruc (SRM:0.54-0.67). Baseline ADC and changes in ADC did not predict clinical outcomes. Conclusions Lesion-based and index-lesion ROI ADC could both be used to evaluate the effectiveness of tumor necrosis factor inhibitor therapy. None of the methods could predict clinical outcomes.
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Affiliation(s)
- Jakob M Møller
- Department of Radiology, Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Henrik S Thomsen
- Department of Radiology, Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simon Krabbe
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Inge J Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Bente Jensen
- Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Ole Rintek Madsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Rheumatology and Spine Diseases, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Mette Klarlund
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Susanne J Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Center for Rheumatology and Spine Diseases, Herlev and Gentofte Hospital, Hellerup, Denmark
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22
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Chen Z, Yang M, Wang Q, Bai J, McAlinden C, Skiadaresi E, Zhang J, Pan L, Mei C, Zeng Z, Yu J, Feng Y, Jiang Z, Xu W, Xu H, Ye X, He H, Wang Q, Deng J, Huang J. Hydrogel eye drops as a non-invasive drug carrier for topical enhanced Adalimumab permeation and highly efficient uveitis treatment. Carbohydr Polym 2020; 253:117216. [PMID: 33278980 DOI: 10.1016/j.carbpol.2020.117216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 12/25/2022]
Abstract
Uveitis is one of the most popular blind-causing eye diseases worldwide. Adalimumab (ADA) is used for the uveitis treatment through systemic or intravitreal injection at the expense of systemic side effects and increased medical risks. Although eye drops, a non-invasive topical treatment, could be a potential strategy to reduce side effects, it remains challenging to apply due to limited bioavailability mainly linked to poor retention time and permeation capacity for eye biological barriers. Here, we reported hydrogel eye drops composed of low-deacetylated chitosan and β-glycerophosphate as an ADA carrier and tested its toxicity, tolerability, intraocular permeability, and efficacy of non-invasive treatment for uveitis. It's found the ADA-loaded hydrogel eye drops were more efficient than free ADA both in permeation rate and clinical efficacy for uveitis, Overall, this study provides a friendly non-invasive strategy to improve drug permeation rate and uveitis treatment efficacy, which may be valuable to clinically ophthalmic medication.
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Affiliation(s)
- Zhongxing Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mei Yang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Qing Wang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jieyi Bai
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Colm McAlinden
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Ophthalmology, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Eirini Skiadaresi
- Department of Ophthalmology, Prince Philip Hospital, Hywel Dda University Health Board, Llanelli, UK
| | - Jun Zhang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Luting Pan
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chenyang Mei
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Zhenhai Zeng
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Jinjin Yu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yifan Feng
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhengxuan Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wenjin Xu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hang Xu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiuhong Ye
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huanhuan He
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qinmei Wang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.
| | - Junjie Deng
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Engineering Research Center of Clinical Functional Materials and Diagnosis & Treatment Devices of Zhejiang Province, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, China.
| | - Jinhai Huang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.
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23
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Fauny M, Cohen N, Morizot C, Leclerc-Jacob S, Wendling D, Lux G, Laurent V, Blum A, Netter P, Baumann C, Chary-Valckenaere I, Peyrin-Biroulet L, Loeuille D. Low Back Pain and Sacroiliitis on Cross-Sectional Abdominal Imaging for Axial Spondyloarthritis Diagnosis in Inflammatory Bowel Diseases. Inflamm Intest Dis 2020; 5:124-131. [PMID: 32999885 DOI: 10.1159/000507930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background Joint damage is the most frequent extraintestinal manifestation in inflammatory bowel disease (IBD). Aims The aim of the study was to assess the value of low back pain (LBP) associated with sacroiliitis on abdominal imaging for the diagnosis of spondyloarthritis (SpA) in IBD. Methods We used a questionnaire assessing rheumatological symptoms for all patients with abdominal computed tomography (CT) and magnetic resonance enterography (MRE). Sacroiliitis was assessed on available CT and MRE. Patients were classified as axial SpA according to the Assessment of SpondyloArthritis International Society criteria. Results Fifty-one patients completed the questionnaire and performed both exams. LBP was present in 27 patients (52.9%), and 10 (19.6%) had an inflammatory component. Sacroiliitis was reported in 12 patients (23.5%), and 6 of them suffered from LBP. Among the 20 patients referred to the rheumatologist, 11 patients suffered from LBP. One patient was HLA-B27 positive and presented sacroiliitis. For the last 10 patients, none of them had a sacroiliitis, and 2 patients were negative for HLA-B27. Conclusion An axial SpA has been diagnosed in 11.8% of IBD patients undergoing cross-sectional imaging, whereas one-fifth had inflammatory LBP, and sacroiliitis was observed in one-quarter of them. To optimize the diagnosis of axial SpA, HLA-B27 testing might be required for patients with both IBD and LBP, but this will require further investigation before its implementation in routine practice.
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Affiliation(s)
- Marine Fauny
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Nicolas Cohen
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Caroline Morizot
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Sophie Leclerc-Jacob
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Daniel Wendling
- Department of Rheumatology, University Hospital of Besancon, Besancon, France
| | - Guillaume Lux
- Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Valérie Laurent
- Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Alain Blum
- Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Cédric Baumann
- Unity of Methodology, Data Management and Statistic, University Hospital of Nancy, Nancy, France
| | - Isabelle Chary-Valckenaere
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France.,Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Hepatology, Inserm NGERE, University Hospital of Nancy, Lorraine University, Nancy, France.,Inserm U1256 NGERE, Lorraine University, Vandoeuvre-Les-Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France.,Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
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24
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Le QA, Kang JH, Lee S, Delevry D. Cost-Effectiveness of Treatment Strategies with Biologics in Accordance with Treatment Guidelines for Ankylosing Spondylitis: A Patient-Level Model. J Manag Care Spec Pharm 2020; 26:1219-1231. [PMID: 32996395 PMCID: PMC10391255 DOI: 10.18553/jmcp.2020.26.10.1219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a form of rheumatic disease caused by chronic inflammation of the axial skeleton. Patients with AS experience significant functional limitations and reduced quality of life. Consequently, AS imposes a substantial economic burden on society due to productivity loss and work disability. Biologics, including tumor necrosis factor (TNF) inhibitors and human anti-interleukin-17A monoclonal antibody (IL-17A) agents, are effective treatment strategies in relieving symptoms and slowing down disease progression. Currently, 5 TNF inhibitors and 2 IL-17A antibody agents are approved by the FDA for the management of AS. Of these agents, there is no clear preferred agent in initial biologic therapy, although an IL-17A antibody agent or alternative TNF inhibitor agent is recommended after failure of the initial TNF inhibitor therapy. OBJECTIVE To assess cost-effectiveness of treatment strategies with biologics, TNF inhibitor or IL-17A, in accordance with the treatment guidelines for patients with AS. METHODS An economic patient-level simulation combining decision-tree and Markov models was constructed from the U.S. health care payer's perspective over a 10-year time horizon. The current model examined 5 treatment strategies: (1) conventional care treatment with nonsteroidal anti-inflammatory drugs, (2) 1 TNF inhibitor, (3) an IL-17A antibody agent, (4) sequential therapy with 2 TNF inhibitors, and (5) sequential therapy with a TNF inhibitor followed by an IL-17A antibody agent. Initially, treatment responses were determined after 12-week treatments. Patients who responded to treatment entered a "responders" Markov model. Patients entered a "nonresponders" Markov model if they inadequately responded to treatment. In sequential treatment strategies, patients who inadequately responded to treatment with the first TNF inhibitor received a second TNF inhibitor or an IL-17A antibody agent. Health utility was estimated based on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Functional Index (BASFI) scores. The models accounted for real-world adherence to TNF inhibitor treatment. Scenario and probabilistic sensitivity analyses were performed to test the robustness and uncertainty of the model results. RESULTS Over a 10-year time horizon and 100,000 simulated patients for each treatment strategy, base-case results produced average total discounted per-patient costs of $19,765, $130,302, $159,934, $190,553, and $179,118 and quality-adjusted life-years (QALYs) of 4.675, 5.410, 5.499, 5.919, and 5.893 for conventional care, treatment strategies with 1 TNF inhibitor, an IL-17A, 2 TNF inhibitors, and a TNF inhibitor followed by an IL-17A, respectively. The optimal treatments at willingness-to-pay (WTP) thresholds ≤ $130,813 per QALY, between $130,813 per QALY and $442,728 per QALY, and > $442,728 per QALY were conventional care and sequential treatment strategies with 1 TNF inhibitor, followed by an IL-17A agent and 2 TNF inhibitors, respectively. CONCLUSIONS Study findings suggested that all treatment strategies with biologics, TNF inhibitors or IL-17A antibody agents, in the treatment guidelines for AS were not cost-effective at the common WTP of $100,000 per QALY. However, the sequential treatment with 1 TNF inhibitor followed by an IL-17A antibody agent was considered cost-effective at a higher WTP of $150,000 per QALY. DISCLOSURES No outside funding supported this study. The authors have nothing to disclose. Primary findings of this study were presented in part at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) in Baltimore, MD, May 2018.
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Affiliation(s)
- Quang A. Le
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California
| | - Jenny H. Kang
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California
| | - Sun Lee
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, North Carolina
| | - Dimittri Delevry
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California
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25
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Lee SH, Park W, Won Lee S, Kim HA, Choe JY, Lee SH, Lee SS, Park SH, Park MC, Sheen DH, Lee HS, Lee YA, Lee Y, Kim TH. Frequency of peripheral diseases in Korean patients with ankylosing spondylitis and the effectiveness of adalimumab. Int J Rheum Dis 2020; 23:1175-1183. [PMID: 32725789 PMCID: PMC8246777 DOI: 10.1111/1756-185x.13917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/19/2020] [Accepted: 06/21/2020] [Indexed: 01/20/2023]
Abstract
Aim Peripheral features contribute to disease burden in ankylosing spondylitis (AS). This study investigated the frequency of peripheral disease and effectiveness of adalimumab among Korean patients with AS. Methods Peripheral disease was evaluated in consecutively enrolled patients with active AS (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] score ≥ 4). An adult subpopulation was subsequently enrolled in a prospective, observational study and received adalimumab 40 mg, every 2 weeks. During a 52‐week follow‐up, AS disease activity was assessed by BASDAI score, and effectiveness in peripheral disease assessed via changes in Maastricht Ankylosing Spondylitis Enthesitis Score (MASES; 0‐13), swollen joint and tender joint counts (SJC, 0‐44; TJC, 0‐46), and dactylitic digits from baseline. Results Of 1161 Korean patients with AS, 178 (15.3%) and 306 (26.4%) had enthesitis and peripheral arthritis, respectively; dactylitis was diagnosed in 28 patients (2.4%). Of 201 patients enrolled in the observational study, 46.3%, 33.3%, and 3.0% had enthesitis, peripheral arthritis, and dactylitis, respectively. Overall, 75.1% of patients achieved >50% improvement in BASDAI score by week 12. Mean MASES was significantly reduced from 2.67 at baseline to 0.85 and 0.34 at weeks 12 and 52, respectively (P < .0001). Similarly, SJC and TJC improved significantly from 2.58 and 3.49 at baseline to 0.80 and 1.68, respectively, by week 12 (P < .0001). Dactylitis was resolved in all affected patients by week 28. Conclusion Of these Korean patients with AS, those who received adalimumab demonstrated higher prevalence for peripheral symptoms and, subsequently, adalimumab treatment improved peripheral features of their AS.
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Affiliation(s)
- Sang-Hoon Lee
- Department of Rheumatology, Hospital at Gang dong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Won Park
- Division of Rheumatology, Inha University College of Medicine, Incheon, Korea
| | - Sung Won Lee
- Division of Rheumatology, Dong-A University College of Medicine, Busan, Korea
| | - Hyun Ah Kim
- Division of Rheumatology, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea
| | - Jung-Yoon Choe
- Division of Rheumatology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Konkuk University Medical Center, Seoul, Korea
| | - Shin-Seok Lee
- Division of Rheumatology, Chonnam National University Hospital, Gwangju, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Hyuk Sheen
- Division of Rheumatology, Eulji University Hospital, Daejeon, Korea
| | - Hye Soon Lee
- Division of Rheumatology, Hanyang University Guri Hospital, Guri, Korea
| | - Yeon-Ah Lee
- Division of Rheumatology, Kyung Hee University Hospital, Seoul, Korea
| | | | - Tae-Hwan Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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Andreasen RA, Kristensen LE, Baraliakos X, Strand V, Mease PJ, de Wit M, Ellingsen T, Hansen IMJ, Kirkham J, Wells GA, Tugwell P, Maxwell L, Boers M, Egstrup K, Christensen R. Assessing the effect of interventions for axial spondyloarthritis according to the endorsed ASAS/OMERACT core outcome set: a meta-research study of trials included in Cochrane reviews. Arthritis Res Ther 2020; 22:177. [PMID: 32711571 PMCID: PMC7382035 DOI: 10.1186/s13075-020-02262-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022] Open
Abstract
The Assessment of SpondyloArthritis international Society (ASAS) has defined core sets for (i) symptom-modifying anti-rheumatic drugs (SM-ARD), (ii) clinical record keeping, and (iii) disease-controlling anti-rheumatic therapy (DC-ART). These include the following domains for all three core sets: “physical function,” “pain,” “spinal mobility,” “spinal stiffness,” and “patient’s global assessment” (PGA). The core set for clinical record keeping further includes the domains “peripheral joints/entheses” and “acute phase reactants,” and the core set for DC-ART further includes the domains “fatigue” and “spine radiographs/hip radiographs.” The Outcome Measures in Rheumatology (OMERACT) endorsed the core sets in 1998. Using empirical evidence from axSpA trials, we investigated the efficacy (i.e., net benefit) according to the ASAS/OMERACT core outcome set for axSpA across all interventions tested in trials included in subsequent Cochrane reviews. For all continuous scales, we combined data using the standardized mean difference (SMD) to meta-analyze outcomes involving the same domains. Also, through meta-regression analysis, we examined the effect of the separate SMD measures (independent variables) on the primary endpoint (log [OR], dependent variable) across all trials. Based on 11 eligible Cochrane reviews, from these, 85 articles were screened; we included 43 trials with 63 randomized comparisons. Mean (SD) number of ASAS/OMERACT core outcome domains measured for SM-ARD/physical therapy trials was 4.2 (1.7). Six trials assessed all proposed domains. Mean (SD) for number of core outcome domains for DC-ART trials was 5.8 (1.7). No trials assessed all nine domains. Eight trials (16%) were judged to have inadequate (i.e., high risk of) selective outcome reporting bias. The most responsible core domains for achieving success in meeting the primary objective per trial were pain, OR (95% CI) 5.19 (2.28, 11.77), and PGA, OR (95% CI) 1.87 (1.14, 3.07). In conclusion, selective outcome reporting (and “missing data”) should be reduced by encouraging the use of the endorsed ASAS/OMERACT outcome domains in clinical trials. Overall outcome reporting was good for SM-ARD/physical therapy trials and poor for DC-ART trials. Our findings suggest that both PGA and pain provide a valuable holistic construct for the assessment of improvement beyond more objective measures of spinal inflammation.
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Affiliation(s)
- Rikke A Andreasen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg and University of Southern Denmark, Odense, Denmark.,Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University Hospital, Copenhagen F, Denmark
| | - Lars E Kristensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University Hospital, Copenhagen F, Denmark
| | | | - Vibeke Strand
- Division Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Philip J Mease
- Swedish Medical Centre/Providence St. Joseph Health and University of Washington, Seattle, USA
| | | | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Inger Marie J Hansen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg and University of Southern Denmark, Odense, Denmark
| | - Jamie Kirkham
- Centre for Biostatistics, Manchester Academic Health Science, Manchester, UK
| | - George A Wells
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lara Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Maarten Boers
- Department of Epidemiology & Biostatistics, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital, Svendborg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University Hospital, Copenhagen F, Denmark. .,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.
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Park EH, Yoon CH, Kang EH, Baek HJ. Utility of Magnetic Resonance Imaging and Positron Emission Tomography in Rheumatic Diseases. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.3.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Eun Hye Park
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Chong-Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gachon University College of Medicine Gil Medical Center, Incheon, Korea
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Su J, Li M, He L, Zhao D, Wan W, Liu Y, Xu J, Xu J, Liu H, Jiang L, Wu H, Zuo X, Huang C, Liu X, Li F, Zhang Z, Liu X, Dong L, Li T, Chen H, Li J, He D, Lu X, Huang A, Tao Y, Wang Y, Zhang Z, Wei W, Li X, Zeng X. Comparison of the Efficacy and Safety of Adalimumab (Humira) and the Adalimumab Biosimilar Candidate (HS016) in Chinese Patients with Active Ankylosing Spondylitis: A Multicenter, Randomized, Double-Blind, Parallel, Phase III Clinical Trial. BioDrugs 2020; 34:381-393. [PMID: 32078145 PMCID: PMC7211209 DOI: 10.1007/s40259-020-00408-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and safety of the biosimilar candidate of adalimumab (HS016) compared with adalimumab (Humira) for the treatment of active ankylosing spondylitis. METHODS A multicenter, randomized, double-blind, parallel, positive control, phase III clinical trial was conducted at 28 locations in China. Patients with active ankylosing spondylitis were randomized in a 2:1 ratio to subcutaneously receive 40 mg of either HS016 or adalimumab every other week for 24 weeks. The primary endpoint was to achieve at least a 20% improvement (ASAS20) in patients at 24 weeks according to the Assessment of Spondyloarthritis International Society criteria. The secondary endpoint included other efficacy assessment parameters, health evaluations, safety, pharmacokinetic, and immunogenicity parameters. RESULTS Following the random assignment of 648 patients into HS016 (n = 416) and adalimumab (n = 232) groups, no significant difference was found in the ASAS20 response rates at 24 weeks between the HS016 (364/416, 87.5%) and adalimumab (209/232, 90.1%) treatments and the difference between the response rates (- 2.59%; 90% confidence interval [CI] - 6.77 to 1.60) was within the predefined equivalence margin (± 15%). There were also no significant differences when the secondary endpoints were compared (all p > 0.05). Similarly, the rates of treatment-emergent adverse events (TEAEs) were not significantly different between the two groups, with most TEAEs being mild to moderate. Only nine severe cases were found, including seven within the HS016 group, three (0.7%) of which were tuberculosis cases. Plasma concentrations of HS016 and adalimumab from weeks 12 to 14 were similar during the steady-state period and steady-state maximal concentration (Cmax,ss) was equivalent for HS016 (7356.6 ng/mL) and adalimumab (7600.3 ng/mL). The accumulated proportion of patients with positive human anti-human antibodies (HAHAs) at week 24 was 326/412 (79.1%) in the HS016 group and 183/229 (79.9%) in the adalimumab group (p > 0.05), while the accumulated proportion of patients with positive neutralizing antibody (NAb) tests were 72/412 (17.5%) in the HS016 group and 43/229 (18.8%) in the adalimumab group (p > 0.05). CONCLUSION HS016 resembled adalimumab in efficacy and safety over the 24-week treatment period. TRIAL REGISTRATION NUMBER ChiCTR1900022520.
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Affiliation(s)
- Jinmei Su
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Immunologic Diseases, Ministry of Science and Technology, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Immunologic Diseases, Ministry of Science and Technology, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Lan He
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dongbao Zhao
- Department of Rheumatology, Changhai Hospital, Shanghai, 200433, China
| | - Weiguo Wan
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, 201907, China
| | - Yi Liu
- Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Jianhua Xu
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230001, China
| | - Jian Xu
- Department of Rheumatology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Huaxiang Liu
- Department of Rheumatology, Qilu Hospital of Shandong University, Jinan, 250001, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Huaxiang Wu
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiaoxia Zuo
- Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Cibo Huang
- Department of Rheumatology, Beijing Hospital, Beijing, 100010, China
| | - Xiumei Liu
- Department of Rheumatology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, 30001, China
| | - Fen Li
- Department of Rheumatology, The Second Xiangya Hospital of Central South University, Changsha, 410007, China
| | - Zhiyi Zhang
- Department of Rheumatology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xiangyuan Liu
- Department of Rheumatology, Peking University Third Hospital, Beijing, 100089, China
| | - Lingli Dong
- Department of Rheumatology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tianwang Li
- Department of Rheumatology, Guangdong Second Provincial General Hospital, Guangzhou, 510310, China
| | - Haiying Chen
- Department of Rheumatology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Jingyang Li
- Department of Rheumatology, Zhuzhou Central Hospital, Zhuzhou, 412000, China
| | - Dongyi He
- Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, China
| | - Xin Lu
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, 100020, China
| | - Anbin Huang
- Department of Rheumatology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yi Tao
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Yanyan Wang
- Department of Rheumatology, Jiangsu Province Hospital, Nanjing, 210000, China
| | - Zhuoli Zhang
- Department of Rheumatology, Peking University First Hospital, Beijing, 100034, China
| | - Wei Wei
- Department of Rheumatology, Tianjian Medical University General Hospital, Tianjin, 300052, China
| | - Xiaofeng Li
- Department of Rheumatology, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
- National Clinical Research Center for Immunologic Diseases, Ministry of Science and Technology, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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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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Burmester GR, Gordon KB, Rosenbaum JT, Arikan D, Lau WL, Li P, Faccin F, Panaccione R. Long-Term Safety of Adalimumab in 29,967 Adult Patients From Global Clinical Trials Across Multiple Indications: An Updated Analysis. Adv Ther 2020; 37:364-380. [PMID: 31748904 PMCID: PMC6979455 DOI: 10.1007/s12325-019-01145-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The safety profile of adalimumab was previously reported in 23,458 patients across multiple indications. Here we report the long-term safety of adalimumab in adults with plaque psoriasis (Ps), hidradenitis suppurativa (HS), rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, non-radiographic axial spondyloarthritis, peripheral spondyloarthritis, Crohn's disease (CD), ulcerative colitis (UC), and non-infectious uveitis (UV). METHODS Safety data from 77 clinical trials were pooled. Safety assessments included adverse events (AEs) and serious AEs (SAEs) that occurred after the first study dose and within 70 days (5 half-lives) after the last study dose. RESULTS A total of 29,967 patients were included, representing 56,916 patient-years (PY) of exposure. The most frequently reported SAE of interest was infection (3.7/100 PY) with highest incidences in CD, RA, UV, and UC (3.5/100 PY-6.9/100 PY); serious infections in Ps (1.8/100 PY) and HS (2.8/100 PY) were lower. The observed number of deaths was below what would be expected in an age- and sex-adjusted population for most adalimumab-treated patients (including Ps). Lack of real-life data and limited long-term data (> 5 years) for most patients are limitations of this analysis. CONCLUSION The safety profile of adalimumab was consistent with previous findings and no new safety signals were observed.
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Affiliation(s)
| | | | - James T Rosenbaum
- Oregon Health and Science University and Legacy Devers Eye Institute, Portland, OR, USA
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Tektonidou MG. JAK inhibitors: promising for a wider spectrum of autoimmune diseases? Lancet 2019; 394:2047-2048. [PMID: 31732181 DOI: 10.1016/s0140-6736(19)32681-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, 11527, Athens, Attiki, Greece.
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Abstract
This article discusses treat-to-target strategies in axial spondyloarthritis and current status. Treatment ranging from nonsteroidal anti-inflammatory drugs to biologic and other disease-modifying drugs is discussed in the context of treat-to-target. The article explores evidence from landmark randomized, controlled trials and observational studies focusing on both radiographic and nonradiographic axial spondyloarthritis. The feasibility of treat-to-target, as well as predictors of remission are addressed in line with existing evidence. Finally, issues around management principles and challenges, as well as unmet need in the field, are highlighted.
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Affiliation(s)
- Elena Nikiphorou
- Department of Inflammation Biology, King's College London, Weston Education Centre, Cutcombe Road, Room 3.53, 3rd Floor, London SE5 9RJ, UK; Department of Rheumatology, King's College Hospital, London, UK
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Claudiusstr. 45, Herne 44649, Germany.
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Mease P, Walsh JA, Baraliakos X, Inman R, de Vlam K, Wei JCC, Hunter T, Gallo G, Sandoval D, Zhao F, Dong Y, Bolce R, Marzo-Ortega H. Translating Improvements with Ixekizumab in Clinical Trial Outcomes into Clinical Practice: ASAS40, Pain, Fatigue, and Sleep in Ankylosing Spondylitis. Rheumatol Ther 2019; 6:435-450. [PMID: 31254223 PMCID: PMC6702662 DOI: 10.1007/s40744-019-0165-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Ixekizumab, a humanized interleukin-17A antibody, has shown efficacy in ankylosing spondylitis (AS), with a greater proportion of ixekizumab-treated patients achieving an ASAS40 (Assessment of Spondyloarthritis International Society 40) endpoint compared to placebo. An ASAS40 response is a high standard that is not routinely used in clinical practice. The goals of this study were (a) to measure improvement in ixekizumab-treated patients in the four ASAS treatment response domains and in other patient-reported outcomes, and (b) to determine how the ASAS response was associated with changes in spinal pain at night, fatigue, sleep, and the Short Form 36-Item Physical Component Summary (SF-36 PCS). METHODS The COAST-V and COAST-W trials were randomized, double-blind, controlled trials examining ixekizumab efficacy in patients with AS who were biologic disease-modifying antirheumatic drug (bDMARD)-naïve and tumor necrosis factor inhibitor (TNFi)-experienced, respectively. Data for the ASAS treatment response domains and other outcomes were collected through 16 weeks. Comparisons between treatment groups were made using a mixed-effects model for repeated measures. To determine how the ASAS response was associated with the changes in spinal pain at night, fatigue, sleep, and SF-36 PCS, comparisons were made between patient groups according to their level of treatment response (ASAS40 vs. ASAS20 vs. ASAS20 nonresponse) using analysis of covariance. RESULTS Compared with placebo, patients treated with ixekizumab reported significantly greater improvement in the four ASAS treatment response domains and other outcomes (p < 0.05). Results were consistent for bDMARD-naïve and TNFi-experienced patients. Compared to ASAS20 nonresponders, patients who achieved ASAS40 reported significantly greater mean changes in spinal pain at night (1.0 vs. 5.1 for bDMARD-naïve; 0.5 vs. 5.4 for TNFi-experienced), fatigue (0.6 vs. 3.8 for bDMARD-naïve; 0.2 vs. 3.9 for TNFi-experienced), sleep quality (1.1 vs. 4.0 for bDMARD-naïve; 0.8 vs. 4.9 for TNFi-experienced), and SF-36 PCS (2.6 vs. 11.6 for bDMARD-naïve; 1.2 vs. 12.6 for TNFi-experienced) (p < 0.0001). CONCLUSION Patients with AS who were treated with ixekizumab reported greater improvements in multiple patient-reported outcomes than patients who received placebo. Importantly, achieving ASAS40 was associated with a 2.6-fold to 5.3-fold greater improvement in pain, fatigue, sleep, and quality of life for bDMARD-naïve patients, and a 5.1-fold to 18.5-fold greater improvement for TNFi-experienced patients, compared to ASAS20 nonresponders. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT02696785 and NCT02696798. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Philip Mease
- Division of Rheumatology Clinical Research, University of Washington and Swedish Medical Center, Seattle, WA, USA.
| | - Jessica A Walsh
- University of Utah School of Medicine and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | | | - Robert Inman
- Departments of Immunology and Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - James Cheng-Chung Wei
- Institute of Medicine , Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | | | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Fangyi Zhao
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Yan Dong
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Pedersen SJ, Maksymowych WP. Beyond the TNF-α Inhibitors: New and Emerging Targeted Therapies for Patients with Axial Spondyloarthritis and their Relation to Pathophysiology. Drugs 2019; 78:1397-1418. [PMID: 30171593 DOI: 10.1007/s40265-018-0971-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Axial spondyloarthritis (axSpA) is a complex disease that affects the joints and entheses of axial and peripheral joints, and is associated with inflammation in extra-articular sites such as the gut. Improved knowledge on genetics and immunology has improved treatment options with the availability of treatments targeting tumor necrosis factor-α (TNF-α) and interleukin (IL)-17. However, these agents do not provide clinical benefit for about 40% of patients, and additional therapeutic options are necessary. Theories on pathogenesis includes misfolding of HLA-B*27 during its assembly leading to endoplasmic reticulum stress and autophagy/unfolded protein response (UPR). HLA-B*27 may express free heavy chain on the cell surface, which activates innate immune receptors on T, natural killer, and myeloid cells with pro-inflammatory effects. Activation of UPR genes is associated with increased TNF-α, interleukin-23 (IL-23), IL-17, interferon-γ expression, and expansion of T helper (Th)-17 cells. Certain genotypes of endoplasmic reticulum aminopeptidase (ERAP) 1 and 2 are associated with ankylosing spondylitis (AS) and functionally interact with the HLA-B27 peptidome. Innate immune cells type 3, which express RORγt, regulate expression of IL-17 and IL-22 in T cells. Stimulation of gamma-delta T cells with IL-23 also induces IL-17. Mucosa-associated invariant T cells residing in the gut mucosa express IL-17 in AS patients after stimulation with IL-7. Prostaglandin E2 induces IL-17A independent of IL-23 via IL-1β and IL-6. The pathogenic role of gut inflammation, zonulin and microbiota, which has a different composition in AS patients, remains to be elucidated. This article also includes a comprehensive review on the mechanism of action and efficacy of the biological treatments currently approved for axSpA (TNF-α inhibitors and IL-17 inhibitors) and future targets for treatment (other IL-17 family member (s), Janus kinase, IL-23, and phosphodiesterase 4).
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Affiliation(s)
- Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Disease, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark.
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada
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Diagnostic Accuracy of MRI-Based Sacroiliitis Scoring Systems: A Systematic Review. AJR Am J Roentgenol 2019; 212:1112-1125. [PMID: 30860884 DOI: 10.2214/ajr.17.19429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE. Accurate and reproducible MRI assessment of the sacroiliac joint (SIJ) is challenging. Numerous scoring systems have been proposed to facilitate consistent SIJ assessment. The purpose of this article is to evaluate the diagnostic accuracy and reliability of existing MRI-based SIJ scoring systems for the evaluation of spondyloarthropathy. CONCLUSION. Among existing methods, there is fair (grade B) evidence to recommend the Spondyloarthropathy Research Consortium of Canada scoring systems as tools for MRI evaluation of the SIJ. However, limited data on criterion validity limit assessment of scoring system accuracy.
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Pelechas E, Kaltsonoudis E, Voulgari PV, Drosos AA. Unmet needs in the treatment of ankylosing spondylitis: a long-term observational study from a single university center. Rheumatol Int 2019; 39:663-668. [PMID: 30877371 DOI: 10.1007/s00296-019-04277-w] [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: 02/01/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022]
Abstract
Despite the progress in the treatment of ankylosing spondylitis (AS), a significant number of patients do not achieve low disease activity (LDA). The aim of the study is to estimate the size of unmet needs in the treatment of AS in a long-term observational study. Between January 2003 and December 2017, 220 patients with radiographic SpA were evaluated fulfilling the ASAS criteria. They were followed up at predefined times and were naive to biological treatment with anti-tumor necrosis factor agents (anti-TNFs) and the interleukin (IL)-17 inhibitor. NSAIDs, all anti-TNFs and the IL-17 inhibitor secukinumab were used according to the European, United States and Canadian guidelines for AS. During follow-up, several clinical parameters including disease activity scores were recorded. All 220 patients had an active disease and received at least two NSAIDs for 3 months. The anti-TNF of first choice was infliximab-51%, followed by adalimumab-27% and etanercept-22%. During follow-up, 22 patients were excluded from the study (18 lost, 4 never received anti-TNF due to comorbidities). From the rest (198), 12 did not receive anti-TNFs (8 due to sustained LDA on NSAIDs solely and 4 due to treatment denial). Finally, 186 (94%) were treated with anti-TNFs demonstrating sustained long-term LDA. However, 16 patients never achieved LDA despite they received two or three anti-TNFs or the IL-17 inhibitor. Thus, a total of 20 (10.1%) patients never achieved LDA. This is the first study aiming to estimate the gap and the size of unmet needs in AS patients using the international guidelines and recommendations for AS treatment, which is 10.1%.
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Affiliation(s)
- Eleftherios Pelechas
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Evripidis Kaltsonoudis
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
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Lee KH, Chung HY, Xu X, Lau VWH, Lau CS. Apparent Diffusion Coefficient as an Imaging Biomarker for Spinal Disease Activity in Axial Spondyloarthritis. Radiology 2019; 291:121-128. [PMID: 30720403 DOI: 10.1148/radiol.2019180960] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background A quantifiable imaging measure to gauge the intensity of individual inflammatory lesions in axial spondyloarthritis (SpA) has not been well established. Previous studies have shown that diffusion-weighted (DW) MRI reflects disease activity in axial SpA. Purpose To determine the association between apparent diffusion coefficient (ADC) at MRI of discovertebral lesions and disease activity in individuals with axial SpA. Materials and Methods In this prospective study, 243 study participants (mean age ± standard deviation, 43.2 years ± 13.5) with back pain who fulfilled the Assessment of SpondyloArthritis International Society criteria for SpA were recruited from four rheumatology centers between April 2014 and March 2018. There were 132 men (mean age, 41.4 years ± 13.3) and 111 women (mean age, 45.3 years ± 13.4). Clinical, biochemical, and radiologic parameters were collected. All participants underwent whole-spine MRI by using a short inversion time inversion-recovery sequence and DW imaging. Two independent readers identified the presence of discovertebral lesions. ADCs were measured and normalized with normal bone marrow. Regression analysis was performed to determine association between the mean, maximum, and normalized mean and maximum ADCs of the discovertebral lesions and disease activity and functional parameters (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Bath Ankylosing Spondylitis Global Index [BASGI]). Results Ninety-one discovertebral lesions (five cervical, 61 thoracic, 25 lumbar) were present in 55 of the 243 study participants (22.6%). After adjusting for confounding factors, increased maximum ADC was independently associated with increased BASFI (regression coefficient [β] = 1.94 [×10-3 mm2/sec], P = .04). Increased normalized maximum ADC was independently associated with BASDAI question 2 (ie, back pain score) (β = 0.45, P = .01), mean stiffness score (β = 0.41, P = .04), and BASGI (β = 0.43, P = .04). Increased normalized mean ADC was independently associated with BASDAI question 2 (β = 0.61, P = .04). Conclusion Apparent diffusion coefficients at MRI of discovertebral lesions were associated with disease activity, functional impairment, and patient global assessment in axial spondyloarthritis. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Guermazi and Roemer in this issue.
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Affiliation(s)
- Kam Ho Lee
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Ho Yin Chung
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Xiaopei Xu
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Vince W H Lau
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Chak Sing Lau
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
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Sari I, Haroon N. Radiographic Progression in Ankylosing Spondylitis: From Prognostication to Disease Modification. Curr Rheumatol Rep 2018; 20:82. [DOI: 10.1007/s11926-018-0795-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Maksymowych WP, Strand V, Nash P, Yazici Y, Thom H, Hunger M, Kalyvas C, Gandhi KK, Porter B, Jugl SM. Comparative effectiveness of secukinumab and adalimumab in ankylosing spondylitis as assessed by matching-adjusted indirect comparison. Eur J Rheumatol 2018; 5:216-223. [PMID: 30388073 PMCID: PMC6267743 DOI: 10.5152/eurjrheum.2018.18162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/05/2018] [Indexed: 12/17/2022] Open
Abstract
Objective Matching-adjusted indirect comparison was used to assess the comparative effectiveness of secukinumab 150 mg and adalimumab 40 mg in biologic-naïve patients with ankylosing spondylitis (AS) for up to 1 year. Methods Pooled individual patient data from the secukinumab arms of MEASURE 1 (NCT01358175) and MEASURE 2 (NCT01649375) trials (n=197) were matched against the ATLAS (NCT00085644) adalimumab population (n=208). Logistic regression analysis was used to determined weights to match for age, sex, Bath AS Functional Index, C-reactive protein levels, and previous tumor necrosis factor inhibitor therapy. Recalculated Assessment of SpondyloArthritis International Society (ASAS) 20 and 40 responses at weeks 8, 12, 16, 24, and 52 from MEASURE 1/2 (effective sample size=120) were compared with those of ATLAS. Anchored (placebo-adjusted) comparisons were possible until week 12, and unanchored (non-placebo-adjusted) comparisons were necessary thereafter. Results For placebo-anchored ASAS 20 and 40 comparisons up to week 12, there were no differences between secukinumab and adalimumab. For unanchored comparisons at week 16, ASAS 20 was higher for secukinumab [odds ratio 1.60 (95% confidence interval, 1.01–2.54); p=0.047]; at week 24, ASAS 20 and 40 were higher for secukinumab [1.76 (1.11–2.79); p=0.017 and 1.79 (1.14–2.82); p=0.012, respectively]; and at week 52, ASAS 40 was higher for secukinumab [1.54 (1.06–2.23); p=0.023] than for adalimumab. Conclusion There were no differences observed in placebo-adjusted ASAS 20 and 40 responses up to 12 weeks between secukinumab- and adalimumab-treated patients with ankylosing spondylitis. After week 12, secukinumab demonstrated signs of greater improvement in non-placebo-adjusted ASAS 20 and 40 responses than adalimumab.
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Affiliation(s)
- Walter P Maksymowych
- Division of Rheumatology, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Vibeke Strand
- Division Immunology-Rheumatology, Stanford University, Palo Alto, California, USA
| | - Peter Nash
- Department of Medicine, University of Queensland, Brisbane, Australia
| | - Yusuf Yazici
- New York University School of Medicine, New York, USA
| | | | | | | | - Kunal K Gandhi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Brian Porter
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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Association between hidradenitis suppurativa and spondyloarthritis. Joint Bone Spine 2018; 85:593-597. [DOI: 10.1016/j.jbspin.2017.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 09/13/2017] [Indexed: 11/19/2022]
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Maksymowych WP, van der Heijde D, Baraliakos X, Deodhar A, Sherlock SP, Li D, Fleishaker D, Hendrikx T, Kanik KS. Tofacitinib is associated with attainment of the minimally important reduction in axial magnetic resonance imaging inflammation in ankylosing spondylitis patients. Rheumatology (Oxford) 2018; 57:1390-1399. [PMID: 29718421 PMCID: PMC6055606 DOI: 10.1093/rheumatology/key104] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives Minimally important changes (MICs) for SPondyloArthritis Research Consortium of Canada (SPARCC) MRI scores are ⩾2.5 for SI joint and ⩾5 for spine. This post hoc analysis assessed achievement of MIC in SPARCC scores in biologic-naïve patients with AS treated with tofacitinib or placebo, and correlation with clinical responses. Methods Adult AS patients in a 12-week phase 2 study (n = 207) were randomized 1: 1: 1: 1 to tofacitinib 2, 5 or 10 mg twice daily (BID) or placebo. MIC in SPARCC SI joint and spine scores were assessed for patients with available MRI data (N = 164; 79%). Clinical endpoints at week 12, including Assessment of SpondyloArthritis international Society 20% improvement (ASAS20), were compared between patients achieving/not achieving MIC. Results A greater proportion of patients achieved MIC with tofacitinib 2, 5 and 10 mg BID vs placebo for SI joint (28.6, 38.6, 29.6 vs 11.8%) and spine scores (29.3, 36.4, 40.9 vs 11.8%). Generally, a greater proportion of patients treated with tofacitinib 2, 5 and 10 mg BID or placebo, respectively, who achieved MIC for SI joint and spine scores achieved ASAS20 (SI joint: 75.0, 88.2, 69.2, 75.0%; spine: 91.7, 85.7, 72.2, 75.0%) vs patients who did not achieve MIC (SI joint: 51.7, 84.0, 58.1, 48.3%; spine: 46.4, 85.7, 53.8, 48.3%). Numerically greater responses were seen in those patients achieving vs not achieving MIC across a range of other efficacy assessments. Conclusion Approximately one-third of tofacitinib-treated AS patients experienced clinically meaningful reductions in spinal MRI inflammation at week 12. Patients achieving MIC for MRI inflammation had greater clinical response.
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Affiliation(s)
| | | | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR
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Development and validation of SCAISS, a tool for semi-automated quantification of sacroilitis by magnetic resonance in spondyloarthritis. Rheumatol Int 2018; 38:1919-1926. [PMID: 30022300 DOI: 10.1007/s00296-018-4104-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
To develop a semi-automated method to quantify inflammation in sacroiliac (SI) joints by measuring bone marrow edema (BME) on MRI. The SCAISS was designed as an image-processing software. Validation followed: (1) three readers evaluated SI images of 23 patients with axial SpA and various levels of BME severity with the SCAISS, and two non-automated methods, SPARCC and Berlin; (2) 20 readers evaluated 12 patients images, also with the three methods; (3) 203 readers evaluated 12 patient images with the Berlin and the SCAISS. Convergent validity, reliability and feasibility were estimated in the first two steps and reliability was confirmed with the third. The interobserver reliability (ICC and 95% CI) in the three observers' study was similar across methods: SCAISS = 0.770 (0.580-0.889); Berlin = 0.725 (0.537-0.860); and SPARCC = 0.824 (0.671-0.916). In the 20 observers' study, ICC was: SCAISS = 0.801 (0.653-0.927); Berlin = 0.702 (0.518-0.882); and SPARCC = 0.790 (0.623-0.923). In the 203 observers' study, ICC were: SCAISS = 0.810 (0.675-0.930), and Berlin = 0.636 (0.458-0.843). SCAISS showed good convergent validity (r with SPARCC = 0.760). Median time (interquartile range) employed in the reading procedure was 28 (27) seconds for the SCAISS, 14 (9) for the Berlin score, and 94 (68) for the SPARCC. The SCAISS permits a valid, reliable, and fast calculation of overall BME lesion at the SI joint on MRI images not dependent on readers' experience.
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Weiss PF, Maksymowych WP, Lambert RG, Jaremko JL, Biko DM, Paschke J, Brandon TG, Xiao R, Chauvin NA. Feasibility and Reliability of the Spondyloarthritis Research Consortium of Canada Sacroiliac Joint Structural Score in Children. J Rheumatol 2018; 45:1411-1417. [PMID: 29907669 DOI: 10.3899/jrheum.171329] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE There is a critical need for measures to evaluate structural progression in the pediatric sacroiliac joint (SIJ). We aimed to evaluate the construct validity and reliability of the Spondyloarthritis Research Consortium of Canada SIJ Structural Score (SSS) in children with suspected or confirmed juvenile spondyloarthritis. METHODS The SSS assesses structural lesions of the SIJ on magnetic resonance imaging (MRI) through the cartilaginous part of the joint. We conducted 3 sequential reading exercises with 6 readers (1 adult and 3 pediatric radiologists, 1 adult and 1 pediatric rheumatologist). Each exercise was preceded by a calibration module. Interobserver reliability was assessed using intraclass correlation coefficients (ICC). Prespecified acceptable reliability thresholds were ICC > 0.5 for erosion, backfill, and sclerosis, and ICC > 0.7 for ankylosis and fat metaplasia. RESULTS The SSS had face validity and was feasible to score in pediatric cases for all 3 reading exercises. Of the cases used in the 3 exercises, 58% were male and the median age was 14 years (range 6.8-18.7 yrs). After calibration, median ICC across all readers for each SSS component were the following: erosion 0.67 (interquartile range 0.54-0.80), backfill 0.33 (0.19-0.52), fat metaplasia 0.74 (0.62-0.85), sclerosis 0.63 (0.48-0.77), and ankylosis 0.44 (0.28-0.62). Prespecified reliability thresholds were achieved in the third exercise for erosion, sclerosis, and fat metaplasia but not for backfill or ankylosis. CONCLUSION The SSS was feasible to score and had acceptable reliability for pediatric SIJ MRI evaluation. The ICC improved with additional calibration and reading exercises, even for readers with limited experience.
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Affiliation(s)
- Pamela F Weiss
- From the Departments of Pediatrics and Radiology, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness (CPCE) at the Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine at the University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, Alberta, Canada. .,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; W.P. Maksymowych, MD, FRCP, Department of Medicine at the University of Alberta; R.G. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging at the University of Alberta; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging at the University of Alberta; D.M. Biko, MD, Department of Radiology at the Children's Hospital of Philadelphia; J. Paschke, BSc, CaRE Arthritis; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia; R. Xiao, PhD, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Department of Radiology and Diagnostic Imaging, University of Alberta; N.A. Chauvin, MD, Department of Radiology at the Children's Hospital of Philadelphia.
| | - Walter P Maksymowych
- From the Departments of Pediatrics and Radiology, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness (CPCE) at the Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine at the University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, Alberta, Canada.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; W.P. Maksymowych, MD, FRCP, Department of Medicine at the University of Alberta; R.G. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging at the University of Alberta; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging at the University of Alberta; D.M. Biko, MD, Department of Radiology at the Children's Hospital of Philadelphia; J. Paschke, BSc, CaRE Arthritis; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia; R. Xiao, PhD, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Department of Radiology and Diagnostic Imaging, University of Alberta; N.A. Chauvin, MD, Department of Radiology at the Children's Hospital of Philadelphia
| | - Robert G Lambert
- From the Departments of Pediatrics and Radiology, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness (CPCE) at the Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine at the University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, Alberta, Canada.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; W.P. Maksymowych, MD, FRCP, Department of Medicine at the University of Alberta; R.G. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging at the University of Alberta; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging at the University of Alberta; D.M. Biko, MD, Department of Radiology at the Children's Hospital of Philadelphia; J. Paschke, BSc, CaRE Arthritis; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia; R. Xiao, PhD, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Department of Radiology and Diagnostic Imaging, University of Alberta; N.A. Chauvin, MD, Department of Radiology at the Children's Hospital of Philadelphia
| | - Jacob L Jaremko
- From the Departments of Pediatrics and Radiology, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness (CPCE) at the Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine at the University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, Alberta, Canada.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; W.P. Maksymowych, MD, FRCP, Department of Medicine at the University of Alberta; R.G. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging at the University of Alberta; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging at the University of Alberta; D.M. Biko, MD, Department of Radiology at the Children's Hospital of Philadelphia; J. Paschke, BSc, CaRE Arthritis; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia; R. Xiao, PhD, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Department of Radiology and Diagnostic Imaging, University of Alberta; N.A. Chauvin, MD, Department of Radiology at the Children's Hospital of Philadelphia
| | - David M Biko
- From the Departments of Pediatrics and Radiology, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness (CPCE) at the Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine at the University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, Alberta, Canada.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; W.P. Maksymowych, MD, FRCP, Department of Medicine at the University of Alberta; R.G. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging at the University of Alberta; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging at the University of Alberta; D.M. Biko, MD, Department of Radiology at the Children's Hospital of Philadelphia; J. Paschke, BSc, CaRE Arthritis; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia; R. Xiao, PhD, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Department of Radiology and Diagnostic Imaging, University of Alberta; N.A. Chauvin, MD, Department of Radiology at the Children's Hospital of Philadelphia
| | - Joel Paschke
- From the Departments of Pediatrics and Radiology, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness (CPCE) at the Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine at the University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, Alberta, Canada.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; W.P. Maksymowych, MD, FRCP, Department of Medicine at the University of Alberta; R.G. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging at the University of Alberta; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging at the University of Alberta; D.M. Biko, MD, Department of Radiology at the Children's Hospital of Philadelphia; J. Paschke, BSc, CaRE Arthritis; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia; R. Xiao, PhD, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Department of Radiology and Diagnostic Imaging, University of Alberta; N.A. Chauvin, MD, Department of Radiology at the Children's Hospital of Philadelphia
| | - Timothy G Brandon
- From the Departments of Pediatrics and Radiology, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness (CPCE) at the Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine at the University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, Alberta, Canada.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; W.P. Maksymowych, MD, FRCP, Department of Medicine at the University of Alberta; R.G. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging at the University of Alberta; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging at the University of Alberta; D.M. Biko, MD, Department of Radiology at the Children's Hospital of Philadelphia; J. Paschke, BSc, CaRE Arthritis; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia; R. Xiao, PhD, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Department of Radiology and Diagnostic Imaging, University of Alberta; N.A. Chauvin, MD, Department of Radiology at the Children's Hospital of Philadelphia
| | - Rui Xiao
- From the Departments of Pediatrics and Radiology, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness (CPCE) at the Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine at the University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, Alberta, Canada.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; W.P. Maksymowych, MD, FRCP, Department of Medicine at the University of Alberta; R.G. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging at the University of Alberta; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging at the University of Alberta; D.M. Biko, MD, Department of Radiology at the Children's Hospital of Philadelphia; J. Paschke, BSc, CaRE Arthritis; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia; R. Xiao, PhD, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Department of Radiology and Diagnostic Imaging, University of Alberta; N.A. Chauvin, MD, Department of Radiology at the Children's Hospital of Philadelphia
| | - Nancy A Chauvin
- From the Departments of Pediatrics and Radiology, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness (CPCE) at the Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine at the University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, Alberta, Canada.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; W.P. Maksymowych, MD, FRCP, Department of Medicine at the University of Alberta; R.G. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging at the University of Alberta; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging at the University of Alberta; D.M. Biko, MD, Department of Radiology at the Children's Hospital of Philadelphia; J. Paschke, BSc, CaRE Arthritis; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology at the Children's Hospital of Philadelphia; R. Xiao, PhD, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Department of Radiology and Diagnostic Imaging, University of Alberta; N.A. Chauvin, MD, Department of Radiology at the Children's Hospital of Philadelphia
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Varkas G, de Hooge M, Renson T, De Mits S, Carron P, Jacques P, Moris M, Souverijns G, Jans L, Elewaut D, Van den Bosch F. Effect of mechanical stress on magnetic resonance imaging of the sacroiliac joints: assessment of military recruits by magnetic resonance imaging study. Rheumatology (Oxford) 2018; 57:508-513. [PMID: 29253272 DOI: 10.1093/rheumatology/kex491] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the baseline condition of the SI joints (SIJs) in healthy individuals without symptoms of back pain and to study the effect of mechanical stress caused by intense physical training on MRI of the SIJs. Methods Twenty-two military recruits underwent an MRI of the SIJs before and after 6 weeks of intense standardized physical training. Bone marrow oedema and structural lesions were scored based on the Spondyloarthritis Research Consortium of Canada (SPARCC) method, by three trained readers blinded for time sequence and clinical findings. Additionally, fulfilment of the Assessment of SpondyloArthritis international Society (ASAS) definition of a positive MRI was evaluated. Results At baseline, 9/22 recruits (40.9%) already presented a SPARCC score ⩾1; this number increased to 11/22 (50.0%) at week 6 (P = 0.625). In these patients, the mean (SD) SPARCC score was 2.4 (0.4) at baseline, compared to 3.7 (1.3) at week 6. Overall, the mean (SD) change in SPARCC score over time in all 22 patients was 0.9 (0.6) (P = 0.109). A positive MRI according to the ASAS definition was present in 5/22 recruits (22.7%) at baseline, which increased to 8/22 (36.4%) at follow-up (P = 0.375). Structural lesions were present in 6/22 subjects (27.3%), both at baseline and after 6 weeks of training. Conclusion A substantial proportion of healthy active individuals without any symptoms of back pain displayed bone marrow oedema lesions on MRI at baseline. However, MRI lesions did not increase significantly after 6 weeks of intensive physical training. Our study underscores the necessity to interpret MRI findings of the SIJs in the appropriate clinical context, even in a young active population.
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Affiliation(s)
- Gaëlle Varkas
- Department of Rheumatology, Military Hospital Queen Astrid, Belgian Defence, Brussels.,VIB Inflammation Research Centre, Military Hospital Queen Astrid, Belgian Defence, Brussels
| | - Manouk de Hooge
- Department of Rheumatology, Military Hospital Queen Astrid, Belgian Defence, Brussels.,VIB Inflammation Research Centre, Military Hospital Queen Astrid, Belgian Defence, Brussels
| | - Thomas Renson
- Department of Rheumatology, Military Hospital Queen Astrid, Belgian Defence, Brussels
| | - Sophie De Mits
- Department of Rheumatology, Military Hospital Queen Astrid, Belgian Defence, Brussels.,Rehabilitation Sciences and Physical Therapy, Ghent University, Military Hospital Queen Astrid, Belgian Defence, Brussels
| | - Philippe Carron
- Department of Rheumatology, Military Hospital Queen Astrid, Belgian Defence, Brussels.,VIB Inflammation Research Centre, Military Hospital Queen Astrid, Belgian Defence, Brussels
| | - Peggy Jacques
- Department of Rheumatology, Military Hospital Queen Astrid, Belgian Defence, Brussels
| | - Muriel Moris
- Department of Rheumatology, Military Hospital Queen Astrid, Belgian Defence, Brussels
| | | | - Lennart Jans
- Department of Radiology, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Military Hospital Queen Astrid, Belgian Defence, Brussels.,VIB Inflammation Research Centre, Military Hospital Queen Astrid, Belgian Defence, Brussels
| | - Filip Van den Bosch
- Department of Rheumatology, Military Hospital Queen Astrid, Belgian Defence, Brussels.,VIB Inflammation Research Centre, Military Hospital Queen Astrid, Belgian Defence, Brussels
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Laloo F, Herregods N, Jaremko JL, Verstraete K, Jans L. MRI of the sacroiliac joints in spondyloarthritis: the added value of intra-articular signal changes for a 'positive MRI'. Skeletal Radiol 2018; 47:683-693. [PMID: 29177804 DOI: 10.1007/s00256-017-2830-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 11/12/2017] [Accepted: 11/15/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if intra-articular signal changes at the sacroiliac joint space on MRI have added diagnostic value for spondyloarthritis, when compared to bone marrow edema (BME). MATERIALS AND METHODS A retrospective study was performed on the MRIs of sacroiliac joints of 363 patients, aged 16-45 years, clinically suspected of sacroiliitis. BME of the sacroiliac joints was correlated to intra-articular sacroiliac joint MR signal changes: high T1 signal, fluid signal, ankylosis and vacuum phenomenon (VP). These MRI findings were correlated with final clinical diagnosis. Sensitivity (SN), specificity (SP), likelihood ratios (LR), predictive values and post-test probabilities were calculated. RESULTS BME had SN of 68.9%, SP of 74.0% and LR+ of 2.6 for diagnosis of spondyloarthritis. BME in absence of intra-articular signal changes had a lower SN and LR+ for spondyloarthritis (SN = 20.5%, LR+ 1.4). Concomitant BME and high T1 signal (SP = 97.2%, LR + = 10.5), BME and fluid signal (SP = 98.6%, LR + = 10.3) or BME and ankylosis (SP = 100%) had higher SP and LR+ for spondyloarthritis. Concomitant BME and VP had low LR+ for spondyloarthritis (SP = 91%, LR + =0.9). When BME was absent, intra-articular signal changes were less prevalent, but remained highly specific for spondyloarthritis. CONCLUSION Our results suggest that both periarticular and intra-articular MR signal of the sacroiliac joint should be examined to determine whether an MRI is 'positive' or 'not positive' for sacroiliitis associated with spondyloarthritis.
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Affiliation(s)
- Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - N Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
| | - J L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - K Verstraete
- Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
| | - L Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
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van der Heijde D, Sieper J, Maksymowych WP, Lambert RG, Chen S, Hojnik M, Anderson JK, Pangan AL. Clinical and MRI remission in patients with nonradiographic axial spondyloarthritis who received long-term open-label adalimumab treatment: 3-year results of the ABILITY-1 trial. Arthritis Res Ther 2018; 20:61. [PMID: 29587851 PMCID: PMC5870399 DOI: 10.1186/s13075-018-1556-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/27/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adalimumab was effective in treating patients with nonradiographic axial spondyloarthritis (nr-axSpA) in the 12-week ABILITY-1 trial. We present long-term efficacy and safety results of adalimumab from the open-label ABILITY-1 extension, including the relationship between clinical and magnetic resonance imaging (MRI) remission and impact of sustained clinical remission on physical function. METHODS Patients received adalimumab 40 mg every other week or placebo for 12 weeks, then open-label adalimumab for up to 144 weeks. Clinical and safety data were collected through 3 years, and MRI data were collected until 2 years. Analyses were performed in the total population and subpopulation with positive MRI and/or elevated C-reactive protein (MRI/CRP-positive) at baseline. Clinical and MRI remission definitions included Ankylosing Spondylitis Disease Activity Score inactive disease (ASDAS ID; score < 1.3) and Spondyloarthritis Research Consortium of Canada (SPARCC) MRI score < 2 for sacroiliac joints (SIJs), spine, or both. Physical function was assessed using the Bath Ankylosing Spondylitis Functional Index. RESULTS Overall, 185 patients were included in the total population and 142 in the MRI/CRP-positive subpopulation; 65% and 68%, respectively, completed 3 years. Clinical, functional, and MRI improvements were similar and equally sustainable in both populations. At year 3, the percentages of patients in ASDAS ID in the MRI/CRP-positive subpopulation were 30%/33% (nonresponder imputation) and 46%/49% (observed) for those initially receiving adalimumab/placebo. At years 1 and 2, patients in ASDAS ID vs not had significantly greater improvements in SPARCC SIJ scores from baseline (P < 0.001). Among patients with baseline MRI scores ≥ 2 who achieved ASDAS ID at year 2, 44-68% also had MRI remission. Significantly more patients with sustained ASDAS ID through year 2 or 3 vs without achieved normal physical function (100% vs 48%; 100% vs 44%; both P < 0.001). No new safety concerns were observed. CONCLUSIONS In the ABILITY-1 study of nr-axSpA, adalimumab therapy provided sustained clinical and functional improvements through 3 years, as well as suppression of MRI axial inflammation, which was greater in patients who achieved clinical remission. Sustained clinical remission was associated with increased attainment of normal physical function. The safety profile of adalimumab was consistent with prior studies. TRIAL REGISTRATION ClinicalTrials.gov , NCT00939003 ; registered on July 10, 2009.
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Affiliation(s)
| | | | | | | | - Su Chen
- AbbVie Inc., North Chicago, IL, USA
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48
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Weiss PF, Maksymowych WP, Lambert RG, Jaremko JL, Biko DM, Paschke J, Brandon TG, Xiao R, Chauvin NA. Feasibility and reliability of the Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation score in children. Arthritis Res Ther 2018; 20:56. [PMID: 29566735 PMCID: PMC5865339 DOI: 10.1186/s13075-018-1543-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/14/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Published methods for quantification of magnetic resonance imaging (MRI) evidence of inflammation in the sacroiliac joint lack validation in pediatric populations. We evaluated the reliability and construct validity of the Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint inflammation score (SIS) in children with suspected or confirmed juvenile spondyloarthritis (JSpA). METHODS The SPARCC SIS measures the presence, depth, and intensity of bone marrow inflammation on MRI through the cartilaginous part of the joint. Six readers blinded to clinical details except age, participated in two reading exercises, each preceded by a calibration exercise. Inter-observer reliability was assessed using intraclass correlation coefficients (ICCs) and for pre-specified acceptable reliability the inraclass correlation coefficient (ICC) was > 0.8. RESULTS The SPARCC SIS had face validity and was feasible to score in pediatric cases in both reading exercises. Cases were mostly male (64%) and the median age at the time of imaging was 14.9 years. After calibration, the median ICC across all readers for the SIS total score was 0.81 (IQR 0.71-0.89). SPARCC SIS had weak correlation with disease activity (DA) as measured by the JSpADA (r = - 0.12) but discriminated significantly between those with and without elevated C-reactive protein (p = 0.03). CONCLUSION The SPARCC SIS was feasible to score and had acceptable reliability in children. The ICC improved with additional calibration and reading exercises, for both experienced and inexperienced readers.
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Affiliation(s)
- Pamela F Weiss
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Center for Pediatric Clinical Effectiveness (CPCE), Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,The Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 11121, Philadelphia, PA, 19146, USA.
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, AB, Canada
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada.,Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, AB, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joel Paschke
- Canadian Research and Education (CaRE) Arthritis Organization, Edmonton, AB, Canada
| | - Timothy G Brandon
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Pediatric Clinical Effectiveness (CPCE), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rui Xiao
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A Chauvin
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Bradbury LA, Hollis KA, Gautier B, Shankaranarayana S, Robinson PC, Saad N, Lê Cao KA, Brown MA. Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis. J Rheumatol 2018; 45:771-778. [PMID: 29449501 DOI: 10.3899/jrheum.170312] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We tested the discriminatory capacity of diffusion-weighted magnetic resonance imaging (DWI) and its potential as an objective measure of treatment response to tumor necrosis factor inhibition in ankylosing spondylitis (AS). METHODS Three cohorts were studied prospectively: (1) 18 AS patients with Bath Ankylosing Spondylitis Disease Activity Index > 4, and erythrocyte sedimentation rate > 25 and/or C-reactive protein > 10 meeting the modified New York criteria for AS; (2) 20 cases of nonradiographic axial spondyloarthritis (nr-axSpA) as defined by the Assessment of Spondyloarthritis international Society (ASAS) criteria; and (3) 20 non-AS patients with chronic low back pain, aged between 18 and 45 years, who did not meet the imaging arm of the ASAS criteria for axSpA. Group 1 patients were studied prior to and following adalimumab treatment. Patients were assessed by DWI and conventional magnetic resonance imaging (MRI), and standard nonimaging measures. RESULTS At baseline, in contrast to standard nonimaging measures, DWI apparent diffusion coefficient (ADC) values showed good discriminatory performance [area under the curve (AUC) > 80% for Group 1 or 2 compared with Group 3]. DWI ADC values were significantly lower posttreatment (0.45 ± 0.433 before, 0.154 ± 0.23 after, p = 0.0017), but had modest discriminating capacity comparing pre- and posttreatment measures (AUC = 68%). This performance was similar to the manual Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. CONCLUSION DWI is informative for diagnosis of AS and nr-axSpA, and has moderate utility in assessment of disease activity or treatment response, with performance similar to that of the SPARCC MRI score.
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Affiliation(s)
- Linda A Bradbury
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Kelly A Hollis
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Benoît Gautier
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Sateesh Shankaranarayana
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Philip C Robinson
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Nivene Saad
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Kim-Anh Lê Cao
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Matthew A Brown
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia. .,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute.
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50
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Krabbe S, Østergaard M, Eshed I, Sørensen IJ, Jensen B, Møller JM, Balding L, Madsen OR, Asmussen K, Eng G, Jørgensen NR, Pedersen SJ. Whole-body Magnetic Resonance Imaging in Axial Spondyloarthritis: Reduction of Sacroiliac, Spinal, and Entheseal Inflammation in a Placebo-controlled Trial of Adalimumab. J Rheumatol 2018; 45:621-629. [DOI: 10.3899/jrheum.170408] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 12/29/2022]
Abstract
Objective.To investigate whether adalimumab (ADA) reduces whole-body (WB-) magnetic resonance imaging (MRI) indices for inflammation in the entheses, peripheral joints, sacroiliac joints, spine, and the entire body in patients with axial spondyloarthritis (axSpA).Methods.An investigator-initiated, randomized, placebo-controlled, double-blinded 48-week followup trial included 49 patients with axSpA, who had Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4.0 despite treatment with nonsteroidal antiinflammatory drugs and a clinical indication for tumor necrosis factor inhibitor treatment. Patients were randomized to subcutaneous ADA 40 mg or placebo every other week for 6 weeks; thereafter, all patients received ADA. Conventional MRI and WBMRI were performed at weeks 0, 6, 24, and 48. The primary WBMRI endpoint was the proportion of patients with an improvement in WBMRI total inflammation index above the smallest detectable change (SDC) at Week 6.Results.The primary WBMRI endpoint (improvement of SDC > 2.3) was met in 11 (44%) patients in the ADA group and 3 (13%) patients in the placebo group (p = 0.025, Fisher’s exact test). The primary conventional MRI endpoint, the minimally important change in Spondyloarthritis Research Consortium of Canada Spine MRI Inflammation Index at Week 6, was achieved by 9 (36%) patients in the ADA group and 4 (17%) patients in the placebo group (p = 0.20). The primary clinical endpoint, BASDAI reduction > 50% or 2.0 at Week 24, was attained by 32 (65%) patients.Conclusion.ADA provided significant reductions in WBMRI indices of peripheral, axial, and whole-body inflammation in patients with axSpA. WBMRI is promising for objective assessment and monitoring of peripheral and axial disease activity in future clinical trials.
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