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Pascu LS, Sârbu N, Brădeanu AV, Jicman (Stan) D, Matei MN, Sârbu MI, Voinescu DC, Nechita A, Tatu AL. MRI Findings in Axial Psoriatic Spondylarthritis. Diagnostics (Basel) 2023; 13:diagnostics13071342. [PMID: 37046559 PMCID: PMC10093281 DOI: 10.3390/diagnostics13071342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
Psoriatic arthritis is a significant medical condition with a high prevalence, a wide variety of non-specific symptoms, and a high degree of overlap with other spondylarthritis disorders, particularly ankylosing spondylitis. Hence, knowledge of the magnetic resonance imaging (MRI) manifestations and a multidisciplinary strategy are required for the better management of these patients. We searched publications from the last 10 years and focused on the most relevant ones which discussed the classification criteria, the MRI characteristics of axial psoriatic arthritis, the importance of MRI for follow up, and the reliability of skin and synovial biopsy. Axial spondylarthritis can be diagnosed and followed up on using the well-established MRI technique and, additionally, a biopsy. The analysis and concordance between them can provide new directions for future studies.
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Affiliation(s)
| | - Nicolae Sârbu
- “Sf. Ioan” Clinical Emergency Children Hospital, 800487 Galati, Romania
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Andrei Vlad Brădeanu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
- “Sf. Andrei” Emergency County Clinical Hospital, 177 Brailei st, 800578 Galati, Romania
| | - Daniela Jicman (Stan)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Madalina Nicoleta Matei
- “Sf. Ioan” Clinical Emergency Children Hospital, 800487 Galati, Romania
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Mihaela Ionela Sârbu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Doina Carina Voinescu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
- “Sf. Andrei” Emergency County Clinical Hospital, 177 Brailei st, 800578 Galati, Romania
| | - Aurel Nechita
- “Sf. Ioan” Clinical Emergency Children Hospital, 800487 Galati, Romania
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Alin Laurențiu Tatu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
- Infectious Diseases Dermatology Department, “Sf. Parascheva” Infectious Diseases Clinical Hospital, 800179 Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR, 800008 Galati, Romania
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Ruytinx P, Vandormael P, Quaden D, Luyten E, Geusens P, Vanhoof J, Agten A, Vandenabeele F, de Vlam K, Somers V. Antibodies of the immunoglobulin a isotype to novel antigens in early axial spondyloarthritis. Front Med (Lausanne) 2023; 9:1072453. [PMID: 36844956 PMCID: PMC9945964 DOI: 10.3389/fmed.2022.1072453] [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: 10/17/2022] [Accepted: 12/29/2022] [Indexed: 02/11/2023] Open
Abstract
Introduction There is an unmet need for biomarkers to identify patients with axial spondyloarthritis (axSpA). Increasing evidence suggest the presence of autoantibodies in a subset of axSpA patients. The aim of this study was to identify novel IgA antibodies in early axSpA patients and to determine their diagnostic potential in combination with previously determined IgG antibodies against UH (Hasselt University)-axSpA-IgG antigens. Methods An axSpA cDNA phage display library constructed from axSpA hip synovium, was used to screen for novel IgA antibodies in plasma from early axSpA patients. The presence of these antibodies against novel UH-axSpA-IgA antigens was determined in two independent axSpA cohorts, in healthy controls and in patients with chronic low back pain. Results We identified antibodies to 7 novel UH-axSpA-IgA antigens, of which 6 correspond to non-physiological peptides and 1 to the human histone deacetylase 3 (HDAC3) protein. IgA antibodies against 2 of these 7 novel UH-axSpA-IgA antigens and IgG antibodies against 2 of the previously identified antigens were significantly more present in early axSpA patients from the UH cohort (18/70, 25.7%) and the (Bio)SPAR cohort (26/164, 15.9%), compared to controls with chronic low back pain (2/66, 3%). Antibodies to this panel of 4 antigens were present in 21.1% (30/142) of patients with early axSpA from the UH and (Bio)SPAR cohorts. The positive likelihood ratio for confirming early axSpA using antibodies to these 4 UH-axSpA antigens was 7.0. So far, no clinical correlation between the novel identified IgA antibodies and inflammatory bowel disease could be identified. Discussion In conclusion, screening an axSpA cDNA phage display library for IgA reactivity resulted in the identification of 7 novel UH-axSpA-IgA antigens, of which 2 show promising biomarker potential for the diagnosis of a subset of axSpA patients, in combination with previously identified UH-axSpA-IgG antigens.
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Affiliation(s)
- Pieter Ruytinx
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium
| | - Patrick Vandormael
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium
| | - Dana Quaden
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium
| | - Elien Luyten
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium
| | - Piet Geusens
- ReumaClinic, Genk, Belgium,Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Anouk Agten
- UHasselt, Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, Diepenbeek, Belgium
| | - Frank Vandenabeele
- UHasselt, Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, Diepenbeek, Belgium
| | - Kurt de Vlam
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium,Department of Development and Regeneration, Skeletal Biology and Engineering Research Center (SBE), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Veerle Somers
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium,*Correspondence: Veerle Somers,
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Mazzucchelli R, Almodóvar R, Turrado-Crespí P, Crespí-Villarías N, Pérez-Fernández E, García-Zamora E, García-Vadillo A. Trends in orthopaedic surgery for spondyloarthritis: outcomes from a National Hospitalised Patient Registry (MBDS) over a 17-year period (1999-2015).TREND-EspA study. RMD Open 2022; 8:rmdopen-2021-002107. [PMID: 35296531 PMCID: PMC8928380 DOI: 10.1136/rmdopen-2021-002107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To assess the incidence of orthopaedic surgery (OS) (including total hip arthroplasty (THA), total knee arthroplasty, upper limb arthroplasty, arthrodesis and spinal surgery) and associated trends in patients with spondyloarthritis (SpA) over a long period (17 years). Methods An observational, retrospective, population-based, serial cross-sectional study was conducted. All hospital admissions of patients with SpA reported between 1999 and 2015 were analysed, and a control group was selected and matched by age, sex and year of admission. Incidence rates for OS (and subtypes) were calculated. Generalised linear models were used to analyse trends; unconditional logistic regression models were used to calculate crude and adjusted ORs (aORs) with the aim of evaluating the association between OS and SpA. Results The study database contained data on 214 280 hospital admissions (SpA/non-SpA 1:1 ratio). In the SpA cohort, 5 382 admissions (5.02%) had undergone OS compared with 3 533 in the non-SpA cohort (3.29%) (AOR 1.64; 95% CI 1.57 to 1.72). OS rates increased for both cohorts (+4.92% per year vs +8.41%). The trend in OS, THA, arthrodesis and spinal surgery decreased or stabilised in patients under age 60 in the SpA cohort, while the non-SpA cohort remained stable. In the SpA cohort, the mean age was 53.68 years (SD 13.65) in 1999, increasing to 62.76 years (SD 12.74) in 2015. In the non-SpA cohort, the mean age remained stable at around 63 years. Conclusions A 9-year difference in the age of patients undergoing OS was observed in patients with SpA. The incidence of OS, THA and arthrodesis decreased in patients under age 60, and the incidence of spinal surgery decreased in patients under age 40. Our findings suggest that these patients are increasingly able to defer surgical interventions.
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Affiliation(s)
- Ramón Mazzucchelli
- Rheumatology Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain .,Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Raquel Almodóvar
- Rheumatology Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.,Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | | | | | - Elia Pérez-Fernández
- Department of Clinical Research, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Elena García-Zamora
- Dermatology Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Tanenbaum ZG, Leider JD, Ehlers CB, Apseloff NA, Ryan JA, Kessler MW. Rare presentation of bilateral thumb psoriatic arthritis treated with arthrodesis: a case report. AME Case Rep 2021; 5:18. [PMID: 33912807 DOI: 10.21037/acr-20-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/26/2020] [Indexed: 11/06/2022]
Abstract
Psoriatic arthritis (PsA) is a seronegative inflammatory arthritis that occurs concomitantly with cutaneous manifestations and tendinous pathology that affects up to 1% of the general population. While the majority of cases are mild, nearly 20% of PsA patients will progress to severe disease manifesting as debilitating polyarticular inflammation and joint destruction. PsA is most commonly asymmetric and bilateral severe disease involving the same joints in each hand has rarely been reported in the literature. It is estimated that PsA only presents bilaterally in a quarter of patients. The recent increase in popularity and efficacy of disease-modifying anti-rheumatic drugs (DMARDs) has led to increasing rarity of such severe disease progression. We present a case of a 47-year-old male with PsA who had a unique pattern of bilateral first metacarpophalangeal (MP) and interphalangeal (IP) involvement with minimal erosion leading to significant joint pain, instability, dislocation, and loss of function. After failure of conservative treatment that included both DMARDs and non-steroidal anti-inflammatory drugs (NSAIDs), the patient opted for surgical management. The purpose of this report is to identify a rare presentation of PsA and consider the significance of MP joint arthrodesis as a viable treatment to restore functional status and improve quality of life.
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Affiliation(s)
- Zachary G Tanenbaum
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Joseph D Leider
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Cooper B Ehlers
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Nicholas A Apseloff
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - James A Ryan
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Michael W Kessler
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
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Quaden D, Vandormael P, Ruytinx P, Geusens P, Corten K, Vanhoof J, Liesenborgs J, van Reeth F, Agten A, Vandenabeele F, de Vlam K, Somers V. Antibodies Against Three Novel Peptides in Early Axial Spondyloarthritis Patients From Two Independent Cohorts. Arthritis Rheumatol 2020; 72:2094-2105. [PMID: 32638516 DOI: 10.1002/art.41427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was undertaken to identify novel autoantibodies in axial spondyloarthritis (SpA) and determine their diagnostic potential in patients with early axial SpA and controls from 2 independent cohorts. METHODS An axial SpA complementary DNA phage display library was used to screen for novel IgG antibodies in plasma from patients with early axial SpA. The presence of these antibodies against novel peptides (i.e., peptides identified in an early axial SpA cohort from Hasselt University, designated UH-axSpA) was determined by enzyme-linked immunosorbent assay in 76 patients with early axial SpA, 75 controls with nonspecific chronic low back pain, 60 patients with rheumatoid arthritis, and 94 healthy controls from the UH cohort. Antibody reactivity to these novel peptides was further validated in 174 patients with axial SpA (of whom 79 had early axial SpA) from the University Hospitals Leuven (Bio)SPAR (Spondyloarthritis [Biologics]) cohort. RESULTS We identified antibodies to 9 novel UH-axSpA peptides, corresponding to randomly formed peptides and to a novel axial SpA autoantigen, double homeobox protein 4. Antibodies to 3 UH-axSpA peptides with the highest positive likelihood ratio (LR) for a diagnosis of axial SpA were present in significantly more patients with early axial SpA from the UH and (Bio)SPAR cohorts (14.2% [22/155]) compared to controls with chronic low back pain (5% [4/75]), resulting in 95% specificity. The positive LR for confirming axial SpA using antibodies to these 3 UH-axSpA peptides was 2.7, which is higher than the LR obtained with the currently used laboratory marker C-reactive protein. Testing for antibodies to these 3 UH-axSpA peptides in patients with chronic low back pain increased the posttest probability of a diagnosis of axial SpA from 79% to 91%. CONCLUSION Antibodies to 3 UH-axSpA peptides could provide a novel tool in the diagnosis of a subset of axial SpA patients.
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Affiliation(s)
| | | | | | - Piet Geusens
- UH, Hasselt, Belgium and ReumaClinic, Genk, Belgium, and Maastricht University Medical Center, Maastricht, The Netherlands
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Guldberg-Møller J, Cordtz RL, Kristensen LE, Dreyer L. Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark. Ann Rheum Dis 2019; 78:1517-1523. [PMID: 31300461 DOI: 10.1136/annrheumdis-2019-215313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/26/2019] [Accepted: 06/29/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate time-trends and cumulative incidence of joint surgery among patients with psoriatic arthritis (PsA) compared with the general population. METHODS In this nationwide register-based cohort study, The Danish National Patient Registry was used to identify incident PsA patients. The 5-year incidence rates (IR) and incidence rate ratios (IRR) of joint surgery were calculated in four calendar-period defined cohorts. Each patient was matched with ten non-PsA individuals from the general population cohort (GPC). The cumulative incidences of any joint and joint-sacrificing surgery, respectively, were estimated using the Aalen-Johansen method. RESULTS From 1996 to 2017, 11 960 PsA patients (mean age 50 years; 57% female) were registered. The IRR of any joint surgery was twice as high for PsA patients compared with GPCs across all calendar periods. Among patients with PsA, 2, 10 and 29% required joint surgery at 5, 10 and 15 years after diagnosis. The risk of surgery in PsA patients diagnosed at 18-40 years was higher (22%) than in GPC 60+ year old (20%) after 15 years of follow-up. CONCLUSIONS The use of joint surgery among PsA patients remained around twofold higher from 1996 to 2012 compared with GPC. After 15 years of follow-up, nearly 30% of the PsA patients had received any surgery, and even a person diagnosed with PsA at the age of 18-40 years had a higher risk of surgery than GPCs of 60+ year old. Thus, the high surgical rates represent an unmet need in the current treatment of PsA.
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Affiliation(s)
- Jørgen Guldberg-Møller
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, The Parker Institute, Frederiksberg, Denmark .,Department of Rheumatology, Slagelse Sygehus, Slagelse, Denmark
| | - Rene Lindholm Cordtz
- Center for Rheumatology and Spine Diseases - Gentofte, Rigshospitalet, Hellerup, Denmark
| | | | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Krakowski P, Gerkowicz A, Pietrzak A, Krasowska D, Jurkiewicz A, Gorzelak M, Schwartz RA. Psoriatic arthritis - new perspectives. Arch Med Sci 2019; 15:580-589. [PMID: 31110522 PMCID: PMC6524178 DOI: 10.5114/aoms.2018.77725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/18/2018] [Indexed: 01/04/2023] Open
Abstract
Psoriatic arthritis (PsA) is a seronegative arthropathy with many clinical manifestations, and it may affect nearly a half of patients with psoriasis. PsA should be diagnosed as early as possible to slow down joint damage and progression of disability. To improve the diagnosis of PsA, physicians should look for peripheral inflammatory pain, axial inflammatory pain, dactylitis, and buttock and sciatic pain. In most patients with PsA, pharmacologic treatment with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and biologic agents is effective. However, when pharmacological treatment fails, patients with PsA may benefit from orthopedic surgery, which can improve both joint function and quality of life. Total hip arthroplasty, total knee arthroplasty, and arthroscopic synovectomy of the knee are the most common surgical procedures offered to patients with PsA. The management of PsA requires the care of a multidisciplinary team, which should include dermatologists, rheumatologists, physiotherapists, and orthopedic surgeons.
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Affiliation(s)
| | - Agnieszka Gerkowicz
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Aldona Pietrzak
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Dorota Krasowska
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Andrzej Jurkiewicz
- Orthopaedic Department, Independent Public District Hospital, Łęczna, Poland
| | - Mieczysław Gorzelak
- Chair and Department of Rehabilitation and Orthopedics, Medical University of Lublin, Lublin, Poland
| | - Robert A. Schwartz
- Dermatology Rutgers New Jersey Medical School Rutgers, The State University of New Jersey, USA
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Nystad TW, Husum YS, Furnes ON, Fevang BTS. Incidence and Predictive Factors for Orthopedic Surgery in Patients with Psoriatic Arthritis. J Rheumatol 2018; 45:1532-1540. [DOI: 10.3899/jrheum.180203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the incidence of orthopedic procedures in patients with psoriatic arthritis (PsA), and how patient characteristics, time of diagnosis, and treatment affect the need for surgery.Methods.We reviewed the medical history of 1432 patients with possible PsA at Haukeland University Hospital in Bergen, Norway. There were 590 patients (mean age 49 yrs, 52% women) who had sufficient journal information and a confirmed diagnosis of PsA, and who were included in the present study. Relevant orthopedic procedures were obtained from the hospital’s administrative patient records. Survival analyses were completed to evaluate the effect of different factors such as year of diagnosis, age, sex, radiographic changes, disease activity, and treatment, on the risk of surgery.Results.There were 171 procedures (25% synovectomies, 15% arthrodesis, and 53% prostheses) performed on 117 patients. These factors all increased the risk of surgery: female sex [relative risk (RR) 1.9, p = 0.001], age ≥ 70 years at diagnosis (RR 2.4, p = 0.001), arthritis in initial radiographs (RR 2.2, p = 0.006), and maximum erythrocyte sedimentation rate 30–59 mm/h (RR 1.6, p = 0.026). Time period of diagnosis had no effect on the outcome. In a subanalysis of surgery exclusive of hip and knee arthroplasty, diagnosis in earlier years (1954–1985 vs 1999–2011) was a risk factor (RR 2.1, p = 0.042). Antirheumatic treatment changed significantly over time.Conclusion.There were 20% of patients with PsA who needed surgery. We found that the prognosis of patients with PsA did not change regarding the risk of orthopedic surgery, despite the change in treatment. A possible explanation is the increase in large joint replacements in the general population.
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