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Kesarwani V, Sinnappan S, Husni ME, Weisman MH, Ermann J. Screening Tools for Spondyloarthritis in Patients With Psoriasis, Uveitis, and Inflammatory Bowel Disease: A Scoping Review. Arthritis Care Res (Hoboken) 2024; 76:860-870. [PMID: 38303576 PMCID: PMC11132942 DOI: 10.1002/acr.25308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Extramusculoskeletal manifestations of spondyloarthritis (SpA) may precede the development of articular features. Patients seen in ophthalmology, dermatology, and gastroenterology clinics with uveitis, psoriasis, or inflammatory bowel disease (IBD) may have undiagnosed SpA. We set out to identify and evaluate screening tools for SpA in patients with psoriasis, uveitis, and IBD and determine factors that influence the performance of these instruments. METHODS This scoping review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Web of Science were searched from inception to January 2022. RESULTS We identified 13 screening tools for psoriatic arthritis, 2 SpA screening tools for uveitis, and 3 SpA screening tools for IBD. All screening tools were patient-oriented questionnaires except for the Dublin Uveitis Evaluation Tool, a physician-applied algorithm. The questionnaires varied in length, scoring method, cutoff score, and spectrum of included SpA features. Average completion time was less than five minutes. Across the three patient populations, the sensitivities and specificities of these screening tools were comparable in the primary validation cohorts. Sensitivities and specificities were generally lower in secondary validation studies, with marked variability among cohorts. CONCLUSION Our results highlight the heterogeneity and limitations of existing SpA screening tools. Although these tools show promise for use within a specific target population, none are generalizable to all patients with extramusculoskeletal manifestations at risk of SpA. Future studies should explore the utility of a generic patient-oriented SpA screening tool that can be applied to patients with psoriasis, uveitis, or IBD; is easy to use and comprehend; and captures all clinical domains of SpA.
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Affiliation(s)
| | | | | | - Michael H. Weisman
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
| | - Joerg Ermann
- Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
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Walsh JA, Pei S, Alexander S, Braaten T, Walker JH, Clewell J, Douglas KM, Penmetsa GK, Ye X, Breviu B, Cannon GW, Kunkel GA, Sauer BC. Missed opportunities for treatment of inflammatory arthritis and factors associated with non-treatment: An observational cohort study in United States Veterans with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis. Semin Arthritis Rheum 2024; 66:152436. [PMID: 38714073 DOI: 10.1016/j.semarthrit.2024.152436] [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: 09/02/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE To identify factors associated with non-treatment with biologic and non-biologic disease modifying anti-rheumatic drugs (DMARDs) during the 12 months after initial inflammatory arthritis (IA) diagnosis. METHODS We identified Veterans with incident IA diagnosed in 2007-2019. We assessed time to treatment with Kaplan-Meier curves. We identified associations between non-treatment and factors relating to patients, providers, and the health system with multivariate Generalized Estimation Equation (GEE) log-Poisson. Subgroup analyses included IA subtypes (rheumatoid arthritis [RA], psoriatic arthritis [PsA], and ankylosing spondylitis [AS]) and timeframes of the initial IA diagnosis (2007-11, 2012-15, and 2016-19). RESULTS Of 18,318 study patients, 40.7 % did not receive treatment within 12 months after diagnosis. In all patients, factors associated with non-treatment included Black race (hazard ratio, 95 % confidence interval: 1.13, 1.08-1.19), Hispanic ethnicity (1.14, 1.07-1.22), Charlson Comorbidity Index ≥2, (1.15, 1.11-1.20), and opiate use (1.09, 1.05-1.13). Factors associated with higher frequency of DMARD treatment included married status (0.86, 0.81-0.91); erosion in joint imaging report (HR: 0.86, 0.81-0.91); female diagnosing provider (0.90, CI: 0.85-0.96), gender concordance between patient and provider (0.91, CI: 0.86-0.97), and diagnosing provider specialty of rheumatology (0.53, CI: 0.49-0.56). CONCLUSION A high proportion of Veterans with IA were not treated with a biologic or non-biologic DMARD within one year after their initial diagnosis. A wide range of factors were associated with non-treatment of IA that may represent missed opportunities for improving the quality of care through early initiation of DMARDs.
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Affiliation(s)
- Jessica A Walsh
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States.
| | - Shaobo Pei
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Swetha Alexander
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Tawnie Braaten
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Jodi H Walker
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Jerry Clewell
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Kevin M Douglas
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Gopi K Penmetsa
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Xiangyang Ye
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Brian Breviu
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Grant W Cannon
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Gary A Kunkel
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Brian C Sauer
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
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McDermott GC, Monshizadeh A, Selzer F, Zhao SS, Ermann J, Katz JN. Factors Associated With Diagnostic Delay in Axial Spondyloarthritis: Impact of Clinical Factors and Social Vulnerability. Arthritis Care Res (Hoboken) 2024; 76:541-549. [PMID: 37881826 PMCID: PMC10963166 DOI: 10.1002/acr.25264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/23/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Patients with axial spondyloarthritis (axSpA) often experience significant delay between symptom onset and diagnosis for reasons that are incompletely understood. We investigated associations between demographic, medical, and socioeconomic factors and axSpA diagnostic delay. METHODS We identified patients meeting modified New York criteria for ankylosing spondylitis (AS) or 2009 Assessment of Spondyloarthritis International Society criteria for axSpA in the Mass General Brigham health care system between December 1990 and October 2021. We determined the duration of diagnostic delay, defined as the duration of back pain symptoms reported at diagnosis, as well as disease manifestations and specialty care prior to diagnosis from the electronic health record. We obtained each patient's Social Vulnerability Index (SVI) by mapping their address to the US Centers for Disease Control SVI Atlas. We examined associations among disease manifestations, SVI, and diagnostic delay using ordinal logistic regression. RESULTS Among 554 patients with axSpA who had a median diagnostic delay of 3.8 years (interquartile range 1.1-10), peripheral arthritis (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.45-0.93) and older age at symptom onset (OR 0.83, 95% CI 0.78-0.88 per five years) were associated with shorter delay. AS at diagnosis (OR 1.85, 95% CI 1.30-2.63), a history of uveitis prior to diagnosis (OR 2.77, 95% CI 1.73-4.52), and higher social vulnerability (defined as national SVI 80th to 99th percentiles; OR 1.99, 95% CI 1.06-3.84) were associated with longer diagnostic delay. CONCLUSION Older age at back pain onset and peripheral arthritis were associated with shorter delay, whereas uveitis was associated with longer diagnostic delay. Patients with higher socioeconomic vulnerability had longer diagnostic delay independent of clinical factors.
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Affiliation(s)
- Gregory C McDermott
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Faith Selzer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Joerg Ermann
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Liu WX, Wu H, Cai C, Lai QQ, Wang Y, Li YZ. Research on automatic recognition radiomics algorithm for early sacroiliac arthritis based on sacroiliac MRI imaging. J Orthop Surg Res 2024; 19:96. [PMID: 38287422 PMCID: PMC10826273 DOI: 10.1186/s13018-024-04569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE To create an automated machine learning model using sacroiliac joint MRI imaging for early sacroiliac arthritis detection, aiming to enhance diagnostic accuracy. METHODS We conducted a retrospective analysis involving 71 patients with early sacroiliac arthritis and 85 patients with normal sacroiliac joint MRI scans. Transverse T1WI and T2WI sequences were collected and subjected to radiomics analysis by two physicians. Patients were randomly divided into training and test groups at a 7:3 ratio. Initially, we extracted the region of interest on the sacroiliac joint surface using ITK-SNAP 3.6.0 software and extracted radiomic features. We retained features with an Intraclass Correlation Coefficient > 0.80, followed by filtering using max-relevance and min-redundancy (mRMR) and LASSO algorithms to establish an automatic identification model for sacroiliac joint surface injury. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was calculated. Model performance was assessed by accuracy, sensitivity, and specificity. RESULTS We evaluated model performance, achieving an AUC of 0.943 for the SVM-T1WI training group, with accuracy, sensitivity, and specificity values of 0.878, 0.836, and 0.943, respectively. The SVM-T1WI test group exhibited an AUC of 0.875, with corresponding accuracy, sensitivity, and specificity values of 0.909, 0.929, and 0.875, respectively. For the SVM-T2WI training group, the AUC was 0.975, with accuracy, sensitivity, and specificity values of 0.933, 0.889, and 0.750. The SVM-T2WI test group produced an AUC of 0.902, with accuracy, sensitivity, and specificity values of 0.864, 0.889, and 0.800. In the SVM-bimodal training group, we achieved an AUC of 0.974, with accuracy, sensitivity, and specificity values of 0.921, 0.889, and 0.971, respectively. The SVM-bimodal test group exhibited an AUC of 0.964, with accuracy, sensitivity, and specificity values of 0.955, 1.000, and 0.875, respectively. CONCLUSION The radiomics-based detection model demonstrates excellent automatic identification performance for early sacroiliitis.
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Affiliation(s)
- Wen-Xi Liu
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Hong Wu
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Chi Cai
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Qing-Quan Lai
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Yi Wang
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China.
| | - Yuan-Zhe Li
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China.
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Zheng X, Chen Z, Wu X, Xie Y, Wu J, Xiao M, Yang M, Tu L, Cao S, Wei Q, Gu J. Diagnostic delay and its associated factors in Chinese axial spondyloarthritis: A single-center study of 1295 patients. Int J Rheum Dis 2024; 27:e14975. [PMID: 37965927 DOI: 10.1111/1756-185x.14975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
AIM To delineate the landscape of diagnostic delay in Chinese axial spondyloarthritis (axSpA), investigate its associated factors, and explore its potential impact on medication modalities. METHODS A total of 1295 patients fulfilling the ASAS classification criteria were obtained. Demographic and clinical data were collected through face-to-face interviews, based on predesigned questionnaires and available medical records. Logistic regression analyses under univariate and multivariable model were performed, using the median of diagnostic delay as the cut-off point for group classification. Differences between early- and late-diagnosed groups were subsequently compared by the Pearson chi-square test or Mann-Whitney U test. RESULTS Of 1295 axSpA patients, 80.3% were male and the median of disease duration was 8.0 years. The median (IQR) diagnostic delay in Chinese axSpA was 3.0 (1.0 ~ 7.0) years and 24.8% of them reported a history of misdiagnosis. Older age at onset (OR = 0.97, p < .001) and higher education attainment (p = .001) were correlated with early diagnosis of axSpA, whereas coming from less developed areas (p = .002), a history of peripheral arthritis at the time of diagnosis (OR = 1.58, p = .002) and history of misdiagnosis (OR = 1.98, p < .001) increased the risk of diagnostic delay. Oral medication modalities were similar between two groups, but the proportion with no medication ever was higher in the late-diagnosed group (26.5% vs. 20.7%, p = .02). CONCLUSION Our findings depicted a detailed spectrum of diagnostic delay in Chinese axSpA, verified five associated factors that may help facilitate timely diagnosis of axSpA, and pinpointed that timely medication was unsatisfying, especially in the late diagnosis group.
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Affiliation(s)
- Xuqi Zheng
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zena Chen
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinyu Wu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ya Xie
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jialing Wu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Xiao
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingcan Yang
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liudan Tu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuangyan Cao
- Department of Rheumatology and Immunology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Qiujing Wei
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Yen YN, Garrido-Cumbrera M, Sun YS, Chen CH, Lai CC, Tsai HC, Chen WS, Liao HT, Tsao YP, Tsai CY, Chou CT. The Taiwanese Map of Axial Spondyloarthritis: Living with the Condition. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1962. [PMID: 38004011 PMCID: PMC10673106 DOI: 10.3390/medicina59111962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/14/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
Background and Objective: The International Map of Axial Spondyloarthritis (IMAS) explores the physical, psychological, and social experiences of patients with axial spondyloarthritis (axSpA). This initiative is now being expanded to Taiwan as the Taiwanese Map of Axial Spondyloarthritis (TMAS). We aim to provide rheumatologists with insights into the perspectives of Taiwanese patients, enabling physicians to better understand the unmet needs of these patients and optimize their management. Materials and Methods: The TMAS is a cross-sectional study gathering data through an online survey of axSpA patients, promoted by the Ankylosing Spondylitis Caring Society of R.O.C. (ASCARES), conducted from July 2017 to March 2018 by Ipsos, and analyzed by the Health & Territory Research (HTR) group of the University of Seville. The questionnaire includes 99 questions that cover domains such as patient profile, diagnosis, habits/lifestyle, employment status, physical/psychological health status, social support, use of healthcare services, and treatments. Results: A total of 112 axSpA patients were included in this survey. The mean age was 38.6 years and 75.0% were male. The average diagnostic delay was 3 years, and 19.6% reported extra-articular manifestations. Out of the 49 respondents who reported HLA-B27 information, 35 were HLA-B27-positive. The disease burden was high, with a mean BASDAI score of 4.9 and 75.9% having a mild to moderate degree of spinal stiffness. Furthermore, they were socially and psychologically burdened, with 88.4% experiencing work-related issues and 25.9% suffering from anxiety. Conclusions: The TMAS sheds light on the overall perspective of axSpA patients in Taiwan. The TMAS shows shorter diagnostic delay compared to patients from the EMAS. However, high disease activity and significant psychological distress still trouble the patients, causing functional impairments and even leading to career failures. Understanding the perspective of axSpA patients can help rheumatologists adjust treatment strategies to their unmet needs and improve their disease outcomes.
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Affiliation(s)
- Yi-Ning Yen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (Y.-N.Y.); (C.-H.C.)
| | - Marco Garrido-Cumbrera
- Health & Territory Research (HTR), Universidad de Sevilla, 41004 Sevilla, Spain;
- Axial Spondyloarthritis International Federation (ASIF), London WC1N 3AX, UK
| | - Yi-Syuan Sun
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Chen-Hung Chen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (Y.-N.Y.); (C.-H.C.)
| | - Chien-Chih Lai
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Hung-Cheng Tsai
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Wei-Sheng Chen
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Yen-Po Tsao
- Division of Holistic and Multidisciplinary Medicine, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan;
| | | | - Chang-Youh Tsai
- Division of Immunology and Rheumatology, Fu Jen Catholic University Hospital, College of Medicine, Fu Jen Catholic University, New Taipei City 243, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
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7
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Van Den Berghe T, Babin D, Chen M, Callens M, Brack D, Maes H, Lievens J, Lammens M, Van Sumere M, Morbée L, Hautekeete S, Schatteman S, Jacobs T, Thooft WJ, Herregods N, Huysse W, Jaremko JL, Lambert R, Maksymowych W, Laloo F, Baraliakos X, De Craemer AS, Carron P, Van den Bosch F, Elewaut D, Jans L. Neural network algorithm for detection of erosions and ankylosis on CT of the sacroiliac joints: multicentre development and validation of diagnostic accuracy. Eur Radiol 2023; 33:8310-8323. [PMID: 37219619 DOI: 10.1007/s00330-023-09704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/25/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the feasibility and diagnostic accuracy of a deep learning network for detection of structural lesions of sacroiliitis on multicentre pelvic CT scans. METHODS Pelvic CT scans of 145 patients (81 female, 121 Ghent University/24 Alberta University, 18-87 years old, mean 40 ± 13 years, 2005-2021) with a clinical suspicion of sacroiliitis were retrospectively included. After manual sacroiliac joint (SIJ) segmentation and structural lesion annotation, a U-Net for SIJ segmentation and two separate convolutional neural networks (CNN) for erosion and ankylosis detection were trained. In-training validation and tenfold validation testing (U-Net-n = 10 × 58; CNN-n = 10 × 29) on a test dataset were performed to assess performance on a slice-by-slice and patient level (dice coefficient/accuracy/sensitivity/specificity/positive and negative predictive value/ROC AUC). Patient-level optimisation was applied to increase the performance regarding predefined statistical metrics. Gradient-weighted class activation mapping (Grad-CAM++) heatmap explainability analysis highlighted image parts with statistically important regions for algorithmic decisions. RESULTS Regarding SIJ segmentation, a dice coefficient of 0.75 was obtained in the test dataset. For slice-by-slice structural lesion detection, a sensitivity/specificity/ROC AUC of 95%/89%/0.92 and 93%/91%/0.91 were obtained in the test dataset for erosion and ankylosis detection, respectively. For patient-level lesion detection after pipeline optimisation for predefined statistical metrics, a sensitivity/specificity of 95%/85% and 82%/97% were obtained for erosion and ankylosis detection, respectively. Grad-CAM++ explainability analysis highlighted cortical edges as focus for pipeline decisions. CONCLUSIONS An optimised deep learning pipeline, including an explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical performance on a slice-by-slice and patient level. CLINICAL RELEVANCE STATEMENT An optimised deep learning pipeline, including a robust explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical metrics on a slice-by-slice and patient level. KEY POINTS • Structural lesions of sacroiliitis can be detected automatically in pelvic CT scans. • Both automatic segmentation and disease detection yield excellent statistical outcome metrics. • The algorithm takes decisions based on cortical edges, rendering an explainable solution.
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Affiliation(s)
- Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Danilo Babin
- Department of Telecommunication and Information Processing - Image Processing and Interpretation (TELIN-IPI), Faculty of Engineering and Architecture, Ghent University - IMEC, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Martijn Callens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Denim Brack
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Helena Maes
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jan Lievens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marie Lammens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Maxime Van Sumere
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Simon Hautekeete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stijn Schatteman
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Tom Jacobs
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Willem-Jan Thooft
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Wouter Huysse
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Robert Lambert
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Walter Maksymowych
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstraße 45, 44649, Herne, Germany
| | - Ann-Sophie De Craemer
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Kiwalkar S, Howard R, Choi D, Deodhar A. A mixed methods study to uncover impediments to accurate diagnosis of nonradiographic axial spondyloarthritis in the USA. Clin Rheumatol 2023; 42:2811-2822. [PMID: 37347434 DOI: 10.1007/s10067-023-06671-z] [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: 06/10/2022] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION/OBJECTIVES Delayed diagnosis of axial spondyloarthritis (axSpA) is well documented; little is known about the diagnostic journey and impediments for US patients with nonradiographic axSpA (nr-axSpA). It is hypothesized that impediments are varied and exist at both the healthcare provider (HCP) and patient levels. This study aims to understand patient experiences and contributors to delayed nr-axSpA diagnosis in the USA. METHOD Interviews of adults with rheumatologist-diagnosed nr-axSpA, recruited through Spondylitis Association of America outreach and patient panels, and of rheumatologists, explored the diagnostic journey and diagnostic barriers. Emerging themes were further explored in an online patient survey. A multiple logistic regression analysis evaluated the main outcome variable, factors affecting time to nr-axSpA diagnosis. RESULTS Interviews were conducted with 25 patients and 16 rheumatologists. Survey responses from 186 eligible patients revealed median time from symptom onset to diagnosis of nr-axSpA was 3.25 years. Delayed diagnosis was significantly more likely for women and people in rural areas. Most patients consulted ≥4 different types of HCPs before a rheumatologist and ≥2 rheumatologists before diagnosis. Impediments to timely diagnosis included insidious chronic pain; episodic symptom patterns attributed to activity; symptoms other than chronic lumbosacral back pain requiring medical consultation; and unfamiliarity with and misperceptions about nr-axSpA among HCPs, radiologists, and rheumatologists. CONCLUSIONS Delayed nr-axSpA diagnosis is common and reflects HCP knowledge gaps and frequent patient presentation with dominant nonaxial symptoms. Targeted HCP education, research into early disease patterns, and interventions sensitive to the broader spectrum of nr-axSpA manifestations are needed to improve timely diagnosis. Key Points • Patients with nr-axSpA often see multiple types of HCPs, and multiple rheumatologists, before receiving a diagnosis. • Both patients and HCPs are unfamiliar with nr-axSpA and its symptoms, lacking understanding that nr-axSpA can occur in young people, females, and those presenting with normal x-rays. • Disease recognition by nonrheumatology HCPs is key for early referral. • Education on cardinal features, epidemiology, burden, and benefits of timely nr-axSpA diagnosis is warranted for HCPs who commonly manage back pain.
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Affiliation(s)
- Sonam Kiwalkar
- The Vancouver Clinic, Washington State University, 700 NE 87th Avenue, Suite 330, Vancouver, WA, 98664, USA.
| | - Richard Howard
- Spondylitis Association of America, 16430 Ventura Blvd, Suite 300, Encino, CA, 91436, USA
| | - Dongseok Choi
- Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, 1810 SW 5th Ave. Suite 510, Portland, OR, 97201, USA
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, 3270 SW Pavilion Loop, Portland, OR, 97239, USA
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Al Rayes H, Salah H, Hamad T, Soliman M, Bedaiwi M. The Impact of Spondyloarthritis on Health-Related Quality of Life and Healthcare Resource Utilization in Saudi Arabia: A Narrative Review and Directions for Future Research. Open Access Rheumatol 2023; 15:161-171. [PMID: 37705696 PMCID: PMC10497044 DOI: 10.2147/oarrr.s414530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/04/2023] [Indexed: 09/15/2023] Open
Abstract
Spondylarthritis (SpA) is an umbrella term that encompasses a wide range of rheumatological disorders. Several studies demonstrated that SpA is associated with increased healthcare resource utilization (HCRU) and a lower health-related quality of life (HRQoL). This review aimed to summarize the current literature regarding the multidimensional impact of SpA on HRQoL and HCRU in Saudi Arabia and explore the correlation of the extent of severity of SpA with HRQoL and HCRU. Although the prevalence of SpA varies across different populations and is correlated with HLA-B27 prevalence, the magnitude of SpA in the Saudi population has not been extensively evaluated. Few studies have investigated the impact of SpA on HRQoL and HCRU in Saudi Arabia and the Middle East. There is a need to study the cost-effectiveness of various SpA treatment strategies, including biologic disease-modifying anti-rheumatic drugs (bDMARDs), to prioritize healthcare spending in the Saudi healthcare system. Data on SpA in Saudi Arabia and the Middle East region are mainly based on expert views, with few population-based studies compared to other regions. Therefore, there is an imperative need to develop high-quality, national-level epidemiological studies that assess the following: (1) more accurate estimates of the current prevalence of SpA in Saudi Arabia, including the prevalence of axial SpA and psoriatic arthritis; (2) the phenotypes/clinical characteristics of SpA, including disease severity and extra-articular involvement; (3) the impact of SpA on the HRQoL of the patients and the factors that can predict the extent of impaired HRQoL in such population, which can represent the first step in developing psychological interventions that should be personalized to this patient population; (4) the impact of implementing formal assessment of disease activity on the management of the patients and, subsequently, their HRQoL; and (5) the HCRU and costs for patients with SpA, and how treatment patterns can affect this cost.
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Affiliation(s)
- Hanan Al Rayes
- Division of Rheumatology, Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hany Salah
- Therapeutic Area Lead Rheumatology, Intercontinental, AbbVie Biopharmaceuticals GmbH, Dubai, United Arab Emirates
| | - Tharwat Hamad
- Medical Manager, Immunology, AbbVie Biopharmaceuticals GmbH, Jeddah, Saudi Arabia
| | - Mohab Soliman
- Medical Advisor, Rheumatology, AbbVie Biopharmaceuticals GmbH, Riyadh, Saudi Arabia
| | - Mohamed Bedaiwi
- Division of Rheumatology, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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10
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Barnett R, Gaffney K, Sengupta R. Diagnostic delay in axial spondylarthritis: A lost battle? Best Pract Res Clin Rheumatol 2023; 37:101870. [PMID: 37658016 DOI: 10.1016/j.berh.2023.101870] [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: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023]
Abstract
Diagnostic delay in axial spondylarthritis (axSpA) remains an unacceptable worldwide problem; with evidence suggesting significant detrimental impact both clinically on the individual, and economically on society. There is therefore, a need for global action across various healthcare professions that come into contact with patients living, and suffering, with undiagnosed axSpA. Recent estimates of the median diagnostic delay suggest that globally, individuals with axSpA wait between 2 and 6 years for a diagnosis - revealing a clear benchmark for improvement. This timespan presents a window of opportunity for earlier diagnosis and intervention, which will likely improve patient outcomes. This review describes the current diagnostic delay as estimated across countries and over time, before presenting evidence from published strategies that may be implemented to improve this delay across primary and secondary care, including for specialties treating extra-musculoskeletal manifestations of axSpA (ophthalmology, gastroenterology, dermatology). Ongoing campaigns tackling delayed diagnosis in axSpA are also highlighted.
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Affiliation(s)
- Rosemarie Barnett
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK; Rheumatology Department, Royal National Hospital for Rheumatic Diseases & Brownsword Therapies Centre, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk & Norwich, University Hospital, Colney Lane, Norwich NR4 7UY, UK.
| | - Raj Sengupta
- Rheumatology Department, Royal National Hospital for Rheumatic Diseases & Brownsword Therapies Centre, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
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11
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Martín-Noguerol T, Casado-Verdugo OL, Beltrán LS, Aguilar G, Luna A. Role of advanced MRI techniques for sacroiliitis assessment and quantification. Eur J Radiol 2023; 163:110793. [PMID: 37018900 DOI: 10.1016/j.ejrad.2023.110793] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/07/2023]
Abstract
The introduction of MRI was supposed to be a qualitative leap for the evaluation of Sacroiliac Joint (SIJ) in patients with Axial Spondyloarthropathies (AS). In fact, MRI findings such as bone marrow edema around the SIJ has been incorporated into the Assessment in SpondyloArthritis International Society (ASAS criteria). However, in the era of functional imaging, a qualitative approach to SIJ by means of conventional MRI seems insufficient. Advanced MRI sequences, which have successfully been applied in other anatomical areas, are demonstrating their potential utility for a more precise assessment of SIJ. Dixon sequences, T2-mapping, Diffusion Weighted Imaging or DCE-MRI can be properly acquired in the SIJ with promising and robust results. The main advantage of these sequences resides in their capability to provide quantifiable parameters that can be used for diagnosis of AS, surveillance or treatment follow-up. Further studies are needed to determine if these parameters can also be integrated into ASAS criteria for reaching a more precise classification of AS based not only on visual assessment of SIJ but also on measurable data.
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Affiliation(s)
| | - Oscar L Casado-Verdugo
- Osatek Alta Tecnología Sanitaria S.A., Department of Magnetic Resonance Imaging, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Luis S Beltrán
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Antonio Luna
- MRI Unit, Radiology Department, HT Medica, Jaén, Spain
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12
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Kerola AM, Rollefstad S, Kazemi A, Wibetoe G, Sexton J, Mars N, Kauppi M, Kvien TK, Haavardsholm EA, Semb AG. Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents. Scand J Rheumatol 2023; 52:42-50. [PMID: 35014920 DOI: 10.1080/03009742.2021.1997436] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA) and the use of biologic agents in these diseases in Norway. METHODS From the Norwegian Patient Registry (NPR), we identified as PsA, axSpA and RA patients ≥18 years those with ≥2 recorded episodes with diagnostic coding for index disease (L40.5, M07.0-M07.3 for PsA; M45, M46.0, M46.1, M46.8 and M46.9 for axSpA; M05-M06 for RA). We calculated the point prevalence of PsA, axSpA and RA as per the 1st of January 2017 in the Norwegian adult population (age ≥18). Dispensed disease-modifying antirheumatic drug (DMARD) prescriptions were obtained from the Norwegian Prescription Database and biologic DMARDs given in hospitals from the NPR. RESULTS The point prevalence of PsA, axSpA, RA, and any of these diseases in total was 0.46%, 0.41%, 0.78%, and 1.56%, respectively. Among women, the prevalence of PsA, axSpA, and RA was 0.50%, 0.37%, and 1.10%, and among men 0.43%, 0.45%, and 0.46%, respectively. In 2017, 27.3% of RA patients, 25.7% of PsA patients and 35.1% of axSpA patients used biologic DMARDs. Treatment with biologics was more frequent in younger age groups in all three diseases, and became more infrequent especially after age ≥55 years. CONCLUSION In Norway, the combined prevalence of PsA, axSpA, and RA was over 1.5%. Reflecting the good overall access to highly effective but costly biologic treatments, more than a fourth of these patients used biologic agents, which corresponds to over 0.4% of Norwegian adult population.
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Affiliation(s)
- A M Kerola
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - S Rollefstad
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - A Kazemi
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - G Wibetoe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - N Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - M Kauppi
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Clinicum, University of Helsinki, Helsinki, Finland
| | - T K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - E A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A G Semb
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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13
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Hahn S, Song JS, Choi EJ, Cha JG, Choi Y, Ju Song Y, Kim I, Park EH. Can Bone Erosion in Axial Spondyloarthropathy be Detected by Ultrashort Echo Time Imaging? A Comparison With Computed Tomography in the Sacroiliac Joint. J Magn Reson Imaging 2022; 56:1580-1590. [PMID: 35247216 DOI: 10.1002/jmri.28110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Structural lesion evaluation in axial spondyloarthropathy (SpA) can improve accuracy of diagnosis. However, structural lesions (bone erosions) are difficult to be assessed using conventional MRI compared to computed tomography (CT). PURPOSE To evaluate the diagnostic performance of ultrashort echo time (UTE) for detecting bone erosion in axial SpA compared to T1WI and three-dimensional double-echo steady-state (3D DESS) imaging using CT as the reference standard. STUDY TYPE Retrospective. POPULATION Fourteen patients (eight females, 57.1%) and 14 healthy controls (seven females, 50.0%) who underwent sacroiliac (SI) joint MRI and CT. FIELD STRENGTH/SEQUENCE 3 T; TSE T1WI, 3D DESS, 2D UTE. ASSESSMENT The bilateral SI joints were assessed for bone erosion. Three observers scored bone erosion for all three sequences of MRI. CT was used as the gold standard. Diagnostic confidence in axial SpA was measured based on a four-point confidence score. STATISTICAL TESTS Correlation of erosion scores between CT and MRI were evaluated using Spearman's correlation test. Sensitivity, specificity, and positive-negative predictive values were calculated. Confidence scores were compared using the Wilcoxon sum rank test. Statistical significance was set at P < 0.05. RESULTS Compared with erosion scores of CT, the correlation coefficients for each MRI sequence showed significant low-to-high positive correlations (0.39-0.72). UTE imaging showed the highest correlation coefficients for all observers (0.70, 0.72, and 0.67, respectively). The specificity of UTE imaging was equal or higher than those of T1WI and 3D DESS for all observers (0.86 vs. 0.71 vs. 0.57; 0.93 vs. 0.71 vs. 0.57; 0.79 vs. 0.79 vs. 0.43). All observers had the highest confidence in interpreting UTE imaging for detecting bone erosion among the three sequences (3.5, 3.4, and 3.3 for UTE; 3.1, 3.0, and 2.6 for T1WI; and 3.2, 2.7, and 2.4 for DESS). DATA CONCLUSION UTE imaging can detect bone erosions in patients with axial SpA and show higher specificity than conventional T1WI and 3D DESS. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Seok Hahn
- Department of Radiology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Eun Jung Choi
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon-si, Republic of Korea
| | - Yunjung Choi
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Division of Rheumatology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Young Ju Song
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - InSeong Kim
- Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Eun Hae Park
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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14
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Aljohani R, Barradah N, Kashkari A. Awareness and knowledge of the common features of inflammatory back pain among primary care physicians in the western region of Saudi Arabia. Medicine (Baltimore) 2022; 101:e31626. [PMID: 36316825 PMCID: PMC9622622 DOI: 10.1097/md.0000000000031626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Often, there is a delay in the diagnosis of inflammatory back pain (IBP) in the primary care setting. This may be attributed to the inability of healthcare providers to distinguish between inflammatory and mechanical back pain. This study aimed to evaluate primary care physicians' current practices for assessing patients with IBP using clinical, radiographic, and laboratory tests. A questionnaire-based survey was emailed to all primary care physicians in the western region of Saudi Arabia by the Saudi Commission of Health Specialists from February to May 2021. The questionnaire included data about axial spondyloarthropathy based on the Calin, Berlin, and European Spondyloarthropathy Study Group criteria. A total of 103 primary care physicians responded who represented around 24% of primary care physicians at primary healthcare. The most often perceived IBP symptoms include a response to NSAIDs, morning stiffness lasting >30 minutes, age of onset <45 years old, duration of back pain >3 months, and improvement with exercise. The most frequently questioned patient or family history conditions were peripheral arthritis (92.2%), family history of spondyloarthritis (83.5%), and inflammatory bowel disease (97.6%). The most-reported investigations were CRP/ESR (86.4%) and spinal radiography (66%). For treatment of IBP, NSAIDs were most prescribed (48.6%), followed by physiotherapy (45.6%) and disease-modifying anti-rheumatic drugs (41.7%). Primary care physicians were more confident in management of mechanical back pain than IBP (P < .001). Primary care physicians have good knowledge of IBP symptoms but not of disease-specific features and modest confidence in evaluating patients with IBP, indicating the need for educational programs and a more effective, feasible referral strategy.
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Affiliation(s)
- Roaa Aljohani
- Department of Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia
- *Correspondence: Roaa Aljohani, Department of Medicine, College of Medicine, Taibah University, Madinah 42312, Saudi Arabia (e-mail: )
| | - Noha Barradah
- Department of Medicine, Taibah University, Medina, Saudi Arabia
| | - Amnah Kashkari
- Department of Medicine, Taibah University, Medina, Saudi Arabia
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Navarro-Compán V, Ermann J, Poddubnyy D. A glance into the future of diagnosis and treatment of spondyloarthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111611. [PMID: 35898564 PMCID: PMC9310200 DOI: 10.1177/1759720x221111611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
The last two decades have seen major developments in the field of
spondyloarthritis (SpA), but there are still important unmet needs to address.
In the future, we envisage important advances in the diagnosis and treatment of
SpA. In the diagnosis of SpA, the use of online and social media tools will
increase awareness of the disease and facilitate the referral of patients to
rheumatology clinics. In addition, more specific diagnostic tests will be
available, especially advanced imaging methods and new biomarkers. This will
allow most patients to be diagnosed at an early stage of the disease. In the
treatment of SpA, an increasing number of novel treatment targets can be
expected, most of which will be directed against intracellular enzymes. We hope
to see more strategy trials shaping treatment pathways in SpA and accommodating
principals of precision medicine. Approved treatment options will be available
for both axial and peripheral SpA. We also hope to intervene not only at the
inflammation level but also at the level of underlying immunological processes
that might be associated with a higher probability of long-standing remission if
not a cure. Finally, artificial intelligence techniques will allow for the
analysis of large-scale data to answer relevant research questions for the
diagnosis and management of patients with SpA.
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Affiliation(s)
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin 12203, Germany
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16
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Shridharmurthy D, Lapane KL, Khan S, Yi E, Baek J, Kay J, Liu SH. Development and test–retest reliability of a screening tool for axial spondyloarthritis. PLoS One 2022; 17:e0269494. [PMID: 35802613 PMCID: PMC9269406 DOI: 10.1371/journal.pone.0269494] [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: 11/22/2021] [Accepted: 05/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background People with axial Spondyloarthritis (axSpA) suffer from lengthy diagnostic delays of ~7 years. The usage of screening tools to identify axSpA patients in primary care can reduce diagnostic delays by facilitating early referral to rheumatologic care. The purpose of this study was to examine the psychometric properties of a potential screening tool for patients with axSpA. Method Content validity was evaluated by soliciting feedback from 7 rheumatologists regarding the relevance and content representativeness of the proposed screening questions. For the test-retest study, participants ≥18 years of age with chronic back pain (≥3 months) without a diagnosis of mechanical or inflammatory back pain (n = 91) were e-recruited through ResearchMatch. Participation included completing identical baseline and follow-up questionnaires ~14 days apart. Weighted quadratic kappa was used to measure test-retest reliability between the two ratings of the ordinal scales. Construct validity was examined using exploratory factor analysis (EFA) and items with factor loadings ≥0.6 were extracted. Scale dimensionality and simplified factorial solutions were measured using Kaiser’s criteria (Eigenvalue >1). Cronbach’s alpha was used to measure internal consistency. Results Most participants were women, non-Hispanic white, and had at least some college education, with a mean age of 45 years. On average, the age at onset of back pain was 31 years. Eleven questions yielded test–retest reliabilities ranging from 0.6 to 0.76. Results from EFA extracted two factors relating to: 1) how pain affects daily life functioning and 2) whether pain improves with movement. Internal consistency was high for questions evaluating how pain affects life, with a Cronbach’s alpha of 0.81. Following assessment for validity and reliability, the questionnaire was revised to create the 6-item screening tool. Conclusions The 6-item SpA-SED screening tool designed to identify potential cases of axSpA was found to have good test–retest reliability and high internal consistency.
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Affiliation(s)
- Divya Shridharmurthy
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, T.H. Chan School of Medicine at UMass Chan Medical School, Worcester, Massachusetts, United States of America
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences at UMass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, T.H. Chan School of Medicine at UMass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Sara Khan
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, T.H. Chan School of Medicine at UMass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
| | - Jonggyu Baek
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, T.H. Chan School of Medicine at UMass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Jonathan Kay
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, T.H. Chan School of Medicine at UMass Chan Medical School, Worcester, Massachusetts, United States of America
- Division of Rheumatology, Department of Medicine, T.H. Chan School of Medicine at UMass Chan Medical School, Worcester, Massachusetts, United States of America
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts, United States of America
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, T.H. Chan School of Medicine at UMass Chan Medical School, Worcester, Massachusetts, United States of America
- Division of Rheumatology, Department of Medicine, T.H. Chan School of Medicine at UMass Chan Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
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Magrey M, Schwartzman S, de Peyrecave N, Sloan VS, Stark JL. Nonradiographic axial spondyloarthritis: expanding the spectrum of an old disease: A narrative review. Medicine (Baltimore) 2022; 101:e29063. [PMID: 35475794 PMCID: PMC9276084 DOI: 10.1097/md.0000000000029063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/24/2022] [Indexed: 01/04/2023] Open
Abstract
Nonradiographic axial spondyloarthritis (nr-axSpA) represents a distinct phenotype within the spectrum of axial spondyloarthritis (axSpA), which is characterized by a range of clinical manifestations. Despite a high disease burden that is comparable to ankylosing spondylitis (also known as radiographic axSpA), there is an unmet need to recognize and effectively manage patients with active nr-axSpA.A targeted literature search was conducted in OVID (MEDLINE and Embase databases) to identify articles on nr-axSpA, including its definition, demographics, epidemiology, burden, diagnosis, clinical presentation, and treatment guidelines.The lack of adequate epidemiological data and incomplete understanding of nr-axSpA among rheumatologists and nonrheumatologists contributes to delayed referrals and diagnosis. This delay results in a substantial burden on patients, physically and psychologically, and the healthcare system. Targeted therapies, such as biologics, including inhibitors of tumor necrosis factor or interleukin-17A, have been approved and utilized for the management of nr-axSpA, and other novel therapeutics with different mechanisms of action are in development. Raising awareness among US internists regarding the prevalence of nr-axSpA, disease burden, clinical presentation, diagnostic tools, and available treatments is important for improved disease management.Future clinical investigations focusing on the development of markers that aid early diagnosis and predict treatment response may also improve the management of nr-axSpA. This review provides an overview of nr-axSpA with the aim of raising awareness of the disease among US internists, with an overarching goal to contribute toward the improved recognition and timely referral of these patients to rheumatologists for diagnosis and management.
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Affiliation(s)
- Marina Magrey
- Case Western Reserve University School of Medicine at MetroHealth Medical Center, Department of Medicine, Division of Rheumatology, Cleveland, OH
- University Hospitals Cleveland Medical Center School of Medicine, Division of Rheumatology, Cleveland, OH
| | | | | | - Victor S. Sloan
- Sheng Consulting LLC, Flemington, NJ
- Rutgers Robert Wood Johnson Medical School, Division of Rheumatology and Connective Tissue Research, New Brunswick, NJ
- The Peace Corps, Washington, DC
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Gavigan K, Nowell WB, Hunter T, Curtis JR, Malatestinic WN, Bolce RJ, Lisse JR, Walsh J. Employment, Work Productivity, and Biologic Treatments in Self-Reported Axial Spondyloarthritis: a Cross-Sectional Study in a Female Predominant Population from the ArthritisPower Registry. Rheumatol Ther 2022; 9:663-677. [PMID: 35191010 PMCID: PMC8964841 DOI: 10.1007/s40744-022-00428-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The aim of this study was to characterize employment, work productivity, and biologic disease-modifying anti-rheumatic drug (bDMARD) treatment in a predominantly female population of axial spondyloarthritis (axSpA) patients in a real-world setting. METHODS This was a cross-sectional study of axSpA participants within the ArthritisPower registry. Outcomes were assessed with surveys (Work Productivity and Activity Impairment [WPAI], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], and Patient-Reported Outcomes Measurement Information System instruments) and compared between subgroups (employed vs. not employed; taking vs. not taking a bDMARD). RESULTS Among the 195 participants, 117 (60.0%) were employed and 78 (40.0%) were not employed entirely or partially due to axSpA. The mean age of the participants was 47.6 years and 86.7% were female. Current bDMARD use was reported by 57.4% of those surveyed (59.8% employed vs. 53.9% not employed; p = 0.408). Compared to not employed participants, employed participants had more favorable disease activity (BASDAI 6.0 vs. 7.6; p < 0.001) and overall health (self-rated health 2.5 vs. 1.8; p < 0.001). Employed participants, compared to not employed participants, were diagnosed at an earlier age (36.0 vs. 42.5 years, respectively) and experienced a shorter time between symptom onset and diagnosis (9.5 vs. 13.6 years, respectively). Employed participants reported missing on average 6.5 days of work and experienced a 52.7% impairment on work productivity due to axSpA over a 3-month period. Absenteeism and presenteeism were statistically similar between participants taking a bDMARD versus those not taking a bDMARD. CONCLUSIONS Although bDMARD treatment rates were similar between employed and not employed participants, disease activity and overall health were better in employed than non-employed participants. Employed participants experienced substantial work productivity impairment due to axSpA.
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Affiliation(s)
- Kelly Gavigan
- Global Healthy Living Foundation, 515 N Midland Ave, Upper Nyack, NY, 10960, USA.
| | - W Benjamin Nowell
- Global Healthy Living Foundation, 515 N Midland Ave, Upper Nyack, NY, 10960, USA
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Pooled safety results across phase 3 randomized trials of intravenous golimumab in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Arthritis Res Ther 2022; 24:73. [PMID: 35313978 PMCID: PMC8935699 DOI: 10.1186/s13075-022-02753-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/27/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Intravenous (IV) golimumab, a TNFi, is approved for treating rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). We analyzed pooled safety results from three phase 3 IV golimumab trials in these rheumatologic diseases and hypothesized that the safety profile of IV golimumab would be similar to that established for other TNFi, including subcutaneous golimumab. METHODS Data from three double-blind, randomized trials of IV golimumab in patients with RA, PsA, and AS, each with a placebo-controlled period and an extension of active treatment, were included. Golimumab 2 mg/kg was administered at weeks 0 and 4, then every 8 weeks through week 100 (RA) or week 52 (PsA, AS). Concomitant low-dose, oral corticosteroids were permitted. Concomitant methotrexate was required in the RA trial and permitted in the PsA and AS trials; placebo patients crossed over to golimumab at weeks 24 (RA, PsA) and 16 (AS), respectively. Adverse events (AEs), including infections, serious infections, malignancies, and major adverse cardiovascular events (MACE), were assessed through week 112 (RA) or week 60 (PsA, AS). RESULTS In total, 539 patients were randomized to placebo, and 740 patients were randomized to golimumab; 1248 patients received ≥ 1 golimumab administration. Among the placebo and golimumab patients, respectively, during the placebo-controlled periods, 40.6% and 50.3% had an AE, 2.4% and 3.8% had a serious AE, and 0.4% and 0.8% had a serious infection. Among all golimumab-treated patients, the numbers of events/100 patient-years (95% CI) were as follows: AEs, 175.2 (169.0, 181.6); serious AEs, 12.7 (11.0, 14.5); serious infections, 3.4 (2.5, 4.4); active tuberculosis, 0.4 (0.1, 0.8); opportunistic infection, 0.2 (0.1, 0.6); malignancies, 0.4 (0.2, 0.9), and MACE, 0.5 (0.2, 1.0). There were no cases of lymphoma. Three (0.6%) placebo-treated patients and 6 (0.5%) golimumab-treated patients died during the studies. Concomitant methotrexate was associated with increased occurrence of elevated alanine transaminase levels and lower incidence of antibodies to golimumab. During the placebo-controlled periods, serious infections in the placebo and golimumab groups were more common in patients receiving concomitant low-dose oral corticosteroids vs. those not receiving corticosteroids. CONCLUSIONS IV golimumab demonstrated a safety profile that was broadly consistent across these rheumatologic indications and with other TNFi, including subcutaneous golimumab. Concomitant methotrexate or corticosteroids were associated with an increase in specific AEs. TRIAL REGISTRATIONS ClinicalTrials.gov , NCT00973479 . Registered on September 9, 2009. CLINICALTRIALS gov , NCT02181673 . Registered on July 4, 2014. CLINICALTRIALS gov , NCT02186873 . Registered on July 10, 2014.
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Yong JH, Hong JP, Lee YH, Huang CC, Huang SW, Lin HW. Association and Risk of Axial Spondyloarthritis of Scoliosis Patients: A Database Study. Spine (Phila Pa 1976) 2022; 47:438-443. [PMID: 34610609 DOI: 10.1097/brs.0000000000004248] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective longitudinal cohort study. OBJECTIVE To investigate the incidence and risk of axial spondyloarthritis (axSpA) in patients with scoliosis in Taiwan. SUMMARY OF BACKGROUND DATA Scoliosis and axSpA causes back pain which reduces quality of life in many patients. Both scoliosis and axSpA had attracted numerous research attention, but the association between the two was hardly known. METHODS In this retrospective study, the data of 25,566 patients were obtained from Taiwan's National Health Insurance Research Database. We identified patients diagnosed with scoliosis and included them in the study cohort. We included age- and sex-matched patients without scoliosis in the control cohort. The total follow-up period was 7 years. Cox proportional hazards models were used to analyze the retrieved data. Hazard ratios (HRs) and adjusted HRs were calculated. RESULTS The study and control cohorts included 4261 and 21,305 patients, respectively. The incidences of axSpA were 141 and 46 per 100,000 person-years in the study and control cohorts, respectively. The crude HRs and adjusted HRs for patients with scoliosis were 2.98 (95% confidence interval, 1.87-4.73; P < 0.001) and 2.78 (95% confidence interval, 1.74-4.43; P < 0.001), respectively. The prevalence of comorbidities such as chronic obstructive pulmonary disease, osteoporosis, depression, autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosus), and thyroid disease was significantly higher in the study cohort. CONCLUSION Our findings indicate an association between scoliosis and axSpA. Additional studies should be performed to explain this phenomenon.Level of Evidence: 3.
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Affiliation(s)
- Jocelyn Huan Yong
- Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jia-Pei Hong
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hao Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Chang Huang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan
- ICF Research Center, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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21
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Deodhar A, Kiwalkar S, Mehendale T, Bhalerao S. Axial Spondyloarthritis in the Chiropractic Care Setting: A Systematic Literature Review. J Clin Rheumatol 2022; 28:e589-e595. [PMID: 34294660 PMCID: PMC8860198 DOI: 10.1097/rhu.0000000000001776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Diagnosis of axial spondyloarthritis (axSpA), an immune-mediated inflammatory disease, is commonly associated with chronic inflammatory back pain (IBP) and often occurs years after initial onset of clinical symptoms. Recognition of IBP is important for timely referral of patients with suspected axSpA to a rheumatologist. Patients with all types of back pain are treated in chiropractic care, but the proportion of patients with undiagnosed axSpA is unknown. This systematic literature review investigated the presence of axSpA in patients treated by chiropractors and identified the chiropractor's role in axSpA diagnosis, referral, and management. A PubMed search was conducted using the following search strings: "chiropract*" AND ("sacroiliac" OR "back pain" OR "spondyloarthritis" OR "ankylosing spondylitis"); English language, since 2009; and (chiropractic OR chiropractor) AND (ankylosing spondylitis OR axial spondyloarthritis), with no date limits. Of 652 articles identified in the searches, 27 met the inclusion criteria. Although back pain was identified as a common reason for patients seeking chiropractic care, there was no mention of axSpA, ankylosing spondylitis, or the distinction between mechanical and IBP. Data from relevant articles suggested that the majority of patients seeking chiropractic care have lower back pain, whereas no articles reported axSpA in this patient population. The near absence of any identified articles on axSpA in chiropractic care may be due to underrecognition of axSpA, resulting in delayed rheumatology referral and appropriate management. Better awareness and increased use of validated screening tools could reduce diagnostic delay of axSpA in chiropractic care.
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Affiliation(s)
- Atul Deodhar
- From the Oregon Health & Science University, Portland, OR
| | - Sonam Kiwalkar
- From the Oregon Health & Science University, Portland, OR
| | - Teja Mehendale
- From the Oregon Health & Science University, Portland, OR
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Pearson NA, Tutton E, Martindale J, Strickland G, Thompson J, Packham JC, Creamer P, Haywood K. Qualitative interview study exploring the patient experience of living with axial spondyloarthritis and fatigue: difficult, demanding and draining. BMJ Open 2022; 12:e053958. [PMID: 35217538 PMCID: PMC8883261 DOI: 10.1136/bmjopen-2021-053958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To explore patients' lived experiences of axial spondyloarthritis (axSpA) and fatigue. DESIGN Interpretative phenomenological analysis (lived experience) was used as the study design. Analysis drew together codes with similar meaning to create superordinate and subordinate themes. SETTING Rheumatology departments in three National Health Service Foundation Trusts in the north, midlands and south of England. PARTICIPANTS A purposive sample of seventeen axSpA patients were recruited. The age range was 22-72 years (median age 46), nine were male and eight, female. RESULTS A central concept of achieving balance was identified as the active process of integrating axSpA symptoms and fatigue into daily life, working with and not against their condition to lead a fulfilled life. This was conveyed through three superordinate themes: struggling to find energy, engaging in everyday life and persevering through difficulties. Struggling to find energy was the challenge of retaining enough stamina to do things in daily life. Engaging in everyday life highlighted dedication to being active and organised, learning through experience and acceptance of a changed way of being. Persevering through difficulties identified the physical and emotional effort required to keep moving forward and the importance of feeling supported. CONCLUSION Achieving balance through finding energy, engaging and persevering everyday was fundamental to having the best possible life. The experience of energy emerged as a distinct but related component of fatigue. However, while energy could be maintained or replenished, fatigue was more difficult to overcome and required greater effort. Energy may be a useful indicator of an individual's current state and ability to sustain activities that supports their well-being, such as exercise. Awareness of the elements of achieving balance in axSpA may enable patients and clinicians to work together to tailor treatments to individual patient need.
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Affiliation(s)
| | - Elizabeth Tutton
- Warwick Research in Nursing, University of Warwick, Coventry, UK
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - J Martindale
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
- Rheumatology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - George Strickland
- Patient Research Partners, Rheumatology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Jean Thompson
- Patient Research Partners, Rheumatology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Jonathan C Packham
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Newcastle-under-Lyme, UK
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Paul Creamer
- Rheumatology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Kirstie Haywood
- Warwick Research in Nursing, University of Warwick, Coventry, UK
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Al Rayes H, Alazmi M, Alderaan K, Alghamdi M, Alghanim N, Alhazmi A, Alkhadhrawi N, Almohideb M, Alzahrani Z, Bedaiwi M, Halabi H, Attar S. Expert recommendations on early diagnosis and referral of axial spondyloarthritis in the Kingdom of Saudi Arabia. Clin Rheumatol 2022; 41:991-1002. [PMID: 34997382 DOI: 10.1007/s10067-021-06019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/11/2021] [Accepted: 12/04/2021] [Indexed: 01/13/2023]
Abstract
Axial spondyloarthritis is a chronic inflammatory disorder that primarily involves the axial skeleton (sacroiliac joints and spine), causing stiffness, severe pain and fatigue. In some patients, definitive structural damage of sacroiliac joints is visible on imaging and is known as radiographic axial spondyloarthritis. Some patients do not have a clear radiographic damage of the sacroiliac joints, and this subtype is known as non-radiographic axial spondyloarthritis. Early diagnosis is important for reducing the risk of irreversible structural damage and disability. Management of axial spondyloarthritis is challenging in Saudi Arabia because of inadequate disease knowledge and the unavailability of local guidelines. Therefore, this expert consensus is intended to provide recommendations, including the referral pathway, the definition of remission and the treat-to-target approach, to all healthcare professionals for the management of patients with axial spondyloarthritis. A Delphi technique of consensus was developed by involving an expert panel of 10 rheumatologists, 1 dermatologist and 1 general physician. The experts offered consensus-based recommendations based on a review of available scientific evidence and clinical experience for the referral, screening and management of patients with axial spondyloarthritis.
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Affiliation(s)
- Hanan Al Rayes
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, 21577, Saudi Arabia.
| | - Mansour Alazmi
- Department of Rheumatology, Prince Mohammed Medical City, Al Jouf, Saudi Arabia
| | - Khaled Alderaan
- Department of Rheumatology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mushabab Alghamdi
- Department of Rheumatology, University of Bisha, Bisha, Saudi Arabia
| | - Nayef Alghanim
- Department of Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alhazmi
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Nadeer Alkhadhrawi
- Department of Family Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammad Almohideb
- Department of Dermatology, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Zeyad Alzahrani
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohamed Bedaiwi
- Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Suzan Attar
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Ciferská H, Vachek J. Differential diagnosis of back pain. VNITRNI LEKARSTVI 2022; 68:332-341. [PMID: 36283825 DOI: 10.36290/vnl.2022.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Back pain (BP) is among the most common reasons for seeking medical attention worldwide. The nature of BP depends on the causative stimulus and its anatomical location. Clinically, BP is manifested by pain, muscle tension, and stiffness. The development of BP is a very complex, multifactorial process in which not only somatic stimuli (anatomical structures), but also psychosocial effects are involved. Using a variety of criteria, BP can be divided into specific where the cause of pain is known, nonspecific wherein the cause remains unclear, or according to its duration (i.e., acute, subacute, and chronic back pain). Simple low back pain must be distinguished from inflammatory BP. Inflammatory BP is one of the symptoms of spondyloarthritides. It is typically a resting pain of insidious onset, peaking at night or in the morning associated with morning stiffness, improved with exercise, and responding to non-steroidal antirheumatic drugs. A red-flag system was developed for the early identification of at-risk patients with a potentially severe disease presenting with BP. Early diagnosis and identification of the cause of complaints often requires multidisciplinary cooperation. The treatment involves pharmacological agents (analgesic and muscle relaxation therapies) and nonpharmacological approaches (rehabilitation, surgical intervention, etc.).
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OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:4198-4206. [DOI: 10.1093/rheumatology/keac059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/23/2022] [Indexed: 11/14/2022] Open
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Schwartzman S, Ruderman EM. A Road Map of the Axial Spondyloarthritis Continuum. Mayo Clin Proc 2022; 97:134-145. [PMID: 34801248 DOI: 10.1016/j.mayocp.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/17/2022]
Abstract
Axial spondyloarthritis (axSpA) is a chronic, immune-mediated inflammatory disease characterized by inflammatory low back pain, inflammation in peripheral joints and entheses, and other extra-articular or systemic manifestations. Although our understanding of the natural history of axSpA has been limited by incomplete knowledge of disease pathogenesis, axSpA is increasingly understood as a spectrum of axial, peripheral, and extra-articular inflammatory conditions that includes nonradiographic axSpA and radiographic axSpA, also known as ankylosing spondylitis. In this narrative review, we present a road map of this axSpA continuum, highlighting genetic risk factors for the development of axSpA, triggers of disease, and reasons for and implications of diagnostic delay. We present a detailed overview of the spectrum of axSpA clinical manifestations and highlight factors known to influence the risk of disease progression. Finally, we provide some expert commentary on the practical use of this road map to assist health care providers in the identification of axSpA in clinical practice.
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Affiliation(s)
| | - Eric M Ruderman
- Northwestern University Feinberg School of Medicine, Chicago, IL
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27
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Lapane KL, Dubé C, Ferrucci K, Khan S, Kuhn KA, Yi E, Kay J, Liu SH. Patient perspectives on health care provider practices leading to an axial spondyloarthritis diagnosis: an exploratory qualitative research study. BMC FAMILY PRACTICE 2021; 22:251. [PMID: 34930136 PMCID: PMC8691008 DOI: 10.1186/s12875-021-01599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The average time to a diagnosis for people with axial spondyloarthritis (axSpA) is 7-10 years. Delayed diagnosis may result in increased structural damage, worse physical function, and worse quality of life relative to patients with a timely axSpA diagnosis. Understanding patient experiences may provide insights for how to reduce diagnostic delays. OBJECTIVE To provide foundational knowledge about patient experiences with healthcare providers leading to an axSpA diagnosis. METHODS We conducted an exploratory qualitative research study with six focus groups interviews with participants recruited from three rheumatology clinics within the United States (MA (n = 3); CO (n = 2); PA (n = 1)) that included a total of 26 adults (10 females, 16 males) with rheumatologist confirmed diagnosis of axSpA in 2019. Focus groups were ~ 2 h, audio recorded, transcribed, and subject to dual coding. The codes reviewed were in relation to the patients' diagnostic experiences. RESULTS Patients described frustrating and lengthy diagnostic journeys. They recognized that the causes of diagnostic delays in axSpA are multifactorial (e.g., no definitive diagnostic test, disease characteristics, lack of primary care provider's awareness about axSpA, trust). Patients described how doctors minimized or dismissed complaints about symptoms or told them that their issues were psychosomatic. Patients believed the healthcare system contributed to diagnostic delays (e.g., lack of time in clinical visits, difficulty accessing rheumatologists, health insurance challenges). Advice to physicians to reduce the diagnostic delay included allowing time for patients to give a complete picture of their illness experience, listening to, and believing patients, earlier referral to rheumatology, provision of HLA-B27 gene testing, and that physicians need to partner with their patients. CONCLUSIONS Patients desire a definitive test that could be administered earlier in the course of axSpA. Until such a test is available, patients want clinicians who listen to, believe, and partner with them, and who will follow them until a diagnosis is reached. Educating primary care clinicians about guidelines and referral for diagnosis of axSpA could reduce diagnostic delay.
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Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA.
| | - Catherine Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
| | - Katarina Ferrucci
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sara Khan
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
| | - Kristine A Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Jonathan Kay
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Deodhar A, Kruzikas D, Zhou L, Biljan A, Saffore CD. Geographic Variations in Diagnosis and Treatment of Ankylosing Spondylitis in the United States: A Real-World Study. Rheumatol Ther 2021; 9:447-463. [PMID: 34927217 PMCID: PMC8964895 DOI: 10.1007/s40744-021-00406-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Diagnosis difficulties are common for ankylosing spondylitis (AS) patients, leading to inadequate and inconsistent treatment. We evaluated the national and geographic variability in disease diagnosis and treatment in the United States. Methods This retrospective, cross-sectional analysis utilized the IBM® MarketScan® Administrative Claims Database from 2014 to 2019. AS patients ≥ 18 years of age with continuous medical and pharmacy enrollment during the calendar year and complete geographic information during the study period were included. Patient cohorts assessed were D1 (≥ 1 AS diagnoses within each calendar year of assessment between 2014 and 2019), D2 (≥ 2 non-rheumatologist AS diagnoses), and D3 (≥ 2 rheumatologist AS diagnoses). For D2 and D3, diagnoses were ≥ 6 months apart, but within 18 months. Annual AS diagnostic prevalence and treatment rates were determined from 2014 to 2019 nationally and per state in 2019. Treatments assessed were disease-modifying antirheumatic drugs (DMARDs), opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and methotrexate. Results Nationally, AS diagnostic prevalence increased from 2014 to 2019, with 2019 rates of 9.6 (D1), 5.1 (D2), and 3.5 (D3) per 10,000 persons. Diagnostic prevalence varied between states, which was not explained by age, sex, racial distribution, or rheumatologists per capita. Nationally, a greater percentage of D3 patients vs. D1 and D2 patients received biologic/targeted synthetic DMARDs (bDMARD/tsDMARDs) and conventional synthetic DMARD. Opioid use ranged from 37 to 40% in 2019 and decreased from 2014 for all cohorts. Corticosteroid and methotrexate use decreased slightly, while NSAID and bDMARD/tsDMARD use generally increased from 2014 to 2019. Conclusions AS diagnostic prevalence is increasing nationally, though it remains low among some states. bDMARD/tsDMARDs use was more common among patients treated by rheumatologists. Opioid and corticosteroid use is decreasing, though national rates remain high with significant state variability. Further education is needed, particularly in states with low prevalence and inadequate treatment, to improve diagnosis and treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00406-9.
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Affiliation(s)
- Atul Deodhar
- Department of Medicine, Rheumatology Clinics, Oregon Health and Science University, Portland, OR, USA.
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Lu J, Yang J, Dong W, Tang B, Cao L, Lin Y, Huang B, Fu X. Predominant frequency of HLA-B*27 in patients with ankylosing spondylitis in southeastern China. Immun Inflamm Dis 2021; 9:1696-1701. [PMID: 34499816 PMCID: PMC8589404 DOI: 10.1002/iid3.524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study was to investigate the polymorphism and distribution of alleles of HLA-B*27 in patients with ankylosing spondylitis (AS) in Han population of southeastern China. METHODS A total of 89 peripheral blood samples from southeastern Chinese Han patients with AS that diagnosed according to Modified New York criteria were subtyped using the high-resolution PCR-SSP.Exon 2-3 of HLA-B*27 gene was amplified and sequenced to further confirm the HLA-B*27 subtype. RESULTS The frequency of HLA-B*27 was 99.87% in AS patients. Three subtypes, HLA-B*2704, HLA-B*2705, and HLA-B*2706 were identified. The frequencies for these three alleles were HLA-B*2704 in 84/88 (95.46%), HLA-B*2705 in 3/88(3.41%), and HLA-B*2706 in 1/88 (1.13%) of the HLA-B*27 positive patients, respectively. CONCLUSIONS Our study shows that HLA-B*2704 has an overwhelming frequency in southeastern Chinese Han AS patients. A combined analysis including previous studies of HLA-B*27-subtype distributions in Chinese Han populations showed that HLA-B*2704 may originate from the southern Han and then migrate and spread to the northern areas, and HLA-B*2705 show the opposite result.
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Affiliation(s)
- JiaoJiao Lu
- Department of Central LaboratoryNingde Municipal Hospital Affiliated to Ningde Normal UniversityNingdeFujianChina
| | - Jing Yang
- Department of Central LaboratoryNingde Municipal Hospital Affiliated to Ningde Normal UniversityNingdeFujianChina
| | - WenXu Dong
- Department of Central LaboratoryNingde Municipal Hospital Affiliated to Ningde Normal UniversityNingdeFujianChina
| | - BaoJia Tang
- Department of Clinical LaboratoryNingde Municipal Hospital Affiliated to Ningde Normal UniversityNingdeFujianChina
| | - LuoYuan Cao
- Department of Central LaboratoryNingde Municipal Hospital Affiliated to Ningde Normal UniversityNingdeFujianChina
| | - YingHua Lin
- Department of Traditional Chinese MedicineNingde Municipal Hospital Affiliated to Ningde Normal UniversityNingdeFujianChina
| | - BaoYing Huang
- Department of Traditional Chinese MedicineNingde Municipal Hospital Affiliated to Ningde Normal UniversityNingdeFujianChina
| | - XianGuo Fu
- Department of Central LaboratoryNingde Municipal Hospital Affiliated to Ningde Normal UniversityNingdeFujianChina
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Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is a chronic, rheumatic disease characterized by inflammation of the sacroiliac joint, spine, and entheses. Axial spondyloarthritis affects up to 1.4% of adults in the United States and is associated with decreased quality of life, increased mortality, and substantial health care-related costs, imposing a high burden on patients, their caregivers, and society. SUMMARY OF WORK Diagnosing axSpA can be difficult. In this review, we seek to help rheumatologists in recognizing and diagnosing axSpA. MAJOR CONCLUSIONS A discussion of challenges associated with diagnosis is presented, including use and interpretation of imaging, reasons for diagnostic delays, differences in disease presentation by sex, and differential diagnoses of axSpA. FUTURE RESEARCH DIRECTIONS The early diagnosis of axSpA and advances in available therapeutic options have improved patient care and disease management, but delays in diagnosis and treatment remain common. Additional research and education are critical for recognizing diverse axSpA presentations and optimizing management early in the course of disease.
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Affiliation(s)
- Jessica A. Walsh
- From the University of Utah School of Medicine and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT
| | - Marina Magrey
- The MetroHealth System and School of Medicine, Case Western Reserve University, Cleveland, OH
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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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Nowell WB, Gavigan K, Hunter T, Malatestinic WN, Bolce RJ, Lisse JR, Himelein C, Curtis JR, Walsh JA. Treatment Satisfaction and Decision-making from the Patient Perspective in Axial Spondyloarthritis: Real-World Data from a Descriptive Cross-sectional Survey Study from the ArthritisPower Registry. ACR Open Rheumatol 2021; 4:85-94. [PMID: 34758105 PMCID: PMC8754015 DOI: 10.1002/acr2.11365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 01/17/2023] Open
Abstract
Objective Aims were to 1) to characterize patient decision‐making with treatment for axial spondyloarthritis (axSpA) and 2) to explore relationships among decision‐making, treatment satisfaction, and biologic disease modifying antirheumatic drugs (bDMARDs). Methods ArthritisPower participants with physician‐diagnosed axSpA were invited to complete an online survey about their treatment and their most recent physician visit. Analysis compared treatment decision by satisfaction and bDMARD status. Results Among the 274 participants, 87.2% were female, and the mean age was 50 years. Of participants, 79.5% had researched treatment before their most recent physician visit, and 56.9% discussed treatment change at their most recent physician visit. Of treatment‐change discussions, 69.2% of them were related to escalation, compared with deescalation (27.6%) and/or switching (39.1%). Among those participants who discussed a change, 73.7% agreed to it because they felt that their disease was not being controlled (54.9%) or felt that it could be better controlled on new treatment (20.3%). Top symptoms prompting change were back/buttock pain (63.3%), other joint pain (55.1%), and fatigue (54.1%). Among bDMARD‐treated participants (n = 128), important factors for treatment decisions were prevention of long‐term axSpA consequences (92.9%) and doctor's advice (87.5%). Among 43.4% of participants reporting treatment dissatisfaction, 37% did not discuss treatment change. Current bDMARD use was more common in satisfied (61.9%) than dissatisfied participants (26.9%). Conclusion In this cross‐sectional study of a predominantly female axSpA population, patients frequently researched treatment options and discussed escalation with their providers. Under two‐thirds of participants who were dissatisfied with treatment discussed changes at their most recent visit. Current bDMARD use was associated with higher satisfaction, and bDMARD users considered prevention of long‐term consequences and doctor's advice to be very important for decision‐making.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jessica A. Walsh
- University of UtahSalt Lake CityUtah
- George E. Wahlen Veterans Affairs Medical Center, RheumatologySalt Lake CityUtah
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Xiang L, Fong W, Low AHL, Leung YY, Gandhi M, Xin X, Uy EJB, Hamilton L, Thumboo J. Early identification of axial spondyloarthritis in a multi-ethnic Asian population. Clin Rheumatol 2021; 41:1095-1103. [PMID: 34625882 DOI: 10.1007/s10067-021-05951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION/OBJECTIVES To address the diagnostic delay in axial spondyloarthritis (axSpA), we have cross-culturally adapted the Hamilton axSpA questionnaire, a self-administered screening questionnaire, in the Singapore population. In this study, we compared the performance of various scoring methods for this questionnaire in detecting axSpA. METHOD The questionnaire was self-administered by eligible subjects. Scoring methods included method A, the original questionnaire scoring, and methods B-E, scoring developed based on the Assessment of SpondyloArthritis International Society (ASAS) criteria for inflammatory back pain (IBP) and the referral, classification and both referral and classification of axSpA, respectively. The reference standard was diagnosis by a rheumatologist. Since the ASAS criteria-based scoring methods were mainly based on clinical axSpA features, self-report and rheumatologist-assessment of clinical axSpA features were also compared in subjects with axSpA. RESULTS Of 1418 subjects (age: 54 ± 14 years, female: 73%) recruited, 46 were diagnosed with axSpA by a rheumatologist. Sensitivities of methods A-E were 35%, 61%, 63%, 48% and 83%, respectively. Self-report of clinical axSpA features exceeded rheumatologist-assessment for arthritis (83 vs 26%), good response to NSAIDs (37 vs 30%), enthesitis (35 vs 30%), dactylitis (20 vs 2%) and family history for axSpA (13 vs 4%). The reverse was true for IBP (41 vs 63%) and uveitis (4 vs 15%). CONCLUSIONS A self-administered questionnaire using the ASAS referral and classification criteria-based scoring yielded relatively high sensitivity in detecting axSpA in subjects newly referred to rheumatology clinics. This supports its evaluation as a screening and referral tool in the general population in future studies. Key Points • A self-administered questionnaire could be used as a screening and referral tool. • ASAS referral and classification criteria-based scoring yielded relatively high sensitivity. • Inaccurate perception of clinical axSpA features was observed in axSpA patients.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.,Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore.,The Center for Child Health Research, Tampere University, Tampere, Finland
| | - Xiaohui Xin
- Academic Clinical Program for Medicine, Singapore General Hospital, Singapore, Singapore
| | - Elenore Judy B Uy
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore
| | - Louise Hamilton
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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Curtis JR, Winthrop K, Bohn RL, Suruki R, Siegel S, Stark JL, Xie F, Yun H, Chen L, Deodhar A. The Annual Diagnostic Prevalence of Ankylosing Spondylitis and Axial Spondyloarthritis in the United States Using Medicare and MarketScan Databases. ACR Open Rheumatol 2021; 3:743-752. [PMID: 34550648 PMCID: PMC8593814 DOI: 10.1002/acr2.11316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/13/2021] [Indexed: 12/17/2022] Open
Abstract
Objective The objective of this study was to investigate the diagnostic prevalence of ankylosing spondylitis (AS) and axial spondyloarthritis (axSpA) in the United States and examine treatment patterns for these diseases. Methods This retrospective observational cohort study drew from 2006‐2014 data in the US Medicare Fee‐for‐Service and IBM MarketScan databases. AS and axSpA diagnoses were identified through International Classification of Diseases, Ninth Revision [ICD‐9] codes. Diagnostic prevalence (per 10,000 patients) was calculated as patients with AS and axSpA with full insurance coverage in each calendar year divided by the total patients with full insurance coverage in the same year. Two diagnosis definitions were used: definition 1 (D1), one or more relevant ICD‐9 codes from hospital claims or two or more relevant ICD‐9 codes from outpatient claims; definition 2 (D2), one or more codes from hospital/outpatient claims. Primary analyses assessed annual AS and axSpA prevalence (D1); sensitivity analyses assessed annual (D2) and 2‐year prevalence. Patterns in prevalence and treatment use were analyzed descriptively; no statistical tests were performed. Results An increase in AS prevalence (per 10,000 patients) was seen from 2006 to 2014 in primary analyses (Medicare: 2.12‐3.60; MarketScan: 0.85‐1.42) and sensitivity analyses. A similar trend occurred for axSpA (Medicare: 4.39‐6.52; MarketScan: 1.33‐2.21). For Medicare, the proportion of patients with AS (D1) using tumor necrosis factor α inhibitors (TNFis), conventional synthetic antirheumatic drugs (csARDs), nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and glucocorticoids remained relatively stable; for MarketScan, TNFi‐treated patients increased (51.7% to 65.7%) and NSAID‐treated patients decreased (63.5% to 55.7%). Conclusion AS and axSpA prevalence may have increased in the United States between 2006 and 2014. Reasons are unknown, but this may be due to increased disease awareness, among other factors.
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Soulard J, Vaillant J, Vuillerme N. Gait in patients with axial spondyloarthritis: A systematic review of the literature. Curr Rheumatol Rev 2021; 18:117-123. [PMID: 34548003 DOI: 10.2174/1573397117666210921114949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022]
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly affecting the axial skeleton. axSpA includes radiographic (i.e., ankylosing spondylitis (AS)) and non-radiographic forms (nr-axSpA). Although recent studies have reported that patients with AS have impaired gait, axSpA's consequences on gait remain unknown. The present review's objectives were to identify: 1) how gait is assessed in patients with axSpA, and 2) what the gait characteristics are of patients with axSpA. This systematic review's protocol was registered in the Prospero database (CRD42020128509). Three databases were systematically searched using keywords related to axSpA and gait. Two independent reviewers selected the articles and extracted the data. The search revealed two hundred titles and abstracts, and two articles were finally included in this review, comprising a total of 132 patients with axSpA. One of the included studies used the 6 m maximum gait velocity test (axSpA: 2.2 ± 0.5 m/s), and the other used the six-minute walk test (axSpA: 414 ± 106 m). Neither study involved a control group to compare gait. Only two published studies assessed the gait performance of patients with axSpA using clinical tests. Furthermore, neither of them compared gait performance to healthy controls or differentiated gait between the AS and nr-axSpA forms of axSPA. The present literature review highlights the need for future research to learn more about how gait is impaired in different types of patients with axSpA.
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Affiliation(s)
- Julie Soulard
- Univ. Grenoble Alpes, AGEIS, Grenoble, France; bGrenoble Alpes University Hospital, Grenoble. France
| | - Jacques Vaillant
- Univ. Grenoble Alpes, AGEIS, Grenoble, France; bGrenoble Alpes University Hospital, Grenoble. France
| | - Nicolas Vuillerme
- Univ. Grenoble Alpes, AGEIS, Grenoble, France; bGrenoble Alpes University Hospital, Grenoble. France
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Do L, Granåsen G, Hellman U, Lejon K, Geijer M, Baraliakos X, Witte T, Forsblad-d'Elia H. Anti-CD74 IgA autoantibodies in radiographic axial spondyloarthritis: a longitudinal Swedish study. Rheumatology (Oxford) 2021; 60:4085-4093. [PMID: 33369649 PMCID: PMC8410007 DOI: 10.1093/rheumatology/keaa882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/26/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives Antibodies against anti-CD74 are related to axial spondyloarthritis (axSpA). The objectives were (i) to study IgA anti-CD74 in radiographic (r)-axSpA patients in the Backbone cohort and to calculate the sensitivity and specificity of anti-CD74, (ii) to study the fluctuation of IgA anti-CD74 levels in prospectively collected samples, and (iii) to explore the relation between IgA anti-CD74 and radiographic spinal changes. Methods IgA anti-CD74 was analysed by ELISA in 155 patients with r-axSpA and age- and sex-matched controls. BASDAI, ASDAS, BASFI and BASMI were assessed and spinal radiographs were scored for r-axSpA-related changes with mSASSS. Previously donated samples, before inclusion in the Backbone study, were identified in the Medical Biobank of Northern Sweden. Results A total of 155 patients comprising 69% men and 31% women, age [mean (s.d.)] 55.5 (11.4) years and 152 (98.1%) HLA-B27 positive, were included. The plasma level of IgA anti-CD74 was significantly higher in the patients [median (interquartile range), 12.9 (7.9–17.9) U/ml] compared with controls [10.9 (7.2–14.6) U/ml, P = 0.003]. IgA anti-CD74 was above the cut-off level of 20 U/ml in 36/155 (23.2%) patients and in 15/151 (9.9%) controls (P = 0.002). Multivariable logistic regression analyses revealed ≥1 syndesmophyte associated with IgA anti-CD74 (odds ratio 5.64; 95% CI: 1.02, 35.58; P = 0.048) adjusted for hsCRP, smoking, BMI, sex and age. No distinct pattern of IgA anti-CD74 over time was revealed. Conclusion Plasma levels of IgA anti-CD74 were increased in r-axSpA and independently associated with radiographic spinal changes, which suggests that IgA anti-CD74 could play a role in the pathogenies of r-axSpA.
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Affiliation(s)
- Lan Do
- Department of Public Health and Clinical Medicine, Rheumatology
| | | | - Urban Hellman
- Department of Public Health and Clinical Medicine, Rheumatology
| | - Kristina Lejon
- Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå
| | - Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg.,Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Torsten Witte
- Department of Rheumatology and Clinical Immunology, Medical University Hannover, Hannover, Germany
| | - Helena Forsblad-d'Elia
- Department of Public Health and Clinical Medicine, Rheumatology.,Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Korotaeva T, Dina O, Holdsworth E, Fallon L, Milligan G, Meakin S, Wang L, Vasilescu R, Cappelleri JC, Deodhar A. Investigating diagnosis, treatment, and burden of disease in patients with ankylosing spondylitis in Central Eastern Europe and the United States: a real-world study. Clin Rheumatol 2021; 40:4915-4926. [PMID: 34319479 PMCID: PMC8794925 DOI: 10.1007/s10067-021-05864-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/17/2021] [Accepted: 07/13/2021] [Indexed: 02/08/2023]
Abstract
Introduction/Objectives Ankylosing spondylitis (AS) is a chronic inflammatory immune-mediated condition. We compared AS diagnosis, treatment, and burden in Central Eastern European countries (CEE), where this has been less researched, and the United States (US) from a real-world perspective. Methods Point-in-time survey of rheumatologists and their AS patients was conducted in the US (Apr–Oct 2018) and CEE (Aug–Nov 2019) via physician- and patient-completed record forms, including clinical and patient-reported outcomes. Statistical analysis included descriptive statistics, t-tests, Fisher’s exact tests, and generalized linear models. Results In total, 487 patients were recruited from 88 rheumatologists in the US and 922 patients from 126 rheumatologists in CEE. Time from onset of symptoms to final AS diagnosis was longer in CEE than the US (4.2 vs 2.7 years, p < 0.05). At diagnosis, a greater use of conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and injected steroids was reported in CEE vs the US (43.7% vs 27.6%, p < 0.05; 19.3% vs 8.7%, p < 0.05). 22.9% of US patients received a biologic DMARD at diagnosis vs 10% of CEE patients (p < 0.05). At current consultation, biologic DMARD use in CEE was lower vs the US (27.9% vs 71.0%, p < 0.05). CEE vs US patients had greater disease activity (mean Bath Ankylosing Spondylitis Disease Activity Index 4.2 vs 3.1, p < 0.05) and worse quality of life (QoL; mean Ankylosing Spondylitis Quality of Life Questionnaire score 6.2 vs 8.4, p < 0.05). Conclusions AS patients in CEE vs the US faced slower diagnosis and worse access to biologics, disease activity, and QoL. Whether early access to biologics can improve symptoms, QoL, and daily activities in AS patients in CEE remains to be seen.Key Points • The study provided evidence on the real-world approach to the diagnosis, treatment, and burden of axSpA (axial spondyloarthritis) in CEE compared with the US. • The study reported patients in CEE experienced longer delays in diagnosis and poorer access to biologics than in the US. • This may have resulted in higher disease activity, greater levels of pain, and poorer outcomes, as reported by patients with axSpA in CEE. |
Supplementary Information The online version contains supplementary material available at 10.1007/s10067-021-05864-8.
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Affiliation(s)
- T Korotaeva
- Institute of Rheumatology V.A. Nasonova, 115522 Kashirskoe shosse 34-A, Moscow, Russia.
| | - O Dina
- Pfizer Inc, New York, NY, USA
| | | | - L Fallon
- Pfizer Inc, Kirkland, QC, Canada
| | | | - S Meakin
- Adelphi Real World, Bollington, UK
| | - L Wang
- Pfizer Inc, Groton, CT, USA
| | | | | | - A Deodhar
- Oregon Health & Science University, Portland, OR, USA
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Passalent L, Sundararajan K, Perruccio AV, Hawke C, Coyte PC, Bombardier C, Bloom JA, Haroon N, Inman RD, Rampersaud YR. Bridging the Gap between Symptom Onset and Diagnosis in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2021; 74:997-1005. [PMID: 34268914 DOI: 10.1002/acr.24751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate a stratified screening process for early identification of axial spondyloarthritis (axSpA) considering: 1) wait times from primary care to rheumatology screen; 2) incremental precision and accuracy from primary care to rheumatology screen; and 3) diagnostic delay. METHODS Adults with low back pain (LBP) attending primary care LBP clinics prospectively underwent a primary standardized clinical screen. Patients with LBP >3 months and onset age <50 years were referred for a comprehensive secondary screen by a physiotherapist with advanced rheumatology training. At secondary screening, patients with inflammatory features were deemed to have a low, medium, or high risk of axSpA vs. no risk. Precision and accuracy of this screening strata were measured against a rheumatologist with axSpA expertise. RESULTS In all, 405 patients underwent primary and secondary screening. Mean age was 36.9 years (±9.9); 55% were female. HLA-B27 was present in 14.4%. Median wait time from primary to secondary screen was 15 days. AxSpA risk assignment by rheumatologist was: 64.9% (none or low risk axSpA) and 35.1% (medium or high risk axSpA). The best combination of sensitivity (68%), specificity (90%), positive (80%) and negative (84%) predictive values was evident with the secondary screen. 15.6% of patients received a final diagnosis of axSpA. Median LBP duration from onset to diagnosis was: 2 years (non-radiographic axSpA) and 7 years (ankylosing spondylitis). CONCLUSION A stratified interprofessional screening process can facilitate rapid diagnosis of persistent LBP, with high precision and accuracy, in patients with axSpA.
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Affiliation(s)
- Laura Passalent
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kala Sundararajan
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network Toronto, Toronto, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Evaluation Unit, University Health Network, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Christopher Hawke
- Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jeff A Bloom
- Family and Community Medicine, University Health Network, Toronto, Canada
| | - Nigil Haroon
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robert D Inman
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Departments of Medicine and Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Xiang L, Low AHL, Leung YY, Fong W, Gandhi M, Yoon S, Lau TC, Koh DR, Thumboo J. Interval between symptom onset and diagnosis among patients with autoimmune rheumatic diseases in a multi-ethnic Asian population. Int J Rheum Dis 2021; 24:1061-1070. [PMID: 34232556 DOI: 10.1111/1756-185x.14165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/22/2021] [Accepted: 06/13/2021] [Indexed: 12/19/2022]
Abstract
AIM The interval between symptom onset and diagnosis (pre-diagnosis interval) can at times be longer than is ideal in patients with autoimmune rheumatic diseases (ARDs). In this study, we aimed to characterize this interval and to identify its associated factors. METHOD We characterized pre-diagnosis interval into 4 intervals: Interval #1 between symptom onset and first visit to healthcare professionals; Interval #2 between first visit to healthcare professionals and rheumatology referral; Interval #3 between rheumatology referral and first rheumatology assessment; and Interval #4 between first rheumatology assessment and diagnosis. Median regression models were used to identify factors associated with longer pre-diagnosis interval and Interval #1. RESULTS Among 259 patients (median age = 52.0 [41.6-61.9] years, 71% female, rheumatoid arthritis [n = 75], axial spondyloarthritis [axSpA] [n = 40] and psoriatic arthritis [n = 35]), median pre-diagnosis interval was 11.5 (4.7-36.0) months. Interval #1 (median = 4.9 months) was significantly longer than Intervals #2-#4 (median = 0.3, 1.5, and 0.0 months, respectively). Patients with axSpA had significantly longer pre-diagnosis interval (median = 38.7 months) and Interval #1 (median = 26.6 months) than patients with the other ARDs. Median regression suggested that patients referred from specialty care had significantly longer pre-diagnosis interval (median difference = 7.7 months) and Interval #1 (median difference = 6.4 months) compared to those referred from primary care. CONCLUSION A long pre-diagnosis interval was observed among patients with ARDs (especially axSpA), due largely to a long interval between symptom onset and the first visit to healthcare professionals. This highlights the importance of interventions targeting patients prior to their first visit to healthcare professionals in reducing pre-diagnosis interval.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Mihir Gandhi
- Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Biostatistics, Singapore Clinical Research Institute.,Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Tang Ching Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Medicine, National University Hospital, Singapore
| | - Dow Rhoon Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Medicine, National University Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
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Dube CE, Lapane KL, Ferrucci KA, Beccia AL, Khan SK, Yi E, Kay J, Kuhn KA, Ogdie A, Liu SH. Personal Experiences with Diagnostic Delay Among Axial Spondyloarthritis Patients: A Qualitative Study. Rheumatol Ther 2021; 8:1015-1030. [PMID: 34059989 PMCID: PMC8217406 DOI: 10.1007/s40744-021-00321-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION On average, patients with axial spondyloarthritis (axSpA) suffer from symptoms up to 13 or more years before diagnosis, contributing to psychological distress and healthcare burden METHODS: We conducted six semi-structured focus groups with 26 axSpA patients (from 3 rheumatology practices located in the states of Massachusetts, Colorado, and Pensylvania, USA) exploring early disease and diagnostic experiences. Verbatim transcripts were coded using a start list with emerging thematic codes added. A qualitative thematic analysis was performed RESULTS: Many participants described meandering and frustrating diagnostic journeys. Participants reported that intermittent axSpA symptoms and idiopathic pain contributed to physician confusion and delay in patients seeking care. Participants were sometimes perceived as somaticizing, drug-seeking, or "crazy." Diagnostic delay led to frustration and mental suffering. Doctors "giving up" was considered profoundly negative. Stories of symptoms fell into five areas: (1) pain; (2) stiffness; (3) impact on sleep; (4) impact on daily activities; and (5) changes with weather. Self-advocacy and family advocacy were considered essential. Participants suggested wider use of HLA-B27 testing and development of a definitive diagnostic test CONCLUSION: Most participants described significant suffering prior to axSpA diagnosis which could have been avoided with earlier intervention. Further research on the early disease experiences of axSpA patients is needed.
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Affiliation(s)
- Catherine E Dube
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA.
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
| | - Katarina A Ferrucci
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ariel L Beccia
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sara K Khan
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Jonathan Kay
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Kristine A Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexis Ogdie
- Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
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Lapane KL, Shridharmurthy D, Khan S, Lindstrom D, Beccia A, Yi E, Kay J, Dube C, Liu SH. Primary care physician perspectives on screening for axial spondyloarthritis: A qualitative study. PLoS One 2021; 16:e0252018. [PMID: 34029339 PMCID: PMC8143395 DOI: 10.1371/journal.pone.0252018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Many patients with axial spondylarthritis (axSpA) experience lengthy diagnostic delays upwards of 14 years. (5-14 years). Screening tools for axSpA have been proposed for use in primary care settings, but whether this approach could be implemented into busy primary care settings remains unknown. OBJECTIVE To solicit feedback from primary care physicians regarding questions from the Inflammatory Back Pain Assessment: the Assessment of Spondyloarthritis International Society (ASAS) Expert Criteria and gain insight about barriers and facilitators for implementing axSpA screening in primary care. METHODS Guided by Consolidated Criteria for reporting Qualitative Research (COREQ-criteria), we recorded, transcribed, and analyzed in-depth interviews with eight family medicine physicians and ten internists (purposeful sampling) using immersion/crystallization techniques. RESULTS Few physicians reported awareness of existing classification criteria for axSpA, and many reported a lack of confidence in their ability to distinguish between inflammatory and mechanical back pain. From three domains, 10 subthemes emerged: 1) typical work-up of axSpA patients in primary care, with subthemes including the clues involved in work-up and role of clinical examinations for axSpA; 2) feedback on questions from the Inflammatory Back Pain Assessment: ASAS Expert Criteria, with subthemes to evaluate contents/questions of a potential screening tool for axSpA; and 3) implementation of the screening tool in primary care settings, with subthemes of perceived barriers including awareness, time, other conditions to screen, rare disease, and lack of structured questionnaire for back pain and perceived facilitators including workflow issues and awareness. CONCLUSIONS Primary care physicians believed that an improved screening instrument and a strong evidence-base to support the need for screening for axSpA are required. The implementation of axSpA screening into a busy primary care practice requires integration into the practice workflow, with use of technology suggested as a possible way to improve efficiency.
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Affiliation(s)
- Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Divya Shridharmurthy
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Sara Khan
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Daniel Lindstrom
- Graduate Medical Education, Internal Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Ariel Beccia
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States of America
| | - Jonathan Kay
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
- Division of Rheumatology, UMass Memorial Medical Center, Worcester, MA, United States of America
| | - Catherine Dube
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
- * E-mail:
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Magrey MN, Mease PJ. Pain in Axial Spondyloarthritis: More to It Than Just Inflammation. J Rheumatol 2021; 48:1632-1634. [PMID: 33934079 DOI: 10.3899/jrheum.210137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The conceptual paradigm of axial spondyloarthritis (axSpA) has evolved and now comprises an expanded spectrum that includes more females and patients with little or no radiographic changes in sacroiliitis or syndesmophyte formation in the spine.1 This broadened paradigm is often, but not always, characterized by an inflammatory magnetic resonance imaging (MRI) signature.
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Affiliation(s)
- Marina N Magrey
- M.N. Magrey, MD, Professor of Medicine, Case Western Reserve University School of Medicine, Director, Rheumatology Fellowship and Spondylarthritis Clinic, MetroHealth Medical Center, Cleveland, Ohio; P.J. Mease, MD, MACR, Director of Rheumatology Research, Swedish Medical Center/ Providence-St Joseph Health, Clinical Professor, University of Washington School of Medicine, Seattle, Washington, USA. MNM is a consultant for Novartis, AbbVie, UCB, Eli Lilly, and Pfizer; has clinical trials with AbbVie and UCB; and has no conflicts pertinent to this editorial. PJM receives research grants from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun, and UCB; is a consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun, and UCB; and is on speakers bureaus for AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Address correspondence to Dr. M.N. Magrey, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
| | - Philip J Mease
- M.N. Magrey, MD, Professor of Medicine, Case Western Reserve University School of Medicine, Director, Rheumatology Fellowship and Spondylarthritis Clinic, MetroHealth Medical Center, Cleveland, Ohio; P.J. Mease, MD, MACR, Director of Rheumatology Research, Swedish Medical Center/ Providence-St Joseph Health, Clinical Professor, University of Washington School of Medicine, Seattle, Washington, USA. MNM is a consultant for Novartis, AbbVie, UCB, Eli Lilly, and Pfizer; has clinical trials with AbbVie and UCB; and has no conflicts pertinent to this editorial. PJM receives research grants from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun, and UCB; is a consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun, and UCB; and is on speakers bureaus for AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Address correspondence to Dr. M.N. Magrey, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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Mease PJ, McLean RR, Dube B, Liu M, Rebello S, Glynn M, Yi E, Park Y, Ogdie A. Comparison of Men and Women With Axial Spondyloarthritis in the US-Based Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol 2021; 48:1528-1536. [PMID: 33858974 DOI: 10.3899/jrheum.201549] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare patient characteristics and disease burden between men and women with axial spondyloarthritis (axSpA) in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis (PsA/SpA) Registry. METHODS Patients aged ≥ 18 years with axSpA enrolled in the Corrona PsA/SpA Registry between March 2013 and November 2018 who were not concurrently diagnosed with PsA were included. Patient demographics, clinical characteristics, disease activity, patient-reported symptoms, work productivity, and treatment history at enrollment were compared between men and women, using t tests or Wilcoxon rank-sum tests for continuous variables and chi-square or Fisher exact tests for categorical variables. RESULTS Of 498 patients with axSpA and available sex information, 307 (61.6%) were men and 191 (38.4%) were women. Compared with men, women had higher disease activity as measured by Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and physician global assessment, and had higher tender/swollen joint counts and enthesitis scores (all P ≤ 0.01). Women also had worse patient-reported symptoms (pain, fatigue, Health Assessment Questionnaire for the Spondyloarthropathies, and EuroQol visual analogue scale; all P < 0.05), had greater work and activity impairment, and were less likely to work full time than men. Prior conventional synthetic disease-modifying antirheumatic drug and prednisone use was more common in women than in men (both P < 0.05). Additionally, women were more likely to have diagnoses of depression and fibromyalgia (both P < 0.01). CONCLUSION In this US registry of patients with axSpA, women had higher overall disease burden and more peripheral manifestations than men. Improved awareness of sex differences in the presentation of axSpA may aid physicians in earlier identification and improved disease management.
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Affiliation(s)
- Philip J Mease
- This study was sponsored by Corrona, LLC. Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Crescendo, Eli Lilly, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Ortho Dermatologics, Pfizer Inc., Regeneron, Roche, Sun, and UCB. The design and conduct of the study were a collaborative effort between Corrona, LLC, and Novartis, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data, and review and approval of the manuscript. P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington; R.R. McLean, DSc, MPH, B. Dube, MPH, M. Liu, PhD, S. Rebello, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts; E. Yi, PharmD, Y. Park, PharmD, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PJM has received research grants from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, and consulting and/ or speakers bureau fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Galapagos, Genentech, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB. RRM and BD are employees of Corrona, LLC. ML, SR, and MG were employees of Corrona, LLC, at the time of this analysis. EY and YP are employees of Novartis Pharmaceuticals Corporation. AO has received consulting fees from Amgen, AbbVie, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD Databank), and Novartis (FORWARD Databank). Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA 98122, USA. . Accepted for publication March 29, 2021
| | - Robert R McLean
- This study was sponsored by Corrona, LLC. Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Crescendo, Eli Lilly, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Ortho Dermatologics, Pfizer Inc., Regeneron, Roche, Sun, and UCB. The design and conduct of the study were a collaborative effort between Corrona, LLC, and Novartis, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data, and review and approval of the manuscript. P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington; R.R. McLean, DSc, MPH, B. Dube, MPH, M. Liu, PhD, S. Rebello, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts; E. Yi, PharmD, Y. Park, PharmD, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PJM has received research grants from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, and consulting and/ or speakers bureau fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Galapagos, Genentech, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB. RRM and BD are employees of Corrona, LLC. ML, SR, and MG were employees of Corrona, LLC, at the time of this analysis. EY and YP are employees of Novartis Pharmaceuticals Corporation. AO has received consulting fees from Amgen, AbbVie, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD Databank), and Novartis (FORWARD Databank). Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA 98122, USA. . Accepted for publication March 29, 2021
| | - Blessing Dube
- This study was sponsored by Corrona, LLC. Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Crescendo, Eli Lilly, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Ortho Dermatologics, Pfizer Inc., Regeneron, Roche, Sun, and UCB. The design and conduct of the study were a collaborative effort between Corrona, LLC, and Novartis, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data, and review and approval of the manuscript. P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington; R.R. McLean, DSc, MPH, B. Dube, MPH, M. Liu, PhD, S. Rebello, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts; E. Yi, PharmD, Y. Park, PharmD, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PJM has received research grants from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, and consulting and/ or speakers bureau fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Galapagos, Genentech, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB. RRM and BD are employees of Corrona, LLC. ML, SR, and MG were employees of Corrona, LLC, at the time of this analysis. EY and YP are employees of Novartis Pharmaceuticals Corporation. AO has received consulting fees from Amgen, AbbVie, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD Databank), and Novartis (FORWARD Databank). Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA 98122, USA. . Accepted for publication March 29, 2021
| | - Mei Liu
- This study was sponsored by Corrona, LLC. Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Crescendo, Eli Lilly, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Ortho Dermatologics, Pfizer Inc., Regeneron, Roche, Sun, and UCB. The design and conduct of the study were a collaborative effort between Corrona, LLC, and Novartis, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data, and review and approval of the manuscript. P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington; R.R. McLean, DSc, MPH, B. Dube, MPH, M. Liu, PhD, S. Rebello, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts; E. Yi, PharmD, Y. Park, PharmD, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PJM has received research grants from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, and consulting and/ or speakers bureau fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Galapagos, Genentech, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB. RRM and BD are employees of Corrona, LLC. ML, SR, and MG were employees of Corrona, LLC, at the time of this analysis. EY and YP are employees of Novartis Pharmaceuticals Corporation. AO has received consulting fees from Amgen, AbbVie, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD Databank), and Novartis (FORWARD Databank). Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA 98122, USA. . Accepted for publication March 29, 2021
| | - Sabrina Rebello
- This study was sponsored by Corrona, LLC. Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Crescendo, Eli Lilly, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Ortho Dermatologics, Pfizer Inc., Regeneron, Roche, Sun, and UCB. The design and conduct of the study were a collaborative effort between Corrona, LLC, and Novartis, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data, and review and approval of the manuscript. P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington; R.R. McLean, DSc, MPH, B. Dube, MPH, M. Liu, PhD, S. Rebello, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts; E. Yi, PharmD, Y. Park, PharmD, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PJM has received research grants from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, and consulting and/ or speakers bureau fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Galapagos, Genentech, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB. RRM and BD are employees of Corrona, LLC. ML, SR, and MG were employees of Corrona, LLC, at the time of this analysis. EY and YP are employees of Novartis Pharmaceuticals Corporation. AO has received consulting fees from Amgen, AbbVie, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD Databank), and Novartis (FORWARD Databank). Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA 98122, USA. . Accepted for publication March 29, 2021
| | - Meghan Glynn
- This study was sponsored by Corrona, LLC. Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Crescendo, Eli Lilly, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Ortho Dermatologics, Pfizer Inc., Regeneron, Roche, Sun, and UCB. The design and conduct of the study were a collaborative effort between Corrona, LLC, and Novartis, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data, and review and approval of the manuscript. P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington; R.R. McLean, DSc, MPH, B. Dube, MPH, M. Liu, PhD, S. Rebello, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts; E. Yi, PharmD, Y. Park, PharmD, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PJM has received research grants from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, and consulting and/ or speakers bureau fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Galapagos, Genentech, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB. RRM and BD are employees of Corrona, LLC. ML, SR, and MG were employees of Corrona, LLC, at the time of this analysis. EY and YP are employees of Novartis Pharmaceuticals Corporation. AO has received consulting fees from Amgen, AbbVie, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD Databank), and Novartis (FORWARD Databank). Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA 98122, USA. . Accepted for publication March 29, 2021
| | - Esther Yi
- This study was sponsored by Corrona, LLC. Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Crescendo, Eli Lilly, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Ortho Dermatologics, Pfizer Inc., Regeneron, Roche, Sun, and UCB. The design and conduct of the study were a collaborative effort between Corrona, LLC, and Novartis, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data, and review and approval of the manuscript. P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington; R.R. McLean, DSc, MPH, B. Dube, MPH, M. Liu, PhD, S. Rebello, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts; E. Yi, PharmD, Y. Park, PharmD, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PJM has received research grants from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, and consulting and/ or speakers bureau fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Galapagos, Genentech, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB. RRM and BD are employees of Corrona, LLC. ML, SR, and MG were employees of Corrona, LLC, at the time of this analysis. EY and YP are employees of Novartis Pharmaceuticals Corporation. AO has received consulting fees from Amgen, AbbVie, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD Databank), and Novartis (FORWARD Databank). Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA 98122, USA. . Accepted for publication March 29, 2021
| | - Yujin Park
- This study was sponsored by Corrona, LLC. Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Crescendo, Eli Lilly, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Ortho Dermatologics, Pfizer Inc., Regeneron, Roche, Sun, and UCB. The design and conduct of the study were a collaborative effort between Corrona, LLC, and Novartis, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data, and review and approval of the manuscript. P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington; R.R. McLean, DSc, MPH, B. Dube, MPH, M. Liu, PhD, S. Rebello, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts; E. Yi, PharmD, Y. Park, PharmD, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PJM has received research grants from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, and consulting and/ or speakers bureau fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Galapagos, Genentech, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB. RRM and BD are employees of Corrona, LLC. ML, SR, and MG were employees of Corrona, LLC, at the time of this analysis. EY and YP are employees of Novartis Pharmaceuticals Corporation. AO has received consulting fees from Amgen, AbbVie, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD Databank), and Novartis (FORWARD Databank). Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA 98122, USA. . Accepted for publication March 29, 2021
| | - Alexis Ogdie
- This study was sponsored by Corrona, LLC. Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Crescendo, Eli Lilly, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Ortho Dermatologics, Pfizer Inc., Regeneron, Roche, Sun, and UCB. The design and conduct of the study were a collaborative effort between Corrona, LLC, and Novartis, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data, and review and approval of the manuscript. P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington; R.R. McLean, DSc, MPH, B. Dube, MPH, M. Liu, PhD, S. Rebello, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts; E. Yi, PharmD, Y. Park, PharmD, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PJM has received research grants from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, and consulting and/ or speakers bureau fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Galapagos, Genentech, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB. RRM and BD are employees of Corrona, LLC. ML, SR, and MG were employees of Corrona, LLC, at the time of this analysis. EY and YP are employees of Novartis Pharmaceuticals Corporation. AO has received consulting fees from Amgen, AbbVie, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD Databank), and Novartis (FORWARD Databank). Address correspondence to Dr. P.J. Mease, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA 98122, USA. . Accepted for publication March 29, 2021
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Hur JW, Ko KM, Park KS, Hong SJ, Kim HS, Lee MS. Real-world experiences of the diagnosis process in Korean patients with ankylosing spondylitis based on a self-report questionnaire. J Int Med Res 2021; 49:3000605211004201. [PMID: 33823632 PMCID: PMC8033485 DOI: 10.1177/03000605211004201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives The diagnosis of ankylosing spondylitis (AS) is often delayed, which affects
various clinical outcomes. This study examined the real-world situation of
patients with AS during diagnosis and treatment. Methods Data were obtained from 26 tertiary care hospitals in Korea using a
self-report questionnaire. The questionnaire assessed symptoms, pain,
extra-articular manifestations, the initial pattern of pain before
diagnosis, factors leading to delayed referral to rheumatology, time until
receiving an AS diagnosis, comorbid diseases, treatment status, and disease
education needs. Results Between September and October 2019, 1012 patients with AS completed the
survey. Of these, 75.8% were men and 51.8% were in their 30s or 40s. Median
disease duration was 76 months. The median time to diagnosis with AS was 12
months. When pain occurred, the medical departments most frequently visited
first were orthopedic (61.5%) and rheumatology (18.7%) departments. The
likelihood of the first visit being to the orthopedic department and the
frequency of biologics use increased with the disease duration. The rates of
uveitis, depressed mood, and comorbid diseases were higher in the group with
delayed diagnosis. Conclusions Physicians should be aware of subtypes of AS that take longer to diagnose and
comorbid diseases in the real-world clinical setting.
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Affiliation(s)
- Jin-Wuk Hur
- Division of Rheumatology, Department of Internal Medicine, Nowon
Eulji University Hospital, Seoul, Republic of Korea
| | - Kyung Min Ko
- Division of Rheumatology, Department of Internal Medicine,
International St. Mary's Hospital, Catholic Kwandong University, Incheon,
Republic of Korea
| | - Kyung-Su Park
- Division of Rheumatology, Department of Internal Medicine, St.
Vincent’s Hospital, The Catholic University of Korea College of Medicine, Suwon,
Republic of Korea
| | - Seung-Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung
Hee University Medical Center, Seoul, Republic of Korea
| | - Hyun-Sook Kim
- Division of Rheumatology, Department of Internal Medicine,
Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
- Hyun-Sook Kim, Division of Rheumatology,
Department of Internal Medicine, Division of Rheumatology, Soonchunhyang Univ.
Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu. Seoul 04401, Republic of Korea.
| | - Myeung-Su Lee
- Division of Rheumatology, Department of Internal Medicine,
Wonkwang University Hospital, Iksan, Republic of Korea
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Axial Spondyloarthritis and Ankylosing Spondylitis. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Saeed MA, Ahmed H, Faiq M, Aslam Z, Elaine Anwer Khan S, Batool S, Farman S, Ahmad NM. Prevalence of inflammatory back pain and radiographic axial spondyloarthritis in a semi-urban community of Lahore, Pakistan. Int J Rheum Dis 2020; 24:207-215. [PMID: 33244897 DOI: 10.1111/1756-185x.14030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 02/06/2023]
Abstract
AIMS To determine the prevalence of inflammatory back pain (IBP) and radiographic axial spondyloarthritis (SpA) in a semi-urban community of Lahore, Pakistan. METHODS This cross-sectional household survey was designed as per the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) model. In Phase 1, the subjects were interviewed for musculoskeletal (MSK) pain in the last 7 days by clinical assistants. In Phase 2, physiotherapists identified subjects with spinal/back pain and interviewed for Assessment in Spondyloarthritis International Working Group (ASAS) criteria for IBP. In Phase 3 subjects having IBP or chronic back pain (CBP) with an age at onset ≤45 years, were assessed and further investigated. RESULTS A total of 4922 subjects with a mean age of 35.3 ± 14.5 years, including 2770 (56%) women were surveyed in Phase 1. MSK pain in last 7 days was reported by 1407 (28.6%) of whom 1034 (21%) had spinal pain. The ASAS criteria for IBP were met in 329 (6.7%, 95% CI 6.0-7.0). In Phase 3, 222 with IBP and 83 having CBP with age at onset ≤45 years were evaluated. Out of this total of 305, 144 (2.9%) were confirmed to have IBP by rheumatologists as per at least 1 of the 3 criteria. ASAS criteria were met in 107 (2.2%, 95% CI 1.8-2.6). ASAS criteria for radiographic axial SpA were met in 47 (1%, 95% CI 0.7-1.3) of the surveyed population. CONCLUSION Inflammatory back pain was reported in 6.7% by physiotherapists, confirmed in 3% by rheumatologists. The prevalence of radiographic axial SpA was 1%.
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Affiliation(s)
- Muhammad Ahmed Saeed
- Rheumatology, Al-Aleem Medical College, Lahore, Pakistan.,Department of Rheumatology, Gulab Devi Teaching Hospital, Al-Aleem Medical College, Lahore, Pakistan.,Department of Rheumatology, National Hospital and Medical Center, Lahore, Pakistan.,Adjunct Faculty Fatima, Jinnah Medical University, Lahore, Pakistan.,Arthritis Care Foundation, Lahore, Pakistan
| | - Hina Ahmed
- Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Muhammad Faiq
- Department of Rheumatology, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Zeeshan Aslam
- Department of Rheumatology, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Saira Elaine Anwer Khan
- Department of Rheumatology, FMH College of Medicine and Dentistry, Lahore, Pakistan.,Arthritis Care Foundation, Lahore, Pakistan
| | - Shabnam Batool
- Department of Rheumatology, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Sumaira Farman
- Department of Rheumatology, National Hospital and Medical Center, Lahore, Pakistan.,Adjunct Faculty Fatima, Jinnah Medical University, Lahore, Pakistan.,Arthritis Care Foundation, Lahore, Pakistan
| | - Nighat Mir Ahmad
- Department of Rheumatology, Gulab Devi Teaching Hospital, Al-Aleem Medical College, Lahore, Pakistan.,Department of Rheumatology, National Hospital and Medical Center, Lahore, Pakistan.,Adjunct Faculty Fatima, Jinnah Medical University, Lahore, Pakistan.,Arthritis Care Foundation, Lahore, Pakistan
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Magrey MN, Danve AS, Ermann J, Walsh JA. Recognizing Axial Spondyloarthritis: A Guide for Primary Care. Mayo Clin Proc 2020; 95:2499-2508. [PMID: 32736944 DOI: 10.1016/j.mayocp.2020.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 01/18/2023]
Abstract
Axial spondyloarthritis (axSpA) is an important cause of chronic low back pain and affects approximately 1% of the US population. The back pain associated with axSpA has a characteristic pattern referred to as inflammatory back pain (IBP). Features of IBP include insidious onset before age 45 years, association with morning stiffness, improvement with exercise but not rest, alternating buttock pain, and good response to treatment with nonsteroidal anti-inflammatory drugs. In patients with IBP, it is essential to look for other features associated with spondyloarthritis (SpA), such as enthesitis, dactylitis, peripheral arthritis, extra-articular manifestations (eg, psoriasis, uveitis, or inflammatory bowel disease), human leukocyte antigen B27 positivity, and a family history of SpA. Axial SpA is underrecognized, and a delay of several years between symptom onset and diagnosis is common. However, with new and effective therapies available for the treatment of active axSpA, early recognition and diagnosis are of critical importance. For this narrative review, we conducted a literature search of English-language articles using PubMed. Individual searches were performed to identify potential articles of interest related to axSpA (search terms: ["axSpA" OR "axial SpA" OR "axial spondyloarthritis" OR "ankylosing spondylitis"]) in combination with terms related to IBP ("inflammatory back pain" OR "IBP" OR "chronic back pain" OR "CBP" OR "lower back pain" OR "LBP"), diagnosis (["diagn∗" OR "classification"] AND ["criteria" OR "recommend∗" OR "guidelines"]), and referral ("refer∗"). No date range was formally selected, as we were interested in providing an overview of the evolution of these concepts in clinical practice. We supplemented the review with insights based on our clinical expertise. Patients with chronic back pain should be screened for IBP and other SpA features; suspicion for axSpA should trigger referral to a rheumatologist for further evaluation.
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Affiliation(s)
- Marina N Magrey
- MetroHealth System and School of Medicine, Division of Rheumatology, Case Western Reserve University, Cleveland, OH.
| | | | - Joerg Ermann
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jessica A Walsh
- University of Utah and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT
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Fassio A, Matzneller P, Idolazzi L. Recent Advances in Imaging for Diagnosis, Monitoring, and Prognosis of Psoriatic Arthritis. Front Med (Lausanne) 2020; 7:551684. [PMID: 33195301 PMCID: PMC7658536 DOI: 10.3389/fmed.2020.551684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory condition characterized by a strong heterogeneity and multifaceted behavior. PsA manifests in two types—axial and peripheral—which may be present at the same time. Peripheral manifestations can be further divided into the articular (arthritis) and extra-articular (i.e., enthesitis and dactylitis) subgroups. In such a complex disease, imaging is often required to characterize the type of involvement and to evaluate the radiological damage and progression of PsA. In addition, imaging plays a pivotal role in clinical practice; that is, for axial involvement. Conventional radiology has been the main standard of reference for many years. However, in recent years, there has been growing interest in different imaging modalities, such as ultrasonography (US) and magnetic resonance imaging (MRI). All these techniques play a role in the diagnosis and follow-up of patients with PsA and cover all the types of the disease. US and MRI have good sensitivities and specificities for detecting synovitis, and this may be helpful for differential diagnosis with other musculoskeletal diseases and useful in the early or preclinical phases of the disease. However, US is not useful in the diagnosis of axial PsA. In addition, other modalities have been investigated in the field of PsA imaging. Computed tomography (CT), in particular, dual energy-CT and high-resolution peripheral CT (HRpQ-CT) might play an important role in the assessment of bone damage, erosions, and new bone formation. Regarding advanced functional imaging, FDG PET/CT is another interesting technique for exploring disease activity.
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Affiliation(s)
- Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
- *Correspondence: Angelo Fassio
| | - Peter Matzneller
- Rheumatology Service, South Tyrolean Health Trust, Silandro Hospital, Silandro, Italy
| | - Luca Idolazzi
- Rheumatology Unit, University of Verona, Verona, Italy
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Barnett R, Ingram T, Sengupta R. Axial spondyloarthritis 10 years on: still looking for the lost tribe. Rheumatology (Oxford) 2020; 59:iv25-iv37. [PMID: 33053196 PMCID: PMC7566532 DOI: 10.1093/rheumatology/keaa472] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the publication of various recommendations, quality standards and referral strategies to promote early diagnosis in axial SpA (axSpA) over the last decade, there remains a significant delay to diagnosis, leading to a lost tribe of undiagnosed, untreated patients with persistent back pain and axSpA symptoms. This review discusses the various factors contributing to diagnostic delay in axSpA, while providing recommendations to improve the diagnostic pathway, for example use of the online Spondyloarthritis Diagnosis Evaluation (SPADE) tool (http://www.spadetool.co.uk/). Significant shortcomings exist at both the primary and secondary care level, with healthcare professionals often lacking knowledge and awareness of axSpA. Myths regarding the classical signs and symptoms still prevail, including the perception of axSpA as a male disease, only occurring in individuals who are HLA-B27 positive with raised inflammatory markers. Individuals within this lost tribe of undiagnosed patients are likely lacking adequate treatment and are thereby at risk of worse clinical outcomes. It is therefore vital that public health initiatives are implemented to improve education of healthcare professionals and to ensure early specialist referral, to ultimately improve the lives of patients with axSpA.
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Affiliation(s)
- Rosemarie Barnett
- Axial Spondyloarthritis Service, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust
- Department of Computer Science, University of Bath
| | - Thomas Ingram
- Axial Spondyloarthritis Service, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust
- Department for Health, University of Bath
| | - Raj Sengupta
- Axial Spondyloarthritis Service, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
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50
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Lapane KL, Khan S, Shridharmurthy D, Beccia A, Dubé C, Yi E, Kay J, Liu SH. Primary care physician perspectives on barriers to diagnosing axial Spondyloarthritis: a qualitative study. BMC FAMILY PRACTICE 2020; 21:204. [PMID: 32993510 PMCID: PMC7526414 DOI: 10.1186/s12875-020-01274-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The average delay in diagnosis for patients with axial spondyloarthritis (axSpA) is 7 to 10 years. Factors that contribute to this delay are multifactorial and include the lack of diagnostic criteria (although classification criteria exist) for axSpA and the difficulty in distinguishing inflammatory back pain, a key symptom of axSpA, from other highly prevalent forms of low back pain. We sought to describe reasons for diagnostic delay for axSpA provided by primary care physicians. METHODS We conducted a qualitative research study which included 18 US primary care physicians, balanced by gender. Physicians provided informed consent to participate in an in-depth interview (< 60 min), conducted in person (n = 3) or over the phone (n = 15), in 2019. The analysis focuses on thoughts about factors contributing to diagnostic delay in axSpA. RESULTS Physicians noted that the disease characteristics contributing to diagnostic delay include: back pain is common and axSpA is less prevalent, slow progression of axSpA, intermittent nature of axSpA pain, and in the absence of abnormal radiographs of the spine or sacroiliac joints, there is no definitive test for axSpA. Patient characteristics believed to contribute to diagnostic delay included having multiple conditions in need of attention, infrequent interactions with the health care system, and "doctor shopping." Doctors noted that patients wait until the last moments of the clinical encounter to discuss back pain. Problematic physician characteristics included lack of rapport with patients, lack of setting appropriate expectations, and attribution of back pain to other factors. Structural/system issues included short appointments, lack of continuity of care, insufficient insurance coverage for tests, lack of back pain clinics, and a shortage of rheumatologists. CONCLUSION Primary care physicians agreed that lengthy axSpA diagnosis delays are challenging to address owing to the multifactorial causes (e.g., disease characteristics, patient characteristics, lack of definitive tests, system factors).
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Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA. .,Sherman Center, University of Massachusetts Medical School, 55 Lake Avenue North, 6th floor, Worcester, MA, 01655, USA.
| | - Sara Khan
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Divya Shridharmurthy
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Ariel Beccia
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Catherine Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, 59 Route 10, East Hanover, NJ, 07936, USA
| | - Jonathan Kay
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, 55 Lake Avenue North, Worcester, MA, 01605, USA.,Division of Rheumatology, UMass Memorial Medical Center, 119 Belmont St, Worcester, MA, 01605, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, 55 Lake Avenue North, Worcester, MA, 01605, USA
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