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Capelusnik D, Benavent D, van der Heijde D, Landewé R, Poddubnyy D, van Tubergen A, Falzon L, Navarro-Compán V, Ramiro S. Treating spondyloarthritis early: does it matter? Results from a systematic literature review. Rheumatology (Oxford) 2022; 62:1398-1409. [PMID: 36099043 DOI: 10.1093/rheumatology/keac532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/15/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To summarize evidence on the relationship between early treatment (definition based on symptom/disease duration or radiographic damage) and treatment clinical response in patients with SpA. METHODS A systematic literature review was conducted in studies on SpA patients treated with NSAIDs or b/tsDMARDs addressing the impact of symptom/disease duration or presence of radiographic damage on treatment response assessed by any disease activity outcome. For categorical outcomes, relative risk, relative risk ratio (RRR) and number needed to treat were calculated, and for continuous outcomes, differences in differences, to compare groups stratified based on symptom/disease duration or the presence of radiographic damage. RESULTS From the 8769 articles retrieved, 25 were included and 1 added by hand-search, all in axSpA, most of them with low risk of bias. Twenty-one studies compared groups based on symptom duration (n = 6) or disease duration (n = 15) and 7 studies based on absence/presence of radiographic damage (2 studies used two comparisons). When early axSpA was defined by symptom duration (<5 years) in RCTs, early treatment was associated with better outcomes in patients with nr-axSpA (n = 2, ASAS40 RRR 5.24 (95%CI 1.12-24.41) and 1.52 (0.60-3.87)) but not in r-axSpA (n = 1) [ASAS20 0.96 (0.53-1.73)]. When early axSpA was defined based on disease duration or radiographic damage, no differences were found between groups. CONCLUSION Evidence towards better outcomes in early axSpA is very limited and restricted to nr-axSpA and <5 years symptom duration. When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found.
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Affiliation(s)
- Dafne Capelusnik
- Care and Public Health Research Institute CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. Department of Rheumatology, Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina
| | - Diego Benavent
- Department of Rheumatology, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | | | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Center, Amsterdam, the Netherlands. Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, and School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Louise Falzon
- University of Sheffield, Sheffield, South Yorkshire, England
| | | | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
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2
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Pons M, Chevret S, Briot K, d'Agostino MA, Roux C, Dougados M, Molto A. Evaluation of long-term TNFi effectiveness after a first switch in early axial spondyloarthritis considering time-varying prescription bias: an inverse-probability weighting analysis of the DESIR cohort. RMD Open 2022; 8:rmdopen-2021-001846. [PMID: 35042728 PMCID: PMC8768912 DOI: 10.1136/rmdopen-2021-001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/17/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate long-term effectiveness of tumour necrosis factor inhibitor (TNFi) after a first switch, and their associated factors in an early axial spondyloarthritis (axSpA) population, considering time-varying prescription bias. Methods Observational prospective cohort (DEvenir des Spondylarthropathies Indifférenciées Récentes) with 5 years of follow-up, including 708 TNFi-naïve patients with early axSpA. Long-term effectiveness of TNFi after a first switch (ASAS40 response after at least 2 visits under treatment) were estimated using marginal structural models (implementing inverse-probability weighting and iterative propensity scores). Factors associated with the outcome were explored by multivariate Cox regression models. Results The hazard to present an ASAS40 response after a first TNFi switch was increased (HR=2.4 (95% CI 1.9 to 3.0)); this response ratio was slightly lower compared with the response in TNFi naïve patients after a first TNFi (HR=3.3 (95% CI 2.9 to 3.8)). HLA-B27 positive was the only factor independently associated with ASAS40 response after a first TNFi switch. Conclusion After application of innovative methods to overcome time-varying prescription bias, the magnitude of the TNFi response after a first switch was found to be numerically lower but clinically relevant from the response in TNFi-naïve patients.
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Affiliation(s)
- Marion Pons
- INSERM U1153, Paris, France .,Department of Rheumatology, Cochin Hospital, Paris, France
| | | | - Karine Briot
- INSERM U1153, Paris, France.,Department of Rheumatology, Cochin Hospital, Paris, France
| | - Maria-Antonietta d'Agostino
- Departement of rheumatology, Paris Ouest university and Ambroise-Paré hospital, Boulogne-Billancourt, France
| | - Christian Roux
- INSERM U1153, Paris, France.,Department of Rheumatology, Cochin Hospital, Paris, France
| | - Maxime Dougados
- INSERM U1153, Paris, France.,Department of Rheumatology, Cochin Hospital, Paris, France
| | - Anna Molto
- INSERM U1153, Paris, France.,Department of Rheumatology, Cochin Hospital, Paris, France
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Maksymowych WP, Kumke T, Auteri SE, Hoepken B, Bauer L, Rudwaleit M. Predictors of long-term clinical response in patients with non-radiographic axial spondyloarthritis receiving certolizumab pegol. Arthritis Res Ther 2021; 23:274. [PMID: 34715908 PMCID: PMC8556993 DOI: 10.1186/s13075-021-02650-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Identification of predictive clinical factors of long-term treatment response may contribute to improved management of non-radiographic axSpA (nr-axSpA) patients. This analysis aims to identify whether any baseline characteristics or Week 12 clinical outcomes in nr-axSpA patients with elevated C-reactive protein (CRP) and/or sacroiliitis on magnetic resonance imaging (MRI) enrolled in the C-axSpAnd study are predictive of achieving clinical response after 1 year of certolizumab pegol (CZP). METHODS C-axSpAnd (NCT02552212) was a phase 3, multicentre study, including a 52-Week double-blind, placebo-controlled period. Enrolled patients were randomised to CZP 200 mg Q2W or placebo. Predictors of Week 12 (CZP group only) and Week 52 clinical response were identified using a multivariate stepwise logistic regression analysis. Response variables included Ankylosing Spondylitis Disease Activity Score major improvement (ASDAS-MI), Assessment of SpondyloArthritis International Society 40% response (ASAS40), Bath Ankylosing Spondylitis Disease Activity Index 50% response (BASDAI50) and ASDAS inactive disease (ASDAS-ID). Predictive factors assessed included demographic and baseline characteristics and clinical outcomes at Week 12. A p-value <0.05 was required for forward selection into the model and p ≥0.1 for backward elimination. Missing data or values collected after switching to open-label treatment were accounted for using non-responder imputation. Sensitivity analyses accounted for patients with changes in non-biologic background medication. RESULTS Of 317 enrolled patients, 159 and 158 were randomised to CZP and placebo, respectively. Younger age and male sex were identified as predictors of Week 12 response across all assessed efficacy outcomes in CZP-treated patients. Consistent predictors of Week 52 response, measured by ASDAS-MI, ASAS40 and BASDAI50, included human leukocyte antigen (HLA)-B27 positivity and sacroiliitis on MRI at baseline. MRI positivity was also predictive of achieving ASDAS-ID at Week 52. Sensitivity analyses were generally consistent with the primary analysis. In placebo-treated patients, no meaningful predictors of Week 52 response were identified. CONCLUSIONS In this 52-Week, placebo-controlled study in nr-axSpA patients with elevated CRP and/or active sacroiliitis on MRI at baseline, MRI sacroiliitis and HLA-B27 positivity, but not elevated CRP or responses at Week 12, were predictive of long-term clinical response to CZP. Findings may support rheumatologists to identify patients suitable for TNFi treatment. TRIAL REGISTRATION ClinicalTrials.gov, NCT02552212 . Registered on 15 September 2015.
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Molto A, Tang S, Combe B, Dougados M, Richette P. Fat mass and response to TNFα blockers in early axial spondyloarthritis: an analysis of the DESIR cohort. Ann Rheum Dis 2021; 81:299-300. [PMID: 34625403 DOI: 10.1136/annrheumdis-2021-221001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/25/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Anna Molto
- Rheumatology, Hospital Cochin, Paris, France .,ECAMO team, INSERM U1153, Paris, France
| | - Solange Tang
- Service de Rhumatologie, Hopital Lariboisiere Centre Viggo Petersen, Paris, France
| | - Bernard Combe
- Rheumatology, University Montpellier 1, Montpellier, Languedoc-Roussillon, France
| | - Maxime Dougados
- Rheumatology, Hopital Cochin, Université de Paris, Paris, France
| | - Pascal Richette
- Service de Rhumatologie, Hopital Lariboisiere Centre Viggo Petersen, Paris, France.,Inserm UMR1132 Bioscar, Universite Paris Diderot UFR de Medecine, Paris, France
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Dougados M. How to fill the gap between clinical trials and daily practice in chronic inflammatory rheumatic diseases? Joint Bone Spine 2021; 88:105252. [PMID: 34314886 DOI: 10.1016/j.jbspin.2021.105252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Maxime Dougados
- Department of Rheumatology, Hôpital Cochin, AP-HP, INSERM (U1153), Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Université de Paris, 75014 Paris, France.
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Sieper J, Poddubnyy D. Twenty years of clinical trials in axial spondyloarthritis: what can we learn for the future? Curr Opin Rheumatol 2021; 33:363-369. [PMID: 33978600 DOI: 10.1097/bor.0000000000000804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We have now about 20 years of experience with the treatment of axial spondyloarthritis with biologics, which raises the question what we can learn from past experience, and which open questions should be addressed in future investigations. RECENT FINDINGS Many studies have shown that axSpA patients - both patients in their nonradiological and radiological stage - respond similarly well to biologic treatment and these patients should be seen as having the same disease at different stages. AxSpA respond best to TNF-blocker - and probably also to other biologics - if the disease duration is short and if objective parameters of inflammation, such as C-reactive protein or MRI are positive. Primary aim of treatment is to reach and maintain clinical remission. Once remission is achieved, it can be maintained by continuing treatment, and in a proportion of yet not well defined patients the drug dose can be reduced without inducing a flare. The recent demonstration of a good efficacy, in addition to TNF blockers, also of IL-17 inhibitors and JAK-inhibitors in axSpA patients raises the question how to select the best patients for the best treatment. Radiographic progression can best be stopped by effectively suppressing inflammation, whether different drugs have here a different effect has still to be defined. More sensitive measurements of radiographic progression are urgently needed. SUMMARY Reaching and maintaining clinical remission and preventing structural bony damage is the primary treatment target in patients with axSpA. How to reach this aim best has to be further explored in the future.
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Affiliation(s)
- Joachim Sieper
- Medical Department I, Campus Benjamin Franklin, Charité University Medicine Berlin, Hindenburgdamm, Berlin, Germany
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Baraliakos X, Ghadir A, Fruth M, Kiltz U, Redeker I, Braun J. Which Magnetic Resonance Imaging Lesions in the Sacroiliac Joints Are Most Relevant for Diagnosing Axial Spondyloarthritis? A Prospective Study Comparing Rheumatologists’ Evaluations With Radiologists’ Findings. Arthritis Rheumatol 2021; 73:800-805. [DOI: 10.1002/art.41595] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/17/2020] [Indexed: 12/17/2022]
Affiliation(s)
- X. Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany, and Ruhr‐Universität Bochum Bochum Germany
| | | | | | - U. Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany, and Ruhr‐Universität Bochum Bochum Germany
| | - I. Redeker
- German Rheumatism Research Center Berlin Berlin Germany
| | - J. Braun
- Rheumazentrum Ruhrgebiet, Herne, Germany, and Ruhr‐Universität Bochum Bochum Germany
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8
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Rusman T, van der Weijden MAC, Nurmohamed MT, Landewé RBM, de Winter JJH, Boden BJH, Bet PM, van der Bijl CMA, van der Laken C, van der Horst-Bruinsma IE. Is Treatment in Patients With Suspected Nonradiographic Axial Spondyloarthritis Effective? Six-Month Results of a Placebo-Controlled Trial. Arthritis Rheumatol 2021; 73:806-815. [PMID: 33277982 PMCID: PMC8251708 DOI: 10.1002/art.41607] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/01/2020] [Indexed: 01/15/2023]
Abstract
Objective To investigate the efficacy of 16‐week treatment with etanercept (ETN) in patients with suspected nonradiographic axial spondyloarthritis (SpA). Methods Tumor necrosis factor inhibitor–naive patients with inflammatory back pain with at least 2 SpA features and high disease activity (Bath Ankylosing Spondylitis Disease Activity Index score ≥4), without the requirement of a positive finding on magnetic resonance imaging (MRI) of the sacroiliac (SI) joint and/or elevated C‐reactive protein (CRP) level, were randomized (1:1) to receive ETN (n = 40) or placebo (n = 40) for 16 weeks and subsequently were followed up for a further 8 weeks (to 24 weeks from baseline) without study medication. The primary end point was the Assessment of SpondyloArthritis international Society 20 (ASAS20) response at 16 weeks. Secondary end points included the Ankylosing Spondylitis Disease Activity Score (ASDAS) and changes in disease parameters, including the Bath Ankylosing Spondylitis Metrology Index (BASMI), CRP level, erythrocyte sedimentation rate (ESR), and Spondyloarthritis Research Consortium of Canada index scores (MRI of the SI joint), after 16 and 24 weeks. Results Patient characteristics at baseline were comparable between the ETN and placebo groups. At 16 weeks, there was no significant difference in the percentage of patients exhibiting ASAS20 response between the ETN group (6 patients [16.7%]) and the placebo group (4 patients [11.1%]) (relative risk 0.7 [95% confidence interval 0.2–2.2], P = 0.5). Only the ESR showed more improvement in the ETN group compared to the placebo group at 16 weeks (decreases of 2.2 mm/hour and 1.4 mm/hour, respectively), but the difference did not reach statistical significance. Between 16 and 24 weeks, without study medication, the BASMI, CRP level, and ESR had worsened to a greater extent in the ETN group compared to the placebo group, with the difference being significant for the CRP level. Conclusion This study shows that in patients with suspected nonradiographic axial SpA with high disease activity but without the requirement of a positive finding on SI joint MRI and/or elevated CRP level, treatment with ETN is not effective.
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Affiliation(s)
- Tamara Rusman
- VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | - Bouke J H Boden
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Pierre M Bet
- VU University Medical Center, Amsterdam, The Netherlands
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9
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The paradigm of non-radiographic sacroiliitis-why the ongoing doubts? Clin Rheumatol 2021; 40:443-446. [PMID: 33405013 DOI: 10.1007/s10067-020-05527-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
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Poddubnyy D, Hammel L, Heyne M, Veit J, Jentzsch C, Baraliakos X. Treat-to-target strategy with secukinumab as a first-line biological disease modifying anti-rheumatic drug compared to standard-of-care treatment in patients with active axial spondyloarthritis: protocol for a randomised open-label phase III study, AScalate. BMJ Open 2020; 10:e039059. [PMID: 32998926 PMCID: PMC7528363 DOI: 10.1136/bmjopen-2020-039059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION In patients with axial spondyloarthritis (axSpA), biological disease-modifying anti-rheumatic drugs (bDMARDs) are recommended to those with inadequate response or contraindications to non-steroidal anti-inflammatory drugs (NSAIDs). In case of failure of the first bDMARD, a switch within the class or to other bDMARD is recommended. Despite these treatment options, there is no optimal treat-to-target (T2T) strategy. This study aims to evaluate the efficacy of a T2T strategy in patients with axSpA, with secukinumab as a first-line bDMARD, compared with standard-of-care (SOC) treatment. METHODS AND ANALYSES This is a randomised, parallel-group, open-label, multicentre ongoing study in patients with axSpA who are naïve to bDMARD and who have had an inadequate response to NSAIDs. The study will include an 8-week screening period, a 36-week treatment period and a 20-week safety follow-up period. At baseline, patients will be randomised (1:1) to T2T or SOC group. In the T2T group, patients will be treated with secukinumab 150 mg subcutaneous (s.c.) weekly until week 4 and then at week 8. For non-responders (patients without Ankylosing Spondylitis Disease Activity Score [ASDAS] clinically important improvement; change from baseline ≥1.1) at week 12, dose will be escalated to 300 mg s.c. every 4 weeks until week 24. Non-responders at week 24 will be switched to adalimumab biosimilar 40 mg s.c. every 2 weeks until week 34. In the SOC group, patients will receive treatment at the discretion of the physician. The primary endpoint is the proportion of patients achieving an Assessment in SpondyloArthritis International Society 40% (ASAS40) response at week 24. ETHICS AND DISSEMINATION The study is being conducted as per the ethical principles of the Declaration of Helsinki and after approval from independent ethics committees/institutional review boards. The first results are expected to be published in early 2022. TRIAL REGISTRATION NUMBER This study is registered with ClinicalTrials.gov, NCT03906136.
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Affiliation(s)
- Denis Poddubnyy
- Head of the Rheumatology Unit Clinic of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Center Berlin, Berlin, Germany
| | - Ludwig Hammel
- Deutsche Vereinigung Morbus Bechterew e.V, Schweinfurt, Germany
| | - Marvin Heyne
- Immunology, Hepatology and Dermatology Franchise, Novartis Pharma GmbH, Nuremberg, Germany
| | - Justyna Veit
- Immunology, Hepatology and Dermatology Franchise, Novartis Pharma GmbH, Nuremberg, Germany
| | - Claudia Jentzsch
- Immunology, Hepatology and Dermatology Franchise, Novartis Pharma GmbH, Nuremberg, Germany
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Lubrano E, Perrotta FM, Manara M, D'Angelo S, Ramonda R, Punzi L, Addimanda O, Salvarani C, Marchesoni A. Improvement of Function and Its Determinants in a Group of Axial Spondyloarthritis Patients Treated with TNF Inhibitors: A Real-Life Study. Rheumatol Ther 2020; 7:301-310. [PMID: 32062827 PMCID: PMC7211226 DOI: 10.1007/s40744-020-00197-5] [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: 01/09/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The aim of this work is to investigate the improvement of physical function and its determinants in axial spondyloarthritis (SpA) patients treated with tumor necrosis factor (TNF) inhibitors in a real clinical practice setting. METHODS An observational study was conducted in patients with axial SpA treated with anti-TNF from 2010 to 2018 with a minimum 6 months of follow-up. All patients fulfilled ASAS or the modified New York criteria. The Bath Ankylosing Spondylitis Metrology Index (BASMI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) were used as objective and self-reported functional indices. The improvement of function and factors associated were evaluated for the present study, as well as disease activity and patient-reported outcome measures. RESULTS A total of 183 patients with axial SpA were examined. Among them, 27 were non-radiographic axial SpA, while the remaining 156 were ankylosing spondylitis patients. BASFI and BASMI significantly improved during follow-up. Improvement of metrology index BASMI inverse correlated with disease duration (rho - 0.2, p = 0.009) and directly correlated with the improvement of BASDAI (rho 0.26, p = 0.003) and CRP (rho 0.26, p = 0.0003). Improvement of BASFI significantly inversely correlated with disease duration and directly correlated with the improvement of BASDAI, CRP, and baseline ESR. Male sex, lower disease duration, high ESR, and the improvement of BASDAI were found to be associated with the improvement of BASFI. CONCLUSIONS Our results showed that in real-life settings, patients improve in BASMI and BASFI. Furthermore, factors associated with this improvement were identified.
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Affiliation(s)
- Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy.
| | - Fabio Massimo Perrotta
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Maria Manara
- Day Hospital di Reumatologia, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO, Milano, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padova, Padua, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padova, Padua, Italy
| | - Olga Addimanda
- SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda Ospedaliera-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Marchesoni
- Day Hospital di Reumatologia, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO, Milano, Italy
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Wei JCC, Chen HH, Hsieh TY, Lan HHC, Tseng JC, Liu CH, Chen YC, Tsai WC, Wu HTH, Chou CT. Clinical practice recommendations for the use of imaging in the diagnosis and management of axial spondyloarthritis in Taiwan. Int J Rheum Dis 2019; 23:24-36. [PMID: 31833212 DOI: 10.1111/1756-185x.13679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 07/02/2019] [Accepted: 07/20/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) is a chronic inflammatory disease bearing challenges in early diagnosis. To improve clinical diagnosis and management of axSpA, recommendations were developed with current axSpA classification criteria and recent advances in medical imaging applications. METHODS A systematic literature review was conducted by 10 rheumatologists and radiologists in Taiwan to retrieve research evidence on the utilization of imaging modalities, including conventional radiography (CR), magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US), quantitative sacroiliac scintigraphy (QSS), and dual-energy X-ray absorptiometry (DXA). The panel of experts proposed six key issues on the role of imaging in early diagnosis of axSpA, monitoring of disease activity and structural changes, predicting treatment effects, and assessing complications such as osteoporosis and spinal fracture. The consensus was established on the basis of research evidence, clinical experiences and expert opinions. For each recommendation statement, the level of evidence was evaluated, the strength of recommendation was graded and the final level of agreement was determined through voting. RESULTS In total, four overarching principles and 13 recommendations were formulated. These recommendations outlined different imaging approaches in the diagnosis and management of axSpA disease progression. Considering CT is easy to perform when MRI is less available in Taiwan, the expert panel proposed a concise and practical diagnostic scheme to strengthen the valuable role of MRI and CT in the diagnostic evaluation of axSpA without evident radiographic features. CONCLUSION These modified recommendations provide guidance for rheumatologists, radiologists and healthcare professionals on timely diagnosis of axSpA and disease management with appropriate imaging modalities.
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Affiliation(s)
- James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chun Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Clinical Training, Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.,Evidence-Based Medicine Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Jui-Cheng Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Buddhist Tzu Chi Medical Foundation, Taipei Tzu Chi Hospital, Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ying-Chou Chen
- Departments of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chan Tsai
- Department of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hung-Ta Hondar Wu
- Department of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Musculoskeletal Section, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Tei Chou
- Division of Allergy Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
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The role of imaging in the diagnosis and management of axial spondyloarthritis. Nat Rev Rheumatol 2019; 15:657-672. [DOI: 10.1038/s41584-019-0309-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
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Favalli EG, Becciolini A, Caporali R, Todoerti M, Iannone F, Dinoia L, Sebastiani M, Spinella A, Gremese E, Cianci F, Atzeni F, Bandinelli F, Ferraccioli G, Lapadula G. The profiling of axial spondyloarthritis patient candidate to a biologic therapy: Consensus from a Delphi-panel of Italian experts. Autoimmun Rev 2018; 17:1251-1258. [DOI: 10.1016/j.autrev.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022]
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Mease PJ, Heijde DVD, Karki C, Palmer JB, Liu M, Pandurengan R, Park Y, Greenberg JD. Characterization of Patients With Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis in the US-Based Corrona Registry. Arthritis Care Res (Hoboken) 2018; 70:1661-1670. [PMID: 29409123 PMCID: PMC6282817 DOI: 10.1002/acr.23534] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/20/2017] [Indexed: 12/17/2022]
Abstract
Objective To describe the characteristics of patients with ankylosing spondylitis (AS) and patients with nonradiographic axial spondyloarthritis (SpA) in the US. Methods Demographics, clinical characteristics, patient‐reported outcomes, and treatment characteristics of patients with AS and those with nonradiographic axial SpA were assessed at the time of enrollment in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. Patients with AS were defined as those who fulfilled the 1984 modified New York criteria for AS; patients with nonradiographic axial SpA were defined as all other patients with axial SpA who did not fulfill the radiology criterion. Results Of the 407 patients with a diagnosis of axial SpA who were included in this study, 310 had AS, and 97 had nonradiographic axial SpA. Although patients with nonradiographic axial SpA were younger and showed a trend toward a shorter symptom duration, the nonradiographic axial SpA and AS groups shared a similar disease burden, as reflected by comparisons of disease activity and function, quality of life, pain, fatigue, job absenteeism, and loss of work productivity (all P > 0.05). The proportions of patients with nonradiographic axial SpA and patients with AS who received prior biologic disease‐modifying drugs (DMARDs) (74.2% and 64.8%, respectively) or were currently receiving biologic DMARDs (63.9% and 61.3%, respectively) were also similar (P > 0.05). Conclusion This was the first nationwide study to characterize patients with AS and nonradiographic axial SpA in the US. Consistent with studies published outside of the US, this study showed that patients with nonradiographic axial SpA and patients with AS shared a comparable degree of disease burden and had similar treatment patterns in clinical practice.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center and University of Washington, Seattle
| | | | | | | | - Mei Liu
- Corrona, LLC, Southborough, Massachusetts
| | | | - Yujin Park
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Jeffrey D Greenberg
- Corrona, LLC, Southborough, Massachusetts and New York University School of Medicine, New York
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Bazin T, Hooks KB, Barnetche T, Truchetet ME, Enaud R, Richez C, Dougados M, Hubert C, Barré A, Nikolski M, Schaeverbeke T. Microbiota Composition May Predict Anti-Tnf Alpha Response in Spondyloarthritis Patients: an Exploratory Study. Sci Rep 2018; 8:5446. [PMID: 29615661 PMCID: PMC5882885 DOI: 10.1038/s41598-018-23571-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/13/2018] [Indexed: 02/07/2023] Open
Abstract
Spondyloarthritis (SpA) pathophysiology remains largely unknown. While the association with genetic factors has been established for decades, the influence of gut microbiota is only an emerging direction of research. Despite the remarkable efficacy of anti-TNF-α treatments, non-responders are frequent and no predictive factors of patient outcome have been identified. Our objective was to investigate the modifications of intestinal microbiota composition in patients suffering from SpA three months after an anti-TNF-α treatment. We performed 16S rDNA sequencing of 38 stool samples from 19 spondyloarthritis patients before and three months after anti-TNF-α treatment onset. SpA activity was assessed at each time using ASDAS and BASDAI scores. Some modifications of the microbiota composition were observed after three months of anti-TNF-α treatment, but no specific taxon was modified, whatever the clinical response. We identified a particular taxonomic node before anti-TNF-α treatment that can predict the clinical response as a biomarker, with a higher proportion of Burkholderiales order in future responder patients. This study suggests a cross-influence between anti-TNF-α treatment and intestinal microbiota. If its results are confirmed on larger groups of patients, it may pave the way to the development of predictive tests suitable for clinical practices.
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Affiliation(s)
- Thomas Bazin
- Univ. Bordeaux, INRA, Mycoplasmal and chlamydial infections in humans, EA 3671, 33000, Bordeaux, France
- Bordeaux Hospital University Center, Department of Hepato-gastroenterology, 33600, Pessac, France
| | - Katarzyna B Hooks
- Univ. Bordeaux, Bordeaux Bioinformatics Center, 33000, Bordeaux, France
- Univ. Bordeaux, CNRS, Immunoconcept, UMR 5164, 33000, Bordeaux, France
| | - Thomas Barnetche
- Bordeaux Hospital University Center, Department of Rheumatology, 33000, Bordeaux, France
| | - Marie-Elise Truchetet
- Bordeaux Hospital University Center, Department of Rheumatology, 33000, Bordeaux, France
| | - Raphaël Enaud
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, FHU ACRONIM, Laboratoire 8 de Parasitologie-Mycologie, F-33000, Bordeaux, France
- CHU Bordeaux, Unité d'Hépatologie, Gastroentérologie et Nutrition Pédiatriques, CRCM Pédiatrique, Service 10 de Rhumatologie, Service d'Exploration Fonctionnelle Respiratoire, 33000, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France
| | - Christophe Richez
- Bordeaux Hospital University Center, Department of Rheumatology, 33000, Bordeaux, France
| | - Maxime Dougados
- AP-HP, Cochin Hospital University Center, Department of Rheumatology, 75014, Paris, France
| | - Christophe Hubert
- Univ. Bordeaux, INSERM, Rare Diseases, genetic and metabolism, U1211, 33000, Bordeaux, France
- Univ. Bordeaux, Genome Transcriptome Facility of Bordeaux, 33000, Bordeaux, France
| | - Aurélien Barré
- Univ. Bordeaux, Bordeaux Bioinformatics Center, 33000, Bordeaux, France
| | - Macha Nikolski
- Univ. Bordeaux, Bordeaux Bioinformatics Center, 33000, Bordeaux, France
- Univ. Bordeaux, CNRS, LaBRI, UMR 5800, 33400, Talence, France
| | - Thierry Schaeverbeke
- Univ. Bordeaux, INRA, Mycoplasmal and chlamydial infections in humans, EA 3671, 33000, Bordeaux, France.
- Bordeaux Hospital University Center, Department of Rheumatology, 33000, Bordeaux, France.
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Gazeau P, Cornec D, Timsit MA, Dougados M, Saraux A. Classification criteria versus physician's opinion for considering a patient with inflammatory back pain as suffering from spondyloarthritis. Joint Bone Spine 2018; 85:85-91. [DOI: 10.1016/j.jbspin.2017.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 01/19/2017] [Indexed: 12/25/2022]
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Monti S, Todoerti M, Codullo V, Favalli EG, Biggioggero M, Becciolini A, Montecucco C, Caporali R. Prevalence of Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease in a cohort of patients treated with TNF-alpha inhibitors. Mod Rheumatol 2017; 28:542-549. [PMID: 28880727 DOI: 10.1080/14397595.2017.1367076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treat to target (T2T), aiming at inactive disease (ID), has become the recommended strategy for axial-SpA (ax-SpA). Using the Ankylosing Spondylitis Disease Activity Score (ASDAS), we assessed the prevalence of ID in ax-SpA patients treated with TNFα inhibitors (TNFi). METHODS A multicentric, cross-sectional study was performed assessing disease activity status (BASDAI and ASDAS) of consecutive patients with ax-SpA on stable treatment with TNFi for at least six months. We analyzed differences with nonradiographic axSpA (nr-ax-SpA) and the influence of population characteristics and comorbidities in reaching ID. ID was defined as ASDAS-CRP <1.3. RESULTS A total of 218 patients were enrolled, 165 with AS and 53 with nr-ax-SpA. ASDAS-CRP ID was reached by 89 (40.8%) patients, while 163 (74.8%) of patients achieved good disease control with BASDAI. There were no significant differences between the two diagnostic groups. Multivariate logistic regression demonstrated a negative correlation of concomitant fibromyalgia, higher BASMI and current NSAIDs with the chances of reaching ASDAS-CRP ID or BASDAI <4. CONCLUSION T2T represents a new challenge in the management of ax-SpA, with recently introduced disease activity measures being significantly more stringent. The prevalence of ID was affected by concomitant fibromyalgia, decreased spine mobility and concomitant NSAIDs.
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Affiliation(s)
- Sara Monti
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
| | - Monica Todoerti
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
| | - Veronica Codullo
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
| | | | | | - Andrea Becciolini
- b Department of Rheumatology , Gaetano Pini Institute , Milan , Italy
| | - Carlomaurizio Montecucco
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
| | - Roberto Caporali
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
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Dougados M, Demattei C, van den Berg R, Vo Hoang V, Thevenin F, Reijnierse M, Loeuille D, Feydy A, Claudepierre P, van der Heijde D. Rate and Predisposing Factors for Sacroiliac Joint Radiographic Progression After a Two-Year Follow-up Period in Recent-Onset Spondyloarthritis. Arthritis Rheumatol 2017; 68:1904-13. [PMID: 26990518 PMCID: PMC5129505 DOI: 10.1002/art.39666] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/25/2016] [Indexed: 01/15/2023]
Abstract
Objective To evaluate the rate of radiographic structural progression in the sacroiliac (SI) joints in patients with radiographic or nonradiographic axial spondyloarthritis (SpA), and to determine factors predisposing to such progression, over 2 years. Methods Patients with recent‐onset axial SpA (from the Devenir des Spondyloarthropathies Indifferérenciées Récentes cohort) were assigned a radiographic SI joint score according to the modified New York criteria. Demographic characteristics, smoking status, HLA–B27 positivity, inflammation on magnetic resonance imaging (MRI) of the SI joints, disease activity, and treatment were investigated as potential predisposing factors. The main analysis consisted of the evaluation of the switch from nonradiographic to radiographic axial SpA, but other definitions of radiographic progression were also evaluated. Results Of the 708 patients enrolled, 449 had baseline and 2‐year pelvic radiographs. Of these patients, 47% were men. Their mean ± SD age was 34 ± 9 years, 61% were B27 positive, and 37% had inflammation of the SI joints on MRI. The percentages of patients who switched from nonradiographic to radiographic axial SpA (4.9% [16 of 326]) and from radiographic to nonradiographic axial SpA (5.7% [7 of 123]) were low. The mean ± SD change in the total SI joint score (range 0–8) was small (0.1 ± 0.8) but highly significant (P < 0.001). The potential baseline predisposing factors for meeting the modified New York criteria in the multivariate analysis were current smoking, HLA–B27 positivity, and inflammation of the SI joints on MRI, with odds ratios of 3.3 (95% confidence interval [95% CI] 1.0–11.5], 12.6 (95% CI 2.3–274), and 48.8 (95% CI 9.3–904), respectively. Conclusion Our findings suggest that structural progression does exist in early SpA, but it is quite small and observed in a small number of patients, and that environmental (smoking status), genetic (HLA–B27 positivity), and inflammation (inflammation of the SI joints on MRI) markers might be independent predisposing factors for progression.
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Affiliation(s)
- Maxime Dougados
- Université Paris Descartes, Hôpital Cochin, AP-HP, and INSERM U1153, PRES Sorbonne Paris-Cité, Paris, France
| | | | | | | | | | | | - Damien Loeuille
- Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Antoine Feydy
- Université Paris Descartes and Hôpital Cochin, AP-HP, Paris, France
| | - Pascal Claudepierre
- Université Paris Est Créteil and Hôpital Henri Mondor, AP-HP, Créteil, France
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Maksymowych WP. The role of MRI in the evaluation of spondyloarthritis: a clinician's guide. Clin Rheumatol 2016; 35:1447-55. [PMID: 27094946 DOI: 10.1007/s10067-016-3265-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 01/17/2023]
Abstract
Plain radiography remains the benchmark for diagnostic evaluation of spondyloarthritis although MRI has much great sensitivity because it can detect a variety of inflammatory lesions as well as fat metaplasia. So, it is the imaging modality of choice when pelvic radiographs are equivocal and especially when important treatment decisions have to be made. Appropriate imaging includes the use of T1-weighted and short tau inversion recovery sequences of the sacroiliac joint in the tilted coronal plane. If there is localized spinal symptomatology, sagittal scans of the spine may also be helpful. However, routine spinal imaging is not recommended. Current consensus designates a positive MRI for classification purposes as requiring the presence of two definite subchondral inflammatory lesions on a single coronal slice or the presence of one such lesion on two consecutive coronal slices. However, such inflammatory lesions can occur in healthy individuals and in those with nonspecific back pain. Erosions are more specific, and their presence can enhance confidence in the diagnosis. MRI, together with CRP, can be helpful in selecting which patients without radiographic sacroiliitis are most likely to respond to tumor necrosis factor inhibitor therapy. The role of MRI in monitoring of patients with SpA remains unclear although it may be helpful in excluding other sources of back pain. A major unanswered question is whether MRI may be useful in predicting relapse following withdrawal of TNFi in patients who have achieved sustained remission.
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Affiliation(s)
- Walter P Maksymowych
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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22
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del Río-Martínez P, Navarro-Compán V, Díaz-Miguel C, Almodóvar R, Mulero J, De Miguel E. Similarities and differences between patients fulfilling axial and peripheral ASAS criteria for spondyloarthritis: Results from the Esperanza Cohort. Semin Arthritis Rheum 2016; 45:400-3. [DOI: 10.1016/j.semarthrit.2015.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/28/2015] [Accepted: 09/11/2015] [Indexed: 02/03/2023]
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Taxter AJ, Wileyto EP, Behrens EM, Weiss PF. Patient-reported Outcomes across Categories of Juvenile Idiopathic Arthritis. J Rheumatol 2015; 42:1914-21. [PMID: 26329337 DOI: 10.3899/jrheum.150092] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although there is increasing reliance on patient-reported outcomes (PRO) for disease management, there is little known about the differences in PRO across juvenile idiopathic arthritis (JIA) categories. The purpose of our study was to assess PRO across JIA categories, including pain, quality of life, and physical function, and to determine clinical factors associated with differences in these measures across categories. METHODS This was a longitudinal cohort study of patients with JIA at a tertiary care pediatric rheumatology clinic. Subjects, PRO, and clinical variables were identified by querying the electronic medical record. Mixed-effects regression assessed pain, quality of life, and function. RESULTS Subjects with enthesitis-related arthritis (ERA) and undifferentiated JIA had significantly more pain, poorer quality of life, and poorer physical function. The ERA and undifferentiated JIA categories, physician's global disease activity assessment, female sex, and nonsteroidal antiinflammatory drug use were significantly associated with more pain, poorer quality of life, and poorer function. In models limited to ERA, female sex and tender enthesis count were significant predictors of decreased function. CONCLUSION ERA and undifferentiated JIA categories had poorer PRO than other JIA categories. Further work is needed to address ways to improve PRO in children with JIA, with a special focus on children with ERA and undifferentiated JIA.
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Affiliation(s)
- Alysha J Taxter
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - E Paul Wileyto
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - Edward M Behrens
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - Pamela F Weiss
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia.
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Moltó A, Granger B, Wendling D, Breban M, Dougados M, Gossec L. Brief Report: Nonsteroidal Antiinflammatory Drug-Sparing Effect of Tumor Necrosis Factor Inhibitors in Early Axial Spondyloarthritis: Results From the DESIR Cohort. Arthritis Rheumatol 2015; 67:2363-8. [DOI: 10.1002/art.39208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/14/2015] [Indexed: 01/17/2023]
Affiliation(s)
- Anna Moltó
- Anna Moltó, MD, PhD: Université Pierre et Marie Curie, GRC-UPMC 08, Hôpital Pitié-Salpêtrière; AP-HP, Université Paris Descartes, Hôpital Cochin, AP-HP, INSERM U1153, and PRES Sorbonne Paris-Cité; Paris France
| | - Benjamin Granger
- Université Pierre et Marie Curie and Hôpital Pitié-Salpêtrière, AP-HP; Paris France
| | - Daniel Wendling
- Université de Franche-Comté and Centre Hospitalier Régional Universitaire de Besançon; Besançon France
| | - Maxime Breban
- Université de Versailles St. Quentin en Yvelines and Hôpital Ambroise Paré, AP-HP; Boulogne-Billancourt France
| | - Maxime Dougados
- Université Paris Descartes, Hôpital Cochin, AP-HP, INSERM U1153, and PRES Sorbonne Paris-Cité; Paris France
| | - Laure Gossec
- Université Pierre et Marie Curie, GRC-UPMC 08, and Pitié-Salpêtrière Hospital, AP-HP; Paris France
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Maksymowych WP, Dougados M, van der Heijde D, Sieper J, Braun J, Citera G, Van den Bosch F, Logeart I, Wajdula J, Jones H, Marshall L, Bonin R, Pedersen R, Vlahos B, Kotak S, Bukowski JF. Clinical and MRI responses to etanercept in early non-radiographic axial spondyloarthritis: 48-week results from the EMBARK study. Ann Rheum Dis 2015; 75:1328-35. [PMID: 26269397 PMCID: PMC4941178 DOI: 10.1136/annrheumdis-2015-207596] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/20/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of etanercept (ETN) after 48 weeks in patients with early active non-radiographic axial spondyloarthritis (nr-axSpA). METHODS Patients meeting Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA, but not modified New York radiographic criteria, received double-blind ETN 50 mg/week or placebo (PBO) for 12 weeks, then open-label ETN (ETN/ETN or PBO/ETN). Clinical, health, productivity, MRI and safety outcomes were assessed and the 48-week data are presented here. RESULTS 208/225 patients (92%) entered the open-label phase at week 12 (ETN, n=102; PBO, n=106). The percentage of patients achieving ASAS40 increased from 33% to 52% between weeks 12 and 48 for ETN/ETN and from 15% to 53% for PBO/ETN (within-group p value <0.001 for both). For ETN/ETN and PBO/ETN, the EuroQol 5 Dimensions utility score improved by 0.14 and 0.08, respectively, between baseline and week 12 and by 0.23 and 0.22 between baseline and week 48. Between weeks 12 and 48, MRI Spondyloarthritis Research Consortium of Canada sacroiliac joint (SIJ) scores decreased by -1.1 for ETN/ETN and by -3.0 for PBO/ETN, p<0.001 for both. Decreases in MRI SIJ inflammation and C-reactive protein correlated with several clinical outcomes at weeks 12 and 48. CONCLUSIONS Patients with early active nr-axSpA demonstrated improvement from week 12 in clinical, health, productivity and MRI outcomes that was sustained to 48 weeks. TRIAL REGISTRATION NUMBER NCT01258738.
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Affiliation(s)
| | - Maxime Dougados
- Rheumatology Department, Paris Descartes University, Hôpital Cochin, Paris, France
| | | | - Joachim Sieper
- Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Gustavo Citera
- Department of Rheumatology, Instituto de Rehabilitación Psicofísica de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Joseph Wajdula
- Clinical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Heather Jones
- Medical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Lisa Marshall
- Medical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Randi Bonin
- Clinical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Ron Pedersen
- Department of Biostatistics, Pfizer, Collegeville, Pennsylvania, USA
| | - Bonnie Vlahos
- Clinical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Sameer Kotak
- Global Health and Value, Pfizer, New York, New York, USA
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Clinical characteristics of Japanese patients with axial spondyloarthritis, and short-term efficacy of adalimumab. J Orthop Sci 2015; 20:1070-7. [PMID: 26245191 PMCID: PMC4653233 DOI: 10.1007/s00776-015-0755-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 07/13/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is rarer in Japan than in Europe, probably because the European criteria, not well known by Japanese general physicians, regard AS as a progressive stage of axial spondyloarthritis (SpA). HLA-B27 is an important diagnostic marker of SpA; however, the incidence of the HLA-B27 allele is as low as 0.4 % in Japan. For Japanese SpA patients, other HLA alleles and clinical findings are required for earlier definitive diagnosis, for determining appropriate treatment timing, and for disease monitoring. METHODS We investigated the HLA-B alleles of 36 patients clinically diagnosed with SpA. For 8 axial SpA patients we evaluated the short-term efficacy of subcutaneous adalimumab injections (40 mg every other week for ≥11 months). Treatment efficacy was evaluated by use of the Bath Ankylosing Spondylitis Activity Index (BASDAI) score, and serum TNF-α and IL-6 levels were measured pre and post-treatment. RESULTS Among the 36 Japanese SpA patients, the HLA-B27 allele occurred infrequently (5.6 %) whereas the HLA-B44 and 61 alleles were the most frequently detected (25.0 %). We also detected severe bamboo spine on radiography in the absence of the HLA-B27 allele. All 8 patients with axial SpA experienced significant symptom improvement after adalimumab treatment; the HLA-B27 allele was absent from these patients. Serum TNF-α and IL-6 levels were elevated in cases with remarkable inflammatory pain and high disease activity. These cytokines decreased after therapy, however. Most patients with normal cytokine levels at baseline retained these low levels. CONCLUSIONS The findings reveal the short-term efficacy of adalimumab. The remarkably low incidence of HLA-B27 among our patients indicates that HLA-B distribution is different from that in other countries. Serum TNF-α and IL-6 levels were not effective as biomarkers for cases without high disease activity, and further research with larger samples is needed. The efficacy of TNF blockers, however, suggested a potential localized TNF effect was present among SpA patients.
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Dougados M, Wood E, Combe B, Schaeverbeke T, Miceli-Richard C, Berenbaum F, Koppiker N, Dubanchet A, Logeart I. Evaluation of the nonsteroidal anti-inflammatory drug-sparing effect of etanercept in axial spondyloarthritis: results of the multicenter, randomized, double-blind, placebo-controlled SPARSE study. Arthritis Res Ther 2014; 16:481. [PMID: 25428762 PMCID: PMC4282738 DOI: 10.1186/s13075-014-0481-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 11/04/2014] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION In clinical practice, nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly discontinued after response to biologic therapy is achieved in patients with axial spondyloarthritis (axSpA), but the impact of NSAID discontinuation has not been assessed in prospective controlled trials. The aim of the SPARSE study was to evaluate the effects of the anti-tumor necrosis factor agent etanercept on NSAID intake and conventional clinical outcomes in axSpA patients. METHODS In the double-blind, placebo-controlled period, patients with active (mini Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4) axSpA despite optimal NSAID intake were randomized to receive etanercept 50 mg or placebo once weekly for 8 weeks. All patients were advised to taper/discontinue their NSAID intake during the treatment period. NSAID intake was self-reported by diary and Assessment of SpondyloArthritis International Society (ASAS)-NSAID scores calculated based on ASAS recommendations. The primary endpoint was change from baseline to week 8 in ASAS-NSAID score (analysis of covariance). RESULTS In 90 randomized patients at baseline, mean age (standard deviation) was 38.9 (11.8) years; disease duration, 5.7 (8.1) years; 59/90 (66%) were human leukocyte antigen-B27 positive; 51/90 (57%) had radiographic sacroiliitis; and 45/90 (50%) were magnetic resonance imaging sacroiliitis-positive. Mean ASAS-NSAID scores were similar between etanercept and placebo groups at baseline (98.2 (39.0) versus 93.0 (23.4)), as were BASDAI (6.0 (1.7) versus 5.9 (1.5)), and Bath Ankylosing Spondylitis Functional Index (5.2 (2.1) versus 5.1 (2.2)). Mean changes (SE) in ASAS-NSAID score from baseline to week 8 were -63.9 (6.1) and -36.6 (5.9) in the etanercept and placebo groups (between-group difference, -27.3; P = 0.002). Significantly higher proportions of patients receiving etanercept versus placebo had an ASAS-NSAID score <10 (46% versus 17%; P = 0.008) and ASAS-NSAID score of 0 (41% versus 14%; P = 0.013) at this time point. Significantly more patients in the etanercept versus placebo group achieved BASDAI50 (39% versus 18%; P = 0.032) and ASAS40 (44% versus 21%; P = 0.028) at week 8. CONCLUSIONS In patients with axSpA, etanercept was associated with clinically relevant NSAID-sparing effects in addition to significant improvements in conventional clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01298531. Registered 16 February 2011.
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Dougados M, Heijde D, Sieper J, Braun J, Maksymowych WP, Citera G, Miceli‐Richard C, Wei JC, Pedersen R, Bonin R, Rahman MU, Logeart I, Wajdula J, Koenig AS, Vlahos B, Alvarez D, Bukowski JF. Symptomatic Efficacy of Etanercept and Its Effects on Objective Signs of Inflammation in Early Nonradiographic Axial Spondyloarthritis: A Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Trial. Arthritis Rheumatol 2014; 66:2091-102. [DOI: 10.1002/art.38721] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/20/2014] [Indexed: 01/17/2023]
Affiliation(s)
- Maxime Dougados
- Université Pierre et Marie Curie Paris 6, Hôpital Cochin, AP‐HP, INSERM U1153, and PRES Sorbonne Paris CitéParisFrance
| | | | | | | | | | - Gustavo Citera
- Instituto de Rehabilitación PsicofísicaBuenos AiresArgentina
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