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Gendelman O, Simon N, Ben-Shabat N, Patt YS, McGonagle D, Cohen AD, Amital H, Watad A. Increased Risk for Pulmonary Embolism among Patients with Ankylosing Spondylitis-Results from a Large Database Analysis. J Clin Med 2024; 13:2790. [PMID: 38792334 PMCID: PMC11122635 DOI: 10.3390/jcm13102790] [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: 03/19/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Axial spondyloarthropathy(AS) is a chronic inflammatory disease primarily affecting the axial skeleton, often characterized by sacroiliitis. While pulmonary embolism (PE), a potentially lethal condition, has been linked to several autoimmune diseases, limited data exist regarding PE risk among patients with AS. Methods: This retrospective cohort study utilized the Clalit Healthcare Services (CHS) database, including 5825 patients with AS and 28,356 matched controls. Follow-up began at the date of first AS diagnosis for patients and at the matched patient's diagnosis date for controls and continued until PE diagnosis, death, or study end date. Results: Prevalence of PE before AS diagnosis in patients compared to controls was 0.4% vs. 0.2% (p < 0.01). The incidence rate of PE was 11.6 per 10,000 person-years for patients with AS and 6.8 per 10,000 person-years for controls. The adjusted hazard ratio (HR) for PE in patients with AS was 1.70 (p < 0.001). Subgroup analysis demonstrated excess risk for PE in patients with AS regardless of gender and age, with variations among AS treatment categories. Discussion: Our findings highlight a significant association between AS and PE, indicating an increased risk in patients with AS independent of age and sex and suggests a subclinical level of inflammation. Preliminary results suggest a protective role of immunosuppressing drugs. Further research into the impact of treatment strategies should be conducted and could inform clinical management and reduce the life-threatening risk of PE in Patients with AS.
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Affiliation(s)
- Omer Gendelman
- Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (O.G.); (N.B.-S.); (Y.S.P.); (H.A.); (A.W.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Neta Simon
- Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (O.G.); (N.B.-S.); (Y.S.P.); (H.A.); (A.W.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Niv Ben-Shabat
- Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (O.G.); (N.B.-S.); (Y.S.P.); (H.A.); (A.W.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yonatan Shneor Patt
- Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (O.G.); (N.B.-S.); (Y.S.P.); (H.A.); (A.W.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK;
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Arnon Dov Cohen
- Chief Physician’s Office, Central Headquarters, Clalit Health Services, Tel Aviv 67754, Israel;
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Howard Amital
- Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (O.G.); (N.B.-S.); (Y.S.P.); (H.A.); (A.W.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Abdulla Watad
- Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (O.G.); (N.B.-S.); (Y.S.P.); (H.A.); (A.W.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Chaudhary H, Bohra N, Syed K, Donato A, Murad MH, Karmacharya P. All-Cause and Cause-Specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2023; 75:1052-1065. [PMID: 34788902 PMCID: PMC9110556 DOI: 10.1002/acr.24820] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/26/2021] [Accepted: 11/11/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic inflammatory diseases associated with a higher risk of cardiometabolic comorbidities compared to the general population. Individual studies examining mortality in these patients have produced conflicting results. The present study was undertaken to perform a systematic review and meta-analysis to analyze the all-cause and cause-specific mortality in PsA and AS from the available literature. METHODS A comprehensive database search was performed for studies reporting all-cause or cause-specific mortality in patients with PsA and AS compared with the general population. Pooled relative risks (RRs) were calculated using a random-effects model. RESULTS We included 19 studies (11 of PsA, 7 of AS, 1 of both). In PsA studies, there was no increased mortality compared to the general population (RR 1.12 [95% confidence interval (95% CI) 0.96-1.30]; n = 10 studies). We found a higher all-cause mortality in female (RR 1.19 [95% CI 1.04-1.36]) but not in male (RR 1.02 [95% CI 0.66-1.59]) PsA patients. Cardiovascular-, respiratory-, and infection-specific mortality risks were significantly higher for PsA patients (RR 1.21 [95% CI 1.06-1.38], RR 3.37 [95% CI 1.30-8.72], and RR 2.43 [95% CI 1.01-5.84], respectively), but not cancer-related mortality (RR 1.01 [95% CI 0.91-1.11]). In AS, we found a higher risk of death from all causes (RR 1.64 [95% CI 1.49-1.80]; n = 6 studies) and cardiovascular causes (RR 1.35 [95% CI 1.01-1.81]; n = 3 studies) compared to the general population. All-cause mortality was high in both male (RR 1.56 [95% CI 1.43-1.71]) and female (RR 1.85 [95% CI 1.56-2.18]) AS patients. The included AS studies did not report mortality data for non-cardiovascular causes. CONCLUSION This systematic review and meta-analysis showed a significantly increased risk of overall mortality in AS but not PsA. Cardiovascular-specific mortality was higher for both PsA and AS, which emphasizes the importance of early screening and management of cardiovascular risk factors.
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Affiliation(s)
- Haseeb Chaudhary
- Department of Internal Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Nidrit Bohra
- Department of Internal Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Khezar Syed
- Department of Internal Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Anthony Donato
- Department of Internal Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | | | - Paras Karmacharya
- Division of Rheumatology, Mayo Clinic, Rochester, MN
- Division of Rheumatology, Vanderbilt University Medical Center, Nashville, TN
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Watad A, McGonagle D, Anis S, Carmeli R, Cohen AD, Tsur AM, Ben-Shabat N, Lidar M, Amital H. TNF inhibitors have a protective role in the risk of dementia in patients with ankylosing spondylitis: Results from a nationwide study. Pharmacol Res 2022; 182:106325. [PMID: 35752359 DOI: 10.1016/j.phrs.2022.106325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/24/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Ankylosing spondylitis (AS) is a chronic progressive and debilitating form of arthritis with associated extra-articular features including uveitis, intestinal and lung apical inflammation and psoriasis. Putative associations between AS and neurologic disorders has been relatively overlooked. The purpose of this study is to assess the link between AS and major neurologic disorders and whether treatment with Tumor-Necrosis-Factor inhibitors (TNFi) has an impact on that association. METHODS A retrospective cross-sectional study was carried out based on the Clalit Health Services (CHS) computerized database. AS patients were compared to age- and gender-matched controls with respect to the proportion of Alzheimer's disease (AD), Parkinson's disease (PD), epilepsy, and multiple sclerosis (MS). The impact of AS therapy (biologic vs conventional therapy) was assessed as well. RESULTS 4,082 AS patients and 20,397 age- and gender-matched controls were identified. AS was associated with a higher prevalence of AD (odds-ratio(OR) 1.46 [95%Confidence-interval(CI) 1.13-1.87], p=0.003), epilepsy (OR 2.33 [95%CI 1.75-3.09] p<0.0001) and PD (OR 2.75 [95%CI 2.04-3.72], p<0.0001), whereas no statistically significant association was found for MS. Association with PD remained significant in the multivariate analysis (OR 1.49 [95%CI 1.05- 2.13],p=0.027). Within AS patients, the use of TNFi (OR 0.10 [95%CI 0.01-0.74], p=0.024) were associated with a lowered risk of developing AD. CONCLUSION AS is positively associated with AD, PD, and epilepsy but not MS. AS patients treated with TNFi have lower rates of AD.
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Affiliation(s)
- Abdulla Watad
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
| | - Dennis McGonagle
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Saar Anis
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Reut Carmeli
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avishai M Tsur
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Niv Ben-Shabat
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Merav Lidar
- Rheumatology unit, Sheba Medical Centre, Ramat Gan, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Centre, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
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García EI, Martin-Delgado J, Queiro R, Pérez Venegas JJ, Gratacos J, Sanz J, Torrés A, Mira JJ. Quality certification standard proposal "SpACE" for axial spondyloarthritis treatment units. ACTA ACUST UNITED AC 2021; 18:299-303. [PMID: 34736873 DOI: 10.1016/j.reumae.2021.04.005] [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: 11/09/2020] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. MATERIALS AND METHODS Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. RESULTS Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. DISCUSSION AND CONCLUSIONS SpACE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.
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Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Sant Joan d'Alacant, Alicante, Spain.
| | - Ruben Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Jordi Gratacos
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Jesús Sanz
- Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain; Universidad Miguel Hernández, Elche, Alicante, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Alicante, Spain
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van der Meer R, Arends S, Kruidhof S, Bos R, Bootsma H, Wink F, Spoorenberg A. Extra-skeletal manifestations in axial spondyloarthritis are associated with worse clinical outcome despite the use of TNF blocking therapy. J Rheumatol 2021; 49:157-164. [PMID: 34393101 DOI: 10.3899/jrheum.210308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the prevalence and 4-year incidence of acute anterior uveitis (AAU), inflammatory bowel disease (IBD) and psoriasis, and to explore associations of newly developed extra-skeletal manifestations (ESMs) with clinical disease outcome in a large cohort of axial spondyloarthritis (SpA) patients. METHODS All consecutive patients included in the Groningen Leeuwarden Axial SpA (GLAS) cohort between 2004 and 2011 were analysed. History of ESMs at baseline and newly developed ESMs during 4-year follow-up were only recorded when diagnosis by an ophthalmologist, gastroenterologist or dermatologist was present. RESULTS Of the 414 included axial SpA patients, 31.5% had a positive history of one or more ESMs: 24.9% AAU, 9.4% IBD, and 4.4% psoriasis. History of psoriasis was significantly associated with more radiographic damage, especially of the cervical spine. Of the 362 patients with 4-year follow-up data, 15.7% patients developed an ESM: 13.3% patients with AAU, of which 3.6% had a first episode and 9.7% had recurrent AAU, 1.9% developed IBD, and 0.8% developed psoriasis. Patients who newly developed ESMs (without history of ESMs) had worse ASQoL score (mean 10.0 vs. 5.9, p=0.001), larger occiput to wall distance (median 6.3 vs. 2.0, p=0.021) and more limited modified Schober test (mean 12.6 vs. 13.6, p=0.014) after 4 years of follow-up. The majority of patients developing an ESM used anti-TNF therapy. CONCLUSION History of ESMs was present at baseline in one-third of axial SpA patients. The 4-year incidence of ESMs was relatively low, but patients who developed a new ESM reported worse quality of life.
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Affiliation(s)
- Rienk van der Meer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Suzanne Arends
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Sandra Kruidhof
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Reinhard Bos
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Hendrika Bootsma
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Freke Wink
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Anneke Spoorenberg
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
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García EI, Martin-Delgado J, Queiro R, Pérez Venegas JJ, Gratacos J, Sanz J, Torrés A, Mira JJ. Quality Certification Standard Proposal "SpACE" for Axial Spondyloarthritis Treatment Units. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00126-1. [PMID: 34148827 DOI: 10.1016/j.reuma.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. MATERIALS AND METHODS Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. RESULTS Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. DISCUSSION AND CONCLUSIONS SpaCE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.
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Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Sant Joan d'Alacant, Alicante, España.
| | - Ruben Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Jordi Gratacos
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Jesús Sanz
- Hospital Puerta de Hierro, Majadahonda, Madrid, España
| | - Antonio Torrés
- Sociedad Española de Calidad Asistencial, Oviedo, España
| | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España; Universidad Miguel Hernández, Elche, Alicante, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Alicante, España
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Stolwijk C, Essers I, van den Bosch F, Dougados M, Etcheto A, van der Heijde D, Landewé R, Molto A, van Tubergen A, Boonen A. Validation of the self-administered comorbidity questionnaire adjusted for spondyloarthritis: results from the ASAS-COMOSPA study. Rheumatology (Oxford) 2020; 59:1632-1639. [PMID: 31665462 PMCID: PMC7310090 DOI: 10.1093/rheumatology/kez482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/17/2019] [Indexed: 12/21/2022] Open
Abstract
Objective To confirm validity of the Self-administered Comorbidity Questionnaire modified for patients with SpA (mSCQ), and assess whether validity improves when adding items on extra-articular manifestations (EAMs), i.e. uveitis, psoriasis, and IBD, and osteoporosis and fractures. Methods Data from the Assessment in SpondyloArthritis international Society COMOrbidities in SPondyloArthritis study were used. Criterion validity of presence of EAMs, osteoporosis and fractures was assessed as agreement (kappa) between patients’ self-reported and physician-confirmed disease. Construct validity of the mSCQ including EAMs, osteoporosis and/or fractures (SpA-SCQ) was assessed by testing hypotheses about correlations with demographics, physical function, work ability, health utility and disease activity, and was compared with construct validity of the rheumatic disease comorbidity index. Results In total, 3984 patients contributed to the analyses. Agreement between patient-reported and physician-reported EAMs was substantial to almost perfect (uveitis ĸ = 0.81, IBD ĸ = 0.73, psoriasis ĸ = 0.86). Agreement for osteoporosis (ĸ = 0.38) and fractures (ĸ = 0.39) was fair. As hypothesized, the mSCQ correlated moderately to weakly with age, physical function, work limitations and health utility, and very weakly with disease activity. In contrast to our hypothesis, adding EAMs, osteoporosis and/or fractures to the mSCQ decreased correlations with several external constructs, especially among patients with peripheral SpA. Correlations with the different constructs were stronger for the both mSCQ and SpA-SCQ (rBASFI = 0.34; rEQ-5D = −0.33) compared with the rheumatic disease comorbidity index (rBASFI = 0.24; rEQ-5D = −0.21). Conclusion The mSCQ is a valid self-report instrument to assess the influence of comorbidities on health outcomes in patients with SpA. Adding EAMs and/or osteoporosis or fractures does not improve validity of the mSCQ.
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Affiliation(s)
- Carmen Stolwijk
- Department of Rheumatology, Maastricht University Medical Center.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ivette Essers
- Department of Rheumatology, Maastricht University Medical Center.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht
| | - Filip van den Bosch
- Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium
| | - Maxime Dougados
- Department of Rheumatology, Paris Descartes University and Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Adrien Etcheto
- Department of Rheumatology, Paris Descartes University and Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology & Immunology Centre, Amsterdam, The Netherlands
| | - Anna Molto
- Department of Rheumatology, Paris Descartes University and Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Astrid van Tubergen
- Department of Rheumatology, Maastricht University Medical Center.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht
| | - Annelies Boonen
- Department of Rheumatology, Maastricht University Medical Center.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht
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Castañeda S, Vicente-Rabaneda EF, García-Castañeda N, Prieto-Peña D, Dessein PH, González-Gay MA. Unmet needs in the management of cardiovascular risk in inflammatory joint diseases. Expert Rev Clin Immunol 2019; 16:23-36. [DOI: 10.1080/1744666x.2019.1699058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
- Department of Medicine, Cátedra UAM-ROCHE, EPID Future, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | | | - Diana Prieto-Peña
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Patrick H. Dessein
- Honorary Research Professor, School of Physiology and School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Miguel A. González-Gay
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- School of Medicine, University of Cantabria, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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9
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Mease PJ, Liu M, Rebello S, Kang H, Yi E, Park Y, Greenberg JD. Comparative Disease Burden in Patients with Rheumatoid Arthritis, Psoriatic Arthritis, or Axial Spondyloarthritis: Data from Two Corrona Registries. Rheumatol Ther 2019; 6:529-542. [PMID: 31529278 PMCID: PMC6858426 DOI: 10.1007/s40744-019-00172-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) are three common inflammatory rheumatic diseases that can lead to deformities and joint destruction. Few studies have compared disease burden across patients with these diseases. The objective of this study was to compare disease burden in patients with RA, PsA, or axSpA in routine US clinical practice. METHODS This study included adults with RA, PsA, or axSpA enrolled in the Corrona RA and PsA/SpA registries between March 2013 and March 2018. Patient and clinical characteristics at enrollment were compared between patients with RA vs. PsA and RA vs. axSpA using t tests or Wilcoxon rank-sum tests for continuous variables and χ2 or Fisher's exact tests for categorical variables. RESULTS A total of 11,350 patients with RA, 2003 with PsA, and 495 with axSpA were included. Patients with RA had shorter mean symptom and disease duration (9.4 and 7.6 years, respectively) than those with PsA (11.2 and 8.4 years) or axSpA (16.7 and 9.8 years). Patients with PsA had lower mean physician global assessment (18.6 vs. 27.3), higher patient global assessment (43.2 vs. 36.9), comparable pain (38.9 vs. 39.5), and lower fatigue (41.1 vs. 43.4) scores than those with RA. Patients with axSpA had comparable mean physician global assessment (25.5 vs. 27.3) and higher patient global assessment (50.2 vs. 36.9), pain (46.1 vs. 39.5), and fatigue (48.3 vs. 43.4) scores than those with RA. CONCLUSIONS Disease burden in patients with PsA or axSpA was comparable to or greater than that in patients with RA on the basis of common patient-reported outcome measures but appeared lower when assessed using RA disease activity measures, suggesting that disease-specific approaches to care are needed to optimize disease management. FUNDING This study was sponsored by Corrona, LLC, and financial support was provided by Novartis. The Rapid Service Fee was funded by Novartis. Plain language summary available for this article.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St, Joseph Health and University of Washington, Seattle, WA, USA.
| | - Mei Liu
- Corrona, LLC, Waltham, MA, USA
| | | | | | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Yujin Park
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Jeffrey D Greenberg
- Corrona, LLC, Waltham, MA, USA
- New York University School of Medicine, New York, NY, USA
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Choi RY, Asquith M, Rosenbaum JT. Fecal transplants in spondyloarthritis and uveitis: ready for a clinical trial? Curr Opin Rheumatol 2019. [PMID: 29538010 DOI: 10.1097/bor.0000000000000506] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The intestinal microbiome is thought to play a role in the pathogenesis of inflammatory bowel disease (IBD). There are many shared clinical manifestations between IBD and spondyloarthritis (SpA), of which the most common are peripheral arthritis and uveitis. Clinical overlap along with similar genetics between these diseases suggests a possible shared pathogenetic mechanism, which might center on the intestinal microbiota. In this review, we discuss the available evidence that SpA is a microbiome-driven disease and indicate how SpA-associated uveitis could be tied to gut dysbiosis. We conclude by discussing different treatment paradigms targeting the intestinal microbiome for SpA. RECENT FINDINGS Recent studies support the growing evidence of the intestinal microbiome as a crucial player in SpA disease pathogenesis. There is emerging evidence that the gut microbiome may play a causative role in uveitis. SUMMARY The field is beginning to discover a new level of understanding how the intestinal microbiome is involved in SpA. Treatment methods to alter intestinal microbiota to treat SpA-related diseases are still in its infancy.
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Affiliation(s)
- Rene Y Choi
- Department of Ophthalmology, Casey Eye Institute
| | - Mark Asquith
- Division of Arthritis and Rheumatic Diseases, Department of Ophthalmology, Oregon Health and Science University
| | - James T Rosenbaum
- Department of Ophthalmology, Casey Eye Institute.,Division of Arthritis and Rheumatic Diseases, Department of Ophthalmology, Oregon Health and Science University.,Legacy Devers Eye Institute, Portland, Oregon, USA
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12
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Macfarlane GJ, MacDonald RIR, Pathan E, Siebert S, Gaffney K, Choy E, Packham J, Martin KR, Haywood K, Sengupta R, Atzeni F, Jones GT. Influence of co-morbid fibromyalgia on disease activity measures and response to tumour necrosis factor inhibitors in axial spondyloarthritis: results from a UK national register. Rheumatology (Oxford) 2019; 57:1982-1990. [PMID: 30053166 PMCID: PMC6199528 DOI: 10.1093/rheumatology/key206] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Indexed: 12/17/2022] Open
Abstract
Objective To quantify the extent to which co-morbid FM is associated with higher disease activity, worse quality of life (QoL) and poorer response to TNF inhibitors (TNFis) in patients with axial SpA. Methods A prospective study recruiting across 83 centres in the UK. Clinical information and patient-reported measures were available, including 2011 criteria for FM. Multivariable linear regression was used to model the effect of meeting the FM criteria on disease activity, QoL and response to TNFis. Results A total of 1757 participants were eligible for analyses, of whom 22.1% met criteria for FM. Those with co-morbid FM criteria had higher disease activity [BASDAI average difference FM+ − FM− 1.04 (95% CI 0.75, 1.33)] and worse QoL [Ankylosing Spondylitis Quality of Life score difference 1.42 (95% CI 0.88, 1.96)] after adjusting for demographic, clinical and lifestyle factors. Among 291 participants who commenced biologic therapy, BASDAI scores in those with co-morbid FM were 2.0 higher at baseline but decreased to 1.1 higher at 12 months. There was no significant difference in the likelihood of meeting Assessment of SpondyloArthritis international Society 20 criteria at 12 months. Less improvement in disease activity and QoL over 3 months of TNFi therapy was most strongly related to high scores on the FM criteria symptom severity scale component. Conclusion Fulfilling criteria for FM has a modest impact on the assessment of axial SpA disease activity and QoL and does not significantly influence response to biologic therapy. Those with a high symptom severity scale on FM assessment may benefit from additional specific management for FM.
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Affiliation(s)
- Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Ross I R MacDonald
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Ejaz Pathan
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK.,Department of Rheumatology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Karl Gaffney
- Department of Rheumatology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Ernest Choy
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Jon Packham
- Research Institute for Applied Clinical Sciences, Keele University, Keele, UK
| | - Kathryn R Martin
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Raj Sengupta
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, UK
| | | | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
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13
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Wang CM, Hong WH, Ho HH, Chen JY, Tsai YL, Pei YC. Features of trunk muscle weakness in patients with ankylosing spondylitis: A cross-sectional study. Biomed J 2019; 42:124-130. [PMID: 31130248 PMCID: PMC6543501 DOI: 10.1016/j.bj.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 11/19/2018] [Accepted: 01/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is an inflammatory autoimmune disorder that manifested with sacroiliitis at its early stage and developed extensive inflammation with syndesmophytes of the lumbar, thoracic and cervical spines at its later stage. In the present study, we characterized the trunk isometric strength in patients with AS with different disease severity, defined by the radiological images. METHODS In a cross-sectional study conducted in a university-affiliated hospital, thirty-eight male AS patients (23 in the early AS group whose radiological findings showed no syndesmophyte, Modified Stoke Ankylosing Spinal Score (m-SASSS <3); and 15 in the syndesmophyte group, m-SASSS ≥24), and 22 healthy controls were recruited. All subjects received assessments of maximum isometric strength of trunk flexor and extensor muscles at a variety of trunk postures measured by an isokinetic device. RESULTS Under all examined trunk postures, the syndesmophyte AS patient group had the lowest isometric trunk muscle strength among the three groups. The flexion/extension ratio, defined by the ratio between isometric trunk flexor and extensor strengths, was highest among the three groups. CONCLUSIONS Trunk muscle strength significantly decreases in patients with syndesmophyte AS. The decrease of trunk muscle is inhomogeneous, which is more profound in extensor than in flexor muscles.
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Affiliation(s)
- Chin-Man Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Hsien Hong
- Department of Sports Medicine, China Medical University, Taichung, Taiwan
| | - Huei-Huang Ho
- Department of Rheumatology and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ji-Yih Chen
- Department of Rheumatology and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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14
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Longo B, Kirchner LA, Simioni J, de Campos APB, Skare TL. Electrocardiographic changes in spondyloarthritis and use of anti-TNF-α drugs: a retrospective study with 100 patients. EINSTEIN-SAO PAULO 2019; 17:eAO4539. [PMID: 30942280 PMCID: PMC6443210 DOI: 10.31744/einstein_journal/2019ao4539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity. METHODS Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed. RESULTS Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters. CONCLUSION Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.
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Affiliation(s)
- Betânia Longo
- Serviço de Reumatologia, Hospital Universitário Evangélico de Curitiba, PR, Brazil
| | | | - Juliana Simioni
- Serviço de Reumatologia, Hospital Universitário Evangélico de Curitiba, PR, Brazil
| | | | - Thelma Larocca Skare
- Serviço de Reumatologia, Hospital Universitário Evangélico de Curitiba, PR, Brazil
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15
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Deodhar A, Gensler LS, Sieper J, Clark M, Calderon C, Wang Y, Zhou Y, Leu JH, Campbell K, Sweet K, Harrison DD, Hsia EC, Heijde D, Ariel F, Asnal CA, Berman A, Citera G, Rodriguez G, Savio VG, Bird P, Griffiths H, Nicholls D, Rischmueller M, Zochling J, De Vlam K, Malaise M, Toukap AN, Van den Bosch F, Vanhoof J, Bonfiglioli R, Keiserman M, Scotton AS, Xavier R, Ximenes AC, Atanasov A, Goranov I, Kazmin I, Licheva RN, Nikolov N, Oparanov B, Stoilov R, Bessette L, Rodrigues J, Bortilik L, Dokoupilova E, Dvoarak Z, Galatikova D, Nemec P, Podrazilova L, Simkova G, Stejfova Z, Moravcova R, Vitek P, Cantagrel A, Baillet A, Banneville B, Combe B, Breban M, Nguyen M, Goupille P, Braun J, Everding A, Kekow J, Koenig R, Rubbert‐Roth A, Witte T, Bartha A, Drescher E, Kerekes K, Kovacs A, Pulai J, Rojkovich B, Szanto S, Toth E, Avila H, Torre IG, Irazoque F, Maradiaga M, Pacheco C, Brzosko M, Dudek A, Jeka S, Krogulec M, Kwiatkowska B, Wiland P, Wojciechowski R, Zielinska A, Santos H, Bugrova O, Christyakov V, Gorbunov V, Ilivanova E, Zemerova E, Kamalova R, Kameneva T, Macievskaya G, Marusenko I, Maslyansky A, Myasoedova S, Myasoutova L, Nemtsov B, Nesmeyanova O, Plaksina T, Pokrovskaya T, Polyakova S, Rebrov A, Savina L, Smakotina S, Stanislav M, Ukhanova O, Vinogradova I, Zonova E, Baek HJ, Kim T, Lee C, Lee S, Lee S, Lee S, Park S, Song Y, Suh C, Ramos JA, Blanco FJ, Collantes E, Diaz MC, Vivar MLG, Gratacos J, Juanola X, Chen D, Chen H, Chen K, Chen Y, Chiu Y, Luo S, Tsai S, Tseng J, Wei C, Weng M, Abrahamovych O, Reshotko D, Golovchenko O, Hospodarsky I, Iaremenko O, Levchenko O, Dudnyk O, Garmish O, Grishyna O, Protsenko G, Rekalov D, Smiyan S, Stanislavchuk M, Trypilka S, Tseluyko V, Turianytsia S, Vasylets V, Virstyuk N, Kleban Y, Ciurtin C, Gaffney K, Gunasekera W, Mackay K, Packham J, Sengupta R, Tahir H, Aelion J, Bennett R, Deodhar A, Gonzalez‐Paoli J, Griffin RM, Grisanti M, Mallepalli J, Peters E, Schechtman J, Singhal A. Three Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Studies Evaluating the Efficacy and Safety of Ustekinumab in Axial Spondyloarthritis. Arthritis Rheumatol 2018; 71:258-270. [DOI: 10.1002/art.40728] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/13/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Michael Clark
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Cesar Calderon
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Yuhua Wang
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Yiying Zhou
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Jocelyn H. Leu
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Kim Campbell
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Kristen Sweet
- Janssen Research & Development, LLC Spring House Pennsylvania
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Abdolmohammadi K, Pakdel FD, Aghaei H, Assadiasl S, Fatahi Y, Rouzbahani NH, Rezaiemanesh A, Soleimani M, Tayebi L, Nicknam MH. Ankylosing spondylitis and mesenchymal stromal/stem cell therapy: a new therapeutic approach. Biomed Pharmacother 2018; 109:1196-1205. [PMID: 30551369 DOI: 10.1016/j.biopha.2018.10.137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis (AS) is an inflammatory rheumatoid disease categorized within spondyloarthropathies (SpA) and manifested by chronic spinal arthritis. Several innate and adaptive immune cells and secreted-mediators have been indicated to play a role in AS pathogenesis. Considering the limitations of current therapeutic approaches (NSAIDs, glucocorticoids, DMARDs and biologic drugs), finding new treatments with fewer side effects and high therapeutic potentials are required in AS. Mesenchymal stem cells (MSCs) with considerable immunomodulatory and regenerative properties could be able to attenuate the inflammatory responses and help tissue repair by cell-to-cell contact and secretion of soluble factors. Moreover, MSCs do not express HLA-DR, which renders them a favorable therapeutic choice for transplantation in immune-mediated disorders. In the present review, we describe immunopathogenesis and current treatments restrictions of AS. Afterwards, immunomodulatory properties and applications of MSCs in immune-mediated disorders, as well as recent findings of clinical trials involving mesenchymal stem cell therapy (MSCT) in ankylosing spondylitis, will be discussed in detail. Additional studies are required to investigate several features of MSCT such as cell origin, dosage, administration route and, specifically, the most suitable stage of disease for ideal intervention.
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Affiliation(s)
- Kamal Abdolmohammadi
- Department of Immunology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Stem Cell Biology, Stem Cell Technology Research Center, Tehran, Iran
| | - Fatemeh Dadgar Pakdel
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Aghaei
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Assadiasl
- Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Fatahi
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Hosseini Rouzbahani
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Stem Cell Biology, Stem Cell Technology Research Center, Tehran, Iran; Department of Immunology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Alireza Rezaiemanesh
- Department of Immunology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Soleimani
- Department of Stem Cell Biology, Stem Cell Technology Research Center, Tehran, Iran; Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA
| | - Mohammad Hossein Nicknam
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Sommerfleck F, Schneeberger E, Citera G. Comorbidities in Argentine patients with axial spondyloarthritis: Is nephrolithiasis associated with this disease? Eur J Rheumatol 2018; 5:169-172. [PMID: 30071942 DOI: 10.5152/eurjrheum.2018.18002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/31/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the frequency of comorbidities among patients with ax-SpA in the general population and to evaluate the impact of these comorbidities on the functional status and quality of life. METHODS Patients with ax-SpA fulfilling the modified New York 1984 criteria for Ankylosing Spondylitis (AS) and/or Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria for patients with ax-SpA belonging to the ESPAXIA cohort ("Estudio de eSPondiloartritis Axial Irep Argentina") were included. Data regarding sociodemographics, comorbidities, and disease characteristics were recorded. Statistical analysis included descriptive statistics using the student t-test, Chi-square, and Fisher's exact test. Multiple logistic regression analysis was performed. A p value <0.05 was considered significant. RESULTS In total, 86 patients were included, 80% were males with a median age of 46 years (interquartile range [IQR]: 32-58) and a median disease duration of 19 years (IQR: 13-31). The most frequent comorbidities reported were hypertension (26.7%), gastritis (25.6%), dyslipidemia (24.4%), gallstone (12.8%), nephrolithiasis (11.6%), anemia (10.5%), hypothyroidism (7%), and type 2 diabetes (6%). The prevalence of these comorbidities in patients with ax-SpA was similar to that observed in the general population, with the exception of a higher frequency of nephrolithiasis among patients with ax-SpA (11.6% in ax-SpA vs 3.96% in the general population). We further categorized the study population into three groups: patients with no comorbidities, those with 1 or 2 comorbidities, and those with ≥3 comorbidities. The presence of ≥3 comorbidities was associated with older age, longer disease duration, worse disease activity, functional status, and quality of life as compared with the patients without comorbidities. In multivariate analysis, older age was the only variable independently associated with the presence of comorbidities. CONCLUSION The frequency of comorbidities in the ax-SpA cohort was high, and the only variable associated with a higher prevalence of comorbidities was older age. Nephrolithiasis was more frequent in the patients with ax-SpA than that reported in the general population.
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Affiliation(s)
- Fernando Sommerfleck
- Department of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Emilce Schneeberger
- Department of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Gustavo Citera
- Department of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
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Wang CR, Weng CT, Lee CT, Huang KY, Hsu SM, Liu MF. Rare occurrence of inflammatory bowel disease in a cohort of Han Chinese ankylosing spondylitis patients- a single institute study. Sci Rep 2017; 7:13165. [PMID: 29030592 PMCID: PMC5640612 DOI: 10.1038/s41598-017-13573-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023] Open
Abstract
Despite a high prevalence of ankylosing spondylitis (AS) in Han Chinese, the clinical experience remains very limited in the extra-articular presentation of inflammatory bowel disease (IBD). A monocentric retrospective study was performed for the AS-associated IBD manifestation. This study analyzed AS patients fulfilling the 1984 revised New York diagnostic criteria, excluding those who had the onset of IBD before or concurrently with the diagnosis of AS, for their demographic, clinical, laboratory, radiological, pathological and medication data, particularly in the usage of anti-TNF monoclonal antibody. Among 988 AS patients with 19.8% female, 4 (0.4%) had the overt IBD presentation, one female and 3 male aged 28 to 47 years (38.8 ± 4.6), all ulcerative colitis with the characteristic histopathological findings. At the onset of colitis, all had a long-term disease duration of 10 to 25 years (17.5 ± 6.5) and high BASDAI 7.5 to 8.8 (8.2 ± 0.5) with the hip joint involvement. There were recurrent flares of colitis despite the treatment with corticosteroids and messalazopyrin/salazopyrin, and no relapses of IBD were observed for 6.0 ± 1.1 years after the adalimumab (ADA) therapy. In this retrospective cohort, we demonstrate the rarity of AS-associated IBD manifestation in Han Chinese with a beneficent effect from the ADA therapy.
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Affiliation(s)
- Chrong-Reen Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Chia-Tse Weng
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chung-Ta Lee
- Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Kuo-Yuan Huang
- Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Min Hsu
- Opthalmology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Fei Liu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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19
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Rudwaleit M, Rosenbaum JT, Landewé R, Marzo-Ortega H, Sieper J, van der Heijde D, Davies O, Bartz H, Hoepken B, Nurminen T, Deodhar A. Observed Incidence of Uveitis Following Certolizumab Pegol Treatment in Patients With Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2017; 68:838-44. [PMID: 26815944 PMCID: PMC5089650 DOI: 10.1002/acr.22848] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/07/2015] [Accepted: 01/19/2016] [Indexed: 12/22/2022]
Abstract
Objective Axial spondyloarthritis (axial SpA) is characterized by inflammation of the spine and sacroiliac joints and can also affect extraarticular sites, with the most common manifestation being uveitis. Here we report the incidence of uveitis flares in axial SpA patients from the RAPID‐axSpA trial, including ankylosing spondylitis (AS) and nonradiographic (nr) axial SpA. Methods The RAPID‐axSpA (NCT01087762) trial is double‐blind and placebo‐controlled to week 24, dose‐blind to week 48, and open‐label to week 204. Patients were randomized to certolizumab pegol (CZP) or placebo. Placebo patients entering the dose‐blind phase were re‐randomized to CZP. Uveitis events were recorded on extraarticular manifestation or adverse event forms. Events were analyzed in patients with/without history of uveitis, and rates reported per 100 patient‐years. Results At baseline, 38 of 218 CZP‐randomized patients (17.4%) and 31 of 107 placebo‐randomized patients (29.0%) had past uveitis history. During the 24‐week double‐blind phase, the rate of uveitis flares was lower in CZP (3.0 [95% confidence interval (95% CI) 0.6–8.8] per 100 patient‐years) than in placebo (10.3 [95% CI 2.8–26.3] per 100 patient‐years). All cases observed during the 24‐week double‐blind phase were in patients with a history of uveitis; in these patients, rates were similarly lower for CZP (17.1 [95% CI 3.5–50.1] per 100 patient‐years) than placebo (38.5 [95% CI 10.5–98.5] per 100 patient‐years). Rates of uveitis flares remained low up to week 96 (4.9 [95% CI 3.2–7.4] per 100 patient‐years) and were similar between AS (4.4 [95% CI 2.3–7.7] per 100 patient‐years) and nr‐axial SpA (5.6 [95% CI 2.9–9.8] per 100 patient‐years). Conclusion The rate of uveitis flares was lower for axial SpA patients treated with CZP than placebo during the randomized controlled phase. Incidence of uveitis flares remained low to week 96 and was comparable to rates reported for AS patients receiving other anti–tumor necrosis factor antibodies.
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Affiliation(s)
| | - J T Rosenbaum
- Devers Eye Institute, Legacy Health System, Portland, Oregon, and Oregon Health & Science University, Portland
| | - R Landewé
- Academic Medical Center, Amsterdam and Atrium Medical Center, Heerlen, the Netherlands
| | - H Marzo-Ortega
- Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - J Sieper
- University Hospital Charité, Berlin, Germany
| | | | | | - H Bartz
- UCB Pharma, Monheim, Germany
| | | | | | - A Deodhar
- Oregon Health & Science University, Portland
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van Weely SFE, Kneepkens EL, Nurmohamed MT, Dekker J, van der Horst-Bruinsma IE. Continuous Improvement of Physical Functioning in Ankylosing Spondylitis Patients by Tumor Necrosis Factor Inhibitors: Three-Year Followup and Predictors. Arthritis Care Res (Hoboken) 2016; 68:1522-9. [DOI: 10.1002/acr.22869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 01/04/2016] [Accepted: 02/09/2016] [Indexed: 01/11/2023]
Affiliation(s)
| | - Eva L. Kneepkens
- Reade, Centre for Rehabilitation and Rheumatology; Amsterdam The Netherlands
| | - Mike T. Nurmohamed
- Reade, Centre for Rehabilitation and Rheumatology; Amsterdam The Netherlands
| | - Joost Dekker
- Reade, Centre for Rehabilitation and Rheumatology and VU University Medical Centre; Amsterdam The Netherlands
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Greenberg JD, Palmer JB, Li Y, Herrera V, Tsang Y, Liao M. Healthcare Resource Use and Direct Costs in Patients with Ankylosing Spondylitis and Psoriatic Arthritis in a Large US Cohort. J Rheumatol 2015; 43:88-96. [DOI: 10.3899/jrheum.150540] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 12/21/2022]
Abstract
Objective.Direct costs of ankylosing spondylitis (AS) and psoriatic arthritis (PsA) have not been well characterized in the United States. This study assessed healthcare resource use and direct cost of AS and PsA, and identified predictors of all-cause medical and pharmacy costs.Methods.Adults aged ≥ 18 with a diagnosis of AS and PsA were identified in the MarketScan databases between October 1, 2011, and September 30, 2012. Patients were continuously enrolled with medical and pharmacy benefits for 12 months before and after the index date (first diagnosis). Baseline demographics and comorbidities were identified. Direct costs included hospitalizations, emergency room and office visits, and pharmacy costs. Multivariable regression was used to determine whether baseline covariates were associated with direct costs.Results.Patients with AS were younger and mostly men compared with patients with PsA. Hypertension and hyperlipidemia were the most common comorbidities in both cohorts. A higher percentage of patients with PsA used biologics and nonbiologic disease-modifying drugs (61.1% and 52.4%, respectively) compared with patients with AS (52.5% and 21.8%, respectively). Office visits were the most commonly used resource by patients with AS and PsA (∼11 visits). Annual direct medical costs [all US dollars, mean (SD)] for patients with AS and PsA were $6514 ($32,982) and $5108 ($22,258), respectively. Prescription drug costs were higher for patients with PsA [$14,174 ($15,821)] compared with patients with AS [$11,214 ($14,249)]. Multivariable regression analysis showed higher all-cause direct costs were associated with biologic use, age, and increased comorbidities in patients with AS or PsA (all p < 0.05).Conclusion.Biologic use, age, and comorbidities were major determinants of all-cause direct costs in patients with AS and PsA.
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van Hoeven L, Vergouwe Y, de Buck PDM, Luime JJ, Hazes JMW, Weel AEAM. External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain. PLoS One 2015. [PMID: 26200904 PMCID: PMC4511700 DOI: 10.1371/journal.pone.0131963] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objectives To validate and optimize a referral rule to identify primary care patients with chronic low back pain (CLBP) suspected for axial spondyloarthritis (axSpA). Design Cross-sectional study with data from 19 Dutch primary care practices for development and 38 for validation. Participants Primary care patients aged 18-45 years with CLBP existing more than three months and onset of back pain started before the age of 45 years. Main Outcome The number of axSpA patients according to the ASAS criteria. Methods The referral rule (CaFaSpA referral rule) was developed using 364 CLBP patients from 19 primary care practices and contains four easy to use variables; inflammatory back pain, good response to nonsteriodal anti-inflammatory drugs, family history of spondyloarthritis and a back pain duration longer than five years. This referral rule is positive when at least two variables are present. Validation of the CaFaSpA rule was accomplished in 579 primary care CLBP patients from 38 practices from other areas. Performance of the referral rule was assessed by c-statistic and calibration plot. To fit the final referral rule the development and validation datasets were pooled leading to a total study population of 943 primary care participants. Results The referral rule was validated in 579 patients (41% male, mean age 36 (sd7.0). The percentage of identified axSpA patients was 16% (n=95). External validation resulted in satisfactory calibration and reasonable discriminative ability (c-statistics 0.70 [95% CI, 0.64-0.75]). In the pooled dataset sensitivity and specificity of the referral rule were 75% and 58%. Conclusions The CaFaSpA referral rule for axSpA consists of four easy to use predictors for primary care physicians and has a good predictive value in this validation study. The referral rule has the potential to be a screening tool for primary care by identifying CLBP patients suspected for axSpA.
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Affiliation(s)
- Lonneke van Hoeven
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
- * E-mail:
| | - Yvonne Vergouwe
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - P. D. M. de Buck
- Department of Rheumatology, MC Haaglanden, Den Haag, The Netherlands
| | - Jolanda J. Luime
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Angelique E. A. M. Weel
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
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Abstract
Psoriatic arthritis (PsA) is a chronic, progressive, inflammatory spondyloarthropathy that affects approximately one-third of patients with all types of psoriasis. Dermatologists are in a unique position to recognize early symptoms of PsA, initiate appropriate therapy, and prevent development of further disability. The course of PsA can be modulated by immunosuppressive therapy; patients with moderate-to-severe disease require aggressive management with medications proven to halt disease progression. It is essential for the dermatologist to understand the safety, tolerability, efficacy, cost, and potential to halt disease progression with available medications for this relatively common and potentially disabling disease.
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Affiliation(s)
- Suzanne J Tintle
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA.
| | - Alice B Gottlieb
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA
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Mercieca C, van der Horst-Bruinsma IE, Borg AA. Pulmonary, renal and neurological comorbidities in patients with ankylosing spondylitis; implications for clinical practice. Curr Rheumatol Rep 2015; 16:434. [PMID: 24925589 DOI: 10.1007/s11926-014-0434-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ankylosing spondylitis (AS) is associated with several comorbidities which contribute significantly to morbidity and mortality and add to the complexity of management. In addition to the well known extra-articular manifestations and increased cardiovascular risk, several pulmonary, renal, and neurological complications which have been associated with AS deserve equal attention. Whereas a clear link has been established for some manifestations, the evidence for other associations is less clear. Interstitial lung disease, apical fibrosis, secondary infection, and ventilatory restriction from reduced chest wall movement are well known pulmonary complications; more recently an association with sleep apnoea has been suggested. Renal amyloidosis and IgA nephropathy remain a treatment challenge which may respond to anti-TNF therapy. Atlanto axial subluxation and vertebral fractures can result in serious neurological complications and are notoriously difficult to diagnose unless a high level of suspicion is maintained. Despite several reports linking AS with demyelination a true link remains to be proved. This review discusses the prevalence, pathophysiology, and management of pulmonary, renal, and neurological complications, and implications for clinical practice.
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Affiliation(s)
- Cecilia Mercieca
- Academic Rheumatology Unit, University Hospitals Bristol, Bristol, BS2 8HW, UK,
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Essers I, Ramiro S, Stolwijk C, Blaauw M, Landewé R, van der Heijde D, Van den Bosch F, Dougados M, van Tubergen A. Characteristics associated with the presence and development of extra-articular manifestations in ankylosing spondylitis: 12-year results from OASIS. Rheumatology (Oxford) 2014; 54:633-40. [PMID: 25234663 DOI: 10.1093/rheumatology/keu388] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify characteristics associated with the presence and development of extra-articular manifestations (EAMs) in a prevalence cohort of patients with AS. METHODS Twelve-year follow-up data from the Outcome in Ankylosing Spondylitis International Study (OASIS) were used. In addition, medical charts were checked for the presence of acute anterior uveitis (AAU), IBD and psoriasis. Demographic, clinical and radiographic characteristics associated with the presence of (any) EAM at baseline or new development during follow-up were identified. RESULTS Two hundred and sixteen patients were included [mean age 43.6 years (s.d. 12.7), 154 (71%) men, mean symptom duration 20.5 years (s.d. 11.7), mean follow-up 8.3 years (s.d. 4.3)]. At baseline, 39 (18%) patients had AAU, 15 (7%) had IBD and 9 (4%) had psoriasis. The history of AAU was univariably associated with increased age [odds ratio (OR) 1.04 (95% CI 1.01, 1.07)], longer symptom duration [OR 1.05 (95% CI 1.02, 1.08)] and more radiographic damage [OR 1.02 (95% CI 1.00, 1.04)]. The history of psoriasis was associated with greater age [OR 1.05 (95% CI 1.00, 1.11)] and lower CRP [OR 0.77 (95% CI 0.59, 1.00)]. At follow-up, 27 patients developed a new EAM. Newly developed IBD was associated with a higher time-varying AS Disease Activity Score [hazard ratio (HR) 2.80 (95% CI 1.43, 5.52)], worse physical function [HR 1.40 (95% CI 1.09, 1.80)] and worse patient global well-being [HR 1.46 (95% CI 1.10, 1.93)]. Newly developed AAU was associated with an elevated time-varying CRP [HR 1.02 (95% CI 1.01, 1.04)]. CONCLUSION Development of EAMs was infrequent in this cohort, despite relatively long follow-up. In particular, markers of disease activity were associated with the development of IBD.
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Affiliation(s)
- Ivette Essers
- Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
| | - Sofia Ramiro
- Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France
| | - Carmen Stolwijk
- Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France
| | - Marc Blaauw
- Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France
| | - Robert Landewé
- Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France
| | - Désirée van der Heijde
- Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France
| | - Filip Van den Bosch
- Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France
| | - Maxime Dougados
- Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France
| | - Astrid van Tubergen
- Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France
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Berg IJ, Semb AG, van der Heijde D, Kvien TK, Hisdal J, Olsen IC, Dagfinrud H, Provan SA. Uveitis is associated with hypertension and atherosclerosis in patients with ankylosing spondylitis: a cross-sectional study. Semin Arthritis Rheum 2014; 44:309-13. [PMID: 24968705 DOI: 10.1016/j.semarthrit.2014.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Uveitis is the most common extra-articular manifestation in patients with ankylosing spondylitis (AS), but the literature describing AS patients with a history of uveitis is limited. The objective was to examine if a history of uveitis in patients with AS is associated with increased disease activity and functional impairment and to investigate whether uveitis is associated with an increased frequency of cardiovascular comorbidities, defined here as hypertension and atherosclerosis. METHODS Data were recorded cross-sectionally through patient interviews, blood samples, clinical examination, and questionnaires. Carotid plaques were identified by ultrasonography. AS disease activity and function were compared across categories of uveitis using ANCOVA analyses. Associations between uveitis and hypertension and atherosclerosis [atherosclerotic cardiovascular disease (CVD) and/or carotid plaque] were analyzed in multivariate logistic regression models. RESULTS Of 159 patients with AS (61.6% male, mean age 50.5 years), 84 (52.8%) had experienced one or more episodes of uveitis. AS disease activity was higher in patients with a history of uveitis, statistically significant for functional impairment [Bath AS Functional Index (BASFI)] [mean difference (95% CI)] lnBASFI = 0.2 (0.0-0.3), p = 0.05. Patients with uveitis had an increased odds ratio [OR (95% CI)] for hypertension [3.29 (1.29-8.41), p = 0.01] and atherosclerosis [2.57 (1.15-5.72), p = 0.02]. CONCLUSIONS AS patients with a history of uveitis had non-significantly higher disease activity and significantly higher functional impairment. A history of uveitis was associated with hypertension as well as atherosclerosis. These results may be important in identifying AS patients with elevated risk of CVD but should be confirmed in longitudinal cohorts.
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Affiliation(s)
- Inger Jorid Berg
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway.
| | - Anne Grete Semb
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway
| | - Désirée van der Heijde
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway
| | - Jonny Hisdal
- Section of Vascular Investigations, Oslo University Hospital Aker, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway
| | - Hanne Dagfinrud
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway
| | - Sella A Provan
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway
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Recommendations of the French Society for Rheumatology (SFR) on the everyday management of patients with spondyloarthritis. Joint Bone Spine 2014; 81:6-14. [PMID: 24412120 DOI: 10.1016/j.jbspin.2013.12.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2013] [Indexed: 01/06/2023]
Abstract
UNLABELLED The management of spondyloarthritis is challenging and has changed with the development of new concepts and treatments. OBJECTIVE To develop practice guidelines for the everyday management of patients with spondyloarthritis (including psoriatic arthritis), by updating previous national and international recommendations, based on a review of recently published data. METHODS A task force and a multidisciplinary literature review group were established. The task force identified the issues that remained unresolved. Based on existing recommendations and recent publications, the task force developed practice guidelines, which were revised by the literature review group and graded according to AGREE. RESULTS Practice guidelines for the management of spondyloarthritis are reported. After a review of the general diagnostic principles, 30 practice guidelines are given: 5 on general principles, 4 on the management strategy, 5 on non-pharmacological treatments, 7 on conventional pharmacological treatments, 6 on biotherapies, and 3 on surgical treatments and follow-up. CONCLUSION The updated practice guidelines reported here constitute a global framework that can guide physicians in the everyday management of spondyloarthritis.
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