1
|
Roels J, De Craemer AS, Renson T, de Hooge M, Gevaert A, Van Den Berghe T, Jans L, Herregods N, Carron P, Van den Bosch F, Saeys Y, Elewaut D. Machine Learning Pipeline for Predicting Bone Marrow Edema Along the Sacroiliac Joints on Magnetic Resonance Imaging. Arthritis Rheumatol 2023; 75:2169-2177. [PMID: 37410803 DOI: 10.1002/art.42650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE We aimed to develop and validate a fully automated machine learning (ML) algorithm that predicts bone marrow edema (BME) on a quadrant level in sacroiliac (SI) joint magnetic resonance imaging (MRI). METHODS A computer vision workflow automatically locates the SI joints, segments regions of interest (ilium and sacrum), performs objective quadrant extraction, and predicts presence of BME, suggestive of inflammatory lesions, on a quadrant level in semicoronal slices of T1/T2-weighted MRI scans. Ground truth was determined by consensus among human readers. The inflammation classifier was trained using a ResNet18 backbone and five-fold cross-validated on scans of patients with spondyloarthritis (SpA) (n = 279), postpartum individuals (n = 71), and healthy subjects (n = 114). Independent SpA patient MRI scans (n = 243) served as test data set. Patient-level predictions were derived from aggregating quadrant-level predictions, ie, at least one positive quadrant. RESULTS The algorithm automatically detects the SI joints with a precision of 98.4% and segments ilium/sacrum with an intersection over union of 85.6% and 67.9%, respectively. The inflammation classifier performed well in cross-validation: area under the curve (AUC) 94.5%, balanced accuracy (B-ACC) 80.5%, and F1 score 64.1%. In the test data set, AUC was 88.2%, B-ACC 72.1%, and F1 score 50.8%. On a patient level, the model achieved a B-ACC of 81.6% and 81.4% in the cross-validation and test data set, respectively. CONCLUSION We propose a fully automated ML pipeline that enables objective and standardized evaluation of BME along the SI joints on MRI. This method has the potential to screen large numbers of patients with (suspected) SpA and is a step closer towards artificial intelligence-assisted diagnosis and follow-up.
Collapse
Affiliation(s)
- Joris Roels
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Thomas Renson
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Manouk de Hooge
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Arne Gevaert
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University, Ghent, Belgium
| | | | | | | | - Philippe Carron
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Filip Van den Bosch
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Yvan Saeys
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
2
|
Mortier C, Quintelier K, De Craemer AS, Renson T, Deroo L, Dumas E, Verheugen E, Coudenys J, Decruy T, Lukasik Z, Van Gassen S, Saeys Y, Hoorens A, Lobatón T, Van den Bosch F, Van de Wiele T, Venken K, Elewaut D. Gut Inflammation in Axial Spondyloarthritis Patients is Characterized by a Marked Type 17 Skewed Mucosal Innate-like T Cell Signature. Arthritis Rheumatol 2023; 75:1969-1982. [PMID: 37293832 DOI: 10.1002/art.42627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/29/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Patients with spondyloarthritis (SpA) often present with microscopic signs of gut inflammation, a risk factor for progressive disease. We investigated whether mucosal innate-like T cells are involved in dysregulated interleukin-23 (IL-23)/IL-17 responses in the gut-joint axis in SpA. METHODS Ileal and colonic intraepithelial lymphocytes (IELs), lamina propria lymphocytes (LPLs), and paired peripheral blood mononuclear cells (PBMCs) were isolated from treatment-naive patients with nonradiographic axial SpA with (n = 11) and without (n = 14) microscopic gut inflammation and healthy controls (n = 15) undergoing ileocolonoscopy. The presence of gut inflammation was assessed histopathologically. Immunophenotyping of innate-like T cells and conventional T cells was performed using intracellular flow cytometry. Unsupervised clustering analysis was done by FlowSOM technology. Serum IL-17A levels were measured via Luminex. RESULTS Microscopic gut inflammation in nonradiographic axial SpA was characterized by increased ileal intraepithelial γδ-hi T cells, a γδ-T cell subset with elevated γδ-T cell receptor expression. γδ-hi T cells were also increased in PBMCs of patients with nonradiographic axial SpA versus healthy controls and were strongly associated with Ankylosing Spondylitis Disease Activity Score. The abundance of mucosal-associated invariant T cells and invariant natural killer T cells was unaltered. Innate-like T cells in the inflamed gut showed increased RORγt, IL-17A, and IL-22 levels with loss of T-bet, a signature that was less pronounced in conventional T cells. Presence of gut inflammation was associated with higher serum IL-17A levels. In patients treated with tumor necrosis factor blockade, the proportion of γδ-hi cells and RORγt expression in blood was completely restored. CONCLUSION Intestinal innate-like T cells display marked type 17 skewing in the inflamed gut mucosa of patients with nonradiographic axial SpA. γδ-hi T cells are linked to intestinal inflammation and disease activity in SpA.
Collapse
Affiliation(s)
- Céline Mortier
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Katrien Quintelier
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium, Data Mining and Modeling for Biomedicine group, VIB-UGent Center for Inflammation Research, Ghent, Belgium, and Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ann-Sophie De Craemer
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Thomas Renson
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Liselotte Deroo
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Emilie Dumas
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Eveline Verheugen
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Julie Coudenys
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Tine Decruy
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Zuzanna Lukasik
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Sofie Van Gassen
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University and Data Mining and Modeling for Biomedicine group, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Yvan Saeys
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University and Data Mining and Modeling for Biomedicine group, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Anne Hoorens
- Department of Pathology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Triana Lobatón
- Department of Internal Medicine and Pediatrics, Ghent University and Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Tom Van de Wiele
- Center for Microbial Ecology and Technology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Koen Venken
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University and Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| |
Collapse
|
3
|
Van Den Berghe T, Babin D, Chen M, Callens M, Brack D, Maes H, Lievens J, Lammens M, Van Sumere M, Morbée L, Hautekeete S, Schatteman S, Jacobs T, Thooft WJ, Herregods N, Huysse W, Jaremko JL, Lambert R, Maksymowych W, Laloo F, Baraliakos X, De Craemer AS, Carron P, Van den Bosch F, Elewaut D, Jans L. Neural network algorithm for detection of erosions and ankylosis on CT of the sacroiliac joints: multicentre development and validation of diagnostic accuracy. Eur Radiol 2023; 33:8310-8323. [PMID: 37219619 DOI: 10.1007/s00330-023-09704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/25/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the feasibility and diagnostic accuracy of a deep learning network for detection of structural lesions of sacroiliitis on multicentre pelvic CT scans. METHODS Pelvic CT scans of 145 patients (81 female, 121 Ghent University/24 Alberta University, 18-87 years old, mean 40 ± 13 years, 2005-2021) with a clinical suspicion of sacroiliitis were retrospectively included. After manual sacroiliac joint (SIJ) segmentation and structural lesion annotation, a U-Net for SIJ segmentation and two separate convolutional neural networks (CNN) for erosion and ankylosis detection were trained. In-training validation and tenfold validation testing (U-Net-n = 10 × 58; CNN-n = 10 × 29) on a test dataset were performed to assess performance on a slice-by-slice and patient level (dice coefficient/accuracy/sensitivity/specificity/positive and negative predictive value/ROC AUC). Patient-level optimisation was applied to increase the performance regarding predefined statistical metrics. Gradient-weighted class activation mapping (Grad-CAM++) heatmap explainability analysis highlighted image parts with statistically important regions for algorithmic decisions. RESULTS Regarding SIJ segmentation, a dice coefficient of 0.75 was obtained in the test dataset. For slice-by-slice structural lesion detection, a sensitivity/specificity/ROC AUC of 95%/89%/0.92 and 93%/91%/0.91 were obtained in the test dataset for erosion and ankylosis detection, respectively. For patient-level lesion detection after pipeline optimisation for predefined statistical metrics, a sensitivity/specificity of 95%/85% and 82%/97% were obtained for erosion and ankylosis detection, respectively. Grad-CAM++ explainability analysis highlighted cortical edges as focus for pipeline decisions. CONCLUSIONS An optimised deep learning pipeline, including an explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical performance on a slice-by-slice and patient level. CLINICAL RELEVANCE STATEMENT An optimised deep learning pipeline, including a robust explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical metrics on a slice-by-slice and patient level. KEY POINTS • Structural lesions of sacroiliitis can be detected automatically in pelvic CT scans. • Both automatic segmentation and disease detection yield excellent statistical outcome metrics. • The algorithm takes decisions based on cortical edges, rendering an explainable solution.
Collapse
Affiliation(s)
- Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Danilo Babin
- Department of Telecommunication and Information Processing - Image Processing and Interpretation (TELIN-IPI), Faculty of Engineering and Architecture, Ghent University - IMEC, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Martijn Callens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Denim Brack
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Helena Maes
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jan Lievens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marie Lammens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Maxime Van Sumere
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Simon Hautekeete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stijn Schatteman
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Tom Jacobs
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Willem-Jan Thooft
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Wouter Huysse
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Robert Lambert
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Walter Maksymowych
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstraße 45, 44649, Herne, Germany
| | - Ann-Sophie De Craemer
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
4
|
Venken K, Jarlborg M, Decruy T, Mortier C, Vlieghe C, Gilis E, De Craemer AS, Coudenys J, Cambré I, Fleury D, Klimowicz A, Van den Bosch F, Hoorens A, Lobaton T, de Roock S, Sparwasser T, Nabozny G, Jacques P, Elewaut D. Distinct immune modulatory roles of regulatory T cells in gut versus joint inflammation in TNF-driven spondyloarthritis. Ann Rheum Dis 2023; 82:1076-1090. [PMID: 37197892 DOI: 10.1136/ard-2022-223757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/19/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES Gut and joint inflammation commonly co-occur in spondyloarthritis (SpA) which strongly restricts therapeutic modalities. The immunobiology underlying differences between gut and joint immune regulation, however, is poorly understood. We therefore assessed the immunoregulatory role of CD4+FOXP3+ regulatory T (Treg) cells in a model of Crohn's-like ileitis and concomitant arthritis. METHODS RNA-sequencing and flow cytometry was performed on inflamed gut and joint samples and tissue-derived Tregs from tumour necrosis factor (TNF)∆ARE mice. In situ hybridisation of TNF and its receptors (TNFR) was applied to human SpA gut biopsies. Soluble TNFR (sTNFR) levels were measured in serum of mice and patients with SpA and controls. Treg function was explored by in vitro cocultures and in vivo by conditional Treg depletion. RESULTS Chronic TNF exposure induced several TNF superfamily (TNFSF) members (4-1BBL, TWEAK and TRAIL) in synovium and ileum in a site-specific manner. Elevated TNFR2 messenger RNA levels were noted in TNF∆ARE/+ mice leading to increased sTNFR2 release. Likewise, sTNFR2 levels were higher in patients with SpA with gut inflammation and distinct from inflammatory and healthy controls. Tregs accumulated at both gut and joints of TNF∆ARE mice, yet their TNFR2 expression and suppressive function was significantly lower in synovium versus ileum. In line herewith, synovial and intestinal Tregs displayed a distinct transcriptional profile with tissue-restricted TNFSF receptor and p38MAPK gene expression. CONCLUSIONS These data point to profound differences in immune-regulation between Crohn's ileitis and peripheral arthritis. Whereas Tregs control ileitis they fail to dampen joint inflammation. Synovial resident Tregs are particularly maladapted to chronic TNF exposure.
Collapse
Affiliation(s)
- Koen Venken
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Matthias Jarlborg
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Tine Decruy
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Céline Mortier
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Carolien Vlieghe
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Elisabeth Gilis
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Julie Coudenys
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Isabelle Cambré
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Devan Fleury
- Immunology and Respiratory Department, Boehringer Ingelheim Corp Pharmaceutical Research and Development Centre Ridgefield, Ridgefield, Connecticut, USA
| | - Alexander Klimowicz
- Immunology and Respiratory Department, Boehringer Ingelheim Corp Pharmaceutical Research and Development Centre Ridgefield, Ridgefield, Connecticut, USA
| | - Filip Van den Bosch
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Anne Hoorens
- Department of Pathology, University Hospital Ghent, Gent, Belgium
| | - Triana Lobaton
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Gastroenterology unit), Ghent University, Ghent, Belgium
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Sytze de Roock
- Department of Pediatric Immunology, Center for Molecular and Cellular Intervention CMCI, Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Sparwasser
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gerald Nabozny
- Immunology and Respiratory Department, Boehringer Ingelheim Corp Pharmaceutical Research and Development Centre Ridgefield, Ridgefield, Connecticut, USA
| | - Peggy Jacques
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Molecular Immunology and Inflammation Unit, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology unit), Ghent University, Ghent, Belgium
| |
Collapse
|
5
|
de Hooge M, Ishchenko A, De Craemer AS, Steinfeld S, Nzeusseu A, Elewaut D, Lories R, de Vlam K, Van den Bosch F. Extent of axial damage in psoriatic arthritis and spondyloarthritis: comparative data from the BEPAS and (Be-)GIANT multicentre cohorts. RMD Open 2023; 9:rmdopen-2023-002994. [PMID: 37137541 PMCID: PMC10163589 DOI: 10.1136/rmdopen-2023-002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/02/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND To examine radiographic axial damage of the sacroiliac joints and spine in patients with psoriatic arthritis (PsA) and spondyloarthritis (SpA) in private and academic Belgian practices. METHODS Patients with PsA with clinical diagnosis of PsA and fulfilling the Classification Criteria for Psoriatic Arthritis from the prospective Belgian Epidemiological Psoriatic Arthritis Study and patients with SpA fulfilling the Assessment of SpondyloArthritis international Society classification criteria for SpA originate from the Ghent and BelGian Inflammatory Arthritis and spoNdylitis cohorTs were included in this study. Baseline pelvic and spinal radiographs were analysed by two calibrated readers. Blinded for the origin of the cohort or clinical data readers assessed the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and modified New York criteria on spinal and pelvic radiographs, respectively. Data were compared between both patient groups. RESULTS Of the 525 patients included (312 PsA and 213 SpA), most patients showed normal spinal radiographs: 87.5% of the patients with PsA and 92.0% of the patients with SpA. Patients with SpA with spinal damage show higher mSASSS than the patients with PsA (p<0.05). In patients with PsA, cervical spine is more often affected; 24/33 patients (72.7%) compared with lumbar spine 11/33 (33.3%). While in patients with SpA, syndesmophyte location was more evenly distributed; cervical 9/14 (64.3%) and lumbar 10/14 (71.4%). CONCLUSION Minimal radiographic spinal damage was observed in Belgian patients with PsA or SpA. Patients with SpA tend to have higher mSASSS values and more syndesmophytes compared with PsA. Syndesmophytes were more often located in the cervical spine of patients with PsA, while the location was equally distributed in axSpA.
Collapse
Affiliation(s)
- Manouk de Hooge
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Alla Ishchenko
- Department of Rheumatology, KU Leuven university Hospital, Leuven, Belgium
| | - Ann-Sophie De Craemer
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Serge Steinfeld
- Department of Rheumatology, Clinique St Jean, Brussels, Belgium
| | - Adrien Nzeusseu
- Department of Rheumatology, St Luc University Hospitals, Brussels, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Rik Lories
- Department of Rheumatology, KU Leuven university Hospital, Leuven, Belgium
- Department of Development and Regeneration, Catholic University College Leuven Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Kurt de Vlam
- Department of Rheumatology, KU Leuven university Hospital, Leuven, Belgium
- Department of Development and Regeneration, Catholic University College Leuven Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| |
Collapse
|
6
|
De Craemer AS, Witte T, Lobaton Ortega T, Hoorens A, De Vos M, Cuvelier C, Vastert SJ, Baraliakos X, Van den Bosch F, Elewaut D. Anti-CD74 IgA antibodies show diagnostic potential for axial spondyloarthritis but are not associated with microscopic gut inflammation. Rheumatology (Oxford) 2023; 62:984-990. [PMID: 35781486 DOI: 10.1093/rheumatology/keac384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Gut inflammation commonly occurs in axial SpA (axSpA), and is linked to disease activity and outcome. Given the role of IgA in mucosal immunity, we explored the association between anti-CD74 IgA antibodies, gut inflammation and axSpA. METHODS Anti-CD74 IgA was measured by ELISA in serum samples of axSpA patients, fulfilling the 2009 Assessment of SpondyloArthritis international Society classification criteria. A group of fibromyalgia (FM) and RA patients served as non-inflammatory and inflammatory controls. Newly diagnosed axSpA patients underwent ileocolonoscopy; mucosal biopsies were histopathologically assessed as normal, acute or chronically inflamed. Optimal anti-CD74 IgA cut-off values were determined with a receiver operating characteristics curve. RESULTS axSpA patients (n = 281) showed higher anti-CD74 IgA levels [mean (s.d.) 18.8 (12.4) U/ml] compared with 100 FM patients [10.9 (5.0) U/ml, P < 0.001] and 34 RA patients [13.7 (9.6) U/ml, P = 0.02]. The area under the receiver operating characteristics curve for diagnosis (axSpA vs FM) was 0.70, providing a sensitivity of 60% and specificity of 87% (cut-off 15 U/ml). Antibody concentrations were not significantly different between axSpA patients with (n = 40) and without (n = 69) gut inflammation (P = 0.83), yielding an area under the receiver operating characteristics curve of 0.51. Anti-CD74 IgA levels were not associated with degree of bone marrow oedema on MRI of the sacroiliac joints, CRP or any other disease-specific feature such as the use of NSAIDs or biological treatment. CONCLUSION Serum anti-CD74 IgA is a potentially useful diagnostic biomarker for axSpA. However, antibody levels do not correlate with any phenotypical feature, including microscopic gut inflammation, suggesting this to be a disease-specific rather than an inflammatory marker.
Collapse
Affiliation(s)
- Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Ghent University
- Department of Rheumatology, Ghent University Hospital, Ghent
- Center for Inflammation Research, Molecular Immunology and Inflammation Unit, VIB-UGent, Zwijnaarde, Belgium
| | - Torsten Witte
- Department of Rheumatology and Clinical Immunology, Medical School Hannover, Hannover, Germany
| | - Triana Lobaton Ortega
- Department of Internal Medicine and Pediatrics, Ghent University
- Department of Gastroenterology
| | - Anne Hoorens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Martine De Vos
- Department of Internal Medicine and Pediatrics, Ghent University
- Department of Gastroenterology
| | - Claude Cuvelier
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Sebastiaan J Vastert
- Department of Pediatric Rheumatology and Immunology, Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University
- Department of Rheumatology, Ghent University Hospital, Ghent
- Center for Inflammation Research, Molecular Immunology and Inflammation Unit, VIB-UGent, Zwijnaarde, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Ghent University
- Department of Rheumatology, Ghent University Hospital, Ghent
- Center for Inflammation Research, Molecular Immunology and Inflammation Unit, VIB-UGent, Zwijnaarde, Belgium
| |
Collapse
|
7
|
De Craemer AS, Deroo L, Renson T, Desimpele I, Delmez L, Decuman S, Janssens X, Boonen A, Elewaut D, Carron P, Van den Bosch F. Work participation is unaffected in Belgian spondyloarthritis patients: data from the BelGian Inflammatory Arthritis and SpoNdylitis cohorT. Rheumatology (Oxford) 2022; 62:1841-1850. [PMID: 36099046 DOI: 10.1093/rheumatology/keac529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/18/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to (1) investigate actual work participation in Belgian spondyloarthritis (SpA) patients compared to the general population, and (2) identify determinants of work-related outcomes. METHODS Adult SpA patients from the Ghent University hospital based Be-GIANT cohort (fulfilling ASAS classification criteria) were cross-sectionally questioned on their socio-economic status and completed a Work Productivity and Activity Impairment questionnaire (May 2018 - May 2019). Results were compared to national and regional data on the general population using indirect standardization. Associations between clinical and job characteristics and work-related outcomes were analyzed with logistic regression (having a paid job) and negative binomial hurdle models (sick leave and presenteeism, i.e. restrictions while at work). RESULTS 215/262 (82%) patients of working-age (<65 y/o) had a paid job, corresponding to an age- and sex-adjusted employment ratio of 1.00 (95%CI 0.88;1.14). Patients worked 39.6±10.5h/week, and 49% (95%CI 42;56%) reported sick leave in the previous year, similar to the general population (39.7h/week, 42%). 56% reported presenteeism of median (IQR) 10% (0-20%). In multivariate analysis, functional impairment (BASFI) and health-related quality of life (HRQoL, EuroQoL-VAS) were associated with each work-related outcome, while contextual factors (education, physically demanding job) were positively associated with respectively having a paid job and presenteeism. Clinical characteristics showed no independent association with any of these outcomes. CONCLUSION Evidence from this academic cohort study does not support a work participation gap between SpA patients and the general population, but confirms the role of physical function, overall HRQoL, and education or job type as risk factors for adverse work outcomes.
Collapse
Affiliation(s)
- Ann-Sophie De Craemer
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Liselotte Deroo
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Thomas Renson
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Ine Desimpele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lauren Delmez
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Saskia Decuman
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Service for benefits, National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Xavier Janssens
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk Elewaut
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Philippe Carron
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| |
Collapse
|
8
|
So J, De Craemer AS, Elewaut D, Tam LS. Spondyloarthritis: How far are we from precision medicine? Front Med (Lausanne) 2022; 9:988532. [PMID: 36160128 PMCID: PMC9492940 DOI: 10.3389/fmed.2022.988532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Spondyloarthritis (SpA) is a family of heterogenous diseases consisting of different phenotypes. The exact disease mechanism remains unclear but evidence shows the complex pathophysiology with interplay between genome, microbiome, and immunome. Biologic DMARDs have markedly improved patients' disease control and quality of life. However, treatment response varies among patients. There is a growing need to identify biomarkers for the diagnosis, prognosis, prevention, and treatment of SpA. Genomic studies have been the research focus in the past two decades and have identified important genes involved in SpA. In recent years, emerging evidence supports the link between gut and joint inflammation in SpA, in which the role of gut microbiome in SpA is of great interest. Herein, potential genetic and gut microbial biomarkers for predicting treatment response are discussed. Novel strategies targeting dysbiosis in SpA are also summarized. These results represent a significant step toward precision medicine for patients with SpA.
Collapse
Affiliation(s)
- Jacqueline So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Ann-Sophie De Craemer
- Division of Rheumatology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
- Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Dirk Elewaut
- Division of Rheumatology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
- Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- *Correspondence: Lai-Shan Tam
| |
Collapse
|
9
|
De Craemer AS, Renson T, Deroo L, Van Praet L, Cypers H, Varkas G, Joos R, Devinck M, Gyselbrecht L, Peene I, Thevissen K, Costantino F, D'Agostino MA, Lenaerts J, Carron P, Van den Bosch F, Elewaut D. Peripheral manifestations are major determinants of disease phenotype and outcome in new onset spondyloarthritis. Rheumatology (Oxford) 2022; 61:3279-3288. [PMID: 34850859 DOI: 10.1093/rheumatology/keab887] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To delineate the impact of peripheral musculoskeletal manifestations on stratification of disease phenotype and outcome in new-onset spondyloarthritis (SpA), using a prospective observational nationwide inception cohort, the BelGian Inflammatory Arthritis and spoNdylitis cohorT (Be-Giant). METHODS Newly diagnosed adult SpA patients, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) criteria for axial or peripheral SpA, were included in Be-Giant and prospectively followed every six months. Peripheral involvement (defined as arthritis, enthesitis and/or dactylitis) was determined in relation to clinically similar patient subsets at baseline and disease activity patterns during two-year follow-up, identified through K-means cluster analysis and latent class growth analysis. RESULTS From November 2010 to March 2020, 367 patients were enrolled in Be-Giant, of whom 162 (44%) had peripheral manifestations. Two patient clusters [A, axial predominant (n = 248) and B, peripheral predominant (n = 119)] were identified at diagnosis. Longitudinal analysis (n = 115) revealed two trajectories of disease activity in each cluster: one with persistently high disease activity over time ('High'), the other rapidly evolving to low disease activity ('Low'). In cluster A patients, peripheral manifestations predisposed to the 'High' trajectory [odds ratio (OR) = 2.0, 95% CI: 1.3, 3.1, P = 0.001], despite more rapid initiation of biologics compared with patients without peripheral manifestations (hazard ratio (HR) = 2.1, 95% CI: 1.0, 4.4, P = 0.04 - Cox proportional-hazards model). CONCLUSION Peripheral musculoskeletal manifestations are major determinants of phenotypical diversity in new-onset SpA. Intriguingly, stratification of axial SpA according to concomitant peripheral involvement identified an endotype with an unfavorable outcome despite more prompt therapeutic intensification with biologics. These observations justify an endotype-tailored approach beyond current ASAS/EULAR management recommendations.
Collapse
Affiliation(s)
- Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, Gent
- Center for Inflammation Research, VIB-UGent, Zwijnaarde
| | - Thomas Renson
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, Gent
- Center for Inflammation Research, VIB-UGent, Zwijnaarde
| | - Liselotte Deroo
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, Gent
- Center for Inflammation Research, VIB-UGent, Zwijnaarde
| | | | | | - Gaëlle Varkas
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, Gent
| | - Rik Joos
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, Gent
- Department of Rheumatology, ZNA Jan Palfijn, Merksem
| | - Mieke Devinck
- Department of Rheumatology, AZ Sint-Lucas, Assebroek
| | - Lieve Gyselbrecht
- Department of Rheumatology, Algemeen Stedelijk Ziekenhuis (ASZ), Aalst
| | - Isabelle Peene
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, Gent
- Department of Rheumatology, AZ Sint-Jan, Brugge
| | - Kristof Thevissen
- Reumacentrum Genk, Genk
- Department of Rheumatology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
| | - Félicie Costantino
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Montigny-Le-Bretonneux
- Rheumatology Department, AP-HP, Ambroise Paré Hospital, 92100, Boulogne-Billancourt, France
| | - Maria-Antonietta D'Agostino
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Montigny-Le-Bretonneux
- Rheumatology Department, AP-HP, Ambroise Paré Hospital, 92100, Boulogne-Billancourt, France
- Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
| | - Jan Lenaerts
- Reuma Instituut
- Department of Rheumatology, AZ Jessa Hospitals, Hasselt
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, Gent
- Center for Inflammation Research, VIB-UGent, Zwijnaarde
- Department of Rheumatology, AZ Alma, Eeklo, Belgium
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, Gent
- Center for Inflammation Research, VIB-UGent, Zwijnaarde
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, Gent
- Center for Inflammation Research, VIB-UGent, Zwijnaarde
| |
Collapse
|
10
|
Renson T, de Hooge M, De Craemer AS, Deroo L, Lukasik Z, Carron P, Herregods N, Jans L, Colman R, Van den Bosch F, Elewaut D. Progressive increase in sacroiliac joint and spinal mri lesions in healthy individuals in relation to age. Arthritis Rheumatol 2022; 74:1506-1514. [PMID: 35436391 DOI: 10.1002/art.42145] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/27/2022] [Accepted: 04/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES MRI plays a pivotal role in spondyloarthritis (SpA) diagnosis. However, detailed description of MRI findings of the sacroiliac joints (SIJ) and spine in healthy individuals is currently lacking. We therefore sought to evaluate the occurrence of MRI-SIJ/spine lesions in healthy individuals in relation to age. METHODS Ninety-five healthy subjects (20-49 years) underwent MRI-SIJ and -spine. BME and structural lesions of the SIJ were scored using the SPARCC method. Spinal inflammatory and structural lesions were evaluated using the SPARCC MRI spine inflammation index and the CANDEN MRI scoring system, respectively. Fulfillment of the ASAS definition of a positive MRI for sacroiliitis/spondylitis was reviewed. Findings were compared with MRI of axial SpA patients from the Be-GIANT cohort. RESULTS 17.2% of subjects aged ≥30 fulfilled the definition of a positive MRI for sacroiliitis, but this occurred rarely in younger subjects. SIJ erosions (20.0%) and fat metaplasia (13.7%) were detected across all age groups. Erosions were more frequently visualized in subjects aged ≥40 (39.3%). Spinal BME (35.7%) and fat metaplasia (28.6%) were common in subjects older than 40 years. Nonetheless, only one subject had ≥3 corner inflammatory lesions. SIJ and spinal SPARCC scores and total structural lesions scores increased progressively with age. CONCLUSION Contrary to what is commonly believed, structural MRI-SIJ lesions are frequently seen in healthy individuals. Especially in older subjects, the high occurrence of inflammatory and structural MRI lesions impacts their specificity for SpA, which has important implications for the interpretation of MRI in patients with clinical suspicion of SpA.
Collapse
Affiliation(s)
- Thomas Renson
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Manouk de Hooge
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Liselotte Deroo
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Zuzanna Lukasik
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Roos Colman
- Department of Biostatistics, Ghent University, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| |
Collapse
|
11
|
Costantino F, Aegerter P, Schett G, De Craemer AS, Molto A, Van den Bosch F, Elewaut D, Breban M, D'Agostino MA. Cluster analysis in early axial spondyloarthritis predicts poor outcome in the presence of peripheral articular manifestations. Rheumatology (Oxford) 2021; 61:3289-3298. [PMID: 34864930 DOI: 10.1093/rheumatology/keab873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess whether two cluster analysis-based axial SpA (axSpA) endotypes (A for purely axial; B for both axial and peripheral) are stable over time and are associated with different long-term disease outcomes. METHODS K-means cluster analysis was performed at each visit (until 5 years) on 584 patients from the DESIR cohort, who completed all planned visits, and validated in 232 consecutive axSpA patients from the BeGiant cohort. Cluster stability overtime was assessed by kappa statistics. A generalized linear mixed-effect analysis was applied to compare outcomes between clusters. Classification and regression tree (CART) analysis was performed to determine a decision rule able to assign a given patient to a definite cluster at onset. RESULTS Both endotypes remained remarkably stable over time. In the DESIR cohort, patients in cluster B showed higher disease activity, worse functional outcome and higher need for anti-rheumatic drugs than patients in cluster A. CART analysis yielded three main clinical features (arthritis, enthesitis, and dactylitis) that accurately determined cluster assignment. These results could be replicated in the Be-GIANT cohort. CONCLUSION Cluster-based axSpA endotypes were reproducible in two different cohorts, stable over time and associated with different long-term outcome. The axSpA endotype with additional peripheral disease manifestations is associated with more severe disease and requires more intensive drug therapy. CLINICAL TRIAL REGISTRATION clinicaltrials.gov, https://clinicaltrials.gov, NCT01648907.
Collapse
Affiliation(s)
- Félicie Costantino
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Montigny-Le-Bretonneux, 78180, France.,Rheumatology Department, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, 92100, France
| | - Philippe Aegerter
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Montigny-Le-Bretonneux, 78180, France.,GIRCI IdF-UFR Médecine Paris-Ile-de-France-Ouest Université, Boulogne-Billancourt, 92100, France
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen- Nuremberg and Universitatsklinikum Erlangen, Erlangen, 91054, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen- Nuremberg and Universitatsklinikum Erlangen, Erlangen, 91054, Germany
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Gent, 9000, Belgium.,Inflammation Research Center, VIB-UGent, Rijvisschestraat 152, Gent, 9052, Belgium
| | - Anna Molto
- Department of Clinical Epidemiology and Biostatistics, Université de Paris, Inserm U1153, Paris, 75000, France.,Rheumatology Department, AP-HP, Cochin Hospital, Paris, 75014, France
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Gent, 9000, Belgium.,Inflammation Research Center, VIB-UGent, Rijvisschestraat 152, Gent, 9052, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Division of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Gent, 9000, Belgium.,Inflammation Research Center, VIB-UGent, Rijvisschestraat 152, Gent, 9052, Belgium
| | - Maxime Breban
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Montigny-Le-Bretonneux, 78180, France.,Rheumatology Department, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, 92100, France
| | - Maria-Antonietta D'Agostino
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Montigny-Le-Bretonneux, 78180, France.,Rheumatology Department, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, 92100, France.,Rheumatology Unit, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
| |
Collapse
|
12
|
Carron P, De Craemer AS, Renson T, Colman R, Elewaut D, Van den Bosch F. TNFi-induced sustained clinical remission in peripheral spondyloarthritis patients cannot be maintained with a step-down strategy based on methotrexate. Rheumatology (Oxford) 2021; 60:4880-4883. [PMID: 33471112 DOI: 10.1093/rheumatology/keab056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/14/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Treatment with golimumab monotherapy in early peripheral SpA (pSpA) results in higher rates of clinical remission compared with treatment in more longstanding disease. When reaching remission, treat-to-target recommendations suggest tapering of treatment. We therefore explored whether addition of MTX would permit discontinuation of golimumab in patients with pSpA in sustained clinical remission. METHODS After a 2-year extension phase with golimumab treatment, patients with pSpA reaching clinical remission in the CRESPA trial were offered a tapering strategy leading to discontinuation of golimumab and replacement by MTX monotherapy. Patients were prospectively followed to assess the rate of sustained biologic-free clinical remission. In case of relapse of arthritis, enthesitis or dactylitis under MTX monotherapy, golimumab was restarted. RESULTS Of the original 60 pSpA patients, 25 entered the step-down strategy. Currently, only 4 patients (16%) are still in sustained remission under MTX monotherapy. In 21 patients (84%), golimumab was reinstalled because of relapse of disease activity (n = 19) or development of adverse events related to MTX (n = 2). Restarting golimumab treatment promptly restored clinical remission in all patients within 12 weeks. CONCLUSION In patients with early pSpA achieving clinical remission after 2 years of golimumab treatment, step-down therapy to monotherapy with MTX led to high rates of clinical relapse. This underscores the overall weak efficacy of MTX in maintaining clinical remission in pSpA. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT01426815.
Collapse
Affiliation(s)
- Philippe Carron
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
| | - Thomas Renson
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
| | - Roos Colman
- Biostatistics Unit of the Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
| | - Filip Van den Bosch
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
| |
Collapse
|
13
|
Karow F, Smiljanovic B, Grün JR, Poddubnyy D, Proft F, Talpin A, Hue C, Boland A, Deleuze JF, Garchon HJ, Ergenç I, De Craemer AS, Erben U, Häupl T, Elewaut D, Breban M, Grützkau A, Syrbe U. Monocyte transcriptomes from patients with axial spondyloarthritis reveal dysregulated monocytopoiesis and a distinct inflammatory imprint. Arthritis Res Ther 2021; 23:246. [PMID: 34560894 PMCID: PMC8461951 DOI: 10.1186/s13075-021-02623-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background In patients with axial spondyloarthritis (axSpA), monocytes show a pre-activated phenotype. Gut inflammation is a trigger of monocyte activation and may also affect their development in the bone marrow (BM). As gut inflammation is commonly observed in axSpA patients, we performed a detailed analysis of monocyte transcriptomes of axSpA patients in two cohorts and searched for signs of activation and developmental adaptations as putative imprints of gut inflammation. Methods Transcriptomes of blood CD14+ monocytes of HLA-B27+ axSpA patients and healthy controls (HC) were generated by microarrays from cohort 1 and by RNA-sequencing from cohort 2. Differentially expressed genes from both analyses were subjected to gene set enrichment analysis (GSEA) and to co-expression analysis in reference transcriptomes from BM cells, blood cells and activated monocytes. As serological markers of translocation, 1,3 beta-glycan, intestinal fatty acid binding protein, and lipopolysaccharide binding protein (LBP) were determined by LAL and ELISA. Results Transcriptome analysis identified axSpA-specific monocyte signatures showing an imprint of LPS/cytokine-activated monocytes, late granulopoietic BM cells, blood neutrophils, and G-CSF-mobilized blood cells, which suggests LPS/TNF activation and more prominent BM adaptation promoting a neutrophil-like phenotype. GSEA mapped axSpA upregulated genes to inflammatory responses and TNFα signaling and downregulated probe-sets to metabolic pathways. Among translocation markers, LBP levels were significantly increased in axSpA patients vs. HC (p < 0.001). Stratified analysis by disease activity and stage identified an “active disease signature” (BASDAI ≥ 4) with an imprint of LPS/cytokine-activated monocytes and CD16+ monocyte subsets. The “AS signature” (vs. non-radiographic axSpA) showed a reinforced neutrophil-like phenotype due to deprivation of dendritic cell transcripts. Conclusions The neutrophil-like phenotype of axSpA monocytes points towards a biased monocytopoiesis from granulocyte-monocyte progenitors. This shift in monocytopoiesis and the LPS/cytokine imprint as well as the elevated LBP levels are indicators of systemic inflammation, which may result from bacterial translocation. The BM adaptation is most prominent in AS patients while disease activity appears to be linked to activation and trafficking of monocytes. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02623-7.
Collapse
Affiliation(s)
- Fabian Karow
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Biljana Smiljanovic
- Medizinische Klinik für Rheumatologie und Klinische Immunologie, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim R Grün
- Deutsches Rheumaforschungszentrum (DRFZ), A Leibniz Institute, Berlin, Germany
| | - Denis Poddubnyy
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Fabian Proft
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Alice Talpin
- Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, Montigny-le-Bretonneux, France.,Laboratoire d'Excellence Inflamex, Universite de Paris, Paris, France
| | - Christophe Hue
- Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, Montigny-le-Bretonneux, France.,Laboratoire d'Excellence Inflamex, Universite de Paris, Paris, France
| | - Anne Boland
- Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, Montigny-le-Bretonneux, France.,CEA, Centre National de Recherche en Génomique Humaine, Université Paris-Saclay, Evry, France
| | - Jean-François Deleuze
- Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, Montigny-le-Bretonneux, France.,CEA, Centre National de Recherche en Génomique Humaine, Université Paris-Saclay, Evry, France
| | - Henri-Jean Garchon
- Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, Montigny-le-Bretonneux, France.,Laboratoire d'Excellence Inflamex, Universite de Paris, Paris, France.,Service de Biochimie, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Ilkay Ergenç
- VIB Center for Inflammation Research, Ghent University Hospital, Ghent, Belgium.,Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Ann-Sophie De Craemer
- VIB Center for Inflammation Research, Ghent University Hospital, Ghent, Belgium.,Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Ulrike Erben
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Thomas Häupl
- Medizinische Klinik für Rheumatologie und Klinische Immunologie, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dirk Elewaut
- VIB Center for Inflammation Research, Ghent University Hospital, Ghent, Belgium.,Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Maxime Breban
- Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, Montigny-le-Bretonneux, France.,Laboratoire d'Excellence Inflamex, Universite de Paris, Paris, France.,Service de Rhumatologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Andreas Grützkau
- Deutsches Rheumaforschungszentrum (DRFZ), A Leibniz Institute, Berlin, Germany
| | - Uta Syrbe
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany.
| |
Collapse
|
14
|
De Mits S, De Craemer AS, Deroo L, Renson T, Van den Bosch FE, Carron P, Elewaut D. Unexpected impact of COVID-19 lockdown on spinal mobility and health perception in spondyloarthritis. Ann Rheum Dis 2021; 80:1638-1640. [PMID: 34187775 DOI: 10.1136/annrheumdis-2021-220584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/23/2021] [Indexed: 01/20/2023]
Affiliation(s)
- Sophie De Mits
- Rheumatology, Ghent University Hospital, Gent, Belgium .,Podiatry, Artevelde University College, Gent, Belgium
| | - Ann-Sophie De Craemer
- Rheumatology, Ghent University Hospital, Gent, Belgium.,Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Liselotte Deroo
- Rheumatology, Ghent University Hospital, Gent, Belgium.,Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Thomas Renson
- Rheumatology, Ghent University Hospital, Gent, Belgium.,Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Filip E Van den Bosch
- Rheumatology, Ghent University Hospital, Gent, Belgium.,Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Philippe Carron
- Rheumatology, Ghent University Hospital, Gent, Belgium.,Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Dirk Elewaut
- Rheumatology, Ghent University Hospital, Gent, Belgium.,Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| |
Collapse
|
15
|
Renson T, Carron P, De Craemer AS, Deroo L, de Hooge M, Krabbe S, Jans L, Østergaard M, Elewaut D, Van den Bosch F. The value of magnetic resonance imaging for assessing disease extent and prediction of relapse in early peripheral spondyloarthritis. Arthritis Rheumatol 2021; 73:2044-2051. [PMID: 33982902 DOI: 10.1002/art.41783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to assess the inflammatory burden in pSpA by lower-extremity MRI in an early remission-induction strategy study with TNF blockade. Furthermore, we sought to determine the value of MRI to predict disease relapse versus sustained remission after treatment discontinuation. METHODS Thirty-two early pSpA patients with lower limb involvement on clinical examination and confirmed by ultrasonography, participated in a remission-induction trial with a TNF-inhibitor (TNFi). Patients underwent MRI of joints and entheses of the lower extremities at baseline and at clinical remission, after which TNFi treatment was withdrawn. Images were evaluated for joint effusion, joint osteitis, entheseal soft tissue inflammation (STI), and entheseal osteitis. RESULTS Joint effusion and enthesitis on clinical examination and ultrasonography correlated well with MRI abnormalities. In addition, a substantial amount of subclinical involvement was seen on MRI, mainly in ankle joints and heel entheses. Inflammation scores were markedly lower in the subclinical joints and entheses versus those clinically involved. Inflammatory load on MRI decreased significantly upon TNFi treatment. Whereas 80% of the clinically involved joints at baseline showed no effusion on remission MRI, two out of three involved entheses at baseline showed residual inflammation. In addition, patients relapsing after treatment discontinuation displayed more entheseal STI on remission MRI compared to those maintaining drug-free remission. CONCLUSION Our findings delineate a differential response of synovitis and enthesitis, with enthesitis on MRI responding less upon TNFi treatment. Furthermore, residual entheseal inflammation might be indicative for the need for continuous therapy.
Collapse
Affiliation(s)
- Thomas Renson
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Liselotte Deroo
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Manouk de Hooge
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1017, Copenhagen, Denmark
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1017, Copenhagen, Denmark
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| |
Collapse
|
16
|
Renson T, Carron P, De Craemer AS, Deroo L, de Hooge M, Krabbe S, Jans L, Chen M, Østergaard M, Van den Bosch FE, Elewaut D. Axial involvement in patients with early peripheral spondyloarthritis: a prospective MRI study of sacroiliac joints and spine. Ann Rheum Dis 2020; 80:103-108. [PMID: 33115761 DOI: 10.1136/annrheumdis-2020-218480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess axial involvement on MRI in early peripheral spondyloarthritis (pSpA) and to evaluate whether axial inflammation predicts relapse on treatment withdrawal. METHODS Fifty-six patients with early, active, newly diagnosed pSpA underwent MRI of the sacroiliac joints (SIJs) and spine prior to golimumab initiation. At sustained clinical remission of pSpA, treatment was withdrawn and a second MRI was performed. Bone marrow oedema (BME) was scored by three readers according to the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Scores were compared with an axial spondyloarthritis cohort (Belgian Arthritis and Spondylitis cohort). Structural lesions were assessed using a similar method. Furthermore, fulfilment of the Assessment of Spondyloarthritis International Society (ASAS) definition of a positive MRI for sacroiliitis was assessed. Spinal images were evaluated for BME and structural lesions using the Canada-Denmark MRI spine scoring system by two readers. RESULTS Thirty-six per cent showed SIJ BME at baseline, all fulfilling the ASAS definition of sacroiliitis. No association with back pain was found. Twenty-one per cent displayed SIJ structural lesions. Spinal BME was limited: the median inflammation scores were low and no patients had ≥5 inflammatory corner lesions. On clinical remission, a significant decrease in SIJ SPARCC scores was detected. On clinical remission, no significant differences in SIJ SPARCC scores were noted between patients relapsing and those maintaining remission after treatment discontinuation. CONCLUSION In patients with early pSpA, a surprisingly high prevalence of sacroiliitis on MRI was observed; SPARCC scores decreased significantly on tumour necrosis factor inhibition. Residual inflammation on MRI was not predictive of relapse of peripheral manifestations. No relevant inflammatory spinal involvement was detected. Collectively, our findings suggest a higher inflammatory burden in patients with early pSpA than anticipated.
Collapse
Affiliation(s)
- Thomas Renson
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium .,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Philippe Carron
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Liselotte Deroo
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Manouk de Hooge
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lennart Jans
- Radiology, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Min Chen
- Radiology, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip E Van den Bosch
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Dirk Elewaut
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| |
Collapse
|
17
|
Carron P, De Craemer AS, Van den Bosch F. Peripheral spondyloarthritis: a neglected entity-state of the art. RMD Open 2020; 6:e001136. [PMID: 32385142 PMCID: PMC7299516 DOI: 10.1136/rmdopen-2019-001136] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023] Open
Abstract
Peripheral spondyloarthritis (pSpA) refers to a number of seemingly different spondyloarthritis subsets in which psoriatic arthritis (PsA) is the most common, and symptoms of arthritis, enthesitis or dactylitis predominate the clinical presentation. Although formal classification criteria for pSpA have been introduced in 2011, only a minority of epidemiological and clinical studies addressed this clinical entity as a separate disease. Moreover, research on outcome measures and treatment modalities in pSpA has been mainly focused on PsA. Subsequently, all biological treatments are off-label in patients with non-psoriatic pSpA. Its neglected status has important implications for clinical practice since the emerging group of early-diagnosed non-psoriatic pSpA patients remains poorly characterised and lacks specific treatment recommendations. This review summarises what is currently known regarding pSpA in terms of epidemiology, clinical presentation, diagnosis and therapeutic approach.
Collapse
Affiliation(s)
- Philippe Carron
- Rheumatology, University Hospital Ghent, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Rheumatology, University Hospital Ghent, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
| | - Filip Van den Bosch
- Rheumatology, University Hospital Ghent, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
| |
Collapse
|
18
|
|
19
|
Renson T, Depicker A, De Craemer AS, Deroo L, Varkas G, de Hooge M, Carron P, Jans L, Herregods N, Dehaene I, Vandenberghe G, Roelens K, Van den Bosch FE, Elewaut D. High prevalence of spondyloarthritis-like MRI lesions in postpartum women: a prospective analysis in relation to maternal, child and birth characteristics. Ann Rheum Dis 2020; 79:929-934. [PMID: 32299794 DOI: 10.1136/annrheumdis-2020-217095] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Bone marrow oedema (BMO) on MRI of sacroiliac joints (SIJs) represents a hallmark of axial spondyloarthritis (SpA), yet such lesions may also occur under augmented mechanical stress in healthy subjects. We therefore sought to delineate the relationship between pregnancy/delivery and pelvic stress through a prospective study with repeated MRI. Results were matched with maternal, child and birth characteristics. METHODS Thirty-five women underwent a baseline MRI-SIJ within the first 10 days after giving birth. MRI was repeated after 6 months and, if positive for sacroiliitis according to the Assessment of SpondyloArthritis International Society (ASAS) definition, after 12 months. BMO and structural lesions were scored by three trained readers using the Spondyloarthritis Research Consortium of Canada (SPARCC) method. RESULTS Seventy-seven per cent of the subjects (27/35) displayed sacroiliac BMO immediately postpartum, 60% fulfilled the ASAS definition of a positive MRI. After 6 months, 46% of the subjects (15/33) still showed BMO, representing 15% (5/33) with a positive MRI. After 12 months, MRI was still positive in 12% of the subjects (4/33). Few structural lesions were detected. Intriguingly, in this study, the presence of BMO was related to a shorter duration of labour and lack of epidural anaesthesia. CONCLUSION A surprisingly high prevalence of sacroiliac BMO occurs in women immediately postpartum. Our data reveal a need for a waiting period of at least 6 months to perform an MRI-SIJ in postpartum women with back pain. This study also underscores the importance of interpreting MRI-SIJ findings in the appropriate clinical context.
Collapse
Affiliation(s)
- Thomas Renson
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium .,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Anaïs Depicker
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Liselotte Deroo
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Gaëlle Varkas
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Manouk de Hooge
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Dehaene
- Department of Obstetrics, Ghent University Hospital, Ghent, Belgium
| | | | - Kristien Roelens
- Department of Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| |
Collapse
|
20
|
Elewaut D, Braun J, Anderson JK, Arikan D, Chen S, Hojnik M, De Craemer AS, Curtis JR. Low Incidence of Inflammatory Bowel Disease Adverse Events in Adalimumab Clinical Trials Across Nine Different Diseases. Arthritis Care Res (Hoboken) 2020; 73:289-295. [PMID: 32100944 PMCID: PMC7898340 DOI: 10.1002/acr.24175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/18/2020] [Indexed: 01/12/2023]
Abstract
Objective Adalimumab is approved for treatment of Crohn’s disease and ulcerative colitis. Thus, we postulated that exacerbation or new‐onset of inflammatory bowel disease (IBD) would be rare events in patients treated with adalimumab for non‐IBD indications. The objective was to evaluate the incidence of IBD adverse events (AEs) across adalimumab trials. Methods IBD AE rates in 75 adalimumab clinical trials in rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, pediatric enthesitis‐related arthritis, uveitis, hidradenitis suppurativa, adult and pediatric psoriasis, psoriatic arthritis, nonpsoriatic arthritis peripheral spondyloarthritis (SpA), axial SpA, including nonradiographic axial SpA, and ankylosing spondylitis, were analyzed. Search terms for IBD AEs (new onset or worsening/flare) included IBD, ulcerative colitis, Crohn’s disease, and ulcerative proctitis. Results This analysis included 24,114 patients, representing 36,508 patient‐years of adalimumab exposure. The overall rate of IBD AEs in adalimumab‐treated patients was 0.1 (95% confidence interval [95% CI] 0.1–0.2)/100 patient‐years (41 events), ranging from no events (psoriatic arthritis, uveitis, and pediatric trials) to 0.8 (95% CI 0.2–2.2)/100 patient‐years in peripheral SpA. The rate of IBD in axial SpA was 0.6 (95% CI 0.4–1.0)/100 patient‐years. During placebo‐controlled trials, the overall IBD rate was 0.1 (95% CI 0.0–0.3)/100 patient‐years for adalimumab groups (3 events in 6,781 patients; 2,752 patient‐years of exposure) and 0.1 (95% CI 0.0–0.4)/100 patient‐years for placebo groups (1 event in 3,493 patients; 1,246 patient‐years of exposure). IBD rates in axial SpA were 0.5 (95% CI 0.1–1.4)/100 patient‐years for adalimumab and 0.6 (95% CI 0.0–3.1)/100 patient‐years for placebo. Conclusion The rates of IBD AEs in adalimumab clinical trials were generally low across the evaluated diseases, including axial SpA; all events occurred in adult patients.
Collapse
Affiliation(s)
- Dirk Elewaut
- Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, and Ruhr Universität Bochum, Bochum, Germany
| | | | | | - Su Chen
- AbbVie, North Chicago, Illinois
| | | | | | | |
Collapse
|
21
|
de Hooge M, van Gaalen FA, Renson T, De Craemer AS, van de Sande MG, Ramonda R, Fagerli KM, Jacobsson LTH, van der Heijde D, Elewaut D, Van den Bosch F. Low specificity but high sensitivity of inflammatory back pain criteria in rheumatology settings in Europe: confirmation of findings from a German cohort study. Ann Rheum Dis 2019; 78:1605-1606. [DOI: 10.1136/annrheumdis-2019-215742] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 11/04/2022]
|