1
|
Proft F, Duran TI, Ghoreschi K, Pleyer U, Siegmund B, Poddubnyy D. Treatment strategies for Spondyloarthritis: Implementation of precision medicine - Or "one size fits all" concept? Autoimmun Rev 2024; 23:103638. [PMID: 39276959 DOI: 10.1016/j.autrev.2024.103638] [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: 07/02/2024] [Revised: 09/05/2024] [Accepted: 09/07/2024] [Indexed: 09/17/2024]
Abstract
Spondyloarthritis (SpA) is a term to describe a group of chronic inflammatory rheumatic diseases, which have common pathophysiological, genetic, and clinical features. Under the umbrella term SpA, two main groups are subsumed: axial SpA (radiographic axSpA and non-radiographic axSpA) and peripheral SpA (with the leading representative being psoriatic arthritis (PsA) but also arthritis associated with inflammatory bowel disease (IBD), reactive arthritis, and undifferentiated pSpA). The key clinical symptom in axSpA is chronic back pain, typically with inflammatory characteristics, which starts in early adulthood, while the leading clinical manifestations of peripheral SpA (pSpA) are arthritis, enthesitis, and/or dactylitis. Furthermore, extra-musculoskeletal manifestations (EMMs) (acute anterior uveitis, psoriasis, and IBD) can accompany axial or peripheral symptoms. All these factors need to be taken into account when making treatment decisions in SpA patients. Despite the major advances in the treatment landscape over the past two decades with the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and most recently targeted synthetic DMARDs (tsDMARDs), a relevant proportion of patients still does not achieve the desired state of remission (=absence of disease activity). With this implementation of new treatment modalities, clinicians now have more choices to make in the treatment algorithms. However, despite generalized treatment recommendations, all factors need to be carefully considered when deciding on the optimal treatment strategy for an individual patient in clinical practice, aiming at an important first step towards personalized treatment strategies in SpA. In this narrative review, we focus on the efficacy of approved and emerging treatment options in axSpA and PsA as the main representative of pSpA and discuss their selective effect on the different manifestations associated with SpA to provide guidance on drivers of treatment decisions in specific situations.
Collapse
Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Tugba Izci Duran
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Clinic of Rheumatology, Denizli State Hospital, Denizli, Turkey
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Berlin, Germany and (5)Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Britta Siegmund
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Epidemiology unit, German Rheumatism Research Centre, Berlin, Germany; Division of Rheumatology, Department of Medicine, University Health Network and University of Toronto, Toronto, Canada
| |
Collapse
|
2
|
Shridharmurthy D, Lapane KL, Baek J, Nunes AP, Weisman MH, Kay J, Liu SH. Sex Differences in Time to Initiate Nonsteroidal Anti-Inflammatory Drugs or Biologic Disease-Modifying Antirheumatic Drugs Among Patients With Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2024; 76:1149-1161. [PMID: 38538532 DOI: 10.1002/acr.25332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE We evaluated sex differences in time to initiation of receiving nonsteroidal anti-inflammatory drugs (NSAIDs) or biologic disease-modifying antirheumatic drugs (bDMARDs) among patients with axial spondyloarthritis (axSpA). METHODS Using the 2013 to 2018 IBM MarketScan Database, we identified 174,632 patients with axSpA aged ≥18 years. We evaluated the time between axSpA diagnosis and the first prescription NSAID dispensing (among those with no baseline NSAIDs reception) or bDMARDs infusion/procedure claim (among those who were dispensed two or more different prescription NSAIDs in the baseline period). Adjusted hazard ratios (aHRs) for time to initiation of patients receiving NSAIDs or bDMARDs were computed using survival analyses. Cox proportional hazard models estimated associations between sex and predictors of treatment initiation. RESULTS Average age at diagnosis was 48.2 years, 65.7% were female, and 37.8% were dispensed one or more NSAIDs before axSpA diagnosis. Of those who did not receive two or more different prescription NSAIDs before diagnosis, NSAID reception was initiated earlier in female patients than in male patients (NSAID reception initiators: female patients (32.9%), male patients (29.3%); aHR 1.14, 95% confidence interval [CI] 1.11-1.16). Among those who received two or more different prescription NSAIDs in the baseline period, 4.2% received a bDMARD, whereas 77.9% continued receiving NSAIDs after diagnosis. Time to bDMARD reception initiation was longer for female patients than for male patients (aHR 0.61, 95% CI 0.52-0.72), but bDMARDs were received sooner among those who received NSAIDs in the baseline period. CONCLUSION Prescription NSAID reception was more common than initiation of receiving bDMARDs among patients newly diagnosed with axSpA. Female patients appeared more likely to continue receiving NSAIDs after diagnosis, and the time to initiation of receiving bDMARDs was longer for female patients than for male patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Jonathan Kay
- UMass Chan Medical School and UMass Memorial Medical Center, Worcester
| | | |
Collapse
|
3
|
Chmielińska M, Olesińska M, Felis-Giemza A, Paradowska-Gorycka A, Palej K, Rejmer-Szcześniak J, Szukiewicz D. Predictors of treatment failure of non-steroidal anti-inflammatory drugs in patients with axial spondyloarthritis with focus on haptoglobin, haptoglobin polymorphism and zonulin. Rheumatol Int 2024; 44:483-495. [PMID: 37847388 DOI: 10.1007/s00296-023-05484-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
According to the Assessment of SpondyloArthritis International Society-European Alliance of Associations for Rheumatology (ASAS-EULAR) recommendations for the management of axial spondyloarthritis (axSpA), patients should undergo at least two courses of non-steroidal anti-inflammatory drugs (NSAIDs) therapy. In our study, we enrolled axSpA patients both at onset and in a flare who had already been treated with NSAIDs ineffectively. Subsequently, according to the recommendations, they received modified NSAID treatment as another attempt to the first-line drug therapy and were monitored from there. We aimed to identify risk factors for treatment failure after 4 weeks (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥ 4) especially amongst zonulin and haptoglobin concentrations, and haptoglobin polymorphism. Treatment failure was observed in 71% of patients, and the following variables were contributed for occurrence of this state: higher zonulin levels, ankylosing spondylitis, X-ray sacroiliitis, magnetic resonance imaging sacroiliitis, long duration of symptoms, high BASDAI, and high value of spinal pain intensity on visual analogue scale. In addition, the following positive correlations were found: haptoglobin concentration with C-reactive protein (r = 0.56; p = 0.0004), and erythrocyte sedimentation rate (r = 0.62; p < 0.0001), as well as between zonulin levels and white blood count (r = 0.5; p = 0.0003). The results of the study presented the identified factors related to the standard treatment failure in axSpA, amongst them zonulin levels. They might be applied to point out the patients for whom the search for a more appropriate method of treatment should be considered.
Collapse
Affiliation(s)
- Magdalena Chmielińska
- Department of Biophysics, Physiology and Pathophysiology, Faculty of Health Sciences, Medical University of Warsaw, 02-004, Warsaw, Poland.
- Department of Outpatient Clinics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland.
| | - Marzena Olesińska
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Anna Felis-Giemza
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Agnieszka Paradowska-Gorycka
- Department of Molecular Biology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Karolina Palej
- Department of Outpatient Clinics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Julita Rejmer-Szcześniak
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Dariusz Szukiewicz
- Department of Biophysics, Physiology and Pathophysiology, Faculty of Health Sciences, Medical University of Warsaw, 02-004, Warsaw, Poland
| |
Collapse
|
4
|
Hansmaennel A, Fakih O, Gerazime A, Prati C, Chouk M, Wendling D, Verhoeven F. Effects of disease-modifying anti-rheumatic drugs on sacroiliac MRI score in axial spondyloarthritis: a systematic review and meta-analysis. Clin Rheumatol 2024; 43:1045-1052. [PMID: 38158505 DOI: 10.1007/s10067-023-06849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Sacroiliac bone marrow edema is an important factor in the diagnosis and management of axial spondyloarthritis (axSpA). The aim of this meta-analysis is to assess the effect of the different bDMARDs and tsDMARDs on the SPARCC score at 12-16 and 48-52 weeks. METHODS A systematic review, performed on PubMed (including Medline), Cochrane (CENTRAL) and DOAJ databases, included randomized controlled studies evaluating the sacroiliac joint (SIJ) SPARCC score at 12-16 or 48-52 weeks in patients with axSpA meeting the ASAS 2009 criteria or the modified New York criteria. We included studies evaluating the effects of the different treatments on the SPARCC score of SIJ in axial spondyloarthritis in comparison to a control group. RESULTS Eighteen studies were included in the meta-analysis. Nine studies evaluated the effect of TNFα inhibitors (TNFi), three for IL-17 inhibitors, and four for JAK inhibitors. At 12 and 16 weeks, SIJ SPARCC score was significantly improved by TNFi (WMD: - 3.29 [95% CI - 4.25; - 2, 34]), by IL-17 inhibitors (WMD: - 4.66 [95% CI - 6.22; - 3.09]), and by JAK inhibitors (JAKi) (WMD: - 3.06 [95% CI - 3.24; - 2.89]). There was no difference between the molecule subgroups. At 48-52 weeks, TNFα inhibitors reduced more SIJ SPARCC, but not significantly (WMD: - 2.26 [95% CI - 4.94; 0.42]), than placebo groups who began a TNFi treatment with delay. CONCLUSION Our meta-analysis shows a comparable improvement of the SIJ SPARCC score regarding TNFi, JAKi, and IL-17 inhibitors at three months and suggests the presence of an opportunity window. Key Points • Anti-TNF Ab, anti-IL17 Ab, and JAK inhibitor treatments reduce the sacroiliac joint SPARCC scores. • There is no difference between the different treatments in the reduction of the sacroiliac joint SPARCC score after 3 months in axial spondyloarthritis.
Collapse
Affiliation(s)
| | - Olivier Fakih
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Aurélie Gerazime
- Unité de méthodologie clinique, CHU de Besançon, Besançon, France
| | - Clément Prati
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4267 "PEPITE", Université de Bourgogne Franche Comté, Besançon, France
| | - Mickaël Chouk
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Daniel Wendling
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4266 "EPILAB", Université de Bourgogne Franche-Comté, Besançon, France
| | - Frank Verhoeven
- Service de Rhumatologie, CHU de Besançon, Besançon, France.
- EA 4267 "PEPITE", Université de Bourgogne Franche Comté, Besançon, France.
| |
Collapse
|
5
|
Tan TC, Roslan NEB, Li JW, Zou X, Chen X, Santosa A. Patient Acceptability of Symptom Screening and Patient Education Using a Chatbot for Autoimmune Inflammatory Diseases: Survey Study. JMIR Form Res 2023; 7:e49239. [PMID: 37219234 PMCID: PMC11019963 DOI: 10.2196/49239] [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: 05/23/2023] [Revised: 08/27/2023] [Accepted: 11/05/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Chatbots have the potential to enhance health care interaction, satisfaction, and service delivery. However, data regarding their acceptance across diverse patient populations are limited. In-depth studies on the reception of chatbots by patients with chronic autoimmune inflammatory diseases are lacking, although such studies are vital for facilitating the effective integration of chatbots in rheumatology care. OBJECTIVE We aim to assess patient perceptions and acceptance of a chatbot designed for autoimmune inflammatory rheumatic diseases (AIIRDs). METHODS We administered a comprehensive survey in an outpatient setting at a top-tier rheumatology referral center. The target cohort included patients who interacted with a chatbot explicitly tailored to facilitate diagnosis and obtain information on AIIRDs. Following the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the survey was designed to gauge the effectiveness, user acceptability, and implementation of the chatbot. RESULTS Between June and October 2022, we received survey responses from 200 patients, with an equal number of 100 initial consultations and 100 follow-up (FU) visits. The mean scores on a 5-point acceptability scale ranged from 4.01 (SD 0.63) to 4.41 (SD 0.54), indicating consistently high ratings across the different aspects of chatbot performance. Multivariate regression analysis indicated that having a FU visit was significantly associated with a greater willingness to reuse the chatbot for symptom determination (P=.01). Further, patients' comfort with chatbot diagnosis increased significantly after meeting physicians (P<.001). We observed no significant differences in chatbot acceptance according to sex, education level, or diagnosis category. CONCLUSIONS This study underscores that chatbots tailored to AIIRDs have a favorable reception. The inclination of FU patients to engage with the chatbot signifies the possible influence of past clinical encounters and physician affirmation on its use. Although further exploration is required to refine their integration, the prevalent positive perceptions suggest that chatbots have the potential to strengthen the bridge between patients and health care providers, thus enhancing the delivery of rheumatology care to various cohorts.
Collapse
Affiliation(s)
- Tze Chin Tan
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
| | - Nur Emillia Binte Roslan
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
| | - James Weiquan Li
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Xinying Zou
- Internal Medicine Clinic, Changi General Hospital, Singapore, Singapore
| | - Xiangmei Chen
- Internal Medicine Clinic, Changi General Hospital, Singapore, Singapore
| | - Anindita Santosa
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
- Division of Rheumatology and Immunology, Department of Medicine, Changi General Hospital, Singapore, Singapore
| |
Collapse
|
6
|
Ciurea A, Götschi A, Bräm R, Bürki K, Exer P, Andor M, Nissen MJ, Möller B, Hügle T, Rubbert-Roth A, Kyburz D, Distler O, Scherer A, Micheroli R. Early axial spondyloarthritis according to the ASAS consensus definition: characterisation of patients and effectiveness of a first TNF inhibitor in a large observational registry. RMD Open 2023; 9:e003455. [PMID: 38053462 DOI: 10.1136/rmdopen-2023-003455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To characterise the population fulfilling the Assessment of SpondyloArthritis international Society (ASAS) consensus definition of early axial spondyloarthritis (axSpA) and to determine the effectiveness of a first tumour necrosis factor inhibitor (TNFi) in early versus established axSpA in a large observational registry. METHODS A total of 3064 patients with axSpA in the Swiss Clinical Quality Management registry with data on duration of axial symptoms were included (≤2 years=early axSpA, N=658; >2 years=established axSpA, N=2406). Drug retention was analysed in patients starting a first TNFi in early axSpA (N=250) versus established axSpA (N=874) with multiple-adjusted Cox proportional hazards models. Adjusted logistic regression analyses were used to determine the achievement of the ASAS criteria for 40% improvement (ASAS40) at 1 year. RESULTS Sex distribution, disease activity, impairments of function and health-related quality of life were comparable between patients with early and established axSpA. Patients with established disease were older, had more prevalent axial radiographical damage and had a higher impairment of mobility. A comparable TNFi retention was found in early versus established disease after adjustment for age, sex, human leucocyte antigen-B27 status, education, body mass index, smoking, elevated C reactive protein and sacroiliac inflammation on MRI (HR 1.05, 95% CI 0.78 to 1.42). The adjusted ASAS40 response was similar in the two groups (OR 1.09, 95% CI 0.67 to 1.78). Results were confirmed in the population fulfilling the ASAS classification criteria. CONCLUSION Considering the recent ASAS definition of early axSpA, TNFi effectiveness seems comparable in early versus established disease.
Collapse
Affiliation(s)
- Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrea Götschi
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - René Bräm
- Swiss Ankylosing Spondylitis Association, Zurich, Switzerland
| | - Kristina Bürki
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Pascale Exer
- Gemeinschaftspraxis Rheuma-Basel, Basel, Switzerland
| | - Michael Andor
- Rheumatologie im Zürcher Oberland, Uster, Switzerland
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Burkhard Möller
- Department of Rheumatology and Immunology, Inselspital, Bern, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, University of Lausanne, Lausanne, Switzerland
| | - Andrea Rubbert-Roth
- Department of Rheumatology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Oliver Distler
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Almut Scherer
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
7
|
Benavent D, Capelusnik D, Ramiro S, Navarro-Compán V. Looking through the window of opportunity in axial spondyloarthritis? Joint Bone Spine 2023; 90:105603. [PMID: 37355203 DOI: 10.1016/j.jbspin.2023.105603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that affects the spine and sacroiliac joints, that can lead to irreversible structural damage. Early detection and timely intervention are crucial for preventing long-term structural damage, improving quality of life, and reducing the burden of the disease. The concept of a window of opportunity suggests that an early intervention in the reversible stage of the disease can lead to improved long-term outcomes. However, it is unclear whether this concept applies in axSpA. Recent advances in axSpA management, including the use of diagnostic techniques such as magnetic resonance imaging as well as the use of advanced therapies, have shown promise in improving outcomes. However, studies investigating the potential window of opportunity in axSpA by assessing the impact of an early treatment on clinical outcomes have yielded inconclusive results. One of the reasons behind this is the lack of a standardized definition of early axSpA. The Assessment of Spondyloarthritis International Society (ASAS)-SPEAR (SPondyloarthritis EARly) project has set the ground for it by working on a consensus definition of early axSpA. Randomized controlled trials specifically focused on the comparison between treating axSpA in the early and late stages of the disease and using the standardised definition of early axSpA are essential to understand better the potential benefits of an early treatment on clinical outcomes. Additionally, it would be relevant to assess the long-term outcomes of early axSpA treatment, especially regarding structural damage, to better grasp the concept of the window of opportunity in axSpA.
Collapse
Affiliation(s)
- Diego Benavent
- Department of Rheumatology, La Paz University Hospital, IdiPaz, Madrid, Spain
| | - Dafne Capelusnik
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | |
Collapse
|
8
|
Baraliakos X, Kiltz U, Kononenko I, Ciurea A. Treatment overview of axial spondyloarthritis in 2023. Best Pract Res Clin Rheumatol 2023; 37:101858. [PMID: 37673758 DOI: 10.1016/j.berh.2023.101858] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023]
Abstract
The treatment of patients with axial spondyloarthritis (axSpA) is characterized by non-pharmacological and pharmacological treatment options. It may depend on the type and extent of musculoskeletal and extramusculoskeletal manifestations. Recent data on non-pharmacological treatment options, such as physical activity, physiotherapy, and modification of lifestyle factors, are summarized in this review. Moreover, we have provided an overview on non-steroidal anti-inflammatory drugs and the ever-expanding number of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs, respectively). In addition to data on efficacy and safety, the review also encompasses data on switching/cycling, tapering, and treatment selection for specific patient subgroups to optimize treatment outcomes.
Collapse
Affiliation(s)
- X Baraliakos
- Ruhr Universität Bochum, and Rheumazentrum Ruhrgebiet, Herne, Germany.
| | - U Kiltz
- Ruhr Universität Bochum, and Rheumazentrum Ruhrgebiet, Herne, Germany.
| | - I Kononenko
- Ruhr Universität Bochum, and Rheumazentrum Ruhrgebiet, Herne, Germany.
| | - A Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
| |
Collapse
|
9
|
Ensslin C, Micheroli R, Kissling S, Götschi A, Bürki K, Bräm R, de Hooge M, Baraliakos X, Nissen MJ, Möller B, Exer P, Andor M, Distler O, Scherer A, Ciurea A. Impact of sex on spinal radiographic progression in axial spondyloarthritis: a longitudinal Swiss cohort analysis over a period of 10 years. RMD Open 2023; 9:e003340. [PMID: 37507208 PMCID: PMC10387740 DOI: 10.1136/rmdopen-2023-003340] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE To investigate sex differences in spinal radiographic progression in axial spondyloarthritis (axSpA). METHODS AxSpA patients in the Swiss Clinical Quality Management cohort with available spinal radiographs every 2 years were included. Paired radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Progression was defined as an increase of ≥2 mSASSS units in 2 years. The relationship between sex and progression was investigated with binomial generalised estimating equation models, considering baseline spinal damage as an intermediate covariate. Additional analyses included adjustments for explanatory variables and multiple imputations for missingness. RESULTS In a total of 505 axSpA patients (317 men and 188 women), mean±SD radiographic progression over 2 years was 1.0±2.8 years in men and 0.3±1.1 years in women (p<0.001). Male sex was associated with enhanced progression in a small model not including baseline damage (OR 3.41, 95% CI 1.87 to 6.21). Both a direct effect of male sex on spinal progression, and an indirect effect, via enhancement of baseline spinal damage were significant (OR 2.06, 95% CI 1.15 to 3.67 and OR 1.04, 95% CI 1.01 to 1.07, respectively). A significant impact of male sex on spinal radiographic progression was still demonstrated after multiple adjustments for covariates known to potentially affect spinal radiographic progression (OR 1.97, 95% CI 1.04 to 3.71). CONCLUSIONS Spinal radiographic progression in axSpA is more severe in men than in women, with three times higher odds of progression in male patients and an effect that is mediated in part through an increase in baseline radiographic damage.
Collapse
Affiliation(s)
- Caroline Ensslin
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Seraphina Kissling
- Statistics Group, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland
| | - Andrea Götschi
- Statistics Group, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland
| | - Kristina Bürki
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - René Bräm
- Swiss Ankylosing Spondylitis Association, Zurich, Switzerland
| | - Manouk de Hooge
- Department of Rheumatology, University Hospital Gent, Gent, Belgium
| | | | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospitals, Geneve, Switzerland
| | - Burkhard Möller
- Department of Rheumatology and Immunology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | | | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Almut Scherer
- Statistics Group, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
10
|
Fernández-Carballido C, Sanchez-Piedra C, Valls R, Garg K, Sánchez-Alonso F, Artigas L, Mas JM, Jovaní V, Manrique S, Campos C, Freire M, Martínez-González O, Castrejón I, Perella C, Coma M, van der Horst-Bruinsma IE. Female Sex, Age, and Unfavorable Response to Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis: Results of Statistical and Artificial Intelligence-Based Data Analyses of a National Multicenter Prospective Registry. Arthritis Care Res (Hoboken) 2023; 75:115-124. [PMID: 36278846 DOI: 10.1002/acr.25048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Real-world studies are needed to identify factors associated with response to biologic therapies in patients with axial spondyloarthritis (SpA). The objective was to assess sex differences in response to tumor necrosis factor inhibitors (TNFi) and to explore possible risk factors associated with TNFi efficacy. METHODS A total of 969 patients with axial SpA (315 females, 654 males) enrolled in the BIOBADASER registry (2000-2019) who initiated a TNFi (first, second, or further lines) were studied. Statistical and artificial intelligence (AI)-based data analyses were used to explore the association of sex differences and other factors to TNFi response, using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), to calculate the BASDAI50, with an improvement of at least 50% of the BASDAI score, and using the Ankylosing Spondylitis Disease Activity Score, calculated using the C-reactive protein level (ASDAS-CRP). RESULTS Females had a lower probability of reaching a BASDAI50 response with a first line TNFi treatment at the second year of follow-up (P = 0.018) and a lesser reduction of the ASDAS-CRP at this time point. The logistic regression model showed lower BASDAI50 responses to TNFi in females (P = 0.05). Other factors, such as older age (P = 0.004), were associated with unfavorable responses. The AI data analyses reinforced the idea that age at the beginning of the treatment was the main factor associated with an unfavorable response. The combination of age with other clinical characteristics (female sex or cardiovascular risk factors and events) potentially contributed to an unfavorable response to TNFi. CONCLUSION In this national multicenter registry, female sex was associated with less response to a first-line TNFi by the second year of follow-up. A higher age at the start of the TNFi was the main factor associated with an unfavorable response to TNFi.
Collapse
Affiliation(s)
| | - Carlos Sanchez-Piedra
- Health Technology Assessment Agency of Carlos III Institute of Health, Madrid, Spain
| | | | | | | | | | | | - Vega Jovaní
- Hospital General Universitario Dr. Balmis, Alicante, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Capelusnik D, Benavent D, van der Heijde D, Landewé R, Poddubnyy D, van Tubergen A, Falzon L, Navarro-Compán V, Ramiro S. Treating spondyloarthritis early: does it matter? Results from a systematic literature review. Rheumatology (Oxford) 2022; 62:1398-1409. [PMID: 36099043 DOI: 10.1093/rheumatology/keac532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/15/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To summarize evidence on the relationship between early treatment (definition based on symptom/disease duration or radiographic damage) and treatment clinical response in patients with SpA. METHODS A systematic literature review was conducted in studies on SpA patients treated with NSAIDs or b/tsDMARDs addressing the impact of symptom/disease duration or presence of radiographic damage on treatment response assessed by any disease activity outcome. For categorical outcomes, relative risk, relative risk ratio (RRR) and number needed to treat were calculated, and for continuous outcomes, differences in differences, to compare groups stratified based on symptom/disease duration or the presence of radiographic damage. RESULTS From the 8769 articles retrieved, 25 were included and 1 added by hand-search, all in axSpA, most of them with low risk of bias. Twenty-one studies compared groups based on symptom duration (n = 6) or disease duration (n = 15) and 7 studies based on absence/presence of radiographic damage (2 studies used two comparisons). When early axSpA was defined by symptom duration (<5 years) in RCTs, early treatment was associated with better outcomes in patients with nr-axSpA (n = 2, ASAS40 RRR 5.24 (95%CI 1.12-24.41) and 1.52 (0.60-3.87)) but not in r-axSpA (n = 1) [ASAS20 0.96 (0.53-1.73)]. When early axSpA was defined based on disease duration or radiographic damage, no differences were found between groups. CONCLUSION Evidence towards better outcomes in early axSpA is very limited and restricted to nr-axSpA and <5 years symptom duration. When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found.
Collapse
Affiliation(s)
- Dafne Capelusnik
- Care and Public Health Research Institute CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. Department of Rheumatology, Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina
| | - Diego Benavent
- Department of Rheumatology, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | | | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Center, Amsterdam, the Netherlands. Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, and School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Louise Falzon
- University of Sheffield, Sheffield, South Yorkshire, England
| | | | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| |
Collapse
|
12
|
Deodhar AA, Shiff NJ, Gong C, Hsia EC, Lo KH, Kim L, Xu S, Reveille JD. Efficacy and Safety of Intravenous Golimumab in Ankylosing Spondylitis Patients With Early and Late Disease Through One Year of the GO-ALIVE Study. J Clin Rheumatol 2022; 28:270-277. [PMID: 35653615 PMCID: PMC9336574 DOI: 10.1097/rhu.0000000000001853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE This post hoc analysis assessed efficacy and safety of intravenous (IV) golimumab in ankylosing spondylitis (AS) patients with early disease (ED) versus late disease (LD). METHODS The phase 3, double-blind, GO-ALIVE study randomized patients to IV golimumab 2 mg/kg at weeks 0 and 4 and then every 8 weeks through week 52, or placebo at weeks 0, 4, and 12 with crossover to IV golimumab at week 16. Clinical efficacy was assessed by ≥20% improvement in Assessment of Spondyloarthritis International Society response criteria (ASAS20), ≥50% improvement in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50), and Ankylosing Spondylitis Disease Activity Score (ASDAS) <1.3 (inactive disease). Using self-reported duration of inflammatory back pain (IBP), patients were grouped into quartiles: first = ED and fourth = LD. Descriptive statistics summarized efficacy and safety findings through 1 year. RESULTS Early disease patients (n = 60) were ~10 years younger and had shorter median AS (IBP) symptom duration (2-3 years) versus LD patients (n = 52; 21-24 years). At week 16, numerically higher proportions of golimumab- than placebo-treated patients achieved ASAS20 (ED: 71% vs. 32%; LD: 67% vs. 21%), BASDAI 50 (ED: 40% vs. 12%; LD: 33% vs. 7%), and ASDAS <1.3 (ED: 17% vs. 4%; LD 8% vs. 0%) regardless of IBP duration. Efficacy was durable through 1 year of treatment; however, response rates were numerically higher in patients with ED versus LD. Through week 60, adverse events and serious adverse events, respectively, were reported by 46% and 3% of ED patients and 61% and 2% of LD patients. CONCLUSION Prompt diagnosis of AS and early treatment with IV golimumab may yield more robust improvements in disease activity.
Collapse
Affiliation(s)
- Atul A. Deodhar
- From the Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR
| | - Natalie J. Shiff
- Janssen Scientific Affairs, LLC, Horsham, PA
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cinty Gong
- Janssen Scientific Affairs, LLC, Horsham, PA
| | - Elizabeth C. Hsia
- Janssen Research & Development, LLC, Spring House, PA
- Department of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Kim Hung Lo
- Department of Biostatistics, Janssen Research & Development, LLC, Spring House, PA
| | - Lilliane Kim
- Department of Biostatistics, Janssen Research & Development, LLC, Spring House, PA
| | - Stephen Xu
- Department of Biostatistics, Janssen Research & Development, LLC, Spring House, PA
| | - John D. Reveille
- Division of Rheumatology, University of Texas McGovern Medical School, Houston, TX
| |
Collapse
|
13
|
Gomollón F, Seoane-Mato D, Montoro MA, Juanola X, Trujillo-Martin E, Carrillo-Palau M, Matallana V, García-Magallón B, Ber Y, Ramos L, Perez-Pampin E, Ferreiro-Iglesias R, Rodríguez-Alonso L, Marco-Pascual C, Sanz Sanz J. Validation of screening criteria for spondyloarthritis in patients with inflammatory bowel disease in routine clinical practice. Dig Liver Dis 2022; 54:755-762. [PMID: 35039222 DOI: 10.1016/j.dld.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Spondyloarthritis (SpA) is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). Diagnostic delay must be avoided. AIMS We assessed the validity of SpA screening criteria (any of the following characteristics: chronic low back pain with onset before 45 years of age; inflammatory lower back pain or alternating buttock pain; arthritis; heel enthesitis; dacylitis; HLA-B27 positivity; sacroiliitis on imaging). METHODS This was a multicenter cross-sectional observational study in IBD patients aged ≥18 years. After evaluating the SpA screening criteria, the gastroenterologists referred the participants to the rheumatologists, who determined whether the patient fulfilled the screening criteria and carried out the necessary tests for SpA diagnosis. RESULTS 35 (11.7%) out of 300 patients were diagnosed with SpA. The combination with the best balance between sensitivity and specificity (91.4% and 72.1%, respectively, when applied by the rheumatologists; 80% and 78.9%, when applied by the gastroenterologists) for SpA screening, was fulfillment of any of the following: chronic low back pain with onset before age 45 years, inflammatory low back pain or alternating buttock pain, arthritis, or dactylitis. CONCLUSION This is one of the first studies to validate SpA screening criteria in IBD patients in routine clinical practice.
Collapse
Affiliation(s)
- Fernando Gomollón
- Medical School, University of Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.
| | | | - Miguel A Montoro
- Unit of Gastroenterology, Hepatology and Nutrition, Hospital General San Jorge, Huesca, Spain
| | - Xavier Juanola
- Department of Rheumatology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elisa Trujillo-Martin
- Department of Rheumatology, Hospital Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | - Marta Carrillo-Palau
- Department of Gastroenterology, Hospital Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | - Virginia Matallana
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Yolanda Ber
- Unit of Gastroenterology, Hepatology and Nutrition, Hospital General San Jorge, Huesca, Spain
| | - Laura Ramos
- Department of Gastroenterology, Hospital Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | - Eva Perez-Pampin
- Department of Rheumatology, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Rocío Ferreiro-Iglesias
- Department of Gastroenterology, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Lorena Rodríguez-Alonso
- Department of Gastroenterology and Hepatology, Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carla Marco-Pascual
- Department of Rheumatology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús Sanz Sanz
- Department of Rheumatology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | |
Collapse
|
14
|
Milota T, Hurnakova J, Pavelka K, Kristkova Z, Nekvindova L, Horvath R. Delayed treatment with a tumor necrosis factor alpha blocker associated with worse outcomes in patients with spondyloarthritis: data from the Czech National Registry ATTRA. Ther Adv Musculoskelet Dis 2022; 14:1759720X221081649. [PMID: 35321118 PMCID: PMC8935402 DOI: 10.1177/1759720x221081649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The administration of biologic disease-modifying antirheumatic drugs, including tumor necrosis factor (TNF)-α inhibitors, is observed to interfere with the disease activity and progression. In this study, we aimed to assess the effectiveness and response predictors of adalimumab (ADA), a TNF-α blocker, in patients with axial spondyloarthritis (AxSpA). Methods: This study was a historical prospective, registry-based observational study on patients with AxSpA treated with first-line ADA after conventional drug failure. For evaluation and comparison, patients were divided into three groups according to the number of years from AxSpA diagnosis to initiation of ADA treatment: (A) <5 years, (B) 5–10 years, and (C) >10 years. The assessment instruments ankylosing spondylitis disease activity score (ASDAS), Bath ankylosing spondylitis activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), health assessment questionnaire (HAQ), Short Form 36 questionnaire (SF-36), and EuroQoL 5 dimension questionnaire (EQ-5D) were regularly administered for up to 24 months of follow-up. Results: This study included 1043 patients with AxSpA (9.2% with non-radiographic AxSpA, 68.9% men). By month 6, a significantly higher proportion of patients with ASDAS remission (<1.3) was achieved upon earlier intervention in group A (30.1%) and B (32.9%) than in the late intervention group C (22.6%) (p ⩽ 0.05). At month 6, lower age and better BASFI at treatment initiation were identified as the strongest predictors of ASDAS remission in both univariable [odds ratio (OR): 0.956, p ⩽ 0.001; OR: 0.834, p ⩽ 0.001, respectively] and multivariable analyses (OR: 0.963, p ⩽ 0.001; OR: 0.859, p ⩽ 0.001, respectively). Earlier intervention also led to improvement in most patient-reported outcomes (PROs) based on HAQ, SF-36, and EQ-5D. Conclusion: Results from the ATTRA registry concur with previous clinical trials that supported efficacy of TNF-α blockers and showed better treatment outcomes with early interventions, including reduction of disease activity and improvement in PROs. We identified age and BASFI as the main factors influencing treatment effectiveness.
Collapse
Affiliation(s)
- Tomas Milota
- Department of Pediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic
- Department of Immunology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jana Hurnakova
- Department of Pediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zlatuse Kristkova
- Institute of Biostatistics and Analyses, Ltd [a spinoff company of Masaryk University], Brno, Czech Republic
| | - Lucie Nekvindova
- Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Ltd [a spinoff company of Masaryk University], Brno, Czech Republic
| | - Rudolf Horvath
- Department of Pediatric and Adult Rheumatology, Motol University Hospital, V Úvalu 84, Prague 150 06, Czech Republic
| |
Collapse
|
15
|
2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. Joint Bone Spine 2022; 89:105344. [PMID: 35038574 DOI: 10.1016/j.jbspin.2022.105344] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Update the French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. METHODS Following standardized procedures, a systematic literature review was done by four supervised rheumatology residents based on questions defined by a task force of 16 attending rheumatologists. The findings were reviewed during three working meetings that culminated in each recommendation receiving a grade and the level of agreement among experts being determined. RESULTS Five general principles and 15 recommendations were developed. They take into account pharmacological and non-pharmacological measures along with treatment methods based on the dominant phenotype present (axial, articular, enthesitis/dactylitis) and the extra-articular manifestations (psoriasis, inflammatory bowel disease, uveitis). NSAIDs are the first-line pharmacological treatment in the various presentations. Conventional synthetic disease modifying antirheumatic drugs (csDMARDs) are not indicated in the axial and isolated entheseal forms. If the response to conventional treatment is not adequate, targeted therapies (biologics, synthetics) should be considered; the indications depend on the clinical phenotype and presence of extra-articular manifestations. CONCLUSION This update incorporates recent data (published since the prior update in 2018) and the predominant clinical phenotype concept. It aims to help physicians with the everyday management of patients affected by spondyloarthritis, including psoriatic arthritis.
Collapse
|
16
|
Francavilla ML, Serai SD, Brandon TG, Biko DM, Khrichenko D, Nguyen JC, Xiao R, Chauvin NA, Gendler L, Weiss PF. Feasibility of T2 Mapping of the Sacroiliac Joints in Healthy Control Subjects and Children and Young Adults with Sacroiliitis. ACR Open Rheumatol 2022; 4:74-82. [PMID: 34757697 PMCID: PMC8754013 DOI: 10.1002/acr2.11354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the feasibility of T2 mapping for evaluating pediatric SIJ cartilage at 3 Tesla (T) magnetic resonance imaging (MRI). METHODS Healthy control subjects and adolescents with sacroiliitis underwent a 3T MRI dedicated pelvic protocol that included a T2 mapping sequence consisting of multislice, multiecho acquisition. Healthy control subjects were prospectively recruited from our primary care practices as part of a larger imaging study, whereas adolescents with sacroiliitis were recruited specifically for this study. Regions of interest (ROIs) were hand-drawn by a senior pediatric radiologist twice and a radiology fellow twice to calibrate and test reliability using the intraclass correlation coefficient (ICC). T2 relaxation time between control subjects and cases was compared using univariate linear regression. We tested the association of T2 relaxation time in adolescents with sacroiliitis with patient-reported outcomes and the Spondyloarthritis Research Consortium of Canada sacroiliac joint (SIJ) inflammation and structural scores using Pearson correlation coefficients. RESULTS Fourteen subjects were evaluable (six control subjects: median age 13.7 years [interquartile range (IQR): 12.2-15.5], 67% male patients; eight cases: median age 17.4 years [IQR: 12.5-20], 88% male patients]. Acquisition time for T2 mapping sequences was approximately 6 minutes, and segmenting the ROI for each SIJ took approximately 3 minutes. The intrarater and inter-rater ICCs were 0.67 and 0.46, respectively, indicating good to fair reliability. There was a trend, albeit statistically insignificant, in longer median T2 relaxation time in cases (43.04 ms; IQR: 41.25-49.76 ms) versus healthy control subjects (40.0 ms; IQR: 38.9-48.6 ms). Although not statistically significant, cases with longer T2 relaxation time tended to occur with poorer patient-reported outcomes. Correlations with the SIJ inflammation and structural lesion scores were weak. CONCLUSION T2 mapping of the SIJ cartilage in children was feasible and reliable. Larger controlled and longitudinal assessments are needed to assess the validity and utility of these measurements for routine clinical practice and trials.
Collapse
Affiliation(s)
- Michael L. Francavilla
- The Children's Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphia
| | - Suraj D. Serai
- The Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | | | - David M. Biko
- The Children's Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphia
| | | | - Jie C. Nguyen
- The Children's Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphia
| | - Rui Xiao
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphia
| | - Nancy A. Chauvin
- Pennsylvania State Health Milton S. Hershey Children's HospitalHershey
| | - Liya Gendler
- The Children's Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphia
| | - Pamela F. Weiss
- The Children's Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphia
| |
Collapse
|
17
|
Baraliakos X, Kruse S, Auteri SE, de Peyrecave N, Nurminen T, Kumke T, Hoepken B, Braun J. Certolizumab Pegol Treatment in Axial Spondyloarthritis Mitigates Fat Lesion Development: 4-Year Post-Hoc MRI Results from a Phase 3 Study. Rheumatology (Oxford) 2021; 61:2875-2885. [PMID: 34791107 PMCID: PMC9258590 DOI: 10.1093/rheumatology/keab841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Fat lesions (FLs) on MRI T1 sequences are considered early indicators of structural spinal progression in axial spondyloarthritis (axSpA) patients. In this post-hoc analysis from RAPID-axSpA, we assess whether TNFi treatment over 4 years impacts FLs in spinal vertebral edges (VEs) of patients with axSpA. METHODS In RAPID-axSpA (NCT01087762), a 4-year, phase 3 randomised trial, participants were randomised to certolizumab pegol (CZP; 400 mg loading dose at Weeks 0/2/4 then 200/400 mg every 2/4 weeks) or placebo (PBO) at baseline; PBO-randomised participants switched to CZP at week 16/24 (denoted PBO-randomised/CZP). Spinal MRI scans were taken at Weeks 0, 12, 48, 96 and 204. Changes in proportions of VEs with FLs are reported as odds ratios (OR) between timepoints. RESULTS Overall, 136 participants (CZP: 89, PBO-randomised/CZP: 47) had a baseline and ≥1 post-baseline MRI. The OR (95% CI) vs baseline of FLs was higher in PBO-randomised/CZP vs CZP-randomised participants at Weeks 48 (3.35 [2.16-5.19] vs 1.45 [1.07-1.97]), 96 (2.62 [1.77-3.88] vs 1.84 [1.36-2.48]) and 204 (2.55 [1.59-4.06] vs 1.71 [1.23-2.37]). Across 204 weeks, FLs increased more in VEs with baseline inflammation (week 204 OR: 4.84 [2.56-9.18]) than those without (OR: 1.15 [0.78-1.71]). VEs in which inflammation was resolved by week 12 had lower FL prevalence at Weeks 48, 96 and 204 compared with VEs with unresolved inflammation. CONCLUSIONS Early and sustained suppression of inflammation mitigates the risk of long-term fat lesion development in the spine in study participants with axSpA evaluated over 4 years.
Collapse
Affiliation(s)
| | - Sebastian Kruse
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Bochum, Germany
| | | | | | | | | | | | - Jürgen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
18
|
Xiang L, Fong W, Low AHL, Leung YY, Gandhi M, Xin X, Uy EJB, Hamilton L, Thumboo J. Early identification of axial spondyloarthritis in a multi-ethnic Asian population. Clin Rheumatol 2021; 41:1095-1103. [PMID: 34625882 DOI: 10.1007/s10067-021-05951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION/OBJECTIVES To address the diagnostic delay in axial spondyloarthritis (axSpA), we have cross-culturally adapted the Hamilton axSpA questionnaire, a self-administered screening questionnaire, in the Singapore population. In this study, we compared the performance of various scoring methods for this questionnaire in detecting axSpA. METHOD The questionnaire was self-administered by eligible subjects. Scoring methods included method A, the original questionnaire scoring, and methods B-E, scoring developed based on the Assessment of SpondyloArthritis International Society (ASAS) criteria for inflammatory back pain (IBP) and the referral, classification and both referral and classification of axSpA, respectively. The reference standard was diagnosis by a rheumatologist. Since the ASAS criteria-based scoring methods were mainly based on clinical axSpA features, self-report and rheumatologist-assessment of clinical axSpA features were also compared in subjects with axSpA. RESULTS Of 1418 subjects (age: 54 ± 14 years, female: 73%) recruited, 46 were diagnosed with axSpA by a rheumatologist. Sensitivities of methods A-E were 35%, 61%, 63%, 48% and 83%, respectively. Self-report of clinical axSpA features exceeded rheumatologist-assessment for arthritis (83 vs 26%), good response to NSAIDs (37 vs 30%), enthesitis (35 vs 30%), dactylitis (20 vs 2%) and family history for axSpA (13 vs 4%). The reverse was true for IBP (41 vs 63%) and uveitis (4 vs 15%). CONCLUSIONS A self-administered questionnaire using the ASAS referral and classification criteria-based scoring yielded relatively high sensitivity in detecting axSpA in subjects newly referred to rheumatology clinics. This supports its evaluation as a screening and referral tool in the general population in future studies. Key Points • A self-administered questionnaire could be used as a screening and referral tool. • ASAS referral and classification criteria-based scoring yielded relatively high sensitivity. • Inaccurate perception of clinical axSpA features was observed in axSpA patients.
Collapse
Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.,Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore.,The Center for Child Health Research, Tampere University, Tampere, Finland
| | - Xiaohui Xin
- Academic Clinical Program for Medicine, Singapore General Hospital, Singapore, Singapore
| | - Elenore Judy B Uy
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore
| | - Louise Hamilton
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| |
Collapse
|
19
|
Tam HKJ, Nash P, Robinson PC. The Effect of Etanercept in Nonradiographic Axial Spondyloarthritis by Stratified C-Reactive Protein Levels. ACR Open Rheumatol 2021; 3:699-706. [PMID: 34405589 PMCID: PMC8516106 DOI: 10.1002/acr2.11312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/07/2021] [Indexed: 12/19/2022] Open
Abstract
Objective Biological agents have shown markedly different response rates by baseline C‐reactive protein (CRP). Here, we determine the response of patients with nonradiographic axial spondyloarthritis (nr‐axSpA) to etanercept stratified by their baseline CRP level. Methods The EMBARK trial was a phase 3, randomized, double‐blind, placebo‐controlled study of etanercept in nr‐axSpA. The primary endpoint was Assessment of Spondyloarthritis International Society (ASAS) 40 at Week 12, the conclusion of the double‐blind phase. It recruited patients who met the ASAS criteria for axial spondyloarthritis, and sacroiliac joint magnetic resonance scans were completed on all patients. In this post hoc analysis, we analyzed outcomes by baseline C‐reactive protein (CRP) level of less than 5 mg/L, 5 mg/L to 10 mg/L, and greater than 10 mg/L. The clinical trial outcome data were accessed via the Vivli platform. Results In the less than 5 mg/L CRP group treated with etanercept, the ASAS20 response, ASAS40 response, Ankylosing Spondylitis Disease Activity Score‐CRP (ASDAS‐CRP), and ASDAS‐ESR (erythrocyte sedimentation rate) outcomes were 49% (P = 0.84), 26% (P = 0.14), 42% (P = 0.002), and 44% (P = 0.006), respectively. In the 5 to 10 mg/L CRP group treated with etanercept, the ASAS20 response, ASAS40 response, ASDAS‐CRP, and ASDAS‐ESR outcomes were 56% (P = 0.99), 31% (P = 0.40), 56% (P = 0.16), and 50% (P = 0.11), respectively. In the greater than10 mg/L CRP group treated with etanercept, the ASAS20 response, ASAS40 response, ASDAS‐CRP, and ASDAS‐ESR outcomes were 74% (P = 0.02), 68% (P = 0.003), 82% (P = 0.005), and 50% (P = 0.001), respectively. Conclusion Although there are reduced ASAS20 and ASAS40 response rates in the groups with baseline CRP less than 10 mg/L, there remain clinically relevant responses when the composite outcome measures ASDAS‐CRP or ASDAS‐ESR were used, and this should be considered when deciding on thresholds for reimbursement.
Collapse
Affiliation(s)
| | - Peter Nash
- Griffith University, Brisbane, Queensland, Australia
| | | |
Collapse
|
20
|
Xiang L, Low AHL, Leung YY, Fong W, Gandhi M, Yoon S, Lau TC, Koh DR, Thumboo J. Interval between symptom onset and diagnosis among patients with autoimmune rheumatic diseases in a multi-ethnic Asian population. Int J Rheum Dis 2021; 24:1061-1070. [PMID: 34232556 DOI: 10.1111/1756-185x.14165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/22/2021] [Accepted: 06/13/2021] [Indexed: 12/19/2022]
Abstract
AIM The interval between symptom onset and diagnosis (pre-diagnosis interval) can at times be longer than is ideal in patients with autoimmune rheumatic diseases (ARDs). In this study, we aimed to characterize this interval and to identify its associated factors. METHOD We characterized pre-diagnosis interval into 4 intervals: Interval #1 between symptom onset and first visit to healthcare professionals; Interval #2 between first visit to healthcare professionals and rheumatology referral; Interval #3 between rheumatology referral and first rheumatology assessment; and Interval #4 between first rheumatology assessment and diagnosis. Median regression models were used to identify factors associated with longer pre-diagnosis interval and Interval #1. RESULTS Among 259 patients (median age = 52.0 [41.6-61.9] years, 71% female, rheumatoid arthritis [n = 75], axial spondyloarthritis [axSpA] [n = 40] and psoriatic arthritis [n = 35]), median pre-diagnosis interval was 11.5 (4.7-36.0) months. Interval #1 (median = 4.9 months) was significantly longer than Intervals #2-#4 (median = 0.3, 1.5, and 0.0 months, respectively). Patients with axSpA had significantly longer pre-diagnosis interval (median = 38.7 months) and Interval #1 (median = 26.6 months) than patients with the other ARDs. Median regression suggested that patients referred from specialty care had significantly longer pre-diagnosis interval (median difference = 7.7 months) and Interval #1 (median difference = 6.4 months) compared to those referred from primary care. CONCLUSION A long pre-diagnosis interval was observed among patients with ARDs (especially axSpA), due largely to a long interval between symptom onset and the first visit to healthcare professionals. This highlights the importance of interventions targeting patients prior to their first visit to healthcare professionals in reducing pre-diagnosis interval.
Collapse
Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Mihir Gandhi
- Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Biostatistics, Singapore Clinical Research Institute.,Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Tang Ching Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Medicine, National University Hospital, Singapore
| | - Dow Rhoon Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Medicine, National University Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
| |
Collapse
|
21
|
Liew DFL, Dau J, Robinson PC. Value-Based Healthcare in Rheumatology: Axial Spondyloarthritis and Beyond. Curr Rheumatol Rep 2021; 23:36. [PMID: 33909169 DOI: 10.1007/s11926-021-01003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW This review examines axial spondyloarthritis (axSpA) and the wider field of rheumatology through a value-based healthcare (VBHC) lens. VBHC is focused on ensuring patients receive high quality care to improve outcomes and reduce unnecessary costs. RECENT FINDINGS There are many opportunities to apply the principles of VBHC in axSpA. These include the appropriate utilization of diagnostic investigations, such as HLA-B27 and magnetic resonance imaging, assessing outcomes meaningful to patients, and optimizing care pathways. Multidisciplinary care may improve value, and reduced specialist review and medication tapering may be appropriate. Increasing the value of the care we provide to patients can occur across domains and directly and indirectly improves patient outcomes. Taking the time to integrate principles of VBHC into our practice will allow us to justifiably gain and maintain access to diagnostic and therapeutic advances for the benefit of all our patients.
Collapse
Affiliation(s)
- David F L Liew
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Jonathan Dau
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, 4006, Australia. .,Department of Rheumatology, Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Bowen Bridge Road, Herston, Queensland, 4006, Australia.
| |
Collapse
|
22
|
da Cruz Lage R, Marques CDL, Oliveira TL, Resende GG, Kohem CL, Saad CG, Ximenes AC, Gonçalves CR, Bianchi WA, de Souza Meirelles E, Keiserman MW, Chiereghin A, Campanholo CB, Lyrio AM, Schainberg CG, Pieruccetti LB, Yazbek MA, Palominos PE, Goncalves RSG, Assad RL, Bonfiglioli R, Lima SMAAL, Carneiro S, Azevedo VF, Albuquerque CP, Bernardo WM, Sampaio-Barros PD, de Medeiros Pinheiro M. Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis. Adv Rheumatol 2021; 61:4. [PMID: 33468245 DOI: 10.1186/s42358-020-00160-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/29/2020] [Indexed: 01/04/2023] Open
Abstract
Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians' decision making, without taking out his/her autonomy when prescribing for an individual patient.
Collapse
Affiliation(s)
- Ricardo da Cruz Lage
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso 175, Ambulatório Bias Fortes, 2° andar, Belo Horizonte, MG, 30150-260, Brazil.
| | | | | | - Gustavo Gomes Resende
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso 175, Ambulatório Bias Fortes, 2° andar, Belo Horizonte, MG, 30150-260, Brazil
| | | | | | | | | | | | | | | | - Adriano Chiereghin
- Pontifícia Universidade Católica (PUC) de Sorocaba, Sorocaba, SP, Brazil
| | | | - André Marun Lyrio
- Pontifícia Universidade Católica (PUC) de Campinas, Campinas, SP, Brazil
| | | | | | | | | | | | | | - Rubens Bonfiglioli
- Pontifícia Universidade Católica (PUC) de Campinas, Campinas, SP, Brazil
| | | | - Sueli Carneiro
- Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | |
Collapse
|
23
|
Komsalova LY, Martínez Salinas MP, Jiménez JFG. Predictive values of inflammatory back pain, positive HLA B27 antigen and acute and chronic magnetic resonance changes in early diagnosis of Spondyloarthritis. A study of 133 patients. PLoS One 2020; 15:e0244184. [PMID: 33347471 PMCID: PMC7751977 DOI: 10.1371/journal.pone.0244184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 12/05/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To analyse the predictive values of inflammatory back pain (IBP), positive HLA B27 antigen, increased C-reactive protein (CRP), Spondyloarthritis (SpA) features, familial history (FH), magnetic resonance sacroiliac joints (MRI-SIJ) imaging and its weight in early SpA diagnosis. METHODS 133 patients with back pain, aged <50, duration of the pain <2 years were included. Data such as IBP, HLA B27, increased CRP, SpA features, FH, SIJ´s radiography and MRI were collected for each patient. STIR sequences were classified as strongly positive bone morrow oedema (SPBME ≥2), clearly present and easily recognisable as positive according to the ASAS criterion, weakly positive (WPBME ≥2), suggestive, but not easily recognisable and, clearly negative none of those features. T1-weighted sequences were assessed as positive/negative for erosion, fat metaplasia, backfill and sclerosis, if ≥1, for each lesion was present. MRI images were read by three blinded readers. RESULTS The average age was 38.9 years. 47 (35.3%) patients received SpA diagnosis according to the clinical opinion. IBP was highly specific, 0.81 and sensitive, 0.83. HLA B27 was positive in a half of the SpA patients. SPBME ≥2 provided a great specificity, 0.94 and an acceptable sensitivity, 0.79. Erosion was significantly more frequent in SpA patients (72% vs 7%), specificity 0.93. The addition of erosion ≥1 to the WPBME ≥2 noticeably improved specificity, 0.98, although slightly decreased sensitivity, 0.64. Fat metaplasia and backfill were highly specific, but poorly sensitive. Factors forecasting positive diagnosis were IBP, followed by SpA features and increased CRP. CONCLUSIONS At the onset, IBP might be a good marker for selecting patients with suspicion of SpA. The addition of erosion to the ASAS criterion might be helpful for early diagnosis, especially in patients with doubtful STIR imaging where BME is present but it is hard to determinate whether the ASAS "highly suggestive" criterion is met.
Collapse
|
24
|
Xiang L, Low AHL, Leung YY, Fong W, Gandhi M, Xin X, Uy EJ, Sparks JA, Karlson EW, Thumboo J. Improving sensitivity of the connective tissue disease screening questionnaire: A comparative study of various scoring methods. Lupus 2020; 30:35-44. [PMID: 33092467 DOI: 10.1177/0961203320966378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Early detection of autoimmune rheumatic diseases is crucial given their high morbidity and mortality and short window of opportunity to improve patient outcomes. Self-administered screening questionnaires such as the connective tissue disease screening questionnaire (CSQ) have been shown to promote early detection of autoimmune rheumatic diseases. However, optimal scoring of screening questionnaires may differ with prevalence of clinical features and changes in classification criteria. We compared the performance of 3 scoring methods for the CSQ for early detection of autoimmune rheumatic diseases in a multi-ethnic Asian population. METHODS Patients who were newly referred for evaluation of possible autoimmune rheumatic diseases were invited to answer the cross-culturally adapted CSQ. Detection of autoimmune rheumatic diseases using 1) the original CSQ scoring, 2) a modified CSQ scoring and 3) a scoring based on current classification criteria, were compared to classification of autoimmune rheumatic diseases by classification criteria. RESULTS Of 819 participants, 85 were classified as having autoimmune rheumatic diseases screened for by the adapted CSQ. The original CSQ scoring yielded relatively lower sensitivities in detecting both any and individual autoimmune rheumatic diseases (67% and 20-57%, respectively) compared to the modified CSQ scoring (81% and 60-73%, respectively) and the scoring based on current classification criteria (89% and 50-88%, respectively). CONCLUSION The adapted CSQ with the classification criteria-based scoring achieved relatively high sensitivities in detecting autoimmune rheumatic diseases, suggesting this could be employed as the first step in population screening.
Collapse
Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore.,Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Xiaohui Xin
- Academic Clinical Program for Medicine, Singapore General Hospital, Singapore, Singapore
| | - Elenore Jb Uy
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Jeffrey A Sparks
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Elizabeth W Karlson
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
25
|
Xiang L, Teo EPS, Low AHL, Leung YY, Fong W, Xin X, Gandhi M, Kwan YH, Uy EJB, Hamilton L, Thumboo J. Cross‐cultural adaptation of the Hamilton axial spondyloarthritis questionnaire and development of a Chinese version in a multi‐ethnic Asian population. Int J Rheum Dis 2019; 22:1652-1660. [DOI: 10.1111/1756-185x.13645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/18/2019] [Accepted: 05/31/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
| | - Edmund Pek Siang Teo
- Health Services Research Unit Singapore General Hospital Singapore City Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Xiaohui Xin
- Academic Clinical Program for Medicine Singapore General Hospital Singapore City Singapore
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute Singapore City Singapore
- Centre for Quantitative Medicine Duke‐NUS Medical School Singapore City Singapore
| | - Yu Heng Kwan
- Duke‐NUS Medical School Singapore City Singapore
| | - Elenore J. B. Uy
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
| | - Louise Hamilton
- Department of Rheumatology Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - Julian Thumboo
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| |
Collapse
|
26
|
Robinson PC, Sengupta R, Siebert S. Non-Radiographic Axial Spondyloarthritis (nr-axSpA): Advances in Classification, Imaging and Therapy. Rheumatol Ther 2019; 6:165-177. [PMID: 30788779 PMCID: PMC6514020 DOI: 10.1007/s40744-019-0146-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Indexed: 12/17/2022] Open
Abstract
Non-radiographic axial spondyloarthritis (nr-axSpA) is a recently described form of axial inflammatory arthritis that has not caused substantial erosive damage to the sacroiliac joints. Nr-axSpA is associated with significant impairment in quality of life and, in a proportion of patients, it can evolve into ankylosing spondylitis (AS, also termed radiographic axSpA). The identification in the clinic of nr-axSpA has been made possible by advances in magnetic resonance imaging (MRI). Classification criteria for nr-axSpA have been proposed but there remains discussion in the international community regarding this. Studies are ongoing to further define the classification and diagnosis of nr-axSpA. There is much further research required regarding the optimal use of MRI in nr-axSpA, including distinguishing sacroiliac MRI changes in the normal population and the definition of a positive MRI in spinal disease. Non-steroidal anti-inflammatory drugs and physiotherapy are the core first-line therapy for nr-axSpA. Tumour necrosis factor inhibitors also play a very important role in treatment of patients with active nr-axSpA who do not respond to first-line therapy. Agents directed at interleukin-17, interleukin-23 and Janus kinase inhibitors are proving effective in AS with ongoing and planned studies in nr-axSpA. A great deal of active research is being undertaken in classification, imaging and therapy in nr-axSpA and so the future for improving the lives of patients with nr-axSpA is promising.
Collapse
Affiliation(s)
- Philip C Robinson
- Royal Brisbane and Women's Hospital, School of Clinical Medicine, University of Queensland, Herston, QLD, 4029, Australia.
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| |
Collapse
|
27
|
Xiang L, Teo EPS, Low AHL, Leung YY, Fong W, Xin X, Gandhi M, Kwan YH, Uy EJB, Sparks JA, Karlson EW, Thumboo J. Cross-cultural adaptation of the connective tissue disease screening questionnaire and development of a Chinese version in a multi-ethnic Asian population. Clin Rheumatol 2019; 38:2383-2397. [DOI: 10.1007/s10067-019-04567-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 01/10/2023]
|
28
|
Burgers LE, Raza K, van der Helm-van Mil AH. Window of opportunity in rheumatoid arthritis - definitions and supporting evidence: from old to new perspectives. RMD Open 2019; 5:e000870. [PMID: 31168406 PMCID: PMC6525606 DOI: 10.1136/rmdopen-2018-000870] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/11/2022] Open
Abstract
The therapeutic window of opportunity in rheumatoid arthritis (RA) is often referred to. However, some have questioned whether such a period, in which the disease is more susceptible to disease-modifying treatment, really exists. Observational studies are most frequently referenced as supporting evidence, but results of such studies are subject to confounding. In addition formal consensus on the definition of the term has never been reached. We first reviewed the literature to establish if there is agreement on the concept of the window of opportunity in terms of its time period and the outcomes influenced. Second, a systemic literature search was performed on the evidence of the benefit of early versus delayed treatment as provided by randomised clinical trials. We observed that the concept of the window of opportunity has changed with respect to timing and outcome since its first description 25 years ago. There is an ‘old definition’ pointing to the first 2 years after diagnosis with increased potential for disease-modifying treatment to prevent severe radiographic damage and disability. Strong evidence supports this concept. A ‘new definition’ presumes a therapeutic window in a pre-RA phase in which the biologic processes could be halted and RA development prevented by very early treatment. This definition is not supported by evidence, although is less well studied in trials. Some suggestions for future research in this area are made.
Collapse
Affiliation(s)
- Leonie E Burgers
- Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Karim Raza
- Immunity and Infection, University of Birmingham, Birmingham, UK.,Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Annette H van der Helm-van Mil
- Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
29
|
Verhoeven F, Prati C, Totoson P, Bordy R, Wendling D, Demougeot C. Structural efficacy of NSAIDs, COX-2 inhibitor and glucocorticoid compared with TNFα blocker: a study in adjuvant-induced arthritis rats. Rheumatology (Oxford) 2019; 58:1099-1103. [DOI: 10.1093/rheumatology/key444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/03/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Frank Verhoeven
- EA 4267 ≪PEPITE≫, UFR Santé, Franche-Comté University, 19 rue Ambroise Paré, bâtiment S 25030 BESANCON cedex, France
- 2Department of Rheumatology, CHRU de Besançon, 3 boulevard Fleming 25000 BESANCON, France
| | - Clément Prati
- EA 4267 ≪PEPITE≫, UFR Santé, Franche-Comté University, 19 rue Ambroise Paré, bâtiment S 25030 BESANCON cedex, France
- 2Department of Rheumatology, CHRU de Besançon, 3 boulevard Fleming 25000 BESANCON, France
| | - Perle Totoson
- EA 4267 ≪PEPITE≫, UFR Santé, Franche-Comté University, 19 rue Ambroise Paré, bâtiment S 25030 BESANCON cedex, France
| | - Romain Bordy
- EA 4267 ≪PEPITE≫, UFR Santé, Franche-Comté University, 19 rue Ambroise Paré, bâtiment S 25030 BESANCON cedex, France
| | - Daniel Wendling
- 2Department of Rheumatology, CHRU de Besançon, 3 boulevard Fleming 25000 BESANCON, France
- EA 4266 ≪EPILAB≫, UFR Santé, Franche-Comté University, 19 rue Ambroise Paré, bâtiment S 25030 BESANCON cedex, France
| | - Céline Demougeot
- EA 4267 ≪PEPITE≫, UFR Santé, Franche-Comté University, 19 rue Ambroise Paré, bâtiment S 25030 BESANCON cedex, France
| |
Collapse
|
30
|
Sanz Sanz J, Juanola Roura X, Seoane-Mato D, Montoro M, Gomollón F. Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre Reumatología y Gastroenterología. ACTA ACUST UNITED AC 2018; 14:68-74. [DOI: 10.1016/j.reuma.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 02/07/2023]
|
31
|
Sanz Sanz J, Juanola Roura X, Seoane-Mato D, Montoro M, Gomollón F. Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre Reumatología y Gastroenterología. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 41:54-62. [DOI: 10.1016/j.gastrohep.2017.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/03/2017] [Indexed: 01/12/2023]
|
32
|
Chang EY, Chen KC, Huang BK, Kavanaugh A. Adult Inflammatory Arthritides: What the Radiologist Should Know. Radiographics 2017; 36:1849-1870. [PMID: 27726745 DOI: 10.1148/rg.2016160011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Developments and improvements in knowledge are rapid and ongoing in both the radiologic and rheumatologic fields. During the past decade, the roles of imaging and the radiologist in the assessment and management of many inflammatory rheumatologic diseases have undergone several changes. To remain effective in patient care, the radiologist needs to be aware of these changes when recommending and interpreting imaging examinations for the referring physician. The goal of contemporary rheumatoid arthritis (RA) management is to redefine RA as a disease that is no longer characterized by erosions, which reflect established or long-standing untreated disease. Most cases of RA are now diagnosed clinically, but imaging increases diagnostic confidence, is superior to clinical examination for the detection of joint inflammation, and plays an important role in patient management. The concept of the seronegative spondyloarthritides has recently been redefined by the Assessment of SpondyloArthritis International Society (ASAS). This new set of ASAS classification criteria divides the spectrum of spondyloarthritis on the basis of predominantly axial skeletal clinical manifestations or predominantly peripheral skeletal clinical manifestations. For axial spondyloarthritis, magnetic resonance imaging and radiography play crucial roles for classification and diagnosis. For both peripheral spondyloarthritis and psoriatic arthritis, the radiologist can provide important information that influences classification and diagnosis, including documenting radiologic evidence of juxta-articular new bone formation, diagnosing sacroiliitis, or delineating the presence and extent of enthesitis and dactylitis. The radiologist's familiarity with recent classification criteria, in addition to the traditional diagnostic characteristics of the individual inflammatory arthritides, maximizes the productive interface between the radiologist and the rheumatologist. ©RSNA, 2016.
Collapse
Affiliation(s)
- Eric Y Chang
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Karen C Chen
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Brady K Huang
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Arthur Kavanaugh
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| |
Collapse
|
33
|
Diagnostic delay in axial spondyloarthritis: A cross-sectional study of 432 patients. Joint Bone Spine 2017; 84:467-471. [DOI: 10.1016/j.jbspin.2016.06.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/12/2016] [Indexed: 02/06/2023]
|
34
|
Gao GM, Li YM, Zheng XL, Jiang DB, Zhang LL, Xu PH, Liu SY, Zheng ZH, Kan QC. The Efficacy of Imrecoxib and Celecoxib in Axial Spondyloarthritis and Their Influence on Serum Dickopff-Related Protein 1 (DKK-1) Levels. Med Sci Monit 2017. [PMID: 28626213 PMCID: PMC5486680 DOI: 10.12659/msm.901727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To observe and demonstrate therapeutic effects and side effects of two selective COX-2 inhibitors, imrecoxib and celecoxib, on patients with axial spondyloarthritis (axSpA) and observe the correlation between imaging scores and serum DKK-1 levels. MATERIAL AND METHODS Sixty patients with axSpA were randomly assigned to receive 200 mg imrecoxib or 200 mg celecoxib twice daily. Fifty-one patients who completed follow-up were included in the study. At baseline, week 4, and week 12, the clinical parameters, inflammatory markers (ESR, CRP), and adverse reactions were recorded. Serum DKK-1 levels were investigated by enzyme-linked immunosorbent assay. Radiographic scores were calculated by sacroiliac joint SPARCC (Spondyloarthritis Research Consortium of Canada) score method at baseline serum DKK-1 levels and week 12. RESULTS Patients in the imrecoxib group (n=25) and patients in the celecoxib group (n=26) were improved at week 4. At week 12, all clinical parameters and inflammatory markers were improved in the two groups and the differences was not statistically significant. Serum DKK-1 levels were decreased and the differences were not statistically significant. Serum DKK-1 levels in patients in the imrecoxib group at baseline were negatively correlated with all study parameters, while those in the celecoxib group had correlations with BASFI (r=-0.048, p=0.027) and Schober test (r=0.437, p=0.048), without any correlation with other clinical parameters or inflammatory markers. CONCLUSIONS Patients experienced significant improvement in disease activity, functional parameters, and inflammatory markers when treated with selective COX-2 inhibitors for 12 weeks, and the efficacy of imrecoxib was not inferior to celecoxib. Selective COX-2 inhibitors imrecoxib and celecoxib had no obvious effects on serum DKK-1 levels.
Collapse
Affiliation(s)
- Guan-Min Gao
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Yan-Min Li
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Xiao-Long Zheng
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Dong-Bin Jiang
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Lei-Lei Zhang
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Peng-Hui Xu
- Department of Pharmacology, First Affiliated Hospital of PLA General Hospital, Beijing, China (mainland)
| | - Sheng-Yun Liu
- Departments of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Zhao-Hui Zheng
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Quan-Cheng Kan
- Department of Pharmacology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| |
Collapse
|
35
|
Tseng HW, Glant TT, Brown MA, Kenna TJ, Thomas GP, Pettit AR. Early anti-inflammatory intervention ameliorates axial disease in the proteoglycan-induced spondylitis mouse model of ankylosing spondylitis. BMC Musculoskelet Disord 2017; 18:228. [PMID: 28558827 PMCID: PMC5450150 DOI: 10.1186/s12891-017-1600-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/22/2017] [Indexed: 12/17/2022] Open
Abstract
Background Ankylosing spondylitis (AS) is characterised by immune-mediated arthritis and osteoproliferation, ultimately leading to joint ankylosis. Whether inflammation is necessary for osteoproliferation is controversial, fuelled by the unclear efficacy of anti-inflammatory treatments on radiographic progression. In proteoglycan-induced spondylitis (PGISp), a mouse model of AS, inflammation is the prerequisite for osteoproliferation as osteoproliferation was only observed following inflammation-driven intervertebral disc (IVD) destruction. We hypothesised that early intervention with a potent anti-inflammatory therapy would protect IVD integrity and consequently alter disease progression. Methods PGISp mice received vehicle or a combination of etanercept (ETN) plus prednisolone (PRD) therapy for 2 or 6 weeks initiated at an early disease stage. Peripheral arthritis was scored longitudinally. Spinal disease was assessed using a semi-quantitative histological scoring regimen including inflammation, joint destruction and excessive tissue formation. Results ETN + PRD therapy significantly delayed the onset of peripheral arthritis. IVD integrity was significantly protected when treatment was commenced in early disease. Six-weeks of treatment resulted in trends towards reductions in intervertebral joint damage and excessive tissue formation. IVD score distribution was dichotomized, likely reflecting the extent of axial disease at initiation of therapy. In the sub-group of mice with high IVD destruction scores, ETN + PRD treatment significantly reduced IVD destruction severity, inflammation and bone erosion and reduced cartilage damage and excessive tissue formation. Conclusions Early intervention with anti-inflammatory treatment not only improved inflammatory symptoms but also ameliorated structural damage of spine in PGISp mice. This preclinical observation suggests that early anti-inflammatory intervention may slow radiographic progression in AS patients. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1600-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hsu-Wen Tseng
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.,Mater Research Institute-The University of Queensland, Faculty of Medicine, Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102, Australia
| | - Tibor T Glant
- Section of Molecular Medicine, Department of Orthopedic Surgery, Rush University Medical Center, 1735 W. Harrison Str., Cohn Research Building, Chicago, IL, 60612, USA
| | - Matthew A Brown
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology: Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102, Australia
| | - Tony J Kenna
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology: Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102, Australia
| | - Gethin P Thomas
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia. .,Charles Sturt University, Boorooma Street, Wagga Wagga, NSW, 2678, Australia.
| | - Allison R Pettit
- Mater Research Institute-The University of Queensland, Faculty of Medicine, Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102, Australia.
| |
Collapse
|
36
|
Brown M, Bradbury LA. New approaches in ankylosing spondylitis. Med J Aust 2017; 206:192-194. [DOI: 10.5694/mja16.01111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/17/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Matt Brown
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD
| | - Linda A Bradbury
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD
| |
Collapse
|
37
|
Jacquemin C, Rubio Vargas R, van den Berg R, Thévenin F, Lenczner G, Reijnierse M, Ferkal S, Le Corvoisier P, Rahmouni A, Loeuille D, Feydy A, Dougados M, van der Heijde D, Claudepierre P. What is the reliability of non-trained investigators in recognising structural MRI lesions of sacroiliac joints in patients with recent inflammatory back pain? Results of the DESIR cohort. RMD Open 2016; 2:e000303. [PMID: 27933207 PMCID: PMC5133415 DOI: 10.1136/rmdopen-2016-000303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/08/2016] [Accepted: 09/12/2016] [Indexed: 12/20/2022] Open
Abstract
Objective The objective of this study was to evaluate the reliability of recognising structural lesions on MRI (erosions, fatty lesions, ankylosis) of the sacroiliac joints (MRI-SIJ) in clinical practice compared to a central reading in patients with a possible recent axial spondyloarthritis (axSpA). Methods Patients aged 18–50 years, with recent (<3 years) and chronic (≥3 months) inflammatory back pain, suggestive of axSpA were included in the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort. MRI-SIJ structural lesions were scored by non-trained local readers, and by two trained central readers. Local readers scored each SIJ as normal, doubtful or definite lesions. Central readers scored separately each type of lesion. The central reading (mean of the two central readers’ scores) was the external standard. Agreement (κ) was calculated first between local (3 definitions of a positive MRI-SIJ) and central readings (9 definitions), and then between the two central readers. Results 664/708 patients with complete available images were included. Agreements between local and central readings were overall ‘fair’, except when considering at least 2 or 3 fatty lesions and at least 3 erosions and/or fatty lesions where agreement was ‘moderate’. Agreement between central readers was similar. MRI-SIJ was positive for 52.6% of patients according to central reading (at least 1 structural lesion) and for 35.4% of patients according to local reading (at least unilateral ‘doubtful‘ or ‘definite’ structural lesions). Conclusions Agreement on a positive structural MRI-SIJ was fair to moderate between local and central readings, as well as between central readers. The reliability improved when fatty lesions were considered. Trial registration number NCTO 164 8907.
Collapse
Affiliation(s)
| | - Roxana Rubio Vargas
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Rosaline van den Berg
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | | | - Gregory Lenczner
- Department of Radiology , Clinique Hartmann , Neuilly-sur-Seine , France
| | - Monique Reijnierse
- Department of Radiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Salah Ferkal
- Clinical Investigation Center 1430, AP-HP and Inserm, Hôpital Henri Mondor , Créteil , France
| | - Philippe Le Corvoisier
- Clinical Investigation Center 1430, AP-HP and Inserm, Hôpital Henri Mondor , Créteil , France
| | - Alain Rahmouni
- Department of Radiology , Hôpital Henri Mondor , Créteil , France
| | - Damien Loeuille
- Department of Rheumatology , Hôpital Brabois , Nancy , France
| | - Antoine Feydy
- Department of Radiology , Hôpital Cochin , Paris , France
| | - Maxime Dougados
- Department of Rheumatology , Hôpital Cochin , Paris , France
| | - Désirée van der Heijde
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Pascal Claudepierre
- Department of Rheumatology, Hôpital Henri Mondor, Créteil, France; Université Paris Est Créteil, EA 7379-EpidermE, F-94010, Créteil, France
| |
Collapse
|
38
|
Different roles of TNF inhibitors in acute anterior uveitis associated with ankylosing spondylitis: state of the art. Clin Rheumatol 2016; 35:2631-2638. [DOI: 10.1007/s10067-016-3426-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/18/2016] [Accepted: 09/18/2016] [Indexed: 12/20/2022]
|
39
|
Braun J, Baraliakos X, Hermann KGA, Xu S, Hsu B. Serum Vascular Endothelial Growth Factor Levels Lack Predictive Value in Patients with Active Ankylosing Spondylitis Treated with Golimumab. J Rheumatol 2016; 43:901-6. [PMID: 26932345 DOI: 10.3899/jrheum.150897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To assess vascular endothelial growth factor (VEGF) correlations with new bone formation and bone marrow edema in patients with ankylosing spondylitis (AS) treated with golimumab (GOL). METHODS Following placebo control (through weeks 16 and 24), GO-RAISE (A Multicenter Randomized, Double-blind, Placebo-controlled Trial of Golimumab, a Fully Human Anti-TNF-α Monoclonal Antibody, Administered Subcutaneously, in Subjects with Active Ankylosing Spondylitis; ClinicalTrials.gov: NCT00265083) all patients received GOL; sera/images were available at weeks 0, 104, and 208. Lateral spinal radiographs and magnetic resonance imaging (MRI) were scored using the modified Stokes Ankylosing Spondylitis Spine Score (mSASSS) and the Ankylosing Spondylitis Spinal MRI activity score, respectively. RESULTS VEGF levels and the mSASSS did not significantly correlate. Logistic regression analyses showed no association between VEGF levels and an increased risk of syndesmophyte formation at weeks 104 and 208. Pretreatment/Week 14 VEGF did not predict MRI scores/changes at Week 104. CONCLUSION Serum VEGF did not predict radiographic progression/spinal inflammation in patients receiving antitumor necrosis factor.
Collapse
Affiliation(s)
- Jürgen Braun
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC.
| | - Xenofon Baraliakos
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC
| | - Kay-Geert A Hermann
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC
| | - Stephen Xu
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC
| | - Benjamin Hsu
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC
| |
Collapse
|
40
|
Haroon M, FitzGerald O. Psoriatic arthritis: complexities, comorbidities and implications for the clinic. Expert Rev Clin Immunol 2016; 12:405-16. [DOI: 10.1586/1744666x.2016.1139453] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
41
|
Conigliaro P, Chimenti MS, Ascolani M, Triggianese P, Novelli L, Onali S, Lolli E, Calabrese E, Petruzziello C, Pallone F, Perricone R, Biancone L. Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients. Autoimmun Rev 2015; 15:184-90. [PMID: 26554932 DOI: 10.1016/j.autrev.2015.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 11/05/2015] [Indexed: 12/11/2022]
Abstract
Spondyloarthritis (SpA) and inflammatory bowel disease (IBD) are chronic autoinflammatory diseases that partially share the genetic predisposition and the unchecked inflammatory response linking the gut to the joints. The coexistence of both conditions in patients and the increased cross-risk ratios between SpA and IBD strongly suggest a shared pathophysiology. The prevalence of Enteropathic-related Spondyloarthritis (ESpA) in IBD patients shows a wide variation and may be underestimated. It is well accepted that the management of joint pain requires rheumatological expertise in conjunction with gastroenterologist assessment. In this view, we aimed at assessing, in a prospective study performed in a combined Gastro-Intestinal and Rheumatologic "GI-Rhe" clinic: (1) the prevalence of ESpA and other rheumatologic diseases in IBD patients with joint pain; (2) the features of the ESpA population; and (3) the diagnostic delay and the potential impact of the combined assessment. From November 2012 to December 2014, IBD patients with joint pain referring to a dedicated rheumatologist by the IBD-dedicated gastroenterologist were enrolled. Clinical and biochemical evaluations, joint involvement and disease activity assessment, diagnostic delay, and treatment were recorded. IBD patients (n=269) with joint pain were jointly assessed in the "GI-Rhe" Unit. A diagnosis of ESpA was made in 50.5% of IBD patients with joint pain. ESpA patients showed a peripheral involvement in 53% of cases, axial in 20.6% and peripheral and axial in 26.4% of cases. ESpA patients had a higher prevalence of other autoimmune extra-intestinal manifestations and received more anti-TNF treatment compared with IBD patients. A mean diagnostic delay of 5.2 years was revealed in ESpA patients. Patients with joint disease onset in the 2002-2012 decade had reduced diagnostic delay compared with those with onset in the 1980-1990 and 1991-2001 decades. Diagnostic delay was further reduced for patients with joint onset in the last two years in conjunction with the establishment of the GI-Rhe clinic. Multidisciplinary approach improved management of rheumatic disorders in IBD patients allowing a more comprehensive care.
Collapse
Affiliation(s)
- Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Marta Ascolani
- GI Unit, Dpt. Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Lucia Novelli
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Sara Onali
- GI Unit, Dpt. Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Elisabetta Lolli
- GI Unit, Dpt. Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Emma Calabrese
- GI Unit, Dpt. Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | | | - Francesco Pallone
- GI Unit, Dpt. Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University Tor Vergata, Rome, Italy.
| | - Livia Biancone
- GI Unit, Dpt. Department of Systems Medicine, University Tor Vergata, Rome, Italy
| |
Collapse
|
42
|
|
43
|
Wendling D. Treating to target in axial spondyloarthritis: defining the target and the arrow. Expert Rev Clin Immunol 2015; 11:691-3. [DOI: 10.1586/1744666x.2015.1039514] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
44
|
Robinson PC, Benham H. Advances in classification, basic mechanisms and clinical science in ankylosing spondylitis and axial spondyloarthritis. Intern Med J 2015; 45:127-33. [DOI: 10.1111/imj.12544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/26/2014] [Indexed: 12/28/2022]
Affiliation(s)
- P. C. Robinson
- University of Queensland Diamantina Institute; Translational Research Institute; Princess Alexandra Hospital; Brisbane Queensland Australia
- Department of Rheumatology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - H. Benham
- University of Queensland Diamantina Institute; Translational Research Institute; Princess Alexandra Hospital; Brisbane Queensland Australia
- Department of Rheumatology; Princess Alexandra Hospital; Brisbane Queensland Australia
- Department of Medicine; University of Queensland School of Medicine; Brisbane Queensland Australia
| |
Collapse
|