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Interligator S, Le Bozec A, Cluzel G, Devilder M, Ghaouche J, Guenoun D, Fleury A, Petit Lemaire F, Carlier RY, Valente C, Creze M. Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation. Skeletal Radiol 2024; 53:2247-2262. [PMID: 38110777 DOI: 10.1007/s00256-023-04535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To describe the frequency of MR and CT features of infectious sacroiliitis (ISI) and assess its extent and complications MATERIALS AND METHODS: This retrospective study included patients with ISI who were evaluated between 2008 and 2021 in a single center. Two radiologists reviewed MRI and CT images to determine the anatomical distribution (unilateral/bilateral, iliac/sacral bone, proximal/middle/distal), severity (bone marrow edema [BME]/periostitis/erosions), concurrent infection (vertebral/nonvertebral), and complications (abscess/probable adjacent osteomyelitis/cavitation/devitalized areas/sequestrum/pelvic venous thrombosis) of ISI. Interobserver reproducibility was assessed. Correlation analysis evaluated the effect of the causative microorganism on severity. Two human bodies were dissected to outline possible ways that ISI can spread. RESULTS Forty patients with ISI (40 years ± 22; 26 women) were evaluated. Ten patients had bilateral ISI. Concurrent vertebral infection was associated in 15% of cases. Reproducibility of sacral BME, periostitis, and reactive locoregional abnormalities was perfect (κ = 1). Reproducibility was low for erosion count (κ = 0.52[0.52-0.82]) and periarticular osteopenia (κ = 0.50[0.18-0.82]). Inflammatory changes were BME (42/42 joints), muscle edema (38/42), and severe periostitis along the ilium (33/37). Destructive structural changes occurred with confluent erosions (iliac, 20/48; sacral, 13/48), sequestrum (20/48), and cavitation (12/48). Complications occurred in 75% of cases, including periarticular abscesses (n = 30/47), probable adjacent osteomyelitis (n = 16/37), and pelvic thrombophlebitis (n = 3). Tuberculous ISI (6/40) correlated with sclerosis (rs = 0.45[0.16; 0.67]; p < 10-2) and bone devitalization (rs = 0.38[0.16; 0.67]; p = .02). The anatomical study highlighted the shared venous vascularization of sacroiliac joints, pelvic organs, and mobile spine. CONCLUSION Complications of ISI are frequent, including abscesses, adjacent osteomyelitis, and periostitis. ISI had bilateral involvement nonrarely and is commonly associated with another spinal infection.
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Affiliation(s)
- Sarah Interligator
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Antoine Le Bozec
- Department of Pharmacy, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Guillaume Cluzel
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Matthieu Devilder
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Jessica Ghaouche
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Daphne Guenoun
- Department of Radiology, Hôpital Sainte-Marguerite, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Albane Fleury
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Florian Petit Lemaire
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Robert-Yves Carlier
- Department of Radiology, Hôpital Raymond Poincaré, Assistance-Publique des Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, 92380 Garches, Paris, France
| | - Catarina Valente
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Maud Creze
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France.
- Laboratoire d'Imagerie Biomedicale Multimodale Paris-Saclay, BioMaps, Paris-Saclay University, 4 place du Général Leclerc, 91401 Orsay, Paris, France.
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Huang H, Zhuang F, Liu X, Wu K, Wang F, Zhao X, Zhang Y, Cao D. T2* cartilage mapping in early axial spondyloarthritis: diagnostic accuracy and correlation with clinical characteristics, sacroiliitis MRI scorings, and diffusion metrics. Eur Radiol 2024:10.1007/s00330-024-10975-2. [PMID: 39048742 DOI: 10.1007/s00330-024-10975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/19/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To determine the performance of T2* cartilage mapping in diagnosing and assessing disease activity in early axial spondyloarthritis (axSpA), and to investigate the interaction of cartilage damage with clinical characteristics, sacroiliitis MRI scorings, and diffusion metrics. MATERIALS AND METHODS This prospective study included 83 axSpA patients and 37 no-axSpA patients. Clinical characteristics, the Assessment of SpondyloArthritis International Society-defined active sacroiliitis on MRI, and T2* SIJs values were recorded. In axSpA, disease activity was evaluated using the ankylosing spondylitis disease activity score-C-reactive protein; active sacroiliitis was evaluated using Spondyloarthritis Research Consortium of Canada, intravoxel incoherent motion, and diffusion kurtosis imaging; chronic sacroiliitis was assessed using composite structural damage score (CSDS) and structural score fat. Mann-Whitney U-test, Kruskal-Wallis test with false discovery rate (FDR), ROC curve, and linear regression were used for statistical analysis. RESULTS AxSpA patients had significantly higher T2*SIJs values than no-axSpA patients. (22.86 ± 2.42 ms vs 20.36 ± 1.30 ms, p < 0.001). The combination of T2*SIJs values and active sacroiliitis on MRI had the highest AUC for identifying axSpA. T2*SIJs values were significantly different between the inactive and very high, moderate and very high, high and very high, as well as inactive and high disease activity groups (all pFDR < 0.05). Dk (β = 0.48) and CSDS (β = 0.48) were independently associated with T2*SIJs values. CONCLUSION T2* values may be a promising biomarker for diagnosing and differentiating disease activity in early axSpA. Both acute and chronic sacroiliitis influence cartilage properties. CLINICAL RELEVANCE STATEMENT Sacroiliac joint cartilage abnormalities can be quantified with T2* relaxation time and allow better characterization of early axSpA. KEY POINTS T2* mapping may have value in evaluating axSpA. The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA. Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.
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Affiliation(s)
- Hongjie Huang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Feifei Zhuang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xi Liu
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Keyi Wu
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Feng Wang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Yuyang Zhang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
| | - Dairong Cao
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
- Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Bozbeyoğlu SG, Öztürk K. Effective diagnosis of sacroiliitis in children: evaluating magnetic resonance imaging with the Canadian scoring system. Clin Rheumatol 2024; 43:2125-2131. [PMID: 38702567 DOI: 10.1007/s10067-024-06979-4] [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: 12/08/2023] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To reveal the differences by comparing the magnetic resonance imaging (MRI) findings of patients with clinically symptomatic sacroiliitis with those undergoing sacroiliac imaging for other reasons using the Canadian Spondyloarthritis Research Consortium-Sacroiliac Inflammatory Scoring System (SPARCC-SIS). METHODS In this retrospective single-center study, sacroiliac MRIs performed between 2017 and 2023 were evaluated from the database. The SPARCC-SIS scoring system is used to evaluate and grade the inflammation of the sacroiliac joints. Mild inflammation is indicated by a score below 24, moderate by a score of 24-48, and severe by a score above 49. Additionally, structural defects of the sacroiliac joint, such as erosion, sclerosis, and ankylosis, were observed. After MRI evaluation, clinically symptomatic (group 1) and non-symptomatic (group 2) patients were divided into two groups. The clinical and laboratory findings of the patients and MRI findings were compared. The patient's age, gender, clinical information from hospital records, acute phase reactants (APRs), and the presence of the Human Leukocyte Antigen (HLA-B27) gene (if applicable) were thoroughly recorded. RESULTS One hundred thirty-six children who performed sacroiliac MRI for any indication were included in the study. The APRs positivity, presence of HLA-B27, and SPARCC scoring system were significantly higher in 24 patients with clinical sacroiliitis (group 1) than in 112 patients without sacroiliitis (group 2). In our study, the most common MRI findings in children were bone marrow edema, capsulitis, synovitis, and erosion, while chronic structural changes such as sclerosis and ankylosing were rare. CONCLUSION In this study, the SPARCC scoring method, which shows the severity of sacroiliac joint inflammation, correlates with the clinical diagnosis of sacroiliitis. In cases with suspected sacroiliitis, except for extraordinary reasons, it can be evaluated with MRI without contrast material and can be graded to guide the clinician in treatment and approach.
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Affiliation(s)
- Sabriye Gülçin Bozbeyoğlu
- Department of Radiology, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey.
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Istanbul Medeniyet University Göztepe Prof. Dr. SuleymanYalcin City Hospital, Istanbul, Turkey
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Maksymowych WP, Claudepierre P, de Hooge M, Lambert RG, Landewé R, Molto A, van der Heijde D, Bukowski JF, Jones H, Pedersen R, Szumski A, Vlahos B, Dougados M. Erosions on T1-Weighted Magnetic Resonance Imaging Versus Radiography of Sacroiliac Joints in Recent-Onset Axial Spondyloarthritis: 2-Year Data (EMBARK Trial and DESIR Cohort). J Rheumatol 2024; 51:462-471. [PMID: 38359938 DOI: 10.3899/jrheum.2023-0906] [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] [Accepted: 12/15/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE (1) To compare the capacity to detect sacroiliac joint (SIJ) erosions and baseline-to-week 104 change in erosions between magnetic resonance imaging (MRI) and radiographs in recent-onset axial spondyloarthritis (axSpA); and (2) to compare treatment-discriminatory capacities of MRI and radiographic scores for erosion detection in patients receiving etanercept in the Effect of Etanercept on Symptoms and Objective Inflammation in Nonradiographic axSpA (EMBARK) trial vs controls in the DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes) cohort. METHODS Anonymized SIJ MRI and radiographs were assessed at patient and joint surface levels. Three readers evaluated MRI; 3 different readers evaluated radiographs. Final scores for comparison of radiographs and MRI for detection of erosions were assigned based on agreement of ≥ 2 of 3 readers' assessments. RESULTS At baseline, discordance in erosion detection between imaging methods was more frequent for MRI erosions in the absence of radiographic erosions (48/224 [21.4%] patients) than for radiographic erosions in the absence of MRI erosions (14/224 [6.3%] patients; P < 0.001). After 104 weeks, a decrease in erosions was observed on MRI but not radiographs in 49/221 (22.2%) patients, and on radiographs but not MRI in 6/221 (2.7%) patients (P < 0.001). In the treatment-discriminant capacity analysis, the largest standardized differences between etanercept and control cohorts at week 104 were changes in Spondyloarthritis Research Consortium of Canada MRI erosion discrete score, changes in erosion average score, and meeting the modified New York criteria on radiographs, with unadjusted/adjusted Hedges G effect sizes of 0.40/0.50, 0.40/0.56, and 0.40/0.43, respectively. CONCLUSION In recent-onset axSpA, SIJ erosions and erosion change were observed more frequently on MRI than radiography. The significance of interval improvement of MRI erosions warrants further research. [ClinicalTrials.gov: NCT01258738, NCT01648907].
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Affiliation(s)
- Walter P Maksymowych
- W.P. Maksymowych, MD, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada;
| | - Pascal Claudepierre
- P. Claudepierre, MD, Department of Rheumatology, CHU Henri Mondor, Paris, France
| | - Manouk de Hooge
- M. de Hooge, PhD, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Robert G Lambert
- R.G. Lambert, MB, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Landewé
- R. Landewé, MD, Amsterdam University Medical Center, Amsterdam, and Zuyderland Medical Center, Heerlen, the Netherlands
| | - Anna Molto
- A. Molto, MD, Department of Rheumatology, CHU Cochin, Paris, INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne, Paris, France
| | - Désirée van der Heijde
- D. van der Heijde, MD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jack F Bukowski
- J.F. Bukowski, MD, B. Vlahos, MBA, BSN, RN, Global Clinical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Heather Jones
- H. Jones, RN, Global Medical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Ron Pedersen
- R. Pedersen, MS, Department of Biostatistics, Pfizer, Collegeville, Pennsylvania, USA
| | | | - Bonnie Vlahos
- J.F. Bukowski, MD, B. Vlahos, MBA, BSN, RN, Global Clinical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Maxime Dougados
- M. Dougados, MD, Department of Rheumatology, CHU Cochin, Paris, France
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Li X, Lin Y, Xie Z, Lu Z, Song L, Ye Q, Wang M, Fang X, He Y, Chen H, Zhao Y. Automatic segmentation of fat metaplasia on sacroiliac joint MRI using deep learning. Insights Imaging 2024; 15:93. [PMID: 38530554 DOI: 10.1186/s13244-024-01659-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE To develop a deep learning (DL) model for segmenting fat metaplasia (FM) on sacroiliac joint (SIJ) MRI and further develop a DL model for classifying axial spondyloarthritis (axSpA) and non-axSpA. MATERIALS AND METHODS This study retrospectively collected 706 patients with FM who underwent SIJ MRI from center 1 (462 axSpA and 186 non-axSpA) and center 2 (37 axSpA and 21 non-axSpA). Patients from center 1 were divided into the training, validation, and internal test sets (n = 455, 64, and 129). Patients from center 2 were used as the external test set. We developed a UNet-based model to segment FM. Based on segmentation results, a classification model was built to distinguish axSpA and non-axSpA. Dice Similarity Coefficients (DSC) and area under the curve (AUC) were used for model evaluation. Radiologists' performance without and with model assistance was compared to assess the clinical utility of the models. RESULTS Our segmentation model achieved satisfactory DSC of 81.86% ± 1.55% and 85.44% ± 6.09% on the internal cross-validation and external test sets. The classification model yielded AUCs of 0.876 (95% CI: 0.811-0.942) and 0.799 (95% CI: 0.696-0.902) on the internal and external test sets, respectively. With model assistance, segmentation performance was improved for the radiological resident (DSC, 75.70% vs. 82.87%, p < 0.05) and expert radiologist (DSC, 85.03% vs. 85.74%, p > 0.05). CONCLUSIONS DL is a novel method for automatic and accurate segmentation of FM on SIJ MRI and can effectively increase radiologist's performance, which might assist in improving diagnosis and progression of axSpA. CRITICAL RELEVANCE STATEMENT DL models allowed automatic and accurate segmentation of FM on sacroiliac joint MRI, which might facilitate quantitative analysis of FM and have the potential to improve diagnosis and prognosis of axSpA. KEY POINTS • Deep learning was used for automatic segmentation of fat metaplasia on MRI. • UNet-based models achieved automatic and accurate segmentation of fat metaplasia. • Automatic segmentation facilitates quantitative analysis of fat metaplasia to improve diagnosis and prognosis of axial spondyloarthritis.
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Affiliation(s)
- Xin Li
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Yi Lin
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, 999077, China
| | - Zhuoyao Xie
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Zixiao Lu
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Liwen Song
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Qiang Ye
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Menghong Wang
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Xiao Fang
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, 999077, China
| | - Yi He
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, China
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, 999077, China
| | - Yinghua Zhao
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China.
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Maksymowych W, Hadsbjerg AEFEF, Østergaard M, Micheroli R, Pedersen SJ, Ciurea A, Vladimirova N, Nissen MS, Bubova K, Wichuk S, de Hooge M, Mathew AJ, Pintaric K, Gregová M, Snoj Z, Wetterslev M, Gorican K, Möller B, Eshed I, Paschke J, Lambert RG. Validation of SPARCC MRI-RETIC e-tools for increasing scoring proficiency of MRI sacroiliac joint lesions in axial spondyloarthritis. RMD Open 2024; 10:e003923. [PMID: 38351052 PMCID: PMC10868186 DOI: 10.1136/rmdopen-2023-003923] [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: 11/19/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The Spondyloarthritis Research Consortium of Canada (SPARCC) developers have created web-based calibration modules for the SPARCC MRI sacroiliac joint (SIJ) scoring methods. We aimed to test the impact of applying these e-modules on the feasibility and reliability of these methods. METHODS The SPARCC-SIJ RETIC e-modules contain cases with baseline and follow-up scans and an online scoring interface. Visual real-time feedback regarding concordance/discordance of scoring with expert readers is provided by a colour-coding scheme. Reliability is assessed in real time by intraclass correlation coefficient (ICC), cases being scored until ICC targets are attained. Participating readers (n=17) from the EuroSpA Imaging project were randomised to one of two reader calibration strategies that each comprised three stages. Baseline and follow-up scans from 25 cases were scored after each stage was completed. Reliability was compared with a SPARCC developer, and the System Usability Scale (SUS) assessed feasibility. RESULTS The reliability of readers for scoring bone marrow oedema was high after the first stage of calibration, and only minor improvement was noted following the use of the inflammation module. Greater enhancement of reader reliability was evident after the use of the structural module and was most consistently evident for the scoring of erosion (ICC status/change: stage 1 (0.42/0.20) to stage 3 (0.50/0.38)) and backfill (ICC status/change: stage 1 (0.51/0.19) to stage 3 (0.69/0.41)). The feasibility of both e-modules was evident by high SUS scores. CONCLUSION The SPARCC-SIJ RETIC e-modules are feasible, effective knowledge transfer tools, and their use is recommended before using the SPARCC methods for clinical research and tria.
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Affiliation(s)
- Walter Maksymowych
- Medicine, University of Alberta, Edmonton, Alberta, Canada
- CARE ARTHRITIS Limited, Edmonton, Alberta, Canada
| | - Anna Enevold Fløistrup E F Hadsbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Susanne Juhl Pedersen
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Nora Vladimirova
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Kristyna Bubova
- First Faculty of Medicine, Rheumatology, Charles University, Prague, Czech Republic
| | - Stephanie Wichuk
- Rheumatology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Manouk de Hooge
- Ghent University Hospital, Ghent, Oost-Vlaanderen, Belgium
- Leiden University, Leiden, Netherlands
| | - Ashish J Mathew
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Clinical Immunology and Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
| | | | - Monika Gregová
- First Faculty of Medicine, Rheumatology, Charles University, Prague, Czech Republic
| | - Ziga Snoj
- Radiology, UKC Ljubljana, Ljubljana, Slovenia
| | - Marie Wetterslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karel Gorican
- Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Burkhard Möller
- Rheumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Robert Gw Lambert
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Jones A, Bray TJP, Sakai NS, Bainbridge AJP, Ciurtin C, Hall-Craggs MA. Measuring response to treatment in axial spondyloarthritis using quantitative imaging biomarkers: a prospective observational cohort study. Br J Radiol 2023; 96:20220530. [PMID: 37751217 PMCID: PMC10646635 DOI: 10.1259/bjr.20220530] [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: 05/20/2022] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Objective assessments of disease activity and response to treatment in axial spondyloarthritis (axSpA) remain a challenge; quantitative imaging biomarkers (QIBs) of inflammation could enhance assessments of disease activity and therapeutic response. We aimed to determine the responsiveness of QIBs obtained from diffusion-weighted imaging (DW-MRI) and chemical shift-encoded MRI (CSE-MRI) using the partially automated Bone Edema and Adiposity Characterisation with Histograms (BEACH) software tool in axSpA patients undergoing biologic therapy. METHODS We conducted a prospective longitudinal cohort study, including 30 patients with axSpA undergoing biologic therapy. Patients were scanned before and after biologic therapy using conventional MRI, DWI and CSE-MRI at 3T. Apparent diffusion coefficient (ADC) and proton density fat fraction (PDFF) were assessed using the BEACH tool (https://github.com/TJPBray/BEACH), and conventional MR images were assessed using established visual scoring methods by expert radiologists. Responsiveness - the ability of the MRI measurements to capture changes in disease occurring as a result of biologic therapy - was assessed using the standardized response mean (SRM). Inter-reader reliability of the ADC and PDFF maps was assessed using Bland-Altman limits of agreement analysis and the intraclass correlation coefficient. RESULTS Responsiveness to therapy was moderate for ADC-based parameters (SRM 0.50) and comparable to established visual scoring methods for bone marrow oedema (SRM 0.53). Interobserver variability was lower for QIBs compared with conventional visual scores methods. CONCLUSIONS QIBs measured using the BEACH tool are sensitive to changes in inflammation in axSpA following biologic therapy, with similar responsiveness and lower interobserver variability to visual scoring by expert radiologists. ADVANCES IN KNOWLEDGE QIBs measured using the partially automated BEACH tool offer an objective measure of response to biologic therapy in axSpA.
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Affiliation(s)
- Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Timothy JP Bray
- Centre for Medical Imaging, University College London, London, UK
| | - Naomi S Sakai
- Centre for Medical Imaging, University College London, London, UK
| | - Alan JP Bainbridge
- Department of Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
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Port H, Holm Nielsen S, Frederiksen P, Madsen SF, Bay-Jensen AC, Sørensen IJ, Jensen B, Loft AG, Madsen OR, Østergaard M, Pedersen SJ. Extracellular matrix turnover biomarkers reflect pharmacodynamic effects and treatment response of adalimumab in patients with axial spondyloarthritis-results from two randomized controlled trials. Arthritis Res Ther 2023; 25:157. [PMID: 37626399 PMCID: PMC10463764 DOI: 10.1186/s13075-023-03132-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To investigate if extracellular matrix (ECM) blood-based biomarkers reflect the pharmacodynamic effect and response to TNF-α inhibitor therapy (adalimumab, ADA), in patients with axial spondyloarthritis (axSpA). METHODS We investigated ECM biomarkers in two randomized, double-blind, placebo-controlled trials of axSpA patients (DANISH and ASIM, n = 52 and n = 49, respectively) receiving ADA 40 mg or placebo every other week for 12 and 6 weeks, respectively, and thereafter ADA to week 48. Serum concentrations of degraded type I (C1M), II (C2M, T2CM), III (C3M), IV (C4M), VI (C6M), type X (C10C) collagen; metabolite of C-reactive protein (CRPM), prolargin (PROM), citrullinated vimentin (VICM), calprotectin (CPa9-HNE); and formation of type II (PRO‑C2), III (PRO‑C3), and VI (PRO‑C6) turnover of type IV collagen (PRO-C4) were measured at baseline and weeks 6 or 12, 24, and 48. The pharmacodynamic effect and treatment response to ADA was evaluated by linear mixed models, and correlations between biomarkers and clinical scores were assessed by Spearman's correlation. RESULTS C1M, C3M, C4M, C6M, CRP, PRO-C4, and CPa9-HNE levels declined after 6 or 12 weeks in patients receiving ADA compared to placebo (all p < 0.05). Patients with AS Disease Activity Score C-reactive protein (ASDAS CRP) major improvement and/or clinically important improvement had significantly higher C1M, C3M, C4M, C6M, and PRO-C4 levels than patients with no/low improvement at baseline (all p < 0.05). Baseline levels of biomarkers showed weak to moderate correlations with ASDAS and structural damage scores. CONCLUSION ECM metabolites showed a pharmacodynamic effect and were associated with ASDAS response during TNF-α inhibitor treatment in patients with axSpA.
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Affiliation(s)
- Helena Port
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Nordic Bioscience A/S, Immunoscience, Herlev, Denmark.
| | - Signe Holm Nielsen
- Nordic Bioscience A/S, Immunoscience, Herlev, Denmark
- Biomedicine and Biotechnology, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | - Sofie Falkenløve Madsen
- Nordic Bioscience A/S, Immunoscience, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Inge Juul Sørensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
| | - Bente Jensen
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Ole Rintek Madsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Østergaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Juhl Pedersen
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
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Herregods N, Anisau A, Schiettecatte E, Vereecke E, Morbée L, Laloo F, Jaremko JL, Jans L. MRI in pediatric sacroiliitis, what radiologists should know. Pediatr Radiol 2023; 53:1576-1586. [PMID: 36856758 DOI: 10.1007/s00247-023-05602-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 03/02/2023]
Abstract
MRI is used for early detection of inflammation of sacroiliac joints as it shows active lesions of sacroiliitis long before radiographs show damage to the sacroiliac joints. Early diagnosis of arthritis allows early treatment of inflammation and can help delay disease progression and prevent irreversible damage. Also, early identification of axial involvement in juvenile spondyloarthropathy is crucial, as treatment options are different than for peripheral juvenile spondyloarthropathy. In general, standard sequences used in adults are also applied to children. However, interpreting MR images of pediatric sacroiliac joints is more challenging than in adults, because of normal physiological changes during skeletal maturation, which can simulate disease on MR images. Furthermore, classical definitions of sacroiliitis used in adults, for both active inflammatory and structural lesions, can be difficult to extrapolate to children. The development of reliable pediatric-specific definitions for sacroiliitis is still in active study. Understanding both normal and pathological signal changes in children is important to distinguish physiologic findings from disease and to make a correct diagnosis. In this review, the main imaging characteristics of sacroiliitis on MRI in children and its frequent pitfalls will be illustrated, while also citing some discussion points regarding the scan protocol.
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Affiliation(s)
- Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Aliaksandr Anisau
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Eva Schiettecatte
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Elke Vereecke
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, 8440-112 Street, EdmontonAlberta, T6G 2B7, Canada
- Medical Imaging Consultants, Edmonton, AB, Canada
| | - Lennart Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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10
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Weiss PF, Brandon TG, Lambert RG, Biko DM, Chauvin NA, Francavilla ML, Jaremko JL, Herregods N, Kasapcopur O, Yildiz M, Hendry AM, Maksymowych WP. Data-Driven Magnetic Resonance Imaging Definitions for Active and Structural Sacroiliac Joint Lesions in Juvenile Spondyloarthritis Typical of Axial Disease: A Cross-Sectional International Study. Arthritis Care Res (Hoboken) 2023; 75:1220-1227. [PMID: 36063392 PMCID: PMC9985663 DOI: 10.1002/acr.25014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/11/2022] [Accepted: 09/01/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We aimed to determine quantitative sacroiliac (SI) joint magnetic resonance imaging (MRI) cutoffs for active and structural lesions that will be incorporated as imaging domains in classification criteria of axial disease in juvenile spondyloarthritis (SpA). METHODS MRI scans from an international cross-section of juvenile SpA patients were reviewed by 6 musculoskeletal imaging experts blinded to clinical details. Raters globally assessed the presence/absence of lesions typical of axial SpA and performed SI joint quadrant- or joint-based scoring. Sensitivity and specificity of lesion cutoffs were calculated using a rater majority (≥4 of 6 raters) on a global assessment of the presence/absence of active or structural lesions typical of axial SpA with high confidence as the reference standard. Cutoffs were validated in an independent cohort. RESULTS Imaging from 243 subjects, 61% male, median age 14.9 years, had sequences available for detailed MRI scoring. Optimal cutoffs for defining lesions typical of axial disease in juvenile SpA were: 1) inflammatory lesion: bone marrow edema in ≥3 SI joint quadrants across all SI joint MRI slices (sensitivity 98.6%, specificity 96.5%); 2) structural lesions: erosion in ≥3 quadrants or sclerosis or fat lesion in ≥2 SI joint quadrants or backfill or ankylosis in ≥2 joint halves across all SI joint MRI slices (sensitivity 98.6%, specificity 95.5%). Sensitivity and specificity of the optimal cutoffs in the validation cohort were excellent. CONCLUSION We propose data-driven cutoffs for active inflammatory and structural lesions on MRI typical of axial disease in juvenile SpA that have high specificity and sensitivity using central imaging global assessment as the reference standard and excellent reliability.
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Affiliation(s)
- Pamela F Weiss
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy G Brandon
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David M Biko
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy A Chauvin
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | - Ozgur Kasapcopur
- Istanbul University-Cerrahpasa and Cerrahpasa Medical School, Istanbul, Turkey
| | - Mehmet Yildiz
- Istanbul University-Cerrahpasa and Cerrahpasa Medical School, Istanbul, Turkey
| | - Alison M Hendry
- Counties Manukau District Health Board, Auckland, New Zealand
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11
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Weiss PF, Brandon TG, Lambert RG, Biko DM, Chauvin NA, Francavilla ML, Jaremko JL, Herregods N, Kasapcopur O, Yildiz M, Hendry AM, Maksymowych WP. Data-Driven Magnetic Resonance Imaging Definitions for Active and Structural Sacroiliac Joint Lesions in Juvenile Spondyloarthritis Typical of Axial Disease: A Cross-Sectional International Study. Arthritis Care Res (Hoboken) 2023; 75:1220-1227. [PMID: 36063392 PMCID: PMC9985663 DOI: 10.1002/acr.25014 10.1002/acr.25014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/11/2022] [Accepted: 09/01/2022] [Indexed: 06/30/2024]
Abstract
OBJECTIVE We aimed to determine quantitative sacroiliac (SI) joint magnetic resonance imaging (MRI) cutoffs for active and structural lesions that will be incorporated as imaging domains in classification criteria of axial disease in juvenile spondyloarthritis (SpA). METHODS MRI scans from an international cross-section of juvenile SpA patients were reviewed by 6 musculoskeletal imaging experts blinded to clinical details. Raters globally assessed the presence/absence of lesions typical of axial SpA and performed SI joint quadrant- or joint-based scoring. Sensitivity and specificity of lesion cutoffs were calculated using a rater majority (≥4 of 6 raters) on a global assessment of the presence/absence of active or structural lesions typical of axial SpA with high confidence as the reference standard. Cutoffs were validated in an independent cohort. RESULTS Imaging from 243 subjects, 61% male, median age 14.9 years, had sequences available for detailed MRI scoring. Optimal cutoffs for defining lesions typical of axial disease in juvenile SpA were: 1) inflammatory lesion: bone marrow edema in ≥3 SI joint quadrants across all SI joint MRI slices (sensitivity 98.6%, specificity 96.5%); 2) structural lesions: erosion in ≥3 quadrants or sclerosis or fat lesion in ≥2 SI joint quadrants or backfill or ankylosis in ≥2 joint halves across all SI joint MRI slices (sensitivity 98.6%, specificity 95.5%). Sensitivity and specificity of the optimal cutoffs in the validation cohort were excellent. CONCLUSION We propose data-driven cutoffs for active inflammatory and structural lesions on MRI typical of axial disease in juvenile SpA that have high specificity and sensitivity using central imaging global assessment as the reference standard and excellent reliability.
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Affiliation(s)
- Pamela F Weiss
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy G Brandon
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David M Biko
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy A Chauvin
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | - Ozgur Kasapcopur
- Istanbul University-Cerrahpasa and Cerrahpasa Medical School, Istanbul, Turkey
| | - Mehmet Yildiz
- Istanbul University-Cerrahpasa and Cerrahpasa Medical School, Istanbul, Turkey
| | - Alison M Hendry
- Counties Manukau District Health Board, Auckland, New Zealand
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12
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Chen M, Yu K, Hu X, Jans L, Qi Y, Liu X, Cheng G. Intermediate-weighted MRI with fat suppression (IW-FS): diagnostic performance for bone marrow edema and erosion detection in axial spondyloarthritis. Acta Radiol 2023; 64:1927-1933. [PMID: 36748101 DOI: 10.1177/02841851231153282] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bone marrow edema (BME) and erosion of the sacroiliac joint are both key lesions for diagnosing axial spondyloarthritis (axSpA) on magnetic resonance imaging (MRI). PURPOSE To qualitatively and quantitatively compare intermediate-weighted MRI with fat suppression (IW-FS) with T2-weighted short tau inversion recovery (T2-STIR) in assessment of sacroiliac BME and erosion in axSpA. MATERIAL AND METHODS Patients aged 18-60 years with axSpA were prospectively enrolled. All patients underwent a 3.0-T MRI examination of the sacroiliac joints. Para-coronal IW-FS, T2-STIR, and T1-weighted (T1W) images were acquired. BME and erosion were scored by two readers in consensus on IW-FS and STIR using a modified Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. Consensus scores on T1WI were used as the reference for erosion. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured for BME. RESULTS In total, 49 patients (mean age=33.4 ± 7.6 years) were included. More patients were scored as having BME on T2-STIR (36 vs. 29, P = 0.016). SPARCC-BME score on IW-FS was lower than that acquired on T2-STIR (mean, 11.5 vs. 14.7, P = 0.002). SNR and CNR of BME were both lower on IW-FS than on T2-STIR (mean SNR, 118 vs. 218, P < 0.001; mean CNR, 44 vs. 137, P < 0.001). The sensitivity of erosion detection was higher on IW-FS (83%) than on T2-STIR (54%, P = 0.006). CONCLUSION IW-FS is not sufficient for BME detection using T2-STIR as the reference standard in patients with axSpA. IW-FS has a much higher sensitivity than T2-STIR for erosion detection in the sacroiliac joint.
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Affiliation(s)
- Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China
| | - Keyan Yu
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Xuehan Hu
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Yulong Qi
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Xin Liu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China
- University of Chinese Academy of Sciences, Beijing, PR China
| | - Guanxun Cheng
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, PR China
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13
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[Chronic back pain in axial spondylarthritis : Current diagnostic challenges and treatment possibilities]. Z Rheumatol 2023; 82:10-17. [PMID: 36044071 PMCID: PMC9894960 DOI: 10.1007/s00393-022-01256-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Among chronic back diseases, axial spondylarthritis (axSpA) is the entity with the largest spectrum of specific anti-inflammatory treatment modalities; however, from a general medical perspective axSpA is only ranked as another etiology of back pain to be considered after spinal cord or cauda equina compression, bone metastases, epidural abscess or osteomyelitis of the vertebrae, radiculopathy or spinal stenosis. Due to its relatively low prevalence and mostly later occurring sequelae, there is a danger that axSpA will be a relatively neglected entity for specialists. RESULTS This article recapitulates the recommendations of the Assessment of Ankylosing Spondyloarthritis International Society (ASAS). This review addresses the practical aspects of the detailed evaluation of treatment attempts carried out so far with nonsteroidal anti-inflammatory drugs (NSAID) for back pain. Undesired effects on the symptoms of the lower intestinal tract could be of particular interest here. The sex-specific differences in the response to treatment with tumor necrosis factor (TNF) inhibitors in axSpA are mentioned. Further aspects of treatment options with biologics in axSpA are discussed based on a case of maintained remission after a course of interleukin (IL) 17 inhibitors in undifferentiated, HLA-B27 and magnetic resonance imaging (MRI) positive axSpA and long-standing good treatment response to IL-12/23 inhibitor treatment in axial psoriatic arthritis. Furthermore, the literature is discussed with respect to uveitis, carditis and amyloidosis in the context of axSpA. CONCLUSION The early diagnosis in the general medical context and the specific consideration of numerous predictive factors play an increasingly more important role in the personalized treatment of axSpA.
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Detection of erosions and fat metaplasia of the sacroiliac joints in patients with suspected sacroiliitis using a chemical shift-encoded sequence (IDEAL-IQ). Eur J Radiol 2023; 158:110641. [PMID: 36495683 DOI: 10.1016/j.ejrad.2022.110641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/08/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the performance of a chemical shift-encoded sequence called IDEAL-IQ for detecting sacroiliac joint (SIJ) erosions and fat metaplasia compared to T1-weighted fast spin echo (T1 FSE) using qualitative and quantitative analysis. METHOD Thirty-four patients with suspicion of sacroiliitis who underwent both MRI and CT were included. Each SIJ was divided into four quadrants for analysis. For qualitative analysis, the diagnostic performance of IDEAL-IQ and T1 FSE for erosions were compared by the McNemar test, using CT as the gold standard. Cochran's Q and McNemar tests were used to determine differences in structural changes detected by different imaging methods. For quantitative analysis, two-sample t test and receiver operating characteristic (ROC) analysis were used for the analysis of histogram parameters of proton density fat fraction (PDFF). RESULTS Diagnostic sensitivity and accuracy of IDEAL-IQ were greater than T1 FSE for erosions (all P < 0.05). IDEAL-IQ and CT detected more erosions than T1 FSE (all P < 0.05). IDEAL-IQ did not statistically significantly differ from T1 FSE for the detection of fat metaplasia (P = 0.678). All histogram parameters were different between groups with and without fat metaplasia (all P < 0.05) and could distinguish the two groups (all P < 0.05). PDFF75th was the most effective histogram parameter. CONCLUSION IDEAL-IQ detects SIJ erosions with better accuracy than T1 FSE and is similar to T1 FSE for detection of fat metaplasia, enabling further quantitative analysis of the latter via histogram analysis.
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15
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Herregods N, Lambert RGW, Schiettecatte E, Dehoorne J, Renson T, Laloo F, Van Den Berghe T, Jans LBO, Jaremko JL. Blurring and Irregularity of the Subchondral Cortex in Pediatric Sacroiliac Joints on T1 Images: Incidence of Normal Findings That Can Mimic Erosions. Arthritis Care Res (Hoboken) 2023; 75:190-197. [PMID: 34235890 DOI: 10.1002/acr.24746] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/15/2021] [Accepted: 07/06/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine prevalence of variations of subchondral bone appearance that may mimic erosions on T1-weighted magnetic resonance imaging (MRI) of pediatric sacroiliac (SI) joints according to age and sex. METHODS With ethics committee approval and informed consent, SI joint MRIs of 251 children (132 girls), mean age 12.4 years (range 6.1-18.0 years), were obtained in 2 cohorts: 127 children imaged for nonrheumatic reasons, and 124 children with low back pain but no features of sacroiliitis at initial clinical MRI review. MRIs were reviewed by 3 experienced radiologists, blinded from each other, for 3 features of the cortical black line representing the subchondral bone plate on T1-weighted MRI: visibility, blurring, and irregularity. RESULTS Based on agreement from 2 or more readers, the cortical black line was partially absent in 88.4% of the children, blurred in 34.7%, and irregular in 41.4%. All these features were most common on the iliac side of SI joints and at the first sacral vertebra level. Clearly visualized, sharply delineated SI joints with none of these features were seen in only 8.0% of children, or in 35.1% if we conservatively required agreement of all 3 readers to consider a feature present. There was no significant difference between sexes or cohorts; findings were similar across pediatric age groups. CONCLUSION Understanding the normal MRI appearance of the developing SI joint is necessary to distinguish physiologic findings from disease. At least two-thirds (65%) of normal pediatric SI joints showed at least 1 feature that is a component of the adult definition of SI joint erosions, risking overdiagnosis of sacroiliitis.
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Affiliation(s)
| | - Robert G W Lambert
- University of Alberta and Medical Imaging Consultants, Edmonton, Alberta, Canada
| | | | | | | | | | | | | | - Jacob L Jaremko
- University of Alberta and Medical Imaging Consultants, Edmonton, Alberta, Canada
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16
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Sacroiliac joint beyond sacroiliitis-further insights and old concepts on magnetic resonance imaging. Skeletal Radiol 2022; 51:1923-1935. [PMID: 35556157 DOI: 10.1007/s00256-022-04067-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
The sacroiliac joint (SIJ) is an amphiarthrosis composed of a posterior syndesmosis and an anterior cartilaginous portion, with limited yet present mobility. Its main function is to transmit the load from the axial skeleton to the lower limbs and vice-versa; it is susceptible to early mechanical and degenerative changes which are much more common than inflammatory sacroiliitis. Magnetic resonance imaging (MRI) has increasingly been used to evaluate these changes, and while subchondral bone marrow edema (BME) is a common finding related to both, care must be taken when applying the ASAS research MRI definition for sacroiliitis without considering lesion BME topography, size and depth, concomitant structural damage and, of course, the clinical picture. In this review, we will discuss the anatomy and biomechanics of the SIJ, the noninflammatory causes of SIJ subchondral BME, and how these concepts combined can be used to increase our diagnostic confidence.
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Zhang Y, Guo Z, Zhan Y, Qu J, Lei X. Evaluation of active inflammation, chronic structural damage, and response to treatment of sacroiliitis in axial spondyloarthritis using the Spondyloarthritis research consortium of Canada scoring system. BMC Musculoskelet Disord 2022; 23:654. [PMID: 35804360 PMCID: PMC9270766 DOI: 10.1186/s12891-022-05609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting the spine and sacroiliac joints. To investigate whether there are differences in inflammatory and chronic structural damages, as assessed by a semiquantitative MRI scoring method, between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) patients with active inflammation at baseline, and to evaluate the treatment response in these patients after 3 months of tumor necrosis factor-alpha (TNF-α) inhibitor treatment. Methods Fifty-eight axSpA patients with active inflammation were included in the study. The patients were divided into nr-axSpA group and AS group. MRI examinations of the sacroiliac joints were performed before and after treatment. Inflammatory and structural damages in these patients were assessed using the established Spondyloarthritis Research Consortium of Canada (SPARCC) inflammation and sacroiliac joint structural (SSS) scoring methods, which are two MRI-based scoring methods. The SPARCC score, SSS score, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were compared between the two groups. Results At baseline, SPARCC scores for patients in the nr-axSpA and AS groups did not differ significantly (P > 0.05); however, SSS scores for fat metaplasia, erosion, and backfill for patients in the AS group were significantly higher (P < 0.001). Compared with baseline, SPARCC scores were significantly decreased in both groups after treatment (P < 0.001); however, after treatment, no statistically significant difference was found regarding SPARCC scores between the AS and nr-axSpA groups. Compared with baseline, a significant increase in the SSS scores for fat metaplasia and backfill (P < 0.001) and a significant decrease in the SSS scores for erosion (P < 0.001) were observed in all axSpA patients. Changes in the SPARCC score was inversely correlated with the changes in the SSS score for fat metaplasia (r = − 0.634, P < 0.001). Changes in the SSS score for backfill were positively correlated with the changes in the SSS score for fat metaplasia (r = 0.277, P < 0.05) and inversely correlated with those for erosion (r = − 0.443, P < 0.001). Conclusion The SPARCC and SSS scoring systems can be used to assess inflammatory and chronic structural damages as well as treatment responses in patients with axSpA. More severe structural damages were seen in AS patients. TNF-α inhibitor treatment for 3 months could effectively reduce inflammation in axSpA patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05609-x.
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Affiliation(s)
- Yimeng Zhang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300070, China.,Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Zikang Guo
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300070, China.,Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Ying Zhan
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Jin Qu
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Xinwei Lei
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China.
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Zhang Y, Guo Z, Wang L, Zhan Y, Qu J, Lei X. Baseline Severity of Sacroiliitis and Extensive Fat Metaplasia Predicts the Progression of Backfill at the Sacroiliac Joint in Patients With Axial Spondyloarthritis. Front Immunol 2022; 13:887470. [PMID: 35833133 PMCID: PMC9271670 DOI: 10.3389/fimmu.2022.887470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesFat metaplasia in an erosion cavity, also known as backfill, is an essential intermediary in new bone formation in axial spondyloarthritis (axSpA) patients; however, the predictors of backfill progression are unknown. This longitudinal study aimed to assess the predictors of backfill progression in axSpA patients on magnetic resonance imaging (MRI).MethodsClinical and MRI data were collected at baseline and follow-up in 52 axSpA patients. Backfill progression was defined as the new or increased T1 hyperintensity within the SI joint space. Logistic regression analyses were performed to identify the predictors of the backfill progression.ResultsA total of 19 patients had “backfill” at baseline and 30 patients exhibited the backfill progression after follow-up. The mean disease duration and SPARCC scores at baseline were significantly different between patients with and without backfill progression (P<0.001, P=0.003, respectively). Patients with backfill progression had a higher frequency of backfill at baseline, a higher SSS score of fat metaplasia, and a higher SSS score of backfill than those without (P=0.001, P<0.001, and P=0.002, respectively). A higher fat fraction value in the fat metaplasia area at the baseline was more frequent in patients with, than without, backfill progression (P=0.019). In the univariate logistic regression analyses, a higher SPARCC score for inflammation and a higher SSS score for fat metaplasia at baseline were associated with backfill progression.ConclusionsSeverity of sacroiliitis and extensive fat metaplasia at baseline are predictors of the backfill progression in axSpA patients.
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Affiliation(s)
- Yimeng Zhang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, China
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Zikang Guo
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, China
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Lisong Wang
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Ying Zhan
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Jin Qu
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Xinwei Lei
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
- *Correspondence: Xinwei Lei,
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19
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Navarro-Compán V, Boel A, Boonen A, Mease PJ, Dougados M, Kiltz U, Landewé RBM, Baraliakos X, Bautista-Molano W, Chiowchanwisawakit P, Dagfinrud H, Fallon L, Garrido-Cumbrera M, Gensler L, ElZorkany BK, Haroon N, Kwan YH, Machado PM, Maksymowych W, Molto A, de Peyrecave N, Poddubnyy D, Protopopov M, Ramiro S, Song IH, van Weely S, van der Heijde D. Instrument selection for the ASAS core outcome set for axial spondyloarthritis. Ann Rheum Dis 2022; 82:763-772. [PMID: 35680390 DOI: 10.1136/annrheumdis-2022-222747] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To define the instruments for the Assessment of SpondyloArthritis international Society-Outcomes Measures in Rheumatology (ASAS-OMERACT) core domain set for axial spondyloarthritis (axSpA). METHODS An international working group representing key stakeholders selected the core outcome instruments following a predefined process: (1) identifying candidate instruments using a systematic literature review; (2) reducing the list of candidate instruments by the working group, (3) assessing the instruments' psychometric properties following OMERACT filter 2.2, (4) selection of the core instruments by the working group and (5) voting and endorsement by ASAS. RESULTS The updated core set for axSpA includes seven instruments for the domains that are mandatory for all trials: Ankylosing Spondylitis Disease Activity Score and Numerical Rate Scale (NRS) patient global assessment of disease activity, NRS total back pain, average NRS of duration and severity of morning stiffness, NRS fatigue, Bath Ankylosing Spondylitis Function Index and ASAS Health Index. There are 9 additional instruments considered mandatory for disease-modifying antirheumatic drugs (DMARDs) trials: MRI activity Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joints and SPARCC spine, uveitis, inflammatory bowel disease and psoriasis assessed as recommended by ASAS, 44 swollen joint count, Maastricht Ankylosing Spondylitis Enthesitis Score, dactylitis count and modified Stoke Ankylosing Spondylitis Spinal Score. The imaging outcomes are considered mandatory to be included in at least one trial for a drug tested for properties of DMARD. Furthermore, 11 additional instruments were also endorsed by ASAS, which can be used in axSpA trials on top of the core instruments. CONCLUSIONS The selection of the instruments for the ASAS-OMERACT core domain set completes the update of the core outcome set for axSpA, which should be used in all trials.
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Affiliation(s)
- Victoria Navarro-Compán
- Department of Rheumatology, La Paz University Hospital, Madrid, Spain .,IdiPaz, Madrid, Spain
| | - Anne Boel
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastrich University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Philip J Mease
- Department of Rheumatology Research, Swedish Medical Center, Seattle, Washington, USA
| | - Maxime Dougados
- Department of Rheumatology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Uta Kiltz
- Department of Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Germany
| | - Robert B M Landewé
- Amsterdam Rheumatology Center, Amsterdam, The Netherlands.,Department of Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | | | - Wilson Bautista-Molano
- School of Medicine, University Hospital Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá, Colombia
| | | | - Hanne Dagfinrud
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lara Fallon
- Inflammation and Immunology - Global Medical Affairs, Pfizer Inc, Montreal, Québec, Canada
| | - Marco Garrido-Cumbrera
- Health and Territory Research, Universidad de Sevilla, Sevilla, Spain.,Axial Spondyloarthritis International Federation, London, UK
| | - Lianne Gensler
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | | | - Nigil Haroon
- Department of Medicine, Schroder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | | | - Pedro M Machado
- Department of Neuromuscular Diseases, Centre for Rheumatology, University College London, London, UK.,National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Walter Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Molto
- Department of Rheumatology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Natasha de Peyrecave
- Department of Rheumatology Global Medical Affairs, UCB Pharma, Brussels, Belgium
| | - Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - In-Ho Song
- Department of Immunology Clinical Development, Abbvie, North Chicago, Illinois, USA
| | - Salima van Weely
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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20
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Improving the design of RCTs in non-radiographic axial spondyloarthritis. Nat Rev Rheumatol 2022; 18:481-489. [PMID: 35562426 DOI: 10.1038/s41584-022-00789-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/09/2022]
Abstract
Concerns have been raised that randomized placebo-controlled trials (RCTs) in non-radiographic axial spondyloarthritis (nr-axSpA) might be failing to identify patients that best show differences in clinical response rates between those receiving active drug and those receiving placebo therapies; in addition, some studies might even be showing spurious differences in responses to TNF and IL-17 inhibitor therapies. In particular, the most recent phase III RCTs in nr-axSpA have reported variable and generally lower response rates than observed in phase III trials of patients with ankylosing spondylitis and in trials conducted a decade ago in patients with early axSpA who were selected on the basis of axial inflammation evident on MRI scans. We argue that these observations at least partly reflect an RCT design that does not take full advantage of MRI to select patients who are responsive to therapy because the current MRI-based inclusion criteria cannot identify patients with axSpA with sufficient specificity. We propose that future studies should be designed using revised patient inclusion criteria based on expanded MRI evaluation and the application of data-driven definitions of a positive MRI for inflammatory and structural lesions typical of axSpA reported in an international multicentre analysis of MRI scans from the Assessment of SpondyloArthritis International Society (ASAS) classification cohort.
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21
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Maksymowych WP, Østergaard M, Landewé R, Barchuk W, Liu K, Tasset C, Gilles L, Hendrikx T, Besuyen R, Baraliakos X. Impact of filgotinib on sacroiliac joint magnetic resonance imaging structural lesions at 12 weeks in patients with active ankylosing spondylitis (TORTUGA trial). Rheumatology (Oxford) 2022; 61:2063-2071. [PMID: 34352069 PMCID: PMC9071516 DOI: 10.1093/rheumatology/keab543] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess the effect of filgotinib, which preferentially inhibits Janus kinase 1 (JAK1), on MRI measures of structural change in the SI joint in patients with active AS in the TORTUGA trial. METHODS Adults with active AS and inadequate response/intolerance to two or more NSAIDs were randomized 1:1 to filgotinib 200 mg (n = 58) or placebo (n = 58) once daily for 12 weeks. In this post hoc analysis, T1-weighted MRI scans of the SI joint were evaluated by two independent readers using Spondyloarthritis Research Consortium of Canada (SPARCC) Sacroiliac Joint Structural Score (SSS) definitions for erosion, backfill, fat metaplasia and ankylosis. Correlations between SPARCC SSS and improvement in clinical outcomes were also assessed. RESULTS MRI scans from 87 patients (48 filgotinib, 39 placebo) were evaluated. At baseline there were no notable differences between filgotinib and placebo for any MRI structural lesion types. From baseline to week 12, filgotinib was associated with a significant reduction in SI joint erosion score (P = 0.02) and an increase in backfill score (P = 0.005) vs placebo, with no significant between-group differences for ankylosis (P = 0.46) or fat metaplasia (P = 0.17). At week 12, the change in SPARCC MRI SI joint inflammation scores correlated positively with erosion scores but negatively with backfill scores. CONCLUSION The significant changes in MRI structural lesions induced by filgotinib in the SI joint by week 12 demonstrate that tissue repair can be observed very soon after starting treatment with a JAK1 preferential inhibitor. This could have prognostic implications for development of ankylosis. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT03117270.
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Affiliation(s)
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert Landewé
- Department of Rheumatology, Amsterdam University Medical Center, Amsterdam and Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Ke Liu
- Clinical Research, Gilead Sciences, Foster City, CA, USA
| | | | - Leen Gilles
- Biostatistics, LACO, Contracted by Galapagos NV, Mechelen, Belgium
| | | | - Robin Besuyen
- Clinical Development, Galapagos BV, Leiden, The Netherlands
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22
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Juanola X, Ramos MJM, Belzunegui JM, Fernández-Carballido C, Gratacós J. Treatment Failure in Axial Spondyloarthritis: Insights for a Standardized Definition. Adv Ther 2022; 39:1490-1501. [PMID: 35201604 PMCID: PMC8990961 DOI: 10.1007/s12325-022-02064-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/26/2022] [Indexed: 12/17/2022]
Abstract
Axial spondyloarthritis is a chronic inflammatory rheumatic disease that affects the axial skeleton and causes severe pain and disability. It may be also associated with extra-articular manifestations. Early diagnosis and appropriate treatment can reduce the severity of the disease and the risk of progression. The biological disease-modifying antirheumatic drugs (bDMARDs) tumor necrosis factor alpha (TNFα) inhibitors (TNFi) and the anti-interleukin (IL)-17A antibodies secukinumab and ixekizumab are effective agents to reduce disease activity and minimize the inflammation that damages the joints. New alternatives such as Janus kinase (JAK) inhibitors are also available. Unfortunately, response rates to bDMARDs are far from optimal, and many patients experience so-called treatment failure. The definition of treatment failure definition is often vague and may depend on the rigorousness of the therapeutic goal, the inclusion or not of peripheral symptoms/extra-articular manifestations, or patients' overall health. After an exhaustive bibliographic review, we propose a definition based on loss of the following status: low disease activity assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, absence of extra-articular manifestations, and low disease impact on the patients' general health. Apart from discontinuing the therapy because of safety or intolerance reasons, two types of treatment failure can be differentiated depending on when it occurs: primary failure (no response within 6 months after treatment initiation, or lack of efficacy) and secondary failure (response within 6 months but lost thereafter, or loss of efficacy over time). Physicians should carefully consider the moment and the reason for the treatment failure to decide the next therapeutic step. In the case of primary failure on a first TNFi, it seems reasonable to switch to another class of drugs, i.e., an anti-IL-17 agent, as phase III trials showed that the response to IL-17 blockade was higher than to placebo in patients previously exposed to TNFi. When secondary failure occurs, and loss of efficacy is suspected to be caused by antidrug antibodies (ADAs), it is advisable to analyze serum TNFi and ADAs concentrations, if possible; in the presence of ADAs and low TNFi levels, changing the TNFi is rational as it may restore the TNFα blocking capacity. If ADAs are absent/low with adequate drug therapeutic levels, switching to another target might be the best strategy.
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Affiliation(s)
- Xavier Juanola
- Rheumatology Service, University Hospital Bellvitge, IDIBELL, Barcelona, Spain
| | | | | | | | - Jordi Gratacós
- Rheumatology Service, Medicine Department UAB, I3PT, University Hospital Parc Taulí Sabadell, Barcelona, Spain.
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23
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Miao TL, Randhawa S, Roth MJ, Bureau Y, Howey J, Garvin GJ. Parallel Line Sign-A New MRI Sign Associated With Chronic Sacroiliitis: Prevalence, Characteristics, and Associations. Can Assoc Radiol J 2022; 73:647-654. [PMID: 35348011 DOI: 10.1177/08465371211069493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The purpose is to demonstrate the existence of the parallel line sign (PLS), a dark line parallel to the sacroiliac joint (SIJ), and determine its prevalence, characteristics, and associations. Methods: 200 consecutive SIJ MRIs referred by rheumatologists were retrospectively reviewed for the presence of the PLS. Presence and extent of imaging features of sacroiliitis (bone marrow edema, fatty infiltration, erosions, sclerosis, and ankylosis) were evaluated. Results: Prevalence of PLS was 11.5% (23/200), with 9 subjects having bilateral PLS, resulting in 32 SIJs showing a PLS. Every PLS involved the synovial portion of the SIJ, and almost all (31/32, 96.9%) involved the iliac (rather than sacral) side of the SIJ. Every PLS occurred with at least one established imaging feature of sacroiliitis. Presence of a PLS was associated with higher prevalence of erosions (78.3% vs 36.7% in those without PLS, P < .001), greater extent of SIJ involvement by erosions (3.6 ± 1.3 vs 2.3 ± 1.1 quadrants of the SIJ involved, P < .001), and higher density of erosions per centimeter (88.9% vs 46.2% with >2 erosions/cm, P = .001). There was higher prevalence of bone marrow edema, fatty infiltration, and sclerosis in those with PLS compared to those without PLS (P = .001, P < .001, and P = .006, respectively). Extent of involvement by any of these features was not significantly different between the two groups (P = .22, P = .16, and P = .46, respectively). Conclusions: The PLS is associated with imaging features of chronic sacroiliitis, especially erosions. Knowledge of the existence of the PLS may help avoid misdiagnosis of an insufficiency fracture and increase confidence in the diagnosis of sacroiliitis.
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Affiliation(s)
- Timothy L Miao
- Department of Medical Imaging, St Joseph's Health Care London, London, ON, Canada.,6221Western University, London, ON, Canada
| | - Shubreet Randhawa
- Department of Medical Imaging, St Joseph's Health Care London, London, ON, Canada.,6221Western University, London, ON, Canada
| | - Michael J Roth
- Department of Medical Imaging, St Joseph's Health Care London, London, ON, Canada.,6221Western University, London, ON, Canada
| | - Yves Bureau
- 6221Western University, London, ON, Canada.,151158Lawson Health Research Institute, London, ON, Canada
| | - Joanne Howey
- Department of Medical Imaging, St Joseph's Health Care London, London, ON, Canada.,6221Western University, London, ON, Canada
| | - Gregory J Garvin
- Department of Medical Imaging, St Joseph's Health Care London, London, ON, Canada.,6221Western University, London, ON, Canada
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24
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Berkowitz JL, Mandl LA, Burge AJ, Roberts JA, Lin B, Schwartzman S, Carrino JA. MRI Assessment of Sacroiliitis With High-Resolution Protocol. HSS J 2022; 18:91-97. [PMID: 35087338 PMCID: PMC8753538 DOI: 10.1177/15563316211006710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 02/03/2023]
Abstract
Background: Sacroiliac (SI) joint subchondral resorption on high-resolution magnetic resonance imaging (MRI) may be an early sign of the development of sacroiliitis. At our institution, high-resolution intermediate-weighted (proton density) MRI sequences are used in the workup of suspected spondyloarthritis (SpA). Questions/Purpose: We sought to test the hypothesis that SI joint subchondral resorption might be a useful MRI feature in the diagnosis of sacroiliitis. Methods: We retrospectively reviewed the records of patients with suspected SpA from a single rheumatologist's practice from January 1, 2010, to December 31, 2017. Patients had an MRI of the SI joints, using our institution's specialized protocol, and underwent standard physical examination and laboratory evaluation. The sensitivity and specificity of SI joint subchondral resorption in the identification of sacroiliitis were estimated using the clinical diagnosis as the reference standard and from a Bayesian latent class model with conditional dependence. Results: SI joint subchondral resorption on SI joint MRI was highly correlated with a positive diagnosis in patients worked up for axial SpA. It demonstrated superior sensitivity when compared with other MRI features used in the MRI diagnosis of sacroiliitis, such as bone marrow edema pattern, erosion, and ankylosis. Interobserver reliability was high for subchondral resorption. Conclusion: This retrospective study found that subchondral resorption on MRI evaluation of the SI joints appeared to be a sensitive indicator of SpA, potentially of early disease. This imaging feature warrants evaluation in other cohorts of patients suspected of having axial SpA to validate diagnostic performance in diverse populations.
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Affiliation(s)
- Jennifer L. Berkowitz
- Department of Radiology & Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Lisa A. Mandl
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA,Lisa A. Mandl, MD, MPH, Department of Medicine, Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY 10021, USA.
| | - Alissa J. Burge
- Department of Radiology & Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - John A. Roberts
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Bin Lin
- Department of Radiology & Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Sergio Schwartzman
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - John A. Carrino
- Department of Radiology & Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
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25
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Gezer HH, Duruöz MT. The value of SPARCC sacroiliac MRI scoring in axial psoriatic arthritis and its association with other disease parameters. Int J Rheum Dis 2022; 25:433-439. [PMID: 35080124 DOI: 10.1111/1756-185x.14285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/23/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to assess patients with axial psoriatic arthritis (AxPsA) using the Canadian Spondyloarthritis Research Consortium (SPARCC) sacroiliac joint (SIJ) scores and to seek correlations between magnetic resonance imaging (MRI) scores and disease characteristics. METHODS Forty PsA patients (32 females, mean age 46.4 years) who had been documented to have active or structural lesions on SIJ MRI were retrospectively evaluated. Disease duration, medications, and disease activity, including Disease Activity in Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), minimal disease activity (MDA), and Ankylosing Spondylitis Disease Activity Score (ASDAS) were recorded. On sacroiliac MRI scans, the SPARCC scores of sacroiliac joint inflammation (SIS) and sacroiliac joint structural damage (SSS) were evaluated. RESULTS The mean disease duration was 51.4 ± 70.4 months. MRI showed active inflammation in 30 patients (75%) and at least 1 structural lesion in 32 patients (92.5%). The most prevalent structural lesion was erosion (82.5%), followed by fat metaplasia (65%), backfill (12.5%), and ankylosis (2.5%). Only fat metaplasia scores were significantly higher in men than in women (P = .007). Of clinical and laboratory parameters, only C-reactive protein (CRP) was significantly higher in the presence of active inflammation (P = .01). The SIS score was significantly correlated with disease duration (r = -.35) and CRP levels (r = .42,). The SSS score was inversely correlated with BASDAI (r = -.37), ASDAS-CRP (r = -.39), and ASDAS - erythrocyte sedimentation rate (r = -.32). The overall SPARCC scores did not differ between patients in DAPSA remission and non-remission and between those in MDA and non-MDA. CONCLUSION Although radiologic involvement is generally not severe in AxPsA, MRI still provides additional information about inflammatory activity and structural lesions. CRP may be helpful in monitoring the radiologic disease activity in AxPsA.
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Affiliation(s)
- Halise Hande Gezer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
| | - Mehmet Tuncay Duruöz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
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26
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Lin C, Liu D, Liu B, Gu J. Distribution of Acute and Chronic Lesions in the Sacroiliac Joints of Patients with Axial Spondyloarthritis. Int J Gen Med 2022; 15:79-86. [PMID: 35018115 PMCID: PMC8742677 DOI: 10.2147/ijgm.s347133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objective In this study, we aimed to investigate whether there was a pattern of distribution of acute and chronic lesions in the sacroiliac joints (SIJ) of patients with axial spondyloarthritis (axSpA). Methods A total of 96 patients diagnosed as axSpA were retrospectively included in this study. The Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation score (SIS) and structural score (SSS) were used to evaluate the acute and chronic lesions in the SIJs. Scores representing the distribution of bone marrow edema, fatty lesions and erosions were extracted respectively. By dividing the SIJs into sacral or iliac sections, upper or lower sections, anterior and posterior levels, differences of scores representing acute and chronic lesions were analyzed by Kruskal Wallis’ tests. Results SIS scores were not significantly different in sacral or iliac sections, in upper or lower sections, on anterior or posterior levels. SSS scores were also not significantly different in different sections, except for higher occurrence rates of erosions in the iliac sections. Post-hoc analysis showed that there was a higher erosion score in the left ilium than left sacrum, as well as in right ilium than left sacrum. Conclusion There was no specific distribution pattern of acute or chronic lesions in the SIJs in patients with axSpA. A bigger study sample was needed to confirm the distribution of erosions in sacral or iliac sections.
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Affiliation(s)
- Churong Lin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Dong Liu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Budian Liu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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27
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Mo Q, Dong Y, Ye C, Zhong J, Cai S, Wang M, Dong L. Structural Lesion Progression of the Sacroiliac Joint and Clinical Features in axSpA During TNFi Reduction: A Retrospective Cohort Study. Front Med (Lausanne) 2021; 8:781088. [PMID: 34950685 PMCID: PMC8688735 DOI: 10.3389/fmed.2021.781088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: In the clinic, some patients with axial spondyloarthritis (axSpA) have to reduce tumor necrosis factor inhibitor (TNFi) for various reasons. However, there are few studies about how to balance the relapse and TNFi reduction. Here we retrospectively analyzed the structural progression of the sacroiliac joint (SIJ) and clinical features in axSpA during TNFi reduction. Methods: A total of 108 patients with axSpA who followed up for 2 years and completed at least baseline, 12-month, and 24-month MRI scans of SIJ were divided into the tapering group (n = 63) and withdrawal group (n = 45) according to whether TNFi was stopped. We divided 2 years into five intervals, calculating the average dose quotient (DQ) for each of 540 intervals from 108 patients. By using generalized estimation equations with inverse probability of treatment weighting, we investigated the unbiased effects of average DQ on structural progression and treatment response. Results: The disease activity (such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, and ASDAS-ESR) and relapse rate were lower in the tapering group at 12 and 24 months (p < 0.05). Δerosion (β = −0.0100, p = 0.00026) and Δthe Spondyloarthritis Research Consortium of Canada (SPARCC; β = −0.0959, p < 0.0001) were negatively correlated with average DQ. The average DQ 30 (74.8%, 80.0%) or 41.6 (76.5%, 83%) was best to discriminate the status of treatment response or the status of bone marrow edema, but considering operability, the average DQ 25 (78.0%, 63.3%) was also acceptable especially for patients with HLA-B27 negative and non-severe fat metaplasia. Conclusion: Complete TNFi withdrawal was not recommended. Our study provided a referable strategy (tapering then maintained the average DQ over 30 or even 25) for patients who need TNFi reduction. Higher dose usage of TNFi was associated with a slower erosion progression of SIJ.
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Affiliation(s)
- Qian Mo
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanji Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Ye
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jixin Zhong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaozhe Cai
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingli Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Brandon TG, Xiao R, Peterson RG, Chauvin NA, Francavilla ML, Biko DM, Rumsey DG, Stoll ML, Weiss PF. Changes over time in inflammatory and structural lesions at the sacroiliac joint in children with spondyloarthritis exposed and unexposed to tumor necrosis factor inhibitor. Pediatr Rheumatol Online J 2021; 19:167. [PMID: 34857002 PMCID: PMC8638346 DOI: 10.1186/s12969-021-00647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this work was to describe magnetic resonance imaging (MRI) changes over time in inflammatory and structural lesions at the sacroiliac joint (SIJ) in children with spondyloarthritis (SpA) exposed and unexposed to tumor necrosis factor inhibitor (TNFi). METHODS This was a retrospective, multicenter study of SpA patients with suspected or confirmed sacroiliitis who underwent at ≥2 pelvic MRI scans. Images were reviewed independently by 3 radiologists and scored for inflammatory and structural changes using the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ inflammation score (SIS) and structural score (SSS). Longitudinal, quantitative changes in patient MRI scans were measured using descriptive statistics and stratified by TNFi exposure. We used an average treatment effects (ATE) regression model to explore the average effect of TNFi exposure over time on inflammatory and structural lesions, adjusting for baseline lesion scores. RESULTS Forty-six subjects were evaluated using the SIS (n = 45) and SSS (n = 18). Median age at baseline imaging was 13.6 years, 63% were male and 71% were white. Twenty-three subjects (50%) were TNFi exposed between MRI studies. The median change in SIS in TNFi exposed and unexposed subjects with a baseline SIS ≥0 was - 20.7 and - 14.3, respectively (p = 0.09). Eleven (85%) TNFi exposed and 8 (89%) unexposed subjects with a baseline SIS ≥0 met the SIS minimal clinically important difference (MCID; ≥2.5). Using the ATE model adjusted for baseline SIS, the average effect of TNFi on SIS in patients with a baseline SIS ≥2 was - 14.5 (p < 0.01). Unadjusted erosion change score was significantly worse in TNFi unexposed versus exposed subjects (p = 0.03) but in the ATE model the effect of TNFi was not significant. CONCLUSION This study quantitatively describes how lesions in the SIJs on MRI change over time in patients exposed to TNFi versus unexposed. Follow-up imaging in TNFi exposed patients showed greater improvement than the unexposed group by most metrics, some of which reached statistical significance. Surprisingly, a majority of TNFi unexposed children with a baseline SIS≥2 met the SIS MCID. Additional studies assessing the short and long-term effects of TNFi on inflammatory and structural changes in juvenile SpA are needed.
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Affiliation(s)
- Timothy G. Brandon
- grid.239552.a0000 0001 0680 8770Division of Rheumatology and Center for Pediatric Clinical Effectiveness at the Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, USA
| | - Rui Xiao
- grid.25879.310000 0004 1936 8972Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Rosemary G. Peterson
- grid.239552.a0000 0001 0680 8770Division of Rheumatology at the Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, USA
| | - Nancy A. Chauvin
- grid.29857.310000 0001 2097 4281Department of Radiology at Penn State Health Milton S. Hershey Children’s Hospital, Hershey, PA USA
| | - Michael L. Francavilla
- grid.25879.310000 0004 1936 8972Department of Radiology at the Children’s Hospital of Philadelphia and Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - David M. Biko
- grid.25879.310000 0004 1936 8972Department of Radiology at the Children’s Hospital of Philadelphia and Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Dax G. Rumsey
- grid.17089.37Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Matthew L. Stoll
- grid.265892.20000000106344187Division of Pediatric Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL USA
| | - Pamela F. Weiss
- grid.25879.310000 0004 1936 8972Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness at the Children’s Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, 2716 South Street, Room 11121, Philadelphia, PA 19104 USA
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Wetterslev M, Georgiadis S, Juul Sørensen I, Juhl Pedersen S, Christiansen SN, Hetland ML, Brahe CH, Bakkegaard M, Duer A, Boesen M, Gosvig KK, Møller JM, Krogh NS, Jensen B, Madsen OR, Christensen J, Hansen A, Nørregaard J, Røgind H, Østergaard M. Tapering of TNF inhibitors in axial spondyloarthritis in routine care-2-year clinical and MRI outcomes and predictors of successful tapering. Rheumatology (Oxford) 2021; 61:2398-2412. [PMID: 34636846 DOI: 10.1093/rheumatology/keab755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/30/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES In a 2-year follow-up study of patients with axial spondyloarthritis (axSpA) in clinical remission who tapered tumor necrosis factor inhibitor (TNFi) treatment according to a clinical guideline, we aimed to investigate the proportion who successfully tapered/discontinued therapy and baseline predictors thereof. The proportion regaining clinical remission after flare and the progression on MRI/radiography were also assessed. METHODS One-hundred-and-nine patients (78(72%)/31(28%) receiving standard respectively reduced dose) in clinical remission (BASDAI < 40, physician global score < 40) and no signs of disease activity the previous year tapered TNFi as follows: to two-thirds of standard dose at baseline, half at week 16, one-third at week 32 and discontinuation at week 48. Patients experiencing clinical, BASDAI or MRI flare (predefined criteria) stopped tapering and escalated to previous dose. Prediction analyses were performed by multivariable regression. RESULTS One-hundred-and-six patients(97%) completed 2-years follow-up; 55 patients(52%) had successfully tapered: 23(22%) receiving two-thirds, 15(14%) half, 16(15%) one-third dose and 1(1%) discontinued. In patients at standard dose at baseline(n = 78), lower physician global score was the only independent predictor of successful tapering (Odds ratio(OR)=0.79(95% Confidence Interval = 0.64-0.93); p= 0.003). In the entire patient group lower physician global score(OR = 0.86(0.75-0.98); p= 0.017), lower Spondyloarthritis Research Consortium of Canada(SPARCC) Sacroiliac Joint Erosion score(OR = 0.78(0.57-0.98); p= 0.029) and current smoking(OR = 3.28(1.15-10.57); p= 0.026) were independent predictors of successful tapering. At 2-years, 97% of patients were in clinical remission. Minimal changes in imaging findings were observed. CONCLUSION After two years following a clinical guideline, 52% of patients with axSpA in clinical remission had successfully tapered TNFi, only 1% discontinued. Baseline physician global score was an independent predictor of successful tapering.
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Affiliation(s)
- Marie Wetterslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Stylianos Georgiadis
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Inge Juul Sørensen
- Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Cecilie Heegaard Brahe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Mads Bakkegaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Anne Duer
- Department of Radiology, Rigshospitalet, Glostrup, Copenhagen, Denmark
| | - Mikael Boesen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | | | | | - Bente Jensen
- Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Ole Rintek Madsen
- Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Jan Christensen
- Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Annette Hansen
- Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Nørregaard
- Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Røgind
- Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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30
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Reliability of the Preliminary OMERACT Juvenile Idiopathic Arthritis MRI Score (OMERACT JAMRIS-SIJ). J Clin Med 2021; 10:jcm10194564. [PMID: 34640579 PMCID: PMC8509611 DOI: 10.3390/jcm10194564] [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: 08/28/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 01/21/2023] Open
Abstract
This study reports the reliability of the juvenile idiopathic arthritis magnetic resonance imaging scoring system (JAMRIS-SIJ). The study comprised of eight raters—two rheumatologists and six radiologists—and 30 coronal T1 and Short-Tau Inversion Recovery (STIR) MRI scans of patients with enthesitis-related juvenile spondylarthritis. The median age of patients was 15 years with a mean disease duration of 5 years and 22 (73.3%) of the sample were boys. The inter-rater agreement of scores for each of the JAMRIS-SIJ items was calculated using a two-way random effect, absolute agreement, and single rater intraclass correlation coefficient (ICC 2.1). The ICC was interpreted together with kurtosis, since the ICC is also affected by the distribution of scores in the sample. The eight-rater, single measure inter-rater ICC (and kurtosis) values for JAMRIS-SIJ inflammation and damage components were the following: bone marrow edema (BME), 0.76 (1.2); joint space inflammation, 0.60 (1.8); capsulitis, 0.58 (9.2); enthesitis, 0.20 (0.1); ankylosis, 0.89 (35); sclerosis, 0.53 (4.6); erosion, 0.50 (6.5); fat lesion, 0.40 (21); backfill, 0.38 (38). The inter-rater reliability for BME and ankylosis scores was good and met the a priori set ICC threshold, whereas for the other items it was variable and below the selected threshold. Future directives should focus on refinement of the scores, definitions, and methods of interpretation prior to validation of the JAMRIS-SIJ through the assessment of its measurement properties.
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31
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Coxitis in axial spondyloarthritis: the unmeasured, yet functionally most important, radiographic progression. Chin Med J (Engl) 2021; 134:2550-2552. [PMID: 34593699 PMCID: PMC8577678 DOI: 10.1097/cm9.0000000000001743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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Tu L, Lin C, Xie Y, Wang X, Wei Q, Zhang Y, Gu J. Active Inflammatory and Chronic Structural Damages of Sacroiliac Joint in Patients With Radiographic Axial Spondyloarthritis and Non-Radiographic Axial Spondyloarthritis. Front Immunol 2021; 12:700260. [PMID: 34386008 PMCID: PMC8353186 DOI: 10.3389/fimmu.2021.700260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/12/2021] [Indexed: 01/31/2023] Open
Abstract
Objective Evaluate the MRI evidence of active inflammatory and chronic structural damages in radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA). Methods A retrospective review of 253 patients who underwent sacroiliac joint (SIJ) MRI between June 2014 and December 2019 was performed. MRI images including short tau inversion recovery scan and T1-weighted spin echo scans were assessed using the Spondyloarthritis Research Consortium of Canada (SPARCC) score and SPARCC MRI SIJ structural score by two independent readers. Results Higher mean score of inflammatory (SPARCC) was seen in r-axSpA patients when compared with nr-axSpA patients (8.08 vs 4.37, P<0.05). Frequencies of MRI structural lesions in r-axSpA patients and nr-axSpA patients were as follows: erosion (65.84 vs 88.23%, P=0.002), backfill (33.17 vs 13.73%, P<0.001), fat metaplasia (79.21 vs 60.78%, P=0.01), and ankylosis (37.13 vs 1.96%, P<0.001). Patients with r-axSpA had a higher mean score for fat metaplasia (8.93 vs 4.06, P=0.0003) and ankylosis (4.49 vs 0.04, P<0.001). Conclusion More active inflammatory and chronic structural damages except for erosion were seen in r-axSpA patients than nr-axSpA patients, while higher percentage of nr-axSpA patients presented with erosion in MRI.
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Affiliation(s)
- Liudan Tu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Churong Lin
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ya Xie
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaohong Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiujing Wei
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanli Zhang
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Advances in Juvenile Spondyloarthritis. Curr Rheumatol Rep 2021; 23:70. [PMID: 34255209 DOI: 10.1007/s11926-021-01036-4] [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: 05/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To provide an overview of recent studies on pathogenesis, diagnosis, and management of juvenile spondyloarthritis (JSpA). RECENT FINDINGS Recent studies show differences in gut microbiome in patients with JSpA in comparison to healthy controls. There is increased recognition of the impact of the innate immune system on disease pathology. Normative reference on MRI of sacroiliac (SI) joints in children is now available. However, there is significant variability in interpretation of MRI of SI joints in children and a need for standardization. NSAIDs, physical therapy, and Tumor Necrosis Factor Inhibitors (TNFi) remain the mainstay of management for patients with JIA who have polyarthritis, sacroiliitis, and/or enthesitis as per recent ACR guidelines. Newer therapeutic options beyond TNFi are needed to manage patients who fail TNFi. This review highlights some of the recent advances in our knowledge of JSpA pathophysiology, diagnosis, and treatment. It also identifies areas in need of further research and standardization to improve our understanding and outcomes in JSpA.
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34
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Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part II: Structural damage lesions. Semin Arthritis Rheum 2021; 51:1099-1107. [PMID: 34311987 DOI: 10.1016/j.semarthrit.2021.07.009] [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] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 01/20/2023]
Abstract
Magnetic resonance imaging (MRI) is the imaging modality of choice for identifying sacroiliitis in juvenile idiopathic arthritis (JIA). Besides active lesions of sacroiliitis, of which bone marrow edema (BME) is the key feature, structural damage lesions can also be detected. Structural changes include erosion, sclerosis, fat lesion, backfill and ankylosis, and are more common at later stages. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the course of the disease and evaluating treatment options. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of structural damage of sacroiliitis. This atlas can serve as a reference for assessing structural lesions of SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 1, Active Lesions.
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35
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Herregods N, Maksymowych WP, Jans L, Otobo TM, Sudoł-Szopińska I, Meyers AB, Van Rossum M, Kirkhus E, Panwar J, Appenzeller S, Weiss P, Tse S, Doria AS, Lambert R, Jaremko JL. Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part I: Active lesions. Semin Arthritis Rheum 2021; 51:1089-1098. [PMID: 34311986 DOI: 10.1016/j.semarthrit.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023]
Abstract
Magnetic resonance imaging (MRI) is an increasingly important tool for identifying involvement of the sacroiliac joints (SIJ) in juvenile idiopathic arthritis (JIA). The key feature for diagnosing active sacroiliitis is bone marrow edema (BME), but other features of active arthritis such as joint space inflammation, inflammation in an erosion cavity, capsulitis and enthesitis can be seen as well. Structural changes may also be seen. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the disease course, choice of therapeutics and evaluating treatment response. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of SIJ inflammation. This atlas demonstrates fundamental MRI disease features of active inflammation in a format that can serve as a reference for assessing SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 2, Structural Lesions.
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Affiliation(s)
- N Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | | | - Lbo Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - T M Otobo
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning, University of Toronto, Toronto, Canada
| | - I Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - A B Meyers
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Maj Van Rossum
- Amsterdam Rheumatology and Immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - E Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - J Panwar
- Department of Radiology, Christian Medical College, Vellore, India
| | - S Appenzeller
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - P Weiss
- University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania, Philadelphia, USA
| | - Sml Tse
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - A S Doria
- Department of Medical Imaging, University of Toronto, Toronto and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Rgw Lambert
- Canada Department of Radiology and Diagnostic Imaging, University of Alberta and WC Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - J L Jaremko
- Canada Department of Radiology and Diagnostic Imaging, University of Alberta and WC Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
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Seven S, Østergaard M, Morsel-Carlsen L, Sørensen IJ, Bonde B, Thamsborg G, Lykkegaard JJ, Pedersen SJ. Morphological characteristics of sacroiliac joint MRI lesions in axial spondyloarthritis and control subjects. Rheumatology (Oxford) 2021; 61:1005-1017. [PMID: 34097000 DOI: 10.1093/rheumatology/keab468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate sacroiliac joint(SIJ) MRI inflammation, structural and degenerative lesion characteristics in patients with axial spondyloarthritis(axSpA) and various control groups. METHODS Patients with axSpA(n = 41) and lumbar disc herniation(n = 25), women with(n = 46) and without(n = 14) post-partum(childbirth within 4-16 months) buttock/pelvic pain, cleaning assistants(n = 26), long-distance runners(n = 23) and healthy men(n = 29) had MRI of the SIJs prospectively performed. MRI lesions were assessed on 9 slices covering the cartilaginous compartment by two experienced readers according to the definitions of the Spondyloarthritis Research Consortium of Canada(SPARCC) SIJ inflammation and structural scores, and were evaluated according to depth and extent. Other morphological characteristics were also analysed. RESULTS Total depth scores for bone marrow oedema(BME) and fat lesion(FAT) and total extent score for erosion were statistically significantly highest in axSpA, while scores for sclerosis were numerically highest in women with post-partum pain. Maximum BME depth > 10mm was frequently and exclusively found in axSpA and post-partum women(39% vs 14-17%) while FAT depth > 5mm was predominantly found in axSpA(76% vs 0-10%). Erosions were primarily seen in axSpA, especially when extensive(≥4 or confluent; 17% vs 0%). Capsulitis was absent in non-axSpA groups. BME and FAT in the ligamentous compartment were primarily found in axSpA(17/22% vs 0/2% in non-axSpA groups). In non-axSpA, osteophytes(axSpA vs non-axSpA: 0% vs 3-17%) and vacuum phenomenon(7% vs 30-66%) were more frequent, and the joint space was wider(mean(SD) 1.5(0.9)mm vs 2.2(0.5)mm). CONCLUSIONS FAT depth > 5mm, but not BME depth > 10mm, could almost differentiate axSpA patients from all other groups. When excluding post-partum women, BME >5mm and erosion were highly specific for axSpA.
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Affiliation(s)
- Sengül Seven
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Inge Juul Sørensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - Birthe Bonde
- The Birthe Bonde Clinic of Physiotherapy, Copenhagen, Denmark
| | - Gorm Thamsborg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - Jens Jørgen Lykkegaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Seven S, Østergaard M, Morsel-Carlsen L, Sørensen IJ, Bonde B, Thamsborg G, Lykkegaard JJ, Pedersen SJ. Anatomic Distribution of Sacroiliac Joint Lesions on Magnetic Resonance Imaging in Patients With Axial Spondyloarthritis and Control Subjects: A Prospective Cross‐Sectional Study, Including Postpartum Women, Patients With Disc Herniation, Cleaning Staff, Runners, and Healthy Individuals. Arthritis Care Res (Hoboken) 2021; 73:742-754. [DOI: 10.1002/acr.24473] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/24/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Sengül Seven
- Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Center of Head and Orthopedics, Rigshospitalet, Glostrup, and University of Copenhagen Copenhagen Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Center of Head and Orthopedics, Rigshospitalet, Glostrup, and University of Copenhagen Copenhagen Denmark
| | | | - Inge J. Sørensen
- Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Center of Head and Orthopedics Rigshospitalet Glostrup Denmark
| | - Birthe Bonde
- The Birthe Bonde Clinic of Physiotherapy Copenhagen Denmark
| | - Gorm Thamsborg
- Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Center of Head and Orthopedics Rigshospitalet Glostrup Denmark
| | - Jens J. Lykkegaard
- Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Center of Head and Orthopedics Rigshospitalet Glostrup Denmark
| | - Susanne J. Pedersen
- Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Center of Head and Orthopedics, Rigshospitalet, Glostrup, and University of Copenhagen Copenhagen Denmark
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Wetterslev M, Østergaard M, Sørensen IJ, Weber U, Loft AG, Kollerup G, Juul L, Thamsborg G, Madsen OR, Møller JM, Pedersen SJ. Development and Validation of 3 Preliminary MRI Sacroiliac Joint Composite Structural Damage Scores In a 5-year Longitudinal Axial Spondyloarthritis Study. J Rheumatol 2021; 48:1537-1546. [PMID: 33858979 DOI: 10.3899/jrheum.201075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In axial spondyloarthritis (axSpA), sacroiliac joint (SIJ) erosion is often followed by fat metaplasia in an erosion cavity (backfill), and subsequently ankylosis. We aimed to combine the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ structural score for erosion, backfill, and ankylosis into 3 versions of a novel preliminary axSpA magnetic resonance imaging (MRI) SIJ Composite Structural Damage Score (CSDS) and to test these. METHODS Thirty-three patients with axSpA, followed for 5 years after initiation of tumor necrosis factor inhibitor, had MRIs of the SIJs at baseline, and yearly thereafter. Three versions of CSDS were calculated based on different weightings of erosion, backfill, and ankylosis: (1) equal weighting: CSDSequal = (erosion × 0.5) + backfill + ankylosis; (2) advanced stages weighting more: CSDSstepwise = (erosion × 1) + (backfill × 4 ) + (ankylosis × 6); and (3) advanced stages overruling earlier stages ("hierarchical") with "<" meaning "overruled by": CSDShierarchical = (erosion × 1) < (backfill × 4) < (ankylosis × 6). RESULTS At baseline, all CSDS correlated positively with SPARCC fat and ankylosis scores and modified New York radiography grading, and negatively with the Bath Ankylosing Spondylitis Disease Index and SPARCC SIJ inflammation scores. CSDSstepwise and CSDShierarchical (not CSDSequal) correlated positively with symptom duration and the Bath Ankylosing Spondylitis Metrology Index, and closer with SPARCC ankylosis score and modified New York radiography grading than CSDSequal. The adjusted annual progression rate for CSDSstepwise and CSDShierarchical (not CSDSequal) was higher the first year compared with fourth year (P = 0.04 and P = 0.01). Standardized response mean (baseline to Week 46) was moderate for CSDShierarchical (0.64) and CSDSstepwise (0.59) and small for CSDSequal (0.25). CONCLUSION Particularly CSDSstepwise and CSDShierarchical showed construct validity and responsiveness, encouraging further validation in larger clinical trials. The potential clinical implication is assessment of SIJ damage progression by 1 composite score.
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Affiliation(s)
- Marie Wetterslev
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Mikkel Østergaard
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Inge J Sørensen
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Ulrich Weber
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Anne G Loft
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Gina Kollerup
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Lars Juul
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Gorm Thamsborg
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Ole R Madsen
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Jakob M Møller
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
| | - Susanne J Pedersen
- The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). . Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark. MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. . Accepted for publication March 31, 2021
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Huang ZX, Deng WM, Zheng SL, Guo X, Zeng SQ, Li TW. Magnetic resonance imaging in ankylosing spondylitis: reduction of active sacroiliitis and hip arthritis during treatment with an adalimumab biosimilar. Clin Rheumatol 2021; 40:2099-2101. [PMID: 33559010 DOI: 10.1007/s10067-021-05628-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/11/2021] [Accepted: 01/31/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Zhi-Xiang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wei-Ming Deng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shao-Ling Zheng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xin Guo
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shao-Qing Zeng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tian-Wang Li
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Malik F, Scherl E, Weber U, Carrino JA, Epsten M, Wichuk S, Pedersen SJ, Paschke J, Schwartzman S, Kroeber G, Maksymowych WP, Longman R, Mandl LA. Utility of magnetic resonance imaging in Crohn's associated sacroiliitis: A cross-sectional study. Int J Rheum Dis 2021; 24:582-590. [PMID: 33528900 DOI: 10.1111/1756-185x.14081] [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] [Received: 06/29/2020] [Revised: 12/14/2020] [Accepted: 01/09/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Prevalence of sacroiliitis in Crohn's disease (CD) is variable depending on defining criteria. This study utilized standardized sacroiliac joint (SIJ) magnetic resonance imaging (MRI) to identify sacroiliitis in CD patients and its association with clinical and serological markers. METHODS Consecutive adult subjects with CD prospectively enrolled from an inflammatory bowel disease clinic underwent SIJ MRI. Data collected included CD duration, history of joint/back pain, human leukocyte antigen-B27 status, Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index, Harvey Bradshaw Index (HBI) for activity of CD, Ankylosing Spondylitis Disease Activity Score, and various serologic markers of inflammation. Three blinded readers reviewed MRIs for active and structural lesions according to the Spondyloarthritis Research Consortium of Canada modules. RESULTS Thirty-three CD patients were enrolled: 76% female, 80% White, median age 36.4 years (interquartile range 27.2-49.0), moderate CD activity (mean HBI 8.8 ± SD 4.5). Nineteen subjects (58%) reported any back pain, 13 of whom had inflammatory back pain. Four subjects (12%) showed sacroiliitis using global approach and 6 (18%) met Assessment of SpondyloArthritis international Society MRI criteria of sacroiliitis. Older age (mean 51.2 ± SD 12.5 vs. 37.2 ± 14; P = .04), history of dactylitis (50.0% vs. 3.4%, P = .03) and worse BASMI (4.1 ± 0.7 vs. 2.4 ± 0.8, P ≤ .001) were associated with MRI sacroiliitis; no serologic measure was associated. CONCLUSION There were 12%-18% of CD patients who had MRI evidence of sacroiliitis, which was not associated with back pain, CD activity or serologic measures. This data suggests that MRI is a useful modality to identify subclinical sacroiliitis in CD patients.
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Affiliation(s)
- Fardina Malik
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Ellen Scherl
- Weill Cornell Medicine, Jill Roberts Institute for Research in Inflammatory Bowel Disease, New York, NY, USA
| | - Ulrich Weber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | | | | | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Georg Kroeber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Walter P Maksymowych
- University of Alberta, Edmonton, AB, Canada.,CARE Arthritis, Edmonton, AB, Canada
| | - Randy Longman
- Weill Cornell Medicine, Jill Roberts Institute for Research in Inflammatory Bowel Disease, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, NY, USA
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Maksymowych WP, Lambert RG, Baraliakos X, Weber U, Machado P, Pedersen SJ, Hooge MD, Sieper J, Wichuk S, Poddubnyy D, Rudwaleit M, van der Heijde D, Landewe R, Eshed I, Ostergaard M. Data-driven definitions for active and structural MRI lesions in the sacroiliac joint in spondyloarthritis and their predictive utility. Rheumatology (Oxford) 2021; 60:4778-4789. [DOI: 10.1093/rheumatology/keab099] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/15/2021] [Indexed: 12/17/2022] Open
Abstract
Abstract
Objectives
To determine quantitative SI joint MRI lesion cut-offs that optimally define a positive MRI for inflammatory and structural lesions typical of axial SpA (axSpA) and that predict clinical diagnosis.
Methods
The Assessment of SpondyloArthritis international Society (ASAS) MRI group assessed MRIs from the ASAS Classification Cohort in two reading exercises where (A) 169 cases and 7 central readers; (B) 107 cases and 8 central readers. We calculated sensitivity/specificity for the number of SI joint quadrants or slices with bone marrow oedema (BME), erosion, fat lesion, where a majority of central readers had high confidence there was a definite active or structural lesion. Cut-offs with ≥95% specificity were analysed for their predictive utility for follow-up rheumatologist diagnosis of axSpA by calculating positive/negative predictive values (PPVs/NPVs) and selecting cut-offs with PPV ≥ 95%.
Results
Active or structural lesions typical of axSpA on MRI had PPVs ≥ 95% for clinical diagnosis of axSpA. Cut-offs that best reflected a definite active lesion typical of axSpA were either ≥4 SI joint quadrants with BME at any location or at the same location in ≥3 consecutive slices. For definite structural lesion, the optimal cut-offs were any one of ≥3 SI joint quadrants with erosion or ≥5 with fat lesions, erosion at the same location for ≥2 consecutive slices, fat lesions at the same location for ≥3 consecutive slices, or presence of a deep (i.e. >1 cm depth) fat lesion.
Conclusion
We propose cut-offs for definite active and structural lesions typical of axSpA that have high PPVs for a long-term clinical diagnosis of axSpA for application in disease classification and clinical research.
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Affiliation(s)
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
- Medical Imaging Consultants, Edmonton, Canada
| | | | - Ulrich Weber
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Pedro M Machado
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust
- Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen, Denmark
| | - Manouk de Hooge
- VIB Inflammation Research Center, Ghent University
- Rheumatology Department, Ghent University Hospital, Ghent, Belgium
| | - Joachim Sieper
- Department of Rheumatology, Charité – Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin
| | | | - Denis Poddubnyy
- Department of Rheumatology, Charité – Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin
| | - Martin Rudwaleit
- Klinikum Bielefeld, Bielefeld
- Department of Rheumatology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Robert Landewe
- Department of Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam
- Atrium Medical Center, Heerlen, the Netherlands
| | - Iris Eshed
- Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Maksymowych WP, Claudepierre P, de Hooge M, Lambert RG, Landewé R, Molto A, van der Heijde D, Bukowski JF, Jones H, Pedersen R, Szumski A, Vlahos B, Dougados M. Structural changes in the sacroiliac joint on MRI and relationship to ASDAS inactive disease in axial spondyloarthritis: a 2-year study comparing treatment with etanercept in EMBARK to a contemporary control cohort in DESIR. Arthritis Res Ther 2021; 23:43. [PMID: 33514428 PMCID: PMC7844996 DOI: 10.1186/s13075-021-02428-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background Limited information is available on the impact of treatment with a tumor necrosis factor inhibitor (TNFi) on structural lesions in patients with recent-onset axial spondyloarthritis (axSpA). We compared 2-year structural lesion changes on magnetic resonance imaging (MRI) in the sacroiliac joints (SIJ) of patients with recent-onset axSpA receiving etanercept in a clinical trial (EMBARK) to similar patients not receiving biologics in a cohort study (DESIR). We also evaluated the relationship between the Ankylosing Spondylitis Disease Activity Score (ASDAS) and change in MRI structural parameters. Methods The difference between etanercept (EMBARK) and control (DESIR) in the net percentage of patients with structural lesion change was determined using the SpondyloArthritis Research Consortium of Canada SIJ Structural Score, with and without adjustment for baseline covariates. The relationship between sustained ASDAS inactive disease, defined as the presence of ASDAS < 1.3 for at least 2 consecutive time points 6 months apart, and structural lesion change was evaluated. Results This study included 163 patients from the EMBARK trial and 76 from DESIR. The net percentage of patients with erosion decrease was significantly greater for etanercept vs control: unadjusted: 23.9% vs 5.3%; P = 0.01, adjusted: 23.1% vs 2.9%; P = 0.01. For the patients attaining sustained ASDAS inactive disease on etanercept, erosion decrease was evident in significantly more than erosion increase: 34/104 (32.7%) vs 5/104 (4.8%); P < 0.001. A higher proportion had erosion decrease and backfill increase than patients in other ASDAS status categories. However, the trend across ASDAS categories was not significant and decrease in erosion was observed even in patients without a sustained ASDAS response. Conclusions These data show that a greater proportion of patients achieved regression of erosion with versus without etanercept. However, the link between achieving sustained ASDAS inactive disease and structural lesion change on MRI could not be clearly established. Trial registration EMBARK: ClinicalTrials.gov identifier: NCT01258738, Registered 13 December 2010; DESIR: ClinicalTrials.gov identifier: NCT01648907, Registered 24 July 2012. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02428-8.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, University of Alberta, 568 Heritage Medical Research Building, Edmonton, AB, T6G 2S2, Canada.
| | - Pascal Claudepierre
- Universite Paris Est Creteil, EA 7379 - EpidermE, AP-HP, Service de Rhumatologie, Hopital Henri Mondor, Creteil, France
| | - Manouk de Hooge
- VIB Center of Inflammation Research, Ghent University, Ghent, Belgium.,Leiden University Medical Center, Leiden, the Netherlands
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Robert Landewé
- Amsterdam University Medical Center, loc. Meibergdreef 9 Amsterdam & Zuyderland MC, Heerlen, the Netherlands
| | - Anna Molto
- René Descartes University, Université de Paris, Department of Rheumatology - Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | | | - Heather Jones
- Global Medical Affairs, Pfizer, Collegeville, PA, USA
| | - Ron Pedersen
- Department of Biostatistics, Pfizer, Collegeville, PA, USA
| | | | - Bonnie Vlahos
- Global Clinical Affairs, Pfizer, Collegeville, PA, USA
| | - Maxime Dougados
- René Descartes University, Université de Paris, Department of Rheumatology - Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
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Seven S, Østergaard M, Morsel-Carlsen L, Sørensen IJ, Bonde B, Thamsborg G, Lykkegaard JJ, Hendricks O, Jørgensen NR, Pedersen SJ. The utility of magnetic resonance imaging lesion combinations in the sacroiliac joints for diagnosing patients with axial spondyloarthritis. A prospective study of 204 participants including post-partum women, patients with disc herniation, cleaning staff, runners and healthy persons. Rheumatology (Oxford) 2021; 59:3237-3249. [PMID: 32240310 DOI: 10.1093/rheumatology/keaa096] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the diagnostic utility of different combinations of SI joint MRI lesions for differentiating patients with axial SpA (axSpA) from other conditions with and without buttock/pelvic pain. METHODS A prospective cross-sectional study included patients with axSpA (n = 41), patients with lumbar disc herniation (n = 25), women with (n = 46) and without (n = 14) post-partum (birth within 4-16 months) buttock/pelvic pain and cleaning assistants (n = 26), long-distance runners (n = 23) and healthy men (n = 29) without pain. Two independent readers assessed SI joint MRI lesions according to the Spondyloarthritis Research Consortium of Canada MRI definitions and pre-defined MRI lesion combinations with bone marrow oedema (BME) and fat lesions (FAT), respectively. Statistical analyses included the proportion of participants with scores above certain thresholds, sensitivity, specificity, positive and negative predictive values and likelihood ratios. RESULTS BME adjacent to the joint space (BME@joint space) was most frequent in axSpA (63.4%), followed by women with post-partum pain (43.5%), but was present in nearly all groups. BME adjacent to fat lesions (BME@FAT) and BME adjacent to erosions (BME@erosion) were only present in axSpA patients and in women with post-partum pain, but scores ≥3 and ≥4, respectively, were only seen in axSpA patients. FAT@erosion was exclusively recorded in axSpA patients. FAT@joint space and FAT@sclerosis were present in most groups, but with higher scores in the axSpA group. CONCLUSION BME@joint space and FAT@joint space were frequent in axSpA but also in other conditions, reducing the diagnostic utility. FAT@erosion, and BME@FAT, BME@erosion and FAT@sclerosis above certain thresholds, were exclusively seen in axSpA patients and may thus have diagnostic utility in the differentiation of axSpA from other conditions.
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Affiliation(s)
- Sengül Seven
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Inge Juul Sørensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Birthe Bonde
- Birthe Bonde Clinic of Physiotherapy, Copenhagen, Denmark
| | - Gorm Thamsborg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Jens Jørgen Lykkegaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | | | - Niklas Rye Jørgensen
- University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Møller JM, Østergaard M, Thomsen HS, Hangaard S, Sørensen IJ, Madsen OR, Pedersen SJ. Repeatability and reproducibility of MRI apparent diffusion coefficient applied on four different regions of interest for patients with axial spondyloarthritis and healthy volunteers scanned twice within a week. BJR Open 2021; 2:20200004. [PMID: 33409446 PMCID: PMC7768406 DOI: 10.1259/bjro.20200004] [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: 02/27/2020] [Revised: 09/24/2020] [Accepted: 10/28/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives: The apparent diffusion coefficient (ADC) may be used as a biomarker for diagnosis and/or monitoring treatment response in patients with axial spondyloarthritis (axSpA), but this requires reliable ADC measurements. This study assessed test–retest repeatability and reproducibility of ADC measurements using four different region of interest (ROI) settings. Methods: In this prospective study, the sacroiliac joints (SIJs) of 25 patients with axSpA and 24 age- and sex-matched healthy volunteers were imaged twice at a mean interval of 6.8 days in a 1.5 T scanner using, multishot echoplanar diffusion-weighted sequences. ADCs at four ROI settings were assessed: 5 mm and 10 mm anatomic band-shaped, 15 mm linear, and 40 mm2 circular. Results: Intraclass correlation coefficient (ICC) assessments showed that the interstudy repeatability was good for median ADC (ADCmed) and 95th-percentile ADC (ADC95) measurements in patients with axSpA (0.77–0.83 and 0.75–0.83, respectively), but poor-to-moderate in healthy subjects (0.27–0.55 and 0.13–0.37, respectively). For all ROI settings, intrareader reproducibility was excellent for ADCmed-measurements (ICC:0.85–0.99) and moderate-to-excellent for ADC95 measurements (ICC:0.68–0.96). The 5 mm ROI had the least estimated bias and highest level of agreement on Bland–Altman plots. The interreader reproducibility was moderate (ICC:0.71). The 15 mm linear ROI produced significantly greater ADCmed and ADC95 measurements than all other ROI settings (p < 0.01–0.02), except for the circular ROI ADC95 measurements. Conclusion: ROI settings influence ADC measurements. Interstudy repeatability of SIJ ADC measurements is independent of ROI settings. However, the 5 mm ROI showed the least bias and random error and seems preferable. Advances in knowledge: ADC measurements are affected by ROI settings, and this should be taken into account when assessing ADC maps.
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Affiliation(s)
| | | | | | - Stine Hangaard
- Department of Radiology, Herlev-Gentofte Hospital, Herlev, Denmark
| | | | | | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
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Bubova K, Storkanova H, Oreska S, Spiritovic M, Hermankova B, Mintalova K, Gregova M, Husakova M, Horinkova J, Forejtova S, Gatterova J, Stolfa J, Komarc M, Vencovsky J, Pavelka K, Senolt L, Tomcik M. Plasma heat shock protein 90 levels in patients with spondyloarthritis and their relation to structural changes: a cross-sectional study. Biomark Med 2021; 15:5-13. [PMID: 33427496 DOI: 10.2217/bmm-2020-0360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022] Open
Abstract
Aim: Heat shock protein 90 (Hsp90) is a molecular chaperone regulating immune response. We aimed to assess systemic Hsp90 as a biomarker for spondyloarthritis (SpA). Materials & methods: Total of 80 axial SpA (axSpA) and 22 psoriatic arthritis patients and a corresponding number of age- and sex-matched healthy controls (HC) were included. Plasma Hsp90 levels were measured by ELISA. Results: Hsp90 was significantly increased in axSpA patients compared with HC (median interquartile range: 15.7 [10.5-19.8] vs 8.3 [6.6-11.8] ng/ml, p < 0.001). Moreover, Hsp90 was superior to C-reactive protein in differentiating axSpA (and both radiographic axSpA [r-axSpA] and nonradiographic-axSpA) from HC. Hsp90 levels correlated with bone marrow edema of sacroiliac joints in r-axSpA patients (r = 0.594, p = 0.019). Conclusion: Hsp90 could become a biomarker for active inflammation in r-axSpA, and can better distinguish axSpA patients from healthy subjects than C-reactive protein.
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Affiliation(s)
- Kristyna Bubova
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Storkanova
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sabina Oreska
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maja Spiritovic
- Institute of Rheumatology, Prague, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education & Sport, Charles University, Prague, Czech Republic
| | - Barbora Hermankova
- Department of Physiotherapy, Faculty of Physical Education & Sport, Charles University, Prague, Czech Republic
| | | | - Monika Gregova
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marketa Husakova
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Horinkova
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sarka Forejtova
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jindriska Gatterova
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Stolfa
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education & Sport, Charles University, Prague, Czech Republic
| | - Jiri Vencovsky
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Senolt
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomcik
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Reyes-Cordero G, Enríquez-Sosa F, Gomez-Ruiz C, Gonzalez-Diaz V, Castillo-Ortiz JD, Duran-Barragán S, Duran-Ortiz JS, Espinosa-Morales R, Gamez-Nava JI, Gonzalez-Lopez L, Julian-Martínez B, Mendoza-Fuentes A, Ramos-Remus C, Pacheco-Tena C, Burgos-Vargas R. Recommendations of the Mexican College of Rheumatology for the Management of Spondyloarthritis. REUMATOLOGIA CLINICA 2021; 17:37-45. [PMID: 31285162 DOI: 10.1016/j.reuma.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To update the recommendations for the management of patients with Spondyloarthritis (SpA) in the Mexican population, and identify which variables could influence patient management. MATERIAL AND METHODS A group of 15 experts in SpA translated, analyzed and modified the recommendations of the Mexican College of Rheumatology (CMR) and the International Society for the Assessment of Spondyloarthritis (ASAS)/European League Against Rheumatism (EULAR) 2016 group through a systematic review of the literature by two external reviewers during the period from 2015 to 2018 using the grade of recommendation, Oxford levels of evidence, percentage of concordance (Delphi). RESULTS Compared to previous recommendations, there were no significant changes from the year 2015. However, we modified the five fundamental principles and reduced the number of recommendations to ten by incorporating the first item in the text and combining five recommendations into two and adding a further recommendation. We confirmed the tendency to use glucocorticoids for patients with inflammatory activity and scarce access to biologicals. We identified the sociodemographic and clinical characteristics of patients with SpA and their influence on the application of the recommendations. CONCLUSIONS The ten recommendations of the CMR and the analysis of the characteristics of the Mexican patients with SpA focussed on step therapy, including pharmacological and non-pharmacological therapies, in a spectrum from easily accessible to high-tech substances available to a small percentage of the population.
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Affiliation(s)
- Greta Reyes-Cordero
- Hospital Ángeles Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Favio Enríquez-Sosa
- Hospital Regional «General Ignacio Zaragoza», ISSSTE, Ciudad de México, México
| | | | - Verónica Gonzalez-Diaz
- Antiguo Hospital Civil de Guadalajara «Fray Antonio Alcalde», Guadalajara, Jalisco, México
| | | | - Sergio Duran-Barragán
- Clínica de Investigación en Reumatología y Obesidad S.C. Instituto de Investigación en Reumatología y del Sistema Musculoesquelético, Departamento de Clínicas Médicas, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - J Santos Duran-Ortiz
- Servicio de Reumatología, Hospital General de Zona N.(o) 1, Instituto Mexicano del Seguro Social, Tepic, Nayarit, México
| | - Rolando Espinosa-Morales
- Servicio de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México
| | - Jorge I Gamez-Nava
- Unidad de Investigación Biomédica 02, UMAE, Hospital de Especialidades Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, México; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Laura Gonzalez-Lopez
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Bernardo Julian-Martínez
- Servicio de Reumatología, Hospital General de Zona N.(o) 1, Instituto Mexicano del Seguro Social Delegación Hidalgo, Pachuca, Hidalgo, México
| | | | - Cesar Ramos-Remus
- Unidad de Investigación en Enfermedades Crónico-Degenerativas, Guadalajara, Jalisco, México
| | - Cesar Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Ruben Burgos-Vargas
- Hospital General de México «Dr. Eduardo Liceaga», Universidad Nacional Autónoma de México, Ciudad de México, México.
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Huang Y, Chen Y, Liu T, Lin S, Yin G, Xie Q. Impact of tumor necrosis factor α inhibitors on MRI inflammation in axial spondyloarthritis assessed by Spondyloarthritis Research Consortium Canada score: A meta-analysis. PLoS One 2020; 15:e0244788. [PMID: 33382842 PMCID: PMC7775088 DOI: 10.1371/journal.pone.0244788] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/16/2020] [Indexed: 02/05/2023] Open
Abstract
Spondyloarthritis Research Consortium Canada (SPARCC) score is an effective magnetic resonance imaging (MRI) evaluation method for inflammation in axial spondyloarthritis. Previously published meta-analyses have shown tumor necrosis factor α inhibitors (TNFi) had great effectiveness on improving disease activity and function in axial spondyloarthritis. However, there still has no one that concentrates on the impact of TNFi on MRI inflammation. We conduct a meta-analysis to summarize the impact of TNFi on MRI inflammation in axial spondyloarthritis using SPARCC score. Comprehensive search was conducted in the databases of OVID Medline, OVID EMBASE, and Cochrane library on November 14, 2020. We investigated the differences in SPARCC score of sacroiliac joint and spine, before and after TNFi treatment in patients with axial spondyloarthritis. SPARCC score was further compared in the subgroup by diagnostic category and TNFi types. In addition, clinical assessment indicators including ankylosing spondylitis disease activity score, bath ankylosing spondylitis disease activity index, bath ankylosing spondylitis functional index, c-reactive protein were also analyzed. Data were pooled by mean differences (MD) with 95% confidence intervals (CI) and publication bias was assessed by Egger's test. Jadad scale was applied to assess the quality of included trials. Compared with control group, TNFi significantly improved SPARCC score of sacroiliac joints (n = 11, MD = 2.86, 95% CI 2.50, 3.23) and spine (n = 5, MD = 1.87,95%CI 1.27, 2.46). This effect was consistent among subgroups by different diagnostic category (ankylosing spondylitis, non-radiographic axial spondyloarthritis) and TNFi types (adalimumab, certolizumab pegol). Analysis of clinical assessment indicators also confirmed the therapeutic effect on axial spondyloarthritis. Egger's test suggested no possibility of publication bias. This meta-analysis shows that TNFi are effective to improve MRI inflammation in patients with axial spondyloarthritis and the treatment effectiveness is not affected by diagnostic category and TNFi types.
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Affiliation(s)
- Yupeng Huang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuehong Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sang Lin
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Geng Yin
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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48
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Diagnostic performance for erosion detection in sacroiliac joints on MR T1-weighted images: Comparison between different slice thicknesses. Eur J Radiol 2020; 133:109352. [DOI: 10.1016/j.ejrad.2020.109352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/05/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
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49
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Weiss PF, Chauvin NA. Imaging in the diagnosis and management of axial spondyloarthritis in children. Best Pract Res Clin Rheumatol 2020; 34:101596. [DOI: 10.1016/j.berh.2020.101596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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50
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Aouad K, Maksymowych WP, Baraliakos X, Ziade N. Update of imaging in the diagnosis and management of axial spondyloarthritis. Best Pract Res Clin Rheumatol 2020; 34:101628. [PMID: 33257146 DOI: 10.1016/j.berh.2020.101628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Imaging of the spine and sacroiliac joints has acquired a central role in the diagnosis and classification of axial spondyloarthritis (axSpA) in the earliest phases of the disease. New definitions of specific imaging lesions, particularly in magnetic resonance imaging (MRI), have been recently updated and revised by the ASAS MRI working group to reach a standardized understanding and diagnosis of axSpA among rheumatologists. Recognizing the misleading pitfalls of MRI lesions and differential diagnosis also represents an essential issue in clinical practice to avoid false-positive findings and establish the diagnosis of axSpA with careful regard to the clinical context, clinical signs, and biological tests. This review summarizes the current evidence on the different imaging modalities of the sacroiliac joints and the spine with their application in the clinical setting of SpA and their main pitfalls; it also highlights the newest emerging imaging techniques.
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Affiliation(s)
- Krystel Aouad
- Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon.
| | - Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, 568A Heritage Medical Research Centre, Edmonton, Alberta T6G2R3, Canada.
| | - Xenofon Baraliakos
- Department of Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Claudiusstr. 45, 44649 Herne, Germany.
| | - Nelly Ziade
- Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon; Department of Rheumatology, Hotel-Dieu de France Hospital, Beirut, Lebanon.
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