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Saad MA, Abdul-Sattar AB, Abdelal IT, Barak A. Association of Endoplasmic Reticulum Aminopeptidase 1 Gene Polymorphism with Susceptibility and Severity of Axial Spondyloarthritis in Egyptian Population: A Single-center Case-Control Study. Ann Afr Med 2024; 23:443-451. [PMID: 39034571 DOI: 10.4103/aam.aam_180_23] [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: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is a systemic, progressive, autoimmune disease. Complex interactions between environmental factors and host immune responses are the origin of axSpA. Together with human leukocyte antigen (HLA-B27), endoplasmic reticulum aminopeptidase 1 (ERAP1) gene is a potential non-HLA contributor to axSpA susceptibility. AIM This study aimed to identify the role of ERAP1 single-nucleotide polymorphisms (SNPs) (rs30187, rs27044, and rs27037) in susceptibility to and severity of axSpA in Egyptian patients. METHODS In this case-control study, we enrolled 120 patients with axSpA and 120 healthy individuals as controls. Real-time polymerase chain reaction was used to identify ERAP1 polymorphisms. RESULTS The present study revealed no significant association between ERAP1 SNPs (rs30187, rs27044, and rs27037) and axSpA susceptibility in Egyptian patients. A significant relationship was found only between the ERAP1 SNP rs27037 "GT" genotype and axSpA HLA-B27-positive cases, demonstrating a functional interaction between ERAP1 and HLA-B27-positive cases. Our analysis revealed a significant association between the ERAP1 SNP rs27037 "GT and TT" genotypes and Bath Ankylosing Spondylitis Disease Activity Index, in addition to an association between the ERAP1 SNP rs27037 "TT" genotype and active enthesitis. The ERAP1 SNP rs27044 "GG" genotype was significantly associated with active enthesitis, but not with clinical axial involvement. Finally, we did not observe a significant relationship between HLA-B27 positivity and disease severity in the studied cases. CONCLUSION Three SNPs (rs30187, rs27044, and rs27037) in ERAP1 do not confer susceptibility to axSpA in Egyptian patients. This association existed exclusively between the ERAP1 SNP (rs27037) "GT" genotype and axSpA HLA-B27-positive cases.
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Affiliation(s)
- Mohamed Ahmed Saad
- Department of Rheumatology and Rehabilitation, PMR Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Amal Bakry Abdul-Sattar
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ibrahim Tharwat Abdelal
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Barak
- Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Garcia-Salinas R, Reyes Jara G, Arguello J, Ruta S, Almada F, Aguerre D. Clinical, Laboratory, and Imaging Features Between Men and Women With Axial Spondyloarthritis in a Specialized Center in Argentina. J Clin Rheumatol 2024; 30:e105-e107. [PMID: 38509033 DOI: 10.1097/rhu.0000000000002063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The aims were to estimate the frequency of axial spondyloarthritis (axSpA) in women and to analyze the clinical, laboratory, and imaging differences with respect to men at the time of diagnosis. METHODS Consecutive patients older than 18 years with a diagnosis of axSpA admitted to the "Reumacheck" SpA program were included between 2017 and 2022. At baseline, all patients underwent clinical assessment, laboratory tests including C-reactive protein and human leukocyte antigen B27, and imaging (plain radiography and magnetic resonance imaging of sacroiliac joints, and ultrasound of heel entheses). All evaluators were blinded to the results of the other evaluations. RESULTS One hundred sixteen patients with a diagnosis of axSpA were included. The frequency at diagnosis in women was 61.55%. In the univariate analysis, the significant differences between women and men at diagnosis of axSpA were good response to nonsteroidal anti-inflammatory drugs, elevated C-reactive protein, New York Criteria (+), enthesis ultrasound (+), years of education, number of swollen joints, erythrosedimentation rate, and the very low frequency of bone bridges in the magnetic resonance imaging of the sacroiliac joints. In the logistic regression analysis, the dependent variable was "men," and the only feature that was independently associated was having radiographic compromise according to the New York criteria (odds ratio, 2.6). CONCLUSIONS The frequency of axSpA in women was 61.55%; clinical, laboratory, and imaging differences were observed. Women experienced less radiographic compromise.
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Affiliation(s)
| | | | | | | | | | - Dario Aguerre
- Radiology Unit, Hospital Italiano de La Plata, La Plata, Argentina
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Resende GG, Saad CGS, Marques CDL, Ribeiro SLE, de Oliveira Gavi MBR, Yazbek MA, de Oliveira Marinho A, de Cássia Menin R, Ochtrop MLG, Soares AM, Cavalcanti NG, Carneiro JN, Werner de Castro GR, Fernandes JMC, da Cruz Ribeiro E Souza E, de Menezes Alvarenga CQ, de Abreu Vieira RMR, Machado NP, Ximenes AC, Gazzeta MO, de Albuquerque CP, Skare TL, Waldemar Keiserman M, Kohem CL, Benacon GS, Rocha VFS, da Cruz Lage R, Malheiro OB, Golebiovski RTM, Oliveira TL, Duque RH, Londe AC, de Medeiros Pinheiro M, Sampaio-Barros PD. To be or not to B27 positive: implications for the phenotypes of axial spondyloarthritis outcomes. Data from a large multiracial cohort from the Brazilian Registry of Spondyloarthritis. Adv Rheumatol 2024; 64:33. [PMID: 38671475 DOI: 10.1186/s42358-024-00372-0] [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: 03/21/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE). METHODS The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age ≥18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical. RESULTS A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (±13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility. CONCLUSIONS Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population.
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Affiliation(s)
- Gustavo Gomes Resende
- Hospital das Clínicas da UFMG, Belo Horizonte, Brazil.
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Alameda Álvaro Celso, 175/2nd floor, Santa Efigênia, Belo Horizonte, MG, Brazil.
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da Silva AB, Lourenço MH, Ramiro S, Falzon L, Cunha-Branco J, van der Heijde D, Landewé R, Sepriano A. Performance of clinical, laboratory and imaging features for diagnosing spondyloarthritis-a systematic literature review and meta-analysis. Rheumatology (Oxford) 2024:keae065. [PMID: 38305346 DOI: 10.1093/rheumatology/keae065] [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: 11/14/2023] [Revised: 01/06/2024] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE The Berlin algorithm was developed to help diagnosing axial spondyloarthritis (axSpA), but new studies suggest some features typical of SpA are less specific than previously assumed. Furthermore, evidence is lacking for other SpA subtypes (e.g. peripheral SpA). We aimed to review the evidence on the performance of SpA features for diagnosing each SpA subtype. METHODS Systematic literature review of studies reporting the diagnostic performance of ≥ 1 SpA feature in patients with suspected SpA. The external reference was the rheumatologist's diagnosis of SpA. Meta-analysis was performed, separately for each SpA subtype, to estimate pooled sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios. Meta-regression assessed the effect of covariates (e.g. feature's prevalence) on each feature's performance. RESULTS Of 13 844 articles screened, 46 were included. Sacroiliitis on magnetic resonance imaging, damage on pelvic radiographs and elevated C-reactive protein (CRP) had the best balance between LR+ and LR- (LR + 3.9-17.0, LR- 0.5-0.7) for diagnosing axSpA. HLA-B27 had an LR+ lower than anticipated (LR + =3.1). Inflammatory back pain (IBP) had low LR + (LR+∼1), but substantially decreased the likelihood of axSpA when absent (LR-=0.3). Conversely, peripheral features and extra-musculoskeletal manifestations showed high LR + (LR+ 1.6-5.0), but were as common in axSpA as no-axSpA (LR-∼1). The specificity of most features was reduced in settings when these were highly prevalent. Limited data precluded a detailed analysis on diagnosing other SpA subtypes. CONCLUSION Imaging features and CRP have good diagnostic value for axSpA. However, the specificity of other features, especially HLA-B27 and IBP, is lower than previously known.
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Affiliation(s)
- Ana Bento da Silva
- Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Lisbon, Portugal
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Helena Lourenço
- Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Lisbon, Portugal
- Faculty of Medicine, NOVA Medical School, Lisbon, Portugal
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Zuyderland Medical Center, Heerlen, The Netherlands
| | - Louise Falzon
- Health Economics and Decision Science, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Jaime Cunha-Branco
- Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Lisbon, Portugal
| | | | - Robert Landewé
- Zuyderland Medical Center, Heerlen, The Netherlands
- Amsterdam University Medical Center (ARC), Amsterdam, The Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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Garcia Salinas R, Jaldin Cespedes R, Gomez RA, Aguerre D, Sommerfleck F. Non-radiographic axial spondyloarthritis in South America. Burden of disease and differential features with respect to ankylosing spondylitis at time of diagnosis. A comprehensive analysis with a focus on images. Int J Rheum Dis 2022; 25:1169-1175. [PMID: 35891615 DOI: 10.1111/1756-185x.14399] [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: 04/20/2022] [Revised: 05/25/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-radiographic axial spondyloarthritis (nr-axSpA) data from South America are scarce, especially regarding image features. Objective To estimate the frequency of nr-axSpA and ankylosing spondylitis (AS) in a cohort of Argentinian patients with chronic low back pain (LBP) and to analyze the difference between both, with focus on magnetic resonance imaging (MRI) lesions, at diagnosis. METHODS Patients with LBP and a diagnosis of axSpA who participated in a reuma-check program were included. All patients with a suspicion of SpA were evaluated using blood analytics, HLA-B27, and images (MRI). Sociodemographic data, SpA features, diagnostic dela,y and clinimetrics were assessed by an operator who was blinded to the patient's test results. On MRI, the presence of SpA lesions was assessed and a concordance exercise was carried out between rheumatologists and radiologist. RESULT Of 198 LBP patients, 97 had axSpA, 54% of whom were nr-axSpA. A positive MRI was found in 50%. No difference in terms of disease activity, functional impact, laboratory or treatments between nr-axSpA and AS were found. Higher frequencies of male sex and chronic lesions on sacroiliac MRI were found in AS patients. In the logistic regression, an independent association with AS diagnosis was found: male (odds ratio [OR] 4.8), MRI fat replacement (OR 4.6), MRI sclerosis (OR 7.6), and diagnostic delay of more than 2 years (OR 10). The concordance between rheumatologists and radiologists was considered good to very good (κ 0.7-0.8). CONCLUSION The frequency of nr-axSpA was 54%. We found a higher frequency of being male, more SpA features, and a longer diagnostic delay in patients with AS. Patients with AS had more structural lesions, with a good concordance between rheumatologist and radiologist.
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Affiliation(s)
| | | | | | - Dario Aguerre
- Radiology Department, Hospital Italiano de La Plata, La Plata, Argentina
| | - Fernando Sommerfleck
- Rheumatology Unit, Sanatorio Mendez, PANLAR: SPA Study Group, Ciudad Autonoma de Buenos Aires, Argentina
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Zabotti A, Luchetti MM, Selmi CF, Ramonda R, Grembiale RD, Dagna L, D'Angelo S, Cafaro G, De Vita S, Felicetti M, Marelli S, Frigerio D, Favalli EG. An Italian Disease-Based Registry of Axial and Peripheral Spondyloarthritis: The SIRENA Study. Front Med (Lausanne) 2021; 8:711875. [PMID: 34631733 PMCID: PMC8492964 DOI: 10.3389/fmed.2021.711875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/16/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Data about the clinical presentation and management of early and mild spondyloarthritis (SpA) are limited. Objectives: The objective of this study was to describe the baseline characteristics of disease-modifying antirheumatic drug (DMARD)-naïve patients with axial or peripheral SpA. Methods: The Spondyloarthritis Italian Registry: Evidence from a National Pathway (SIRENA) study is an ongoing, Italian, multicenter, prospective registry of patients with a first or newly confirmed diagnosis of SpA according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. To be included, patients had to be naïve to conventional, targeted, and biological DMARDs for SpA. Patients were enrolled between June 2017 and June 2019 and classified into groups according to disease presentation: predominantly axial or peripheral manifestations. The study is ongoing, and patients are being followed for 2 years, with an evaluation every 6 months according to clinical practice. Differences in baseline demographics, lifestyle, and clinical characteristics between axial and peripheral SpA were evaluated. Results: In this study, 350 patients were enrolled, of which 123 (35.1%) were axial and 227 (64.9%) were peripheral patients. Patients with axial SpA were significantly younger at enrollment (median age: 44 vs. 53 years), had significantly more anxiety/depression (13 vs. 2.6%), and expressed higher disease activity compared to patients with peripheral SpA. Patients with peripheral SpA had significantly more cardiometabolic disorders (33 vs. 18.7%), skin psoriasis (65.2 vs. 21.1%), and nail psoriasis (35.5 vs. 17.1%) than patients with axial SpA. Dactylitis, enthesitis, and fibromyalgia were observed, respectively, in 17.6, 51.2, and 5.7% of patients with axial SpA and 24.3, 40, and 3.1% of patients with peripheral SpA. In both disease groups, women tended to report depression, joint tenderness, and higher disease activity more frequently than their male counterparts. At inclusion, a new diagnosis of SpA was performed in 58% of axial and 77% of peripheral patients, with a median time from symptom onset to diagnosis of 36 and 24 months, respectively. At baseline, most patients with axial SpA (77%) started a biological DMARD, while over half of the peripheral patients started a conventional DMARD. Conclusions: Based on a well-characterized clinical registry of SpA, we provided real-world insights on the clinical features of DMARD-naïve SpA patients, pointing out major differences between axial and peripheral disease in terms of clinical characteristics and treatment pattern. Future prospective evaluations within the SIRENA study will improve knowledge on SpA and contribute to defining the best therapeutic approach.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital S. Maria della Misericordia, Udine, Italy
| | - Michele Maria Luchetti
- Clinica Medica, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Francesco Selmi
- Rheumatology and Clinical Immunology, Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Rosa Daniela Grembiale
- Rheumatology Research Unit, Dipartimento di Scienze della Salute, Università "Magna Graecia", Catanzaro, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan and Vita-Salute San Raffaele University, Milan, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania, San Carlo Hospital, Potenza, Italy
| | - Giacomo Cafaro
- Reumatologia, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital S. Maria della Misericordia, Udine, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Silvia Marelli
- Medical Affairs Department, Immunology, Janssen-Cilag SpA, Milan, Italy
| | - Daniela Frigerio
- Medical Affairs Department, Immunology, Janssen-Cilag SpA, Milan, Italy
| | - Ennio Giulio Favalli
- S.C. Reumatologia ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini - CTO, Milan, Italy
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