The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection

IgG-seq identifies immune-reactive enteric bacteria in Crohn's disease with spondyloarthritis

Joint inflammation is the most common extraintestinal manifestation of Crohn's disease (CD). Although alterations in the enteric microbiota are described in CD with spondyloarthritis (CD-SpA), it is not known whether distinct taxa serve as markers for clinical subtypes of axial (AxSpA) or peripheral SpA (pSpA) in CD. Moreover, it is not yet known whether these taxa generate a specific systemic IgG response. Here, we sequenced the fecal microbiome from 106 individuals (44 CD, 39 CD-SpA, 14 CD-AxSpA, and 9 healthy controls [HC]). This unique cohort revealed distinct taxonomic compositions of CD and CD-SpA compared to HC and demonstrates that the composition of the CD-AxSpA microbiome is distinct from that of CD-pSpA. Using autologous serum, we identified enteric bacteria recognized by serum IgG and demonstrate differences in the IgG coating index of specific bacterial genera associated with CD-SpA. The IgG coating index of Mediterraneibacter gnavus differentiated patients with CD-pSpA and is positively associated with joint disease activity. This work illustrates divergent microbiome compositions in CD-SpA subtypes, as well as the recognition of distinct enteric bacteria by serum IgG with the potential to serve as a marker of joint inflammation in CD.

Rethinking spondyloarthritis: beyond lumping and splitting

PURPOSE OF REVIEW

The classification of spondyloarthritis (SpA) has long been debated, with ongoing discussions about whether to "lump" various subtypes together or "split" them into smaller distinct disease categories. This review explores the evolution of the SpA concept and discusses novel approaches that move beyond traditional models of SpA classification.

RECENT FINDINGS

Since its introduction in the 1970s, the SpA concept has undergone substantial modifications, incorporating advances in genetics, imaging, and clinical research. The recognition of axial and peripheral SpA as distinct yet overlapping entities has reshaped classification and drug approval processes. Data-driven methodologies have provided new insights into disease heterogeneity. Recent research highlights the limitations of traditional classification systems, emphasizing the need for unbiased approaches that integrate clinical and molecular features.

SUMMARY

Current historically derived classification paradigms for SpA are largely based on clinical phenotype and fail to capture the full spectrum of disease heterogeneity. Defining SpA subsets by incorporating genetic and immunological characteristics may improve diagnostic precision and improve outcomes. Future research should focus on refining classification frameworks across the entire clinical spectrum of SpA to improve patient stratification, guide treatment decisions, and address existing gaps in SpA care.

The association of cervical and lumbar mobility with functional ability in axial spondyloarthritis: Insights from the CASTRO registry using Inertial Measurement Unit system

OBJECTIVE

This study aimed to evaluate the association of cervical and lumbar mobility with functional ability in patients with axial spondyloarthritis (axSpA) using an inertial measurement unit (IMU) sensor system, as well as the influence of disease duration on this association.

METHODS

This cross-sectional study included 156 patients with axSpA from the Córdoba axSpA Task Force Registry and Outcomes (CASTRO) registry. Spinal mobility was assessed with the IMU system and functional ability was measured using the Bath Ankylosing Spondylitis Functional Index (BASFI). Patients were categorized into non-longstanding (≤23 years) and longstanding (>23 years) groups based on the median disease duration. Univariable and multivariable linear regressions were conducted to evaluate the variability of BASFI explained by each spinal movement (coefficient of determination [R²]).

RESULTS

Multivariable linear regression analysis showed that cervical movements collectively explained 19.9 % (R2 = 0.199) of BASFI variability, while lumbar mobility accounted for 11.3 %. Among longstanding axSpA patients, cervical rotation (unstandardized regression coefficient [B] = -0.68, 95 % CI1.13 to -0.24) and lumbar flexion (B = 0.65, 95 % CI 0.05 to 1.24), were independently associated with the BASFI scores. In non-longstanding patients, lumbar mobility, particularly lumbar rotation (B = -0.51, 95 % CI0.97 to -0.05), showed a stronger association with functional ability.

CONCLUSIONS

This study suggests that cervical mobility is more strongly associated with functional ability than lumbar mobility in axSpA patients. However, the impact of cervical and lumbar mobility on functional ability varies with disease duration.

A combined analysis of spinal mobility and gait spatiotemporal parameters in axial spondyloarthritis using wearable sensors

BACKGROUND

Axial spondyloarthritis is a chronic rheumatic disease which impacts spinal mobility and physical functions, including gait. However, current clinical assessments mostly rely on composite indices and questionnaires which involve a degree of subjectivity. This study aimed to assess the discriminant validity of wearable sensors for objective monitoring of axial spondyloarthritis in clinical practice.

METHODS

Twenty participants with axial spondyloarthritis and 20 healthy controls were included. Spinal mobility alongside gait were assessed while data were collected using inertial measurement units. Data were compared between the two groups and classification performance was assessed by performing receiver-operating characteristic curve analysis. Finally, correlations between parameters measured through inertial measurement units and clinical measures were also evaluated.

FINDINGS

The axial spondyloarthritis group showed significantly reduced trunk maximum angles in all planes and direction of motion. Gait was characterized by a reduction in cadence (P = 0.004) and speed (P = 0.015). The combination of gait cadence and trunk kinematics enhanced the classification performance (sensitivity = 95 % vs. 55 % with trunk sagittal range of motion alone). Trunk kinematic variables were correlated to mobility items of clinical measures while spatiotemporal gait parameters showed correlations with the disease activity and its functional impact in daily life.

INTERPRETATION

The present study demonstrated the ability of inertial measurement units to effectively discriminate axial spondyloarthritis individuals, with an enhanced classification performance while combining trunk kinematics and gait spatiotemporal parameters. These findings highlight the potential of wearable sensors as valuable tools for assessment and follow-up in clinical practice.

Performance of spondyloarthritis-specific health utilities based on the ASAS Health Index: an ancillary analysis from the ASAS-HI validation study

OBJECTIVES

To compare the Spondyloarthritis (SpA)-specific universal utility estimation from ASAS Health Index (U-ASAS-HI) with generic utilities and to understand the contribution of health outcomes, personal- and country-level factors to the U-ASAS-HI.

METHODS

This was an ancillary analysis of the ASAS-HI international validation study. SpA patients who completed the ASAS-HI, 5-level EuroQol-5D (EQ-5D-5L) and Short Form-36 (SF-36) questionnaires were selected, and utilities calculated. Correlations between U-ASAS-HI and generic utility values were tested. Potential explanatory variables were evaluated in a linear multivariable mixed-effects model analysis with multilevel modelling fitted by country.

RESULTS

The number of patients included was 1425, with a mean (s.d.) age of 42 (13.5) years, with 65% male. The mean (s.d.) utility scores were for EQ-5D-5L 0.75 (0.11), for short-form 6-dimension (SF-6D) 0.72 (0.24), and for U-ASAS-HI 0.42 (0.29). Correlation between U-ASAS-HI and EQ-5D-5L and SF-6D was strong (r = 0.75 and r = 0.72, respectively; P < 0.001). The linear mixed-effects model showed that worse disease activity (ASDAS) and lower physical function (BASFI) were associated with lower U-ASAS-HI. Additionally, younger age, female gender, higher comorbidity score and symptoms of depression were associated with lower U-ASAS-HI. SpA subtype had no influence on health utility. The random effects model indicated an intercept s.d. of 0.045 with a 5.5% variance ratio between countries and the total U-ASAS-HI variation.

CONCLUSION

The U-ASAS-HI captures the physical and mental impact of SpA, as well as personal contextual factors such as age, gender and comorbidities. The influence of the country of residence seems negligible. The U-ASAS-HI algorithm has sufficient support to be used in health economic evaluations for SpA patients across different countries.

Do the Provisional Paediatric Rheumatology International Trials Organisation Enthesitis/Spondylitis-Related Juvenile Idiopathic Arthritis Criteria Capture Youth With Axial Spondyloarthritis?

OBJECTIVE

The Paediatric Rheumatology International Trials Organisation (PRINTO) recently undertook an effort to better harmonize the pediatric and adult arthritis criteria. These provisional criteria are being refined for optimal performance. We aimed to investigate differences between patients who did and did not fulfill these PRINTO criteria among youth diagnosed with juvenile spondyloarthritis (SpA) that met axial juvenile SpA (axJSpA) classification criteria.

METHODS

This was a retrospective cross-sectional sample of youth diagnosed with juvenile SpA who met the axJSpA classification criteria. Demographics, clinical manifestations, and physician and patient-reported outcomes were abstracted from medical records. Magnetic resonance imaging (MRI) scans underwent central imaging review by at least two central raters. Differences between groups were compared using Wilcoxon signed-rank test or chi-square test, as appropriate.

RESULTS

Of 158 patients who met axJSpA criteria, 107 patients (68%) met the PRINTO provisional criteria for enthesitis/spondylitis-related arthritis. A total of 41 patients (26%) did not fulfill any of the three major PRINTO criteria due to lack of peripheral disease manifestations. Demographics, prevalence of inflammatory or structural lesions on MRI, family history of SpA, and duration of pain were not statistically different between those who did and did not meet PRINTO criteria. Those who fulfilled the PRINTO criteria had significantly more peripheral arthritis, enthesitis, and HLA-B27 positivity but reported less sacral/buttock pain.

CONCLUSION

Phenotypic differences of children with axJSpA between those who were and were not classified by the PRINTO criteria were primarily due to peripheral disease manifestations and HLA-B27 positivity. Modification of the PRINTO provisional criteria may facilitate capture of youth with primarily axial disease.

Performance of classification criteria for spondyloarthritis: where do we stand in many Latin American countries? A systematic literature review and meta-analysis

INTRODUCTION

Spondyloarthritis (SpA) encompasses a group of chronic inflammatory diseases affecting the spine and peripheral joints. Although classification criteria for SpA have been tested globally, their validity and performance in Latin American (LA) populations remain debated.

METHODS

A systematic literature review was conducted following PRISMA guidelines, with the protocol registered in PROSPERO (CRD42023464861). Searches were performed in Medline, Cochrane library, Embase and Virtual Health Library databases based on the PIRO framework. Studies assessing SpA classification criteria in LA patients were included, focusing on performance characteristics. Pooled sensitivity and specificity were estimated using a proportional meta-analysis with random-effect model, followed by sensitivity analysis.

RESULTS

Six studies met the inclusion criteria. Of the multinational studies, fewer than 10% included LA patients. Most of the studies evaluated the ASAS, the most recent criteria, and clinical diagnosis by a physician as the gold standard. The Amor criteria reported a pooled sensitivity of 71% and specificity of 46%. The ESSG criteria had a pooled sensitivity of 83% and specificity of 35%. The ASAS criteria had a pooled sensitivity of 75% and specificity of 43%.

CONCLUSIONS

These systematic literature review and meta-analysis, including SpA patients from six LA countries, suggest that the ASAS classification criteria offer the best balance for sensitivity and specificity. However, these findings highlight the need for high-quality, homogeneous studies to validate SpA classification criteria in LA populations as patient assessment continues to evolve.

Impact of combining magnetic resonance images and radiographs on radiographic grading of sacroiliitis and classification in axial spondyloarthritis: a reliability study

To investigate the reliability of sacroiliac radiographic grading based on the modified New York criteria, both through grading pelvic radiographs alone and in combination with sacroiliac magnetic resonance imaging and the influence of alone and multimodal interpretation on the categorization of radiographic and non-radiographic axial spondyloarthritis (r-axSpA and nr-axSpA). Radiographs of the SI joints from patients with axSpA were graded by two rheumatologists independently in two sessions (radiographs only and MRI + radiographs) and followed by consensus sessions with the participation of a radiologist. Overall, anteroposterior pelvic radiographs and T1 weighted MR scans of the sacroiliac joints from 138 patients with axSpA were eligible. Intra- and inter-reader reliability was fair to moderate for both techniques regardless of whether they were examined alone or in conjunction with MRI, however confidence levels of readers were relatively higher in the MRI + radiographs combined technique compared to radiographs only. Regarding the classification, both readers' intra and inter reader agreements were moderate to substantial. The kappa values and agreement were notably higher for the combined reading technique. In the consensus sessions, 10.2% of patients were recategorized. Merging the information from MRI scans with pelvic radiographs yielded no notable enhancement in the accuracy of radiographic grading of SI joint. Categorizing axSpA as either radiographic or non-radiographic based on pelvic radiography falls short in reliability even after combining with MR images and may likely call for a more reliable definition, axSpA with or without structural changes, relying on more advanced imaging techniques than radiographs.

Remote monitoring or patient-initiated care in axial spondyloarthritis: a 3-armed randomised controlled noninferiority trial

OBJECTIVES

This study aimed to determine whether novel follow-up regimen, remote monitoring, or patient-initiated care is noninferior to usual care in maintaining low disease activity, in patients with axial spondyloarthritis (axSpA).

METHODS

This is a randomised, controlled, 3-armed, parallel-group, open-label, noninferiority trial. Patients with axSpA in low disease activity on stable treatment with tumour necrosis factor inhibitor were recruited from a Norwegian outpatient clinic. Patients were randomly allocated 1:1:1 to remote monitoring, patient-initiated care, or usual care (control group), with 18 months of follow-up. Primary outcome was mean probability of axSpA Disease Activity Score (ASDAS) of <2.1, compared between groups at 6, 12, and 18 months, with 15% noninferiority margin. Secondary outcomes included other measures of disease activity, physical function, patient satisfaction, change of medication, resource use, and adverse events.

RESULTS

Of 243 patients enrolled patients, 235 completed the study (remote monitoring = 75, patient-initiated care = 79, usual care = 81). At the 6-month, 12-month, and 18-month assessments, 90% or more patients in all 3 groups had ASDAS of <2.1. The estimated difference of probability of ASDAS < 2.1 was as follows: usual care vs remote monitoring, -4.1% (97.5% CI, -9.9% to 1.8%); usual care vs patient-initiated care, -1.1% (97.5% CI, -7.2% to 4.9%); and remote monitoring vs patient-initiated care, 2.9% (95% CI, -1.5% to 7.4%). Health providers' resource use was lowest in patient-initiated care; other secondary outcomes were comparable.

CONCLUSIONS

In patients with axSpA in low disease activity and on stable treatment with tumour necrosis factor inhibitor, follow-up with remote monitoring or patient-initiated care was noninferior to usual care in maintaining low disease activity, supporting the implementation of novel follow-up strategies.

Trace Element Deficiency in Axial Spondyloarthritis and Psoriatic Arthritis in Relation to Markers of Inflammation and Remission

Selenium (Se) is an essential micronutrient for antioxidant defense. Selenoproteins are involved in metabolic and signaling pathways of autoimmune and autoinflammatory diseases. Copper (Cu) and zinc (Zn) are integral components of key enzymes and regulatory proteins. Trace element (TE) dysregulations have potential relevance as disease biomarkers. In this study, we compare TE status and TE profiles between patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), and relate the results to markers of inflammation, remission, and healthy controls. Serum TE was measured using total reflection X-ray fluorescence. The Se transporter SELENOP and extracellular glutathione peroxidase (GPx3) were determined by ELISA and enzymatic assay, respectively. Both groups of patients (axSpA; n = 84, and PsA; n = 76) displayed TE deficiency compared to healthy European adults. Serum Cu, Se, Zn, SELENOP, and GPx3 levels were not different between the groups. The serum Cu and Cu-Zn ratio correlated positively with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). An inverse correlation of serum Se, Zn, and SELENOP with CRP was observed in axSpA, but not in PsA. On average, all TE, including the inflammation-responsive Cu levels, were below reference ranges, indicating a TE deficiency in both groups. Increasing CRP was associated with low SELENOP levels, suggesting personalized Se substitution as indicated to maintain systemic Se supply and protect from ferroptotic cell loss under inflammatory conditions.

Golimumab retention in patients with psoriatic arthritis and axial spondyloarthritis: evidence from up to a decade of follow-up

BACKGROUND

While there are relatively large number of studies on the retention of biologics in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), very long-term retention studies are scarce.

RESEARCH DESIGN AND METHODS

Retrospective longitudinal study including patients with up to a decade of follow-up. Survival rate was analyzed using Kaplan-Meier curves and drug discontinuation-associated factors using multivariate Cox regression. Hazard Ratio (HR) was used as a measure of the association.

RESULTS

Ninety PsA patients and 93 with axSpA were included. Retention rate ranged from 64% at year 1 to 25% at year 11 in PsA, whereas in axSpA, these figures ranged from 68% at year 1 to 34% at year 12. The rate of any event leading to drug discontinuation was 20.9/100PYs and 14.8/100PYs in PsA and axSpA, respectively. Age at arthritis onset (HR 0.93, 95%CI: 0.87-0.99, p = 0.048) and psoriasis duration (HR 1.08, 95%CI: 1.0-1.2, p = 0.036) were linked to drug discontinuation in PsA. In axSpA, retention rate was significantly higher in men compared to women (long-rank p = 0.037).

CONCLUSION

In this real-world study, a non-negligible retention of GOL is observed. The two diseases differ in the factors that appear to determine drug persistence.

CD28 and CTLA4 polymorphisms associated with ankylosing spondylitis: a study in the context of HLA-B27

BACKGROUND

The human leukocyte antigen (HLA)-B27 gene is highly associated with ankylosing spondylitis (AS). However, not everyone who carries the HLA-B27 antigen develops AS, indicating that factors beyond the HLA-B27 gene contribute to the disease's onset. AS is an autoimmune disease in which co-stimulatory systems have been widely explored. Therefore, we aimed to analyze the association between single-nucleotide polymorphisms (SNPs) in co-stimulatory/inhibitory molecules and AS to identify other key factors involved in developing the disease.

RESULTS

This study recruited 32 patients with AS and 32 controls. DNA was extracted from whole blood, and PCR amplification was performed to target the promoter regions of the CTLA4, CD28, and PDCD1 genes. Chi-square and Fisher's exact tests were used under various genetic models to assess differences in genotype and allele distribution between cases and controls. The results showed that rs201801072 of the CD28 gene (TT + CT vs. CC, p = 0.001) and rs11571319 of the CTLA4 gene were associated with AS (GG vs. AG + AA, p = 0.001). Logistic regression analysis showed that rs201801072 (CD28) and rs11571319 (CTLA4) were independently associated with AS. A significant positive interaction was observed between these SNPs and HLA-B27 positivity, further increasing the risk of AS (T-allele: OR = 6.15; G-allele: OR = 13.30, both p < 0.001). HLA-B27 carriers exhibited an extremely high risk of AS (OR = 65.0, p = 1.19E-06).

CONCLUSIONS

The elevated frequencies of specific alleles in AS patients compared to controls highlight the potential involvement of these SNPs as key factors in the pathogenesis of AS, offering new insights into the genetic mechanisms underlying the disease.

The imaging crisis in axial spondyloarthritis

Imaging holds a pivotal yet contentious role in the early diagnosis of axial spondyloarthritis. Although MRI has enhanced our ability to detect early inflammatory changes, particularly bone marrow oedema in the sacroiliac joints, the poor specificity of this finding introduces a substantial risk of overdiagnosis. The well intentioned push by rheumatologists towards earlier intervention could inadvertently lead to the misclassification of mechanical or degenerative conditions (eg, osteitis condensans ilii) as inflammatory disease, especially in the absence of structural lesions. Diagnostic uncertainty is further fuelled by anatomical variability, sex differences, and suboptimal imaging protocols. Current strategies-such as quantifying bone marrow oedema and analysing its distribution patterns, and integrating clinical and laboratory data-offer partial guidance for avoiding overdiagnosis but fall short of resolving the core diagnostic dilemma. Emerging imaging technologies, including high-resolution sequences, quantitative MRI, radiomics, and artificial intelligence, could improve diagnostic precision, but these tools remain exploratory. This Viewpoint underscores the need for a shift in imaging approaches, recognising that although timely diagnosis and treatment is essential to prevent long-term structural damage, robust and reliable imaging criteria are also needed. Without such advances, the imaging field risks repeating past missteps seen in other rheumatological conditions.

Spondyloarthritis features in IBD patients: prevalence, referral trends and clinical implications. A questionnaire-based study

OBJECTIVES

This study examines the prevalence of spondyloarthritis (SpA) features in patients with inflammatory bowel disease (IBD) and their rates of referral to rheumatologists.

MATERIAL AND METHODS

A questionnaire was administered to 2087 IBD patients (≥18 years) in Sweden, assessing demographics, medications and SpA features based on the ASAS and ESSG classification criteria. Patient that met our self-reported adapted criteria are referred to as suspected SpA.

RESULTS

Among the 1032 respondents, 59.1% met our questionnaire-based adapted SpA criteria. However, depending on different criteria (based on adapted ASAS, ESSG, peripheral or axial symptoms) only 24.3-44.0% of these patients had been referred to a rheumatologist. Patients with suspected SpA had higher usage of immunomodulators (42.8-48.8% vs. 37.0%), biologics (27.1-32.4% vs. 14.9%) and steroids (58.1-64.8% vs. 46.2%) compared to those without suspected SpA. Additionally, suspected SpA patients reported a higher incidence of active colitis (30.4-40.4% vs. 11.8%). Logistic regression analysis identified significant associations between suspected axial SpA and factors such as age, smoking, psoriasis, anterior uveitis and a high P-SCCAI score (≥5). Female gender and BMI ≥30 kg/m2 were linked to suspected peripheral SpA.

CONCLUSION

The study highlights a significant prevalence of self-reported SpA in IBD patients, with many remaining undiagnosed and un-referred to rheumatologists. These findings emphasize the need for greater awareness and improved collaboration between gastroenterologists and rheumatologists for better SpA management in IBD patients.

Precision prediction of intervertebral disc degeneration in ankylosing spondylitis using a nomogram model reveals the pivotal role of Th2-type immune dysregulation

Background

Ankylosing spondylitis (AS) is an immune-mediated chronic inflammatory disease. When AS is complicated by intervertebral disc degeneration (IVDD), disease complexity increases substantially, often resulting in poor long-term outcomes. Although previous studies have explored the mechanisms linking AS and IVDD, reliable tools for precise risk prediction and early intervention remain scarce.

Methods

In this retrospective study, we enrolled 144 patients with AS (60 with and 84 without IVDD). Their clinical features, immune status, and inflammatory cytokine levels were analyzed. A nomogram prediction model was constructed using multivariable logistic regression. Model performance was evaluated via receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

Results

Multivariable analysis identified body mass index (BMI), peripheral blood Th2 cell percentage (Th2%), and serum IL-4 levels as independent risk factors for IVDD in patients with AS. All associations remained statistically significant after Benjamini-Hochberg correction (BMI: BH-adjusted P = 0.001; Th2%: BH-adjusted P = 0.019; IL-4: BH-adjusted P = 0.019). Incorporation of these factors into a nomogram yielded excellent discriminative performance (area under the curve, AUC = 0.83) and calibration, outperforming a simplified model based solely on BMI (AUC = 0.74). This improvement in predictive accuracy was statistically significant, as determined by DeLong's test (P = 0.018). DCA revealed that at a threshold probability of 60.8%, the nomogram effectively distinguished high-risk patients, underscoring its strong clinical applicability.

Conclusions

This study is the first to highlight the critical roles of Th2 cells and IL-4 in AS complicated by IVDD, and establishes a nomogram that accurately predicts the risk of IVDD in AS. Beyond offering a tool for early detection and personalized management, these findings open avenues for investigating overlapping pathogenic mechanisms and potential immunotherapeutic targets in AS-IVDD.

Upadacitinib for the treatment of radiographic axial spondyloarthritis - case series and review of the literature

Upadacitinib is a Janus kinase (JAK) inhibitor approved for the treatment of different rheumatic diseases, including axial spondyloarthritis (axSpA). In phase III clinical trials, upadacitinib was associated with rapid and significant improvement in disease parameters, including scores for pain, function and mobility, signs of structural damage, and patient-reported outcomes, and had an overall incidence of adverse events similar to that in the placebo group. Improvement in axSpA disease severity was observed in both biologic-naive patients and those with prior biologic exposure, and this improvement was sustained during open-label treatment. Indirect comparisons with other agents suggest that upadacitinib is more effective than biologics and other JAK inhibitors in patients with axSpA and is associated with the lowest number-needed-to-treat. Long-term safety data indicate that upadacitinib is well tolerated in patients with axSpA, with a low rate of infections, malignancies, major adverse cardiovascular events and thromboembolism. Four case studies described here illustrate the effectiveness of upadacitinib in a range of real-world patients with axSpA, including patients with early disease and those who have been pre-treated with biologics.

Comparative Characteristics of Axial Spondyloarthritis and Psoriatic Arthritis with Axial Involvement

of the study was to compare clinical characteristics of patients with axial spondyloarthritis (axSpA)/ankylosing spondylitis (AS) and with axial psoriatic arthritis (axPsA). MATERIALS AND METHODS: . A total of 100 patients were examined: 45 with axSpA/AS (group 1) and 55 with axPsA (group 2). Patients of group 1 were included according to axSpA/AS criteria; patients of group 2, according to CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria, and having axial involvement (axPsA). Axial involvement was detected in case of radiologically significant sacroiliitis (SI, bilateral grade ≥2 or unilateral grade ≥3), or active MRI significant sacroiliitis, or ≥1 syndesmophyte(s) of the cervical and/or lumbar spine. Patients were evaluated for the presence of inflammatory back pain (IBP) by ASAS (Assessment of Spondyloarthritis International Society) criteria. RESULTS AND DISCUSSION. : Patients of group 1 were younger (p < 0.001), more often were HLA-B27 positive (p < 0.001), and more often had IBP (p = 0.001). Patients of group 2 had older age (> 40 years) at back pain onset (p < 0.001) and more often had peripheral arthritis (p < 0.001), dactylitis (p = 0.004), and skin psoriasis (p < 0.001). Nail psoriasis was found only in group 2 patients (p < 0.001). Group 1 patients more often had heel enthesitis (p = 0.005). Group 2 patients had worse axial disease activity scores: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index; p = 0.006) and ASDAS-СRP (Ankylosing Spondylitis Disease Activity Score with C-reactive protein level determination; р < 0.001); and worse patient-reported outcomes: BASFI (Bath Ankylosing Spondylitis Functional Index; p = 0.004), patients' pain (p = 0.005) and patients' global assessments (p = 0.036). Patients of group 2 had more syndesmophytes of the lumbar (р = 0.009) and cervical (р = 0.007) spine. Only in group 2 patients, chunky "non-marginal" syndesmophytes (in 32.1%), as well as spinal lesions without sacroiliitis (in 20.0%) were found. Patients of group 2 had more joint erosions (р = 0.001), osteolysis (р = 0.015), juxta-articular bone formation (р < 0.001) and joint ankyloses (р = 0.02). All patients of group 1 and only 80% of group 2 (р = 0.003) met ASAS criteria for axSpA. AxSpA/AS and axPsA seem to be two different diseases. In our cohort of patients, axPsA patients had worse disease status compared to axSp and AS.

Imaging in clinical trials of axial spondyloarthritis: what type of imaging should be used

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition predominantly affecting the sacroiliac joints and spine. Early and accurate diagnosis is crucial to prevent structural damage and improve patient outcomes. Imaging plays a pivotal role in axSpA diagnosis, monitoring, and clinical trials, offering insights into both inflammatory activity and structural progression. Conventional radiography has been foundational for detecting structural changes, such as syndesmophytes and erosions, but it is limited by poor sensitivity for early disease detection and significant interobserver variability. Advanced imaging modalities, such as magnetic resonance imaging (MRI) and low-dose computed tomography (ld-CT), have emerged as more sensitive tools. MRI excels in identifying active inflammation, particularly bone marrow edema, and is integral to early diagnosis and disease monitoring. ld-CT provides superior spatial resolution for detecting structural lesions while minimizing radiation exposure. However, challenges remain in achieving standardized imaging protocols and consistent scoring systems across clinical trials. Scoring systems like the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), Spondyloarthritis Research Consortium of Canada (SPARCC) scores, and Berlin methods require rigorous calibration to ensure reliability. The purpose of this review is to explore the strengths and limitations as well as the use in clinical trials of the different imaging modalities and to offer guidance on selecting the most suitable imaging techniques for assessing both disease activity and structural progression in clinical trials.

Non-infectious uveitis: a multicenter study from Argentina

PURPOSE

To describe etiologies and clinical characteristics of patients from Argentina with non-infectious uveitis (NIU). Differences between the anatomic segments involved were described as well.

METHODS

This is a multicentric, cross-sectional study from January 2008 to March 2021. We included patients with NIU from private and public institutions. Uveitis diagnosis was made by ophthalmologists specializing in uveitis, and rheumatologists diagnosed the autoimmune conditions. Patients were classified according to the International Uveitis Study Group classification system. RESULTS°: We included 468 patients with NIU. Most of them were female (64.1%), with a mean age at diagnosis of 37.9 years (SD 17.2). Idiopathic uveitis and Vogt-Koyanagi-Harada disease (VKH) were the most frequent causes. Among anterior uveitis, the most prevalent causes were idiopathic, spondyloarthritis, juvenile idiopathic arthritis, and sarcoidosis. VKH and Behçet were predominant within the panuveitis group. Over half of the patients (57%) required immunosuppressants. Methotrexate (20.6%) and azathioprine (8.9%) were mostly used. Eleven percent of the patients needed biologics, mostly adalimumab (9.4%). Two hundred fifty-six (54.7%) patients had eye complications, and cataracts were the most frequent (30%). A comparative analysis was performed between public and private institutions. There was no difference in the causes of uveitis or complications (p = 0.38; p = 0.06, respectively).

CONCLUSION

The most prevalent causes of uveitis were VKH and idiopathic uveitis, different from the etiologies observed in the United States and Europe.

An Evaluation of Magnetic Resonance Imaging Dixon Sequence Fat-Water Separation Techniques (T2w Dixon FSTs) to Detect Dorso-Lumbar Structural Lesions in Patients with Axial Spondyloarthritis

OBJECTIVE

The aim of this study was to assess and compare the diagnostic accuracy of two MRI techniques for identifying structural bone lesions (fatty lesions [BMFs], subchondral erosions [BMEs], sclerosis [BMS], and ankylosis [A]) in the dorso-lumbar joints. This assessment specifically focused on the application of MRI Dixon sequence fat-water separation techniques (T2w Dixon FSTs) when acquiring T1-weighted (T1w) images as the reference standard, among patients diagnosed with axial spondyloarthritis (SpA).

METHODS

Conducted at a single center, this study involved the recruitment of patients who underwent both spinal and sacroiliac (SI) joint MRI between 2019 and 2022, with follow-up continuing until 2023. In 2023, three independent readers reassessed the initial MRI datasets to evaluate specific radiological features of SpA. They recorded confidence estimates regarding the use of T2w Dixon FSTs when acquiring T1w images. The centralized MRI interpretations were then compared to established rheumatologic diagnoses.

RESULTS

A total of 73 patients (42 men and 31 women) were included in the study. The mean sensitivity, specificity, and accuracy of T2w Dixon FSTs (fat-only images) were at least 75%, 100%, and 96%, respectively, based on the 2023 assessment for all considered items. The diagnostic performance of T2w Dixon FSTs was comparable to that of T1w images.

CONCLUSIONS

The diagnostic performance of T2w Dixon FSTs (fat-only images) matched that of T1w images not only in assessing structural and fatty lesions, but also in the evaluation of subchondral erosions, sclerosis, and ankylosis in the dorso-lumbar joints of patients with a rheumatologic diagnosis of SpA. These findings suggest the potential avoidance of T1-weighted images when employing multi-parameter, multi-sequence imaging, such as the Dixon sequence.

EULAR/American College of Rheumatology Risk Stratification Criteria for Development of Rheumatoid Arthritis in the Risk Stage of Arthralgia

OBJECTIVE

The field of rheumatoid arthritis (RA) is moving towards identification of and intervention in people at risk of RA, but a validated risk stratification method is lacking. This work was undertaken to develop a risk stratification method for persons presenting with arthralgia considered to be at risk of RA.

METHODS

A joint EULAR/American College of Rheumatology (ACR) expert committee was established. Risk factor and outcome data from 10 arthralgia cohorts (including clinically suspect arthralgia and autoantibody-positive arthralgia) were studied. The work focused on differentiating the risk of progression to clinically apparent inflammatory arthritis (IA) within 1 year, using clinical and serologic variables, without and with subclinical joint inflammation detected by ultrasound (US) or magnetic resonance imaging (MRI). Developing RA according to the 2010 EULAR/ACR criteria within 1 year was a secondary outcome. A set of validated risk stratification criteria was developed.

RESULTS

Using data from 2,293 symptomatic at-risk individuals, a stratification method was derived consisting of 6 clinical and serologic variables (morning stiffness, patient-reported joint swelling, difficulty making a fist, C-reactive protein, rheumatoid factor, and anti-citrullinated peptide antibody) yielding an area under the curve (AUC) of 0.80 (95% confidence interval [CI] 0.77-0.83) for IA development. The inclusion of US variables did not increase the discriminative ability. When MRI-detected subclinical inflammation variables were included, the AUC was 0.87 (95% CI 0.82-0.90). In the presence of clinical, serologic, and MRI variables, a sensitivity and specificity of >75% was achieved. For RA development, the AUC of the criteria with MRI was 0.93 (95% CI 0.90-0.97).

CONCLUSIONS

EULAR/ACR risk stratification criteria have been developed for people with arthralgia in secondary care who are considered at risk for RA. The criteria can be applied in the absence or presence of imaging data and have been developed to define homogeneous risk groups for future prevention trials.

Muscle health in ankylosing spondylitis: effects of disease duration, inflammation, education level, and spinal mobility on skeletal muscle atrophy

Background

Ankylosing spondylitis (AS) is a progressive chronic disease that primarily affects the axial skeleton, leading to significant musculoskeletal impairment. This condition may extend its inflammatory impact to peripheral muscles, potentially resulting in muscle wasting.

Objectives

The study aimed to investigate the prevalence of sarcopenia among AS patients, to determine the specific cutoff values for muscle status, and to identify risk factors that may impact muscle status in AS patients.

Design

A cross-sectional study was conducted involving consecutive AS patients attending the Department of Rheumatology and Immunology at the First Medical Center of the Chinese PLA General Hospital. Clinical characteristics and body composition were evaluated.

Methods

Based on the Asian Working Group for Sarcopenia criteria, the prevalence of sarcopenia among AS patients were calculated. Additionally, specific cutoff values for muscle mass and muscle strength in AS patients were analyzed. Univariable and multivariable logistic regression analyses were employed to scrutinize risk factors impacting muscle status in AS patients, including appendicular skeletal muscle mass index (ASMI) and grip strength.

Results

Measurements of body composition, including ASM at 22.79 kg and ASMI at 7.69 kg/m², were significantly lower compared to the healthy control group (p < 0.05). The prevalence of sarcopenia, as identified by the sex-specific fifth percentile, is 8.66% in AS patients. In our study, the ASMI cutoffs were set at 7.48 kg/m² for males and 5.63 kg/m² for females. Logistic regression analysis revealed that AS patients who had a longer disease duration, lower level of education, elevated inflammatory markers, and a higher Bath Ankylosing Spondylitis Metrology Index (BASMI) were more likely to experience a decrease in ASMI. Regarding the muscle strength, lower education level and higher Bath Ankylosing Spondylitis Functional Index were correlated with a reduced grip strength in individuals with AS.

Conclusion

Our study indicates that AS patients may have a diminished muscle status. Although the incidence of sarcopenia among AS patients is relatively low, a notable subset does suffer from muscle atrophy. Variables such as disease duration, education level, inflammatory markers, and BASMI are likely to influence muscle status in AS patients, warranting consideration in clinical management and intervention strategies.

Associations between comorbidities and patient-reported outcomes in axial spondyloarthritis: data from a single-center real-world cohort

INTRODUCTION

Comorbidities are frequently present in patients with axial spondyloarthritis (axSpA) and may contribute to poorer health-related outcomes. Patient-reported outcomes (PROs) serve as tools to assess the patient's perspective on the burden of the disease. The study aimed to evaluating the impact of comorbidities on selected PROs in axSpA.

METHOD

Adult patients diagnosed with axSpA based on ASAS classification criteria were included in this cross-sectional study. Data collected included comorbidities and PROs [Health Assessment Questionnaire (HAQ), Multi-Dimensional Health Assessment Questionnaire (MDHAQ), 36-Item Short Form Health Survey (SF-36), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI)].

RESULTS

In total, 323 participants were included in the study (44.0% female). Multimorbidity and extended multimorbidity were observed in 63.8% and 38.7% of patients, respectively. Extended multimorbidity was associated with higher HAQ (0.5 [0.1-1.0] vs. 0.3 [0.0-0.8], p < 0.01) and MDHAQ scores (0.3 [0.0-0.6] vs. 0.1 [0.0-0.5], p = 0.03). The BASDAI score was higher in patients with three or more comorbidities than in patients with no comorbidities (2.8 [1.7-4.3] vs. 1.9 [0.9-3.6], p < 0.01). The number of comorbidities was associated with higher scores in the mental health (β = 0.20, p < 0.01) and vitality (β = 0.16, p = 0.02) domains of the SF-36 questionnaire.

CONCLUSIONS

Multimorbidity was present in almost two-thirds of cases. Extended multimorbidity was associated with poorer physical functioning, HAQ, MDHAQ, and BASDAI scores, whereas multimorbidity was related to better scores in the mental health and vitality domains. The impact of comorbidities on PROs in axSpA should not be overlooked. Key Points • Multimorbidity is frequent among axial spondyloarthritis' patients. • Only extended multimorbidity (presence of two or more additional diseases, excluding axial spondyloarthritis) was found to be associated with poorer results of patient-reported outcomes, in particular these regarding physical functioning. • Multimorbidity might influence positively some domains of quality of life such as mental health or vitality. • The findings included in the study support the belief that in patients with spondyloarthritis comorbidities might impact patient-reported outcomes which are important when assessing disease activity and response to treatment and should not be disregarded.

The effect of ixekizumab treatment on MRI sacroiliac joint structural lesions in patients with radiographic axial spondyloarthritis: post-hoc analysis of a 52-week, randomised, placebo-controlled trial with an active reference arm

BACKGROUND

The effect of biological disease-modifying antirheumatic drugs (DMARDs) on sacroiliac joint lesions over 52 weeks in biological DMARD-naive patients with radiographic axial spondyloarthritis is unknown. This post-hoc analysis evaluated the effect of ixekizumab and adalimumab versus placebo on structural lesions in sacroiliac joints assessed by MRI in patients naive to biological DMARDs with radiographic axial spondyloarthritis from the COAST-V study.

METHODS

COAST-V was a phase 3, multicentre, randomised, double-blind, placebo-controlled trial with an active reference arm done over 52 weeks at 84 sites in 12 countries. Eligible patients were adults (aged ≥18 years) naive to biological DMARDs with active radiographic axial spondyloarthritis, radiographic evidence of sacroiliitis, and an inadequate response or intolerance to non-steroidal anti-inflammatory drugs. Patients were randomly assigned (1:1:1:1) to 80 mg ixekizumab every 2 weeks (Q2W) or every 4 weeks (Q4W), 40 mg adalimumab Q2W, or placebo. At week 16, patients receiving placebo or adalimumab were randomly assigned (1:1) again to ixekizumab Q2W or ixekizumab Q4W. Post-hoc analyses of patients with MRI available at baseline, 16 weeks, and 52 weeks are reported. MRIs were scored using the Spondyloarthritis Research Consortium of Canada sacroiliac joint structural scores for erosion, backfill, fat lesions, and ankylosis. ANCOVA was used for treatment comparisons in observed cases adjusting for baseline values, bone marrow oedema, and stratification factors. Subgroup analyses by sex, HLA-B27, and baseline bone marrow oedema were done.

FINDINGS

Between June 20, 2016, and Aug 22, 2017, 341 patients were enrolled in the COAST-V study. MRI scans were available for 325 (95%) of 341 patients at baseline and week 16, and for 301 (88%) patients at week 52. 264 (81%) of 325 patients were male and 61 (19%) were female, and the mean age was 41·5 years (SD 11·6). At week 16, erosion significantly decreased versus placebo in the ixekizumab Q2W group (least squares mean -0·91 [SE 0·19] vs 0·10 [0·18]; p<0·0001) and the ixekizumab Q4W group (-0·57 [SE 0·19]; p=0·0086]); the effect of adalimumab was similar. Backfill significantly increased from baseline to week 16 in ixekizumab Q2W versus placebo (0·52 [0·12] vs 0·04 [0·12]; p=0·0042). At week 16, decreases in erosion differed significantly between the placebo group and ixekizumab Q2W or Q4W groups, and differences were seen by sex, HLA-B27 status, and baseline bone marrow oedema score. At week 52, at both ixekizumab doses, further changes were observed in erosion and backfill, which were greatest with continuous ixekizumab Q2W (mean erosion -1·50 [SD 2·70], mean backfill 0·76 [SD 2·09]). A decrease in erosion was also noted in patients switching from adalimumab to ixekizumab at week 16. COAST-V was registered with ClinicalTrials.gov (NCT02696785).

INTERPRETATION

A decrease in erosion and increase in backfill were observed at week 16 with further reductions in erosion and increases in backfill occurring at week 52 in patients receiving ixekizumab. Ixekizumab, like adalimumab, modifies structural lesions that is consistent with a rapid tissue response in patients with radiographic axial spondyloarthritis. However, the effect on the development of ankylosis in sacroiliac joints or the spine requires further analysis.

FUNDING

Eli Lilly.

Real-World Insights From Türkiye: Biologic DMARDs Usage in Spondyloarthritis Patients With Chronic Kidney Disease

AIM

The objective was to evaluate biologic disease-modifying antirheumatic drugs (DMARDs) and their side effects that hindered the continuation of treatment in a patient population diagnosed with spondyloarthritis (SpA) with a glomerular filtration rate (GFR) ≤ 60 mL/min, and to compare these side effects between patients with chronic kidney disease (CKD) and those without.

METHODS

This multicenter, observational cohort study utilized data from the TReasure database, which records SpA patients in a web-based system across Türkiye. A total of 6052 patients being included. SpA patients were categorized into two main groups: non-CKD patients and CKD patients. The clinical characteristics, disease activity, treatment options, drug retention rates, reasons for drug discontinuation, and types of adverse effects were compared between the groups.

RESULTS

Biologics prescription pattern varied between CKD and non-CKD patients. Etanercept was prescribed more frequently (53.1%) in CKD patients. Regarding the number of side effects and drug discontinuations in CKD patients, no statistically significant differences were found between the non-CKD and CKD groups for any of the bDMARDs (adalimumab, etanercept, golimumab, infliximab, ustekinumab, secukinumab, and certolizumab). No statistically significant differences were observed in the duration of drug retention based on CKD status for bDMARDs.

CONCLUSION

This study offers preliminary evidence supporting the effective and safe use of bDMARDs in patients with SpA and CKD.

Utility of Radiofrequency Echographic Multi-spectrometry in Evaluating Bone Health in Patients With Spondylarthritis

INTRODUCTION

Osteoporosis, a condition characterized by reduced bone strength and increased fracture risk, frequently coexists with spondyloarthritis (SpA), an inflammatory rheumatic disease. Dual-energy X-ray absorptiometry (DXA), the gold standard for diagnosing osteoporosis, faces limitations in SpA patients due to spinal deformities and calcifications. Some studies have shown overestimation of BMD values, especially in individuals with syndesmophytic bridges and coexistent mechanical modifications such as osteophytes and discopathic lesions.

MATERIALS AND METHODS

A cross-sectional study was performed to compare the results of bone mineral density (BMD) lumbar spine evaluations performed with Radiofrequency Echographic Multi-spectrometry (REMS) between a control group and a group of patients recently diagnosed with axial spondyloarthritis (axSpA) who did not follow any specific treatment. All study participants were informed about the objectives, examinations performed, and the use of anonymous data in databases to conduct statistical analyses and publish findings in reference medical scientific journals.

RESULTS

The ratio between male and female participants differed between the study groups. No significant differences were observed between the control and SpA groups, in both female and male subjects, with regard to BMD values. When factoring in the age of the patients, it was observed that the mean age of the control group was 55.53 years, while that of the SpA group was 36.96 years. This suggests that the BMD values of younger SpA patients were equivalent to those of older individuals in the control group.

CONCLUSION

REMS is a useful tool for evaluating BMD both in the general population and in SpA patients. Furthermore, the lack of any statistically significant correlation between the control and SpA groups confirms that the rheumatic disease influences lumbar bone mineralization. Also, similar BMD values were observed between the groups, despite significantly different mean ages, supporting the conclusion that bone degradation appears early in the evolution of SpA and can be correctly identified using REMS.

Performance of Disease Activity Indices Used in Axial Spondyloarthritis in Real-World Clinical Settings

OBJECTIVE

Monitoring axial spondyloarthritis (axSpA) disease activity using validated indices (eg, Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Axial Spondyloarthritis Disease Activity Score [ASDAS]) is widely recommended but rarely followed in practice. The reasons, although varied, may be found in the scarcity of studies comparing the performance of these indices in daily practice. Here, we compare the performance of disease activity indices in clinical practice.

METHODS

This was an observational cross-sectional study involving 330 patients. The BASDAI, ASDAS, Bath Ankylosing Spondylitis Functional Index (BASFI), and Assessment of SpondyloArthritis international Society Health Index (ASAS HI) indices were included. Their correlations, degree of concordance, and discriminating capacity for different levels of disease activity and impact were compared using the appropriate statistics.

RESULTS

A total of 127 women (38.5%) and 203 men (61.5%) were included, with a mean age of 47.6 (SD 12.9) years and median disease duration of 8 (IQR 4-16) years. At inclusion, 209 patients (63.3%) were receiving biologic therapies, mostly tumor necrosis factor inhibitors. All measurement indices were highly correlated (Pearson r ≥ 0.73). Concordance between instruments was substantial, both with regard to the different activity thresholds and the different disease impact categories (κ ≥ 0.61). BASDAI cutoffs of 3.95 (area under the receiver-operating characteristic curve [AUC] 0.90) and 5.85 (AUC 0.90) accurately identified the ASDAS high and very high activity categories, respectively. An ASDAS ≥ 2.1 (AUC 0.87) and a BASDAI ≥ 3 (AUC 0.92) accurately discriminated the ASAS HI high impact category. Regardless of systemic therapy use, there was substantial agreement between BASDAI remission (≤ 2) and ASDAS inactive disease (< 1.3).

CONCLUSION

The metrological performance of standard disease activity indices in axSpA were similar. The BASDAI values that identify the ASDAS categories are novel. We suggest using these indices interchangeably in routine clinical practice.

Risk of ankylosing spondylitis in long-term follow-up of hematopoietic stem cell donors: impact of HLA-B27 status and donation type

Hematopoietic stem cell transplantation (HSCT) is a pivotal curative therapy for various hematologic diseases, and donor safety is paramount. A few cases of ankylosing spondylitis (AS) have been reported in healthy unrelated donors, but the incidence has not been previously described. This retrospective cohort study analyzed 1098 bone marrow (BM) and 3890 peripheral blood stem cell (PBSC) donors between January 1998 and December 2018, along with healthy participants from the donor registry using de-identified data from the Taiwan National Health Insurance Research Database. The overall AS incidences among donors and non-donors were both 0.38%. AS incidence did not differ between BM and PBSC donors and their matched counterparts. Individuals with HLA-B27 exhibited higher incidence rate ratios than those without HLA-B27 in both the BM and PBSC cohorts. In those individuals with HLA-B27, BM donors showed a relative risk of 3.85 (p = 0.0017) compared to non-donors, while the risk for PBSC donors was not significantly higher (1.36, p = 0.339). The findings suggest that while AS incidence among HSC donors is comparable to non-donors, HLA-B27 positivity is the main risk factor associated with AS development, particularly among BM donors. This study provides valuable insights into the safety of HSCT donation and long-term follow-up.

Prevalence and incidence of uveitis in patients with spondyloarthritis: the impact of the biologics era. Data from the international ASAS-COMOSPA study

OBJECTIVES

Uveitis is a common extra-musculoskeletal manifestation in SpA. The aim of this study was to analyze the prevalence of uveitis in SpA patients, and its association with geographical areas, and to determine whether its incidence differed between before and after the biologics era.

METHODS

ASAS-COMOSPA is a retrospective study that includes patients fulfilling Assessment in SpondyloArthritis International Society (ASAS) SpA classification criteria from 22 countries. The overall prevalence of uveitis was calculated, and factors associated with the onset of a first episode of uveitis were evaluated using a Cox regression. A Log-Rank test was performed to compare the new onset of uveitis in the non-biologics era (SpA onset before 2000) vs biologics era (SpA onset after 2000).

RESULTS

A total of 3984 patients were included. The likelihood of presenting a first uveitis episode increased over time, from a prevalence of 10.5% (95% CI 9.5-11.4%) at the time of the SpA diagnosis to 46.6% (41.6-51.5%) after 30 years since the SpA diagnosis. HLA-B27 positivity, family history of uveitis, peripheral enthesitis, and IBD were associated with higher risk of uveitis. Patients with SpA disease onset after the year 2000 showed a lower prevalence of uveitis compared with those with disease onset before the year 2000 (8.2% vs 25.5%, P <0.01), as well as a lower incidence (2.8 per 100 person-years vs 6.1 per 100 person-years, respectively).

CONCLUSION

In our study, the risk of having suffered from at least one episode of uveitis ranged from 10% at the time of the diagnosis of axial SpA to 47% after 30 years of disease duration. Patients with disease onset after biologic therapy introduction showed a significantly lower prevalence and incidence of first episodes of uveitis.

Use of double-echo ultrashort echo time magnetic resonance imaging to assess proximal femoral cortical bone changes in axial spondyloarthritis

OBJECTIVE

We quantitatively evaluated proximal femoral cortical bone changes associated with generalized bone loss in axial spondyloarthritis (axSpA) patients using double-echo ultrashort echo time (UTE) MRI. To achieve non-radiation, clinically available visualization of cortical microstructural deterioration in the proximal femur of axSpA and to determine the factors influencing it.

MATERIALS AND METHODS

Patients with axSpA (n = 83) and age- and sex-matched healthy controls (n = 61) were recruited and underwent double-echo UTE MR scan of the nondominant proximal femur. Porosity index (PI) and cortical bone thickness (CbTh) were measured by two radiologists and their average measurements were used for subsequent analyses. Additionally, demographic characteristics of all subjects and disease-specific characteristics of axSpA patients were recorded. Proximal femoral cortical bone PI and CbTh values were compared between axSpA patients and healthy controls using independent samples t-test. Correlation analyses (Pearson or Spearman or Point-biserial correlation coefficients) were conducted to investigate factors potentially associated with UTE measurements in axSpA patients, and Bonferroni correction was applied at the α = 0.002 level for more stringent correction. Multiple linear regression analyses were performed to further identify influencing factors of UTE measurements with multiple correlated variables.

RESULTS

A total of 72 axSpA patients and 52 healthy control subjects were finally included. Patients and control subjects were comparable in sex, age, and body mass index (BMI). Proximal femoral cortical PI was higher (p < 0.001) and CbTh was lower (p < 0.001) in axSpA patients than in healthy controls. Sex (p < 0.001), BMI (p = 0.003), disease duration (p = 0.044), onset age (p = 0.01), alkaline phosphatase (ALP) (p < 0.001), radiographic axSpA (r-axSpA) (p = 0.02), Sacroiliac Joint Structural Score (SSS)-backfill (p = 0.03), SSS-ankylosis (p = 0.01), and nonsteroidal anti-inflammatory drugs (NSAIDs) use (p = 0.03) were potentially correlated to proximal femoral cortical PI, and among them, sex (p < 0.001) and BMI (p = 0.01) were independently associated demographic characteristics, and ALP (p = 0.02), SSS-backfill (p = 0.044) and SSS-ankylosis (p = 0.01) were independently associated disease-specific characteristics, and when all types of variables were considered, sex (p < 0.001), BMI (p = 0.016), and SSS-ankylosis (p = 0.042) were independently associated with PI. BMI (p = 0.043) and NSAIDs use (p = 0.041) were potentially negatively associated with CbTh.

CONCLUSION

Double-echo UTE measurements revealed deteriorated proximal femoral cortical bone microstructure in axSpA patients than controls, potentially associated with sex, BMI, disease duration, onset age, ALP, r-SpA, SSS-backfill, SSS-ankylosis, and NSAIDs use, where sex, BMI, ALP, SSS-backfill and SSS-ankylosis were the independently relevant factors. It offers a novel tool for axSpA's cortical bone assessment.

Defining a genetic background for bamboo spine and axial spondyloarthritis

OBJECTIVE

Bamboo spine is the most severe complication of axial spondyloarthritis (AxSpA). This study aims to address whether haplotypes of endoplasmic reticulum aminopeptidase (ERAP)1 and ERAP2 single nucleotide polymorphisms (SNPs), previously associated with AxSpA, are associated with the development of bamboo spine in an AxSpA cohort.

METHODS

The study included 192 patients with AxSpA followed in MARS (MARmara Spondyloarthritis) clinic and fulfilling the modified New York criteria. ERAP1 and ERAP2 polymorphisms were determined by real-time PCR on genomic DNA using the TaqMan SNP Genotyping Assay for SNPs rs72773968, rs3734016, rs26653, rs26618, rs27895, rs2287987, rs30187, rs10050860, rs17482078, rs27044, rs2549782, rs2248374. The HLA-B genotypes were assessed using the LABTypeTM SSO method.

RESULTS

Male gender (P<0.001) and HLA-B27 positivity (P<0.05) were associated with an increased risk of developing a bamboo spine, and peripheral arthritis was significantly less prevalent in AxSpA patients with a bamboo spine (P<0.05). Of the ten ERAP1 haplotypes, haplotype 3 was significantly more prevalent in AxSpA patients with bamboo spine adjusted for HLA-B27 status (P<0.05). Haplotype 3 and -6 were significantly more prevalent exclusively in HLA-B27 (+) patients (P<0.05). Allele frequencies and genotype distributions of single ERAP1 SNPs alone were not significantly different between AxSpA patients with and without bamboo spines. There was no association between bamboo spine development and ERAP2 SNPs.

CONCLUSIONS

Our results indicate that HLA-B27 positivity, ERAP1 haplotype 3 and -6, and being male confer a significant risk for developing bamboo spine. Whether the association of haplotype 3 and -6 with bamboo spine is confined only to our Turkish patient cohort may deserve attention in other ethnicities.

Interleukin 17-producing C-C motif chemokine receptor 6 + conventional CD4+ T cells are arthritogenic in an animal model of spondyloarthritis

OBJECTIVE

Spondyloarthritis (SpA) is a group of chronic inflammatory disorders associated with the human leukocyte antigen (HLA) class I allele HLA-B27. Transgenic rats expressing HLA-B27 and human β2-microglobulin (B27 rats) develop clinical manifestations resembling SpA called rat SpA. IL-17 and TNF are key proinflammatory cytokines implicated in both human and rat SpA. We aimed to determine which T cell subset(s) produce IL-17 and TNF during rat SpA, characterize their tissue distribution and tested their pathogenicity in vivo.

METHODS

Cytokine production by T cell subsets was evaluated in target tissues and lymphoid organs during rat SpA. Pathogenicity of purified IL-17+ cells was assessed in vivo by cell transfer. Blood samples were used to translate B27 rats findings to SpA patients.

RESULTS

Conventional CD4+ T cells (Foxp3-; Tconv) and γδ T cells were the main producers of both IL-17 and TNF in B27 rats. IL-17-producing Tconv and γδ T cells were expanded in the colon of premorbid 3-weeks-old B27 rats. C-C motif chemokine receptor 6 (CCR6) allowed the isolation of IL-17+ Tconv (Th17) in rat. Transfer of B27 rat IL-17-producing CCR6+ Tconv but not of γδ T cells into disease-free nude B27 rats induced arthritis, directly demonstrating for the first time the arthritogenic potential of Th17 cells in SpA. Finally, a CCR6+ IL-17+ Tconv expansion enriched for IL-17F production was evidenced in SpA patients.

CONCLUSION

Our study demonstrates that IL-17+TNF+CCR6+ Th17 cells and IL-17+ γδ T cells are expanded preceding SpA onset in B27 rats and that only IL-17+TNF+CCR6+ Th17 cells can trigger arthritis.

Characteristics, risk factors, and disease course of musculoskeletal manifestations in patients with inflammatory bowel disease: a prospective longitudinal cohort study

BACKGROUND

Musculoskeletal manifestations occur in half of the patients with inflammatory bowel disease (IBD) and contribute to a reduced quality of life (QoL) and increased work disability. We aimed to evaluate the natural disease course, characteristics, and risk factors of musculoskeletal manifestations in patients with IBD.

METHODS

We performed a prospective longitudinal cohort study in patients with IBD with and without musculoskeletal manifestations with a 1-year follow-up. Primary outcome was the proportion of patients with resolution of musculoskeletal manifestations. Secondary outcomes included the proportion of patients with IBD that developed new musculoskeletal manifestations during follow-up; the correlation among IBD activity, baseline characteristics, and musculoskeletal disease course; and the difference in QoL between patients with and without musculoskeletal manifestations.

RESULTS

In total, 243 patients with IBD were included (124 with and 119 without musculoskeletal manifestations). In the majority of patients (62.2%), musculoskeletal manifestations were of noninflammatory nature. Overall, peripheral and axial manifestations were persistent in 85.7 and 44.6% at 1 year, respectively. The QoL at baseline and at 1 year was lower in the group with musculoskeletal manifestations compared with patients without these manifestations. Female sex and age above 40 were associated with the presence of musculoskeletal manifestations.

CONCLUSION

Musculoskeletal manifestations in patients with IBD are mostly noninflammatory disorders, persist at 1 year of follow-up, and occur more frequently in patients of age above 40 and female sex. Overall, patients with musculoskeletal manifestations have lower QoL compared with patients without musculoskeletal manifestations.

Piriformis muscle abnormalities in sacroiliac MRI of patients with axial spondyloarthritis

BackgroundPiriformis syndrome, an often-overlooked cause of sciatica, commonly presents as chronic gluteal pain and poses a diagnostic challenge, particularly in patients with axial spondyloarthritis (axSpA).PurposeTo examine piriformis muscle abnormalities on sacroiliac magnetic resonance imaging (MRI) and their association with clinical outcomes in patients with axSpA.Material and MethodsThis cross-sectional study included 100 axSpA patients (50 radiographic [r-axSpA], 50 non-radiographic [nr-axSpA]), classified by the 2009 ASAS Axial Spondyloarthritis criteria, who underwent MRI evaluations of the sacroiliac joints over a 6-month period. Piriformis evaluation included the measurement of muscle size, signal intensity, and the assessment of fatty infiltration. Sciatic neuritis was assessed by identifying enlarged sciatic nerves or increased signal intensity. Data collection included demographic details, disease activity, and functionality parameters. Statistical analysis was performed using appropriate methods, with P < 0.05 indicating significance.ResultsPiriformis syndrome findings were identified in 10% of patients, with a slightly higher incidence in r-axSpA patients (12%) compared to nr-axSpA patients (8%); however, this difference was not statistically significant (P = 0.739). Patients with these MRI findings had significantly higher disease activity, as indicated by the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (3.5 vs. 2.82; P = 0.015), and greater functional impairment, measured by the Bath Ankylosing Spondylitis Functional Index (5.45 vs. 2.7; P = 0.041).ConclusionThis study highlights the presence of MRI findings associated with piriformis syndrome among axSpA patients, which are linked to increased disease activity and reduced function. Recognizing piriformis syndrome as a co-morbidity may improve diagnosis and treatment, leading to better patient outcomes.

Dual-Energy Computed Tomography Applications in Rheumatology

Dual-energy computed tomography (DECT) has emerged as a transformative tool in the past decade. Initially employed in gout within the field of rheumatology to distinguish and quantify monosodium urate crystals through its dual-material discrimination capability, DECT has since broadened its clinical applications. It now encompasses various rheumatic diseases, employing advanced techniques such as bone marrow edema assessment, iodine mapping, and collagen-specific imaging. This review article aims to examine the unique characteristics of DECT, discuss its strengths and limitations, illustrate its applications for accurately evaluating various rheumatic diseases in clinical practice, and propose future directions for DECT in rheumatology.

Development and validation of machine learning algorithms for early detection of ankylosing spondylitis using magnetic resonance images

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joints and spine, often leading to disability if not diagnosed and treated early.ObjectiveIn this study, we present the development and validation of machine learning (ML) algorithms for AS detection only using Short Tau Inversion Recovery (STIR) sequenced magnetic resonance (MR) images.MethodsThe detection process is based on creating Gray Level Co-occurrence Matrices (GLCM) from MR images, followed by the computation of Haralick features and the training of ML-based models. A total of 696 MR images (AS+: 348, AS-: 348) were utilized for AS detection. Models were trained and tested on 70% of the dataset using a 10-fold cross-validation method to prevent overfitting, while the remaining 30% of the data was used for validation. In addition, care was taken to ensure that different images from the same patient were not split between the training and validation sets during this separation process to prevent potential data leakage.ResultsThe proposed ML-based model demonstrated superior performance during the validation phase (accuracy: 0.885, AUC: 0.941). The results of our study show promising outcomes when compared to previous works employing GLCM-based ML detection models.Conclusions: This study introduces a new perspective on AS detection, focusing on the assignment of ML techniques to STIR-sequenced MR images with a notable absence of literature on interpreting ML models for AS detection. This typology also addresses a lack of knowledge, as most models do not provide practical interpretability or knowledge alongside accurate prediction. The system also offers an effective strategy for early and correct diagnosis of AS, which is important for timely intervention and treatment planning.

The role of social determinants of health on disease outcomes in axial spondyloarthritis: A narrative review

This review provides a narrative exploration of the literature on various social determinants of health that influence outcomes in axial Spondyloarthritis (axSpA). By using the PROGRESS-Plus framework (place of residence, race, occupation, gender/sex, religion, education, socioeconomic status, social capital, age), this review discusses how these factors have been studied and their impact on disease outcomes in axSpA. The findings suggest that various patient-level factors (e.g. female sex, blue-collar jobs, low educational level) and country-level factors (e.g. low-income countries) associate with worse health outcomes in axSpA. These insights highlight the importance of adopting a multifaceted and holistic approach, that also considers social determinants of health, when managing patients with axSpA. This work also identifies unmet needs in this area including the importance of thinking beyond just biological factors, when considering drivers of suboptimal outcomes in axSpA.

DEUS Enthesitis Index (DEI): a new tool integrating ultrasound and clinical examination for enthesitis assessment in spondyloarthritis

OBJECTIVES

(1) To develop a composite score, the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) Enthesitis Index (DEI), which integrates ultrasound and clinical examination findings for enthesitis assessment in patients with spondyloarthritis (SpA); (2) to examine the relationships between DEI and clinical features in this population, compared to the clinical examination of the entheses alone.

METHODS

This was a cross-sectional, observational, multicentric study involving 20 rheumatology centres across 11 countries. Ultrasound and clinical examinations were performed bilaterally on the lower limb large entheses (ie, quadriceps tendon, proximal and distal patellar tendons, Achilles tendon and plantar fascia) in 413 patients with SpA, including 224 patients with axial SpA and 189 patients with psoriatic arthritis (PsA). A score of 1.0 for clinical enthesitis and 1.0 for ultrasound enthesitis was assigned for each of the 10 entheses evaluated. The total DEI score, which combines clinical and ultrasound findings, ranged from 0 to 20 per patient. Logistic and gamma regression models based on DEI were compared with those derived solely from clinical enthesitis assessment to evaluate their relative performance in explaining disease-related outcomes.

RESULTS

Among patients with SpA, the median DEI was 1.0 (IQR 0.0-3.0). DEI showed significant associations with SpA disease activity and severity indices in regression analyses, except for the Disease Activity in Psoriatic Arthritis score in patients with PsA. Compared with the clinical examination alone of the same entheses, DEI models exhibited a significantly better fit with C-reactive protein levels and ultrasound-detected structural damage at the enthesis (ie, enthesophytes and bone erosions). By contrast, the clinical examination alone models showed a significantly stronger fit with SpA disease activity indices and patient-reported outcomes compared with the DEI.

CONCLUSIONS

DEI is a novel tool that integrates both ultrasound and clinical examination findings for enthesitis assessment, potentially ensuring a more reliable evaluation of this key domain in SpA.

Enhanced diagnosis of axial spondyloarthritis using machine learning with sacroiliac joint MRI: a multicenter study

OBJECTIVES

To develop a machine learning (ML)-based model using MRI and clinical risk factors to enhance diagnostic accuracy for axial spondyloarthritis (axSpA).

METHODS

We retrospectively analyzed datasets from four centers (A-D), focusing on patients with chronic low back pain. A subset from center A was used for prospective validation. A deep learning (DL) model based on ResNet50 was constructed using sacroiliac joint MRI. Clinical variables were integrated with DL scores in ML algorithms to distinguish axSpA from non-axSpA patients. Model performance was assessed by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy.

RESULTS

The study included 1294 patients (median age 31 years [interquartile range 24-42]; 35.5% females). Clinical risk factors identified were age, sex, and human leukocyte antigen-B27 status. The MRI-based DL model demonstrated an AUC of 0.837, 0.636, 0.724, 0.710, and 0.812 on the internal test set, three external test sets, and the prospective validation set, respectively. The combined model, particularly the K-nearest-neighbors-11 algorithm, demonstrated superior performance across multiple test sets with AUCs ranging from 0.853 to 0.912. It surpassed the Assessment of SpondyloArthritis International Society criteria with better AUC (0.858 vs. 0.650, p < 0.001), sensitivity (87.8% vs. 42.4%, p < 0.001), and accuracy (78.7% vs. 56.9%, p < 0.001).

CONCLUSION

The ML method integrating MRI and clinical risk factors effectively identified axSpA, representing a promising tool for the diagnosis and management of axSpA.

CLINICAL RELEVANCE STATEMENT

The machine learning model combining MRI and clinical risk factors potentially enables earlier diagnosis and intervention for axial spondyloarthritis patients, reducing the delays commonly associated with traditional diagnostic approaches.

KEY POINTS

Axial spondyloarthritis (AxSpA) lacks definitive diagnostic criteria or markers, leading to diagnostic delay. MRI-based deep learning provided quantitative analysis of sacroiliac joint changes indicative of axSpA. A machine learning model combining sacroiliac joint MRI and clinical risk factors enhanced axSpA identification.

Prevalence and clinical features of early axial spondyloarthritis according to ASAS definition: a cross-sectional analysis from the reuma-check cohort

Objectives to estimate the prevalence at diagnosis of early axial spondyloarthritis in Argentinian Reuma-Check cohort, according to ASAS definition (early axSpA) and to identify clinical, laboratory, and imaging features associated with this group in a Latin American cohort. This single-center, observational, cross-sectional study included consecutive adult patients diagnosed with axSpA. Early axSpA was defined as ≤ 2 years of axial symptoms at diagnosis. Clinical, laboratory, and imaging assessments were performed following standardized protocols. A primary analysis was conducted on the entire cohort of diagnosed patients, followed by two subgroup analyses: one including only those fulfilling the ASAS 2009 criteria and another excluding patients with psoriasis. Logistic regression was conducted to identify factors independently associated with early axSpA. Among 124 patients, 38% (n = 47) had early axSpA at diagnosis. Significant differences between early and established axSpA included smoking habit (30 vs. 51%, p = 0.02), NSAID response (58 vs. 74%, p = 0.06), family history (38 vs. 23%, p = 0.04), and radiographic sacroiliitis (37 vs. 71%, p = 0.03). Logistic regression identified family history (OR: 2.4) as an independent risk factor, whereas smoking was inversely associated (OR: 0.4). Similar patterns were observed in the ASAS-fulfilling (33%) and psoriasis-excluded (36%) subgroups. At diagnosis, approximately one third of patients meet the ASAS definition of early axSpA. These patients are characterized by a higher frequency of family history, less smoking and structural damage. These results support the feasibility and relevance of future studies including patients with early axSpA to provide further scientific evidence at earlier stages of the disease.

Clinical and immunological differences between primary and autoimmune-associated neuromyelitis optica spectrum disorders: a retrospective study

INTRODUCTION

Neuromyelitis optica spectrum disorder (NMOSD) is a rare immune-mediated disease affecting the spinal cord and optic nerves. While NMOSD has been widely studied, limited data exist on the subset associated with autoimmune diseases (AD-NMOSD), particularly in Taiwanese patients. Additionally, relapse and prognostic factors in AD-NMOSD remain unclear.

METHODS

We retrospectively analysed 71 NMOSD cases diagnosed between 2008 and 2023 at Taipei Veterans General Hospital. Clinical features, laboratory findings, autoimmune comorbidities, imaging and treatments were examined. Patients were stratified by relapse status and the presence of severe sequelae.

RESULTS

Among 71 NMOSD cases, 26 (37%) patients had AD-NMOSD. While no significant differences were observed in the number or severity of relapses and sequelae between AD-NMOSD and primary (p)-NMOSD, patients with AD-NMOSD exhibited lower white blood cell counts, haemoglobin, platelet counts, immunoglobulin G and C reactive protein levels. Specific risk factors for relapse in AD-NMOSD included onset age under 50 years, concurrent SLE and a longer duration of SLE before NMOSD presentation. In both AD-NMOSD and p-NMOSD, more relapses were associated with severe neurological sequelae. Although relapse-free survival did not differ significantly between the two groups, patients with AD-NMOSD tended to have a longer period without severe sequelae.

DISCUSSION

Taiwanese patients with AD-NMOSD show distinct laboratory characteristics compared with those without autoimmune diseases. Younger age and longer disease duration are key risk factors for relapses, which are linked to more severe neurological sequelae. Despite various treatments, no significant differences were found in relapse rates or sequelae severity, highlighting the need for personalised management strategies.

Long-term safety of bimekizumab in adult patients with axial spondyloarthritis or psoriatic arthritis: pooled results from integrated phase IIb/III clinical studies

OBJECTIVE

To assess the long-term safety profile of bimekizumab (BKZ) in patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA).

METHODS

Safety data pooled from six integrated phase IIb/III studies in axSpA and PsA are reported (to the July 2022 data-cut for phase III) for patients who received ≥1 dose of BKZ 160 mg every 4 weeks. Treatment-emergent adverse events (TEAEs) are reported using exposure-adjusted incidence rate per 100 patient-years (EAIR/100 PY).

RESULTS

The axSpA and PsA safety pools included 848 (total BKZ exposure: 2034.4 PY) and 1407 patients (2590.8 PY), respectively. TEAEs occurred at an EAIR/100 PY of 136.9 in axSpA and 139.6 in PsA; study discontinuation due to TEAEs was low (axSpA: 2.7/100 PY; PsA: 3.1/100 PY). The three most frequently reported TEAEs were SARS-CoV-2 (COVID-19) infection (axSpA: 7.8/100 PY; PsA: 8.8/100 PY), nasopharyngitis (axSpA: 8.2/100 PY; PsA: 7.7/100 PY) and upper respiratory tract infection (axSpA: 5.0/100 PY; PsA: 5.6/100 PY). EAIR/100 PY of oral candidiasis was 3.7 in axSpA and 4.2 in PsA; most events were mild/moderate. EAIR of BKZ discontinuation due to oral candidiasis was low (both axSpA and PsA: 0.3/100 PY). No systemic fungal infections or cases of active tuberculosis were reported. EAIRs of adjudicated definite/probable inflammatory bowel disease, uveitis, adjudicated major adverse cardiovascular events and adjudicated suicidal ideation/behaviour were low.

CONCLUSION

Overall, BKZ demonstrated good tolerability, with TEAE EAIRs comparable between axSpA and PsA cohorts, remaining stable over extended treatment periods. No new safety signals were identified.

TRIAL REGISTRATION NUMBERS

NCT02963506 (BE AGILE); NCT03355573 (BE AGILE 2); NCT03928704 (BE MOBILE 1); NCT03928743 (BE MOBILE 2); NCT04436640 (BE MOVING); NCT02969525 (BE ACTIVE); NCT03347110 (BE ACTIVE 2); NCT03895203 (BE OPTIMAL); NCT03896581 (BE COMPLETE); NCT04009499 (BE VITAL).

Effect of biological treatment on the thiol/disulfide parameters in patients with axial spondyloarthritis

OBJECTIVE

Aim of this study is to compare the thiol/disulfide variables before treatment, at the 3rd and 6th months of biologic treatment in patients with axSpA.

MATERIALS & METHODS

Consecutive patients with axial spondyloarthritis to whom biologic treatment was initiated in our clinic were enrolled upon consent. Demographics, clinical characteristics, laboratory parameters and treatment agents were collected. Disease activity scores and thiol-disulfide balance parameters were recorded at baseline and 3rd, 6th months of treatment. Statistical analyses were performed in all patients and in subgroups of ankylosing spondylitis and non-radiographic axial spondyloarthritis patients.

RESULTS

In all patients, total thiol levels were significantly increased at 6th month in comparison to baseline values (470.5 ± 74.7 vs 491.9 ± 69.6, p = 0.047). Native thiol levels were increased at 6th month close to significance (438.9 ± 70.4 vs 458.8 ± 63.7, p = 0.060). Moderately strong negative correlations were observed between native thiol levels and disease activity parameters (BASDAI: p = 0,019; ASDAS-CRP: p = 0,035; ASDAS-ESR: p = 0,030), and between total thiol levels and disease activity parameters (BASDAI: p = 0,031; ASDAS-CRP: p = 0,020; ASDAS-ESR: p = 0,026) at 6th month evaluation.

DISCUSSION & CONCLUSIONS

Our results demonstrated oxidative stress reducing effect of biologics in axSpA patients parallel to suppression of disease activity at 6th month of the treatment.

Which Is the Best Option for AxSpA Patients After First TNFi Failure: Switch to Secukinumab or Cycling With Other TNFi?

OBJECTIVES

Evaluation of drug survival and predictive factors of alternative tumor necrosis factor inhibitor (TNFi) and secukinumab (SEC) use after TNFi therapy in patients with axial spondyloarthritis (axSpA).

METHODS

This was an observational retrospective study of axSpA patients who switched to second-line biological disease modifying antirheumatic drugs (bDMARD) between January 2018 and February 2023. Drug retention rate was evaluated using Kaplan-Meier analysis and log-rank test. Factors associated with drug survival of the second bDMARD were analyzed by multivariate regression analyses.

RESULTS

A total of 201 axSpA patients (alternative TNFi: 143 patients, SEC: 58 patients) with a mean age 37.1 ± 8.6 years and consist of 58.2% male were included. Clinical characteristics and laboratory results at switching were comparable between groups. During a median follow-up period of 22.3 months, 80 (39.8%) of 201 patients discontinued bDMARD. Median follow-up period, drug discontinuation frequency, and drug retention rate were similar between groups. C-reactive protein (CRP) level (Hazard ratio (HR) = 0.98, 95% confidence interval (CI) = 0.95-0.99, p = 0.032) and primary failure (HR = 1.52, 95% CI = 1.03-2.27, p = 0.037) were significantly associated with the risk of TNFi discontinuation. Smoking (HR = 1.96, 95% CI = 1.05-3.69, p = 0.036) and Achilles enthesitis (HR = 1.93, 95% CI = 1.09-3.40, p = 0.024) were significantly associated with the risk of SEC discontinuation.

CONCLUSION

In axSpA exposed to a TNFi, switching to a second TNFi has comparable effectiveness to switching to SEC. SEC may be a better option in patients who experienced primary failure of TNFi, whereas an alternative TNFi may be preferred in patients with higher CRP levels or Achilles enthesitis, or who are currently smoking.

Disease characteristics, co-morbidities and treatment response in a contemporary axial spondyloarthritis cohort: Analysis of 717 patients from the Greek AxSpA registry

BACKGROUND

Significant advances have recently reshaped the management of axial spondyloarthritis (AxSpA). Real-world data from contemporary cohorts are important to capture the current landscape in AxSpA.

METHODS

A prospective multicenter observational study of patients with AxSpA was undertaken supported by the Greek Rheumatology Society. Here we analyze disease characteristics, comorbidities and treatment patterns at baseline.

RESULTS

717 patients (64.9% males) with a mean age of 50 years and a median disease duration of 13 years were included. Two thirds of patients had r-AxSpA. The prevalence of peripheral arthritis ever (45%) equaled that of enthesitis, with hip involvement affecting 28% of patients. The leading comorbidities were increased BMI (60%), dyslipidemia (30%) hypertension (30%), depression (14%) and osteoporosis (10%). Most patients (78%) received a bDMARD, while 12% received no treatment at all. Inactive disease or low disease activity was attained by 65% of patients. ASDAS, BASDAI and BASFI were comparable between r-AxSpA and nr-AxSpA, but nr-AxSpA patients reported higher Global and Pain VAS scores. In multivariable analyses, predictors of high ASDAS were dactylitis ever, current smoking and the number of previous bDMARDs, while HLA B27 positivity and low alcohol intake were associated with a lower ASDAS. Male sex, HLA B27 positivity, high CRP at diagnosis, older age and longer diagnosis delay independently predicted the presence of syndesmophytes.

CONCLUSION

In this sizable contemporary AxSpA cohort, one third of patients still miss treatment targets. Additional to cardiovascular risk factors, depression and osteoporosis are considerably prevalent. Smoking predicts a higher ASDAS, while HLA B27 positivity predicts syndesmophyte formation, but also better ASDAS responses.

Whole-body Magnetic Resonance Imaging in Inflammatory Spine and Joint Disease

Whole-body magnetic resonance imaging (WB-MRI) can effectively diagnose rheumatologic diseases with systemic and multifocal characteristics, such as spondyloarthritis, chronic recurrent multifocal osteomyelitis, and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, among others. Advances in rheumatic disease treatments have emphasized the importance of early diagnosis for effective management, function preservation, and improved quality of life. WB-MRI offers comprehensive imaging of the musculoskeletal system, detecting early and subtle disease changes that traditional methods might overlook. Initially used for spondyloarthritis, the technique has recently expanded to other rheumatic diseases and is becoming the gold standard for diagnosing and monitoring chronic nonbacterial osteomyelitis in pediatric patients. This review article presents the current status of WB-MRI in rheumatologic conditions.

HLA-B5 prevalence in patients with spondyloarthritis and impact on disease phenotype: a multicentric case-control study

OBJECTIVE

The study aimed to estimate the prevalence of HLA-B51 and HLA-B52 in Lebanese patients with spondyloarthritis (SpA) compared with healthy controls (HC). We further aimed to evaluate the impact of HLA-B51 on phenotype and identify the distribution of the alleles in the HLA-B locus.

METHODS

A case-control study enrolled consecutive SpA patients from three rheumatology clinics in Lebanon, including axial (axSpA), peripheral SpA (pSpA), and psoriatic arthritis (PsA) and HCs from blood donors. Demographic and disease data were collected through interviews and file reviews, with testing of the entire HLA-B locus using molecular techniques. The prevalence of HLA-B51 and B52 was estimated in SpA patients vs controls. Prevalence comparisons were made, and logistic regression identified factors associated with HLA-B51 in patients.

RESULTS

Data from 120 HCs and 86 SpA patients (65 axSpA, 15 pSpA, 6 PsA), mean age 25.6 and 46.4 years, respectively, showed a higher HLA-B51 prevalence in SpA (25.6%), especially axSpA (29.2%) vs HC (12.5%) (P = 0.016), and a numerically higher HLA-B52 prevalence (8.1% vs 4.2%, P = 0.230). HLA-B51 correlated with recurrent oral ulcerations (OR 7.99; 95% CI: 2.14, 29.84) and radiographic juxta-articular erosions (OR 7.65; 95% CI: 1.14, 38.03). HLA-B35 was the most dominant allele in both groups (18.7%), followed by HLA-B27 (15.7%) and HLA-B51 (13.4%) in SpA.

CONCLUSION

HLA-B51 was identified more frequently in patients with SpA compared with HC and was associated with recurrent oral ulcerations and juxta-articular radiographic erosions. Longitudinal studies are needed to determine whether this association indicates a disease overlap or might correlate with a specific SpA phenotype.

The history of ankylosing spondylitis/axial spondyloarthritis - what is the driving force of new knowledge?

The history of (axial) spondyloarthritis has started several centuries ago. Since the end of the 19th century major achievements have been made. This historical review tries to show how closely the advances in clinical medicine in rheumatology have been related to advances made in basic sciences.