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Diekhoff T, Deppe D, Poddubnyy D, Ziegeler K, Proft F, Radny F, Niedermeier C, Hermann KG, Makowski MR. Characterization of bone marrow lesions in axial spondyloarthritis using quantitative T1 mapping MRI. Skeletal Radiol 2024; 53:1295-1302. [PMID: 38224381 DOI: 10.1007/s00256-024-04583-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Conventional magnetic resonance imaging (MRI) uses T1-weighted and short-tau inversion recovery (STIR) sequences to characterize bone marrow in axial spondyloarthritis. However, quantification is restricted to estimating the extent of lesions because signal intensities are highly variable both within individuals and across patients and MRI scanners. This study evaluates the performance of quantitative T1 mapping for distinguishing different types of bone marrow lesions of the sacroiliac joints. MATERIALS AND METHODS In this prospective study, 62 patients underwent computed tomography (CT) and MRI of the sacroiliac joints including T1, STIR, and T1 mapping. Bone marrow lesions were characterized by three readers and assigned to one of four groups: sclerosis, osteitis, fat lesions, and mixed marrow lesions. Relaxation times on T1 maps were compared using generalized estimating equations and receiver operating characteristics (ROC) analysis. RESULTS A total of 119 lesions were selected (sclerosis: 38, osteitis: 27, fat lesions: 40; mixed lesions: 14). T1 maps showed highly significant differences between the lesions with the lowest values for sclerosis (1516±220 ms), followed by osteitis (1909±75 ms), and fat lesions (2391±200 ms); p<0.001. T1 mapping differentiated lesions with areas under the ROC curve of 99% (sclerosis vs. osteitis) and 100% (other comparisons). CONCLUSION T1 mapping allows accurate characterization of sclerosis, osteitis, and fat lesions at the sacroiliac joint but only for homogeneous, non-mixed lesions. Thus, further sequence development is needed before implementation in clinical routine.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Dominik Deppe
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Radny
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Niedermeier
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kay Geert Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
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2
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Derungs T, Poddubnyy D, Schneider T. Pancytopenia following adjuvant therapy with interferon-gamma in a patient with disseminated nocardiosis. Int J Infect Dis 2024; 142:106997. [PMID: 38458424 DOI: 10.1016/j.ijid.2024.106997] [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: 12/20/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/10/2024] Open
Abstract
A patient with disseminated nocardiosis developed pancytopenia after treatment with recombinant interferon-gamma (IFN-γ). While no previous clinical reports link pancytopenia to IFN-γ, our observations align with basic research on myelosuppressive effects of IFN-γ. Adjunctive IFN-γ may improve standard nocardiosis therapy, but vigilant monitoring of its hematologic effects is necessary.
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Affiliation(s)
- Thomas Derungs
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany.
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany
| | - Thomas Schneider
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany
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3
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Adams LC, Bressem KK, Ziegeler K, Vahldiek JL, Poddubnyy D. Artificial intelligence to analyze magnetic resonance imaging in rheumatology. Joint Bone Spine 2024; 91:105651. [PMID: 37797827 DOI: 10.1016/j.jbspin.2023.105651] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Rheumatic disorders present a global health challenge, marked by inflammation and damage to joints, bones, and connective tissues. Accurate, timely diagnosis and appropriate management are crucial for favorable patient outcomes. Magnetic resonance imaging (MRI) has become indispensable in rheumatology, but interpretation remains laborious and variable. Artificial intelligence (AI), including machine learning (ML) and deep learning (DL), offers a means to improve and advance MRI analysis. This review examines current AI applications in rheumatology MRI analysis, addressing diagnostic support, disease classification, activity assessment, and progression monitoring. AI demonstrates promise, with high sensitivity, specificity, and accuracy, achieving or surpassing expert performance. The review also discusses clinical implementation challenges and future research directions to enhance rheumatic disease diagnosis and management.
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Affiliation(s)
- Lisa C Adams
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Keno K Bressem
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Hematology, Oncology , and Cancer Immunology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Germany; Evidia Radiologie am Rheumazentrum Ruhrgebiet, Germany
| | - Janis L Vahldiek
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
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4
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van der Heijde D, Molto A, Ramiro S, Braun J, Dougados M, van Gaalen FA, Gensler LS, Inman RD, Landewé RBM, Marzo-Ortega H, Navarro-Compán V, Phoka A, Poddubnyy D, Protopopov M, Reveille J, Rudwaleit M, Sampaio-Barros P, Sepriano A, Sieper J, Van den Bosch FE, van der Horst-Bruinsma I, Machado PM, Baraliakos X. Goodbye to the term 'ankylosing spondylitis', hello 'axial spondyloarthritis': time to embrace the ASAS-defined nomenclature. Ann Rheum Dis 2024; 83:547-549. [PMID: 38071514 DOI: 10.1136/ard-2023-225185] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023]
Abstract
Ankylosing spondylitis (AS) is the historic term used for decades for the HLA-B27-associated inflammatory disease affecting mainly the sacroiliac joints (SIJ) and spine. Classification criteria for AS have radiographic sacroiliitis as a dominant characteristic. However, with the availability of MRI of SIJ, it could be demonstrated that the disease starts long before definite SIJ changes become visible on radiographs. The Assessment of SpondyloArthritis international Society, representing a worldwide group of experts reached consensus on changes in the nomenclature pertaining to axial spondyloarthritis (axSpA), such as the terminology of diagnosis and of assessment of disease activity tools. These are important changes in the field, as experts in axSpA are now in agreement that the term axSpA is the overall term for the disease. A further differentiation, of which radiographic versus non-radiographic is only one aspect, may be relevant for research purposes. Another important decision was that the terms AS and radiographic axSpA (r-axSpA) can be used interchangeably, but that the preferred term is r-axSpA. Based on the decision that axSpA is the correct terminology, a proposal was made to officially change the meaning of the ASDAS acronym to 'Axial Spondyloarthritis Disease Activity Score'. In addition, for simplification it was proposed that the term ASDAS (instead of ASDAS-CRP) should be preferred and applied to the ASDAS calculated with C reactive protein (CRP). It is hoped that these changes will be used consequently for education, in textbooks, manuscripts and presentations.
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Affiliation(s)
| | - Anna Molto
- Rheumatology, Hospital Cochin, Paris, France
- Université Paris-Cité, INSERM U1153, Paris, France
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes Faculté de Médecine, Paris, France
| | | | - Lianne S Gensler
- Medicine/Rheumatology, University of California, San Francisco, California, USA
| | - Robert D Inman
- Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert B M Landewé
- Rheumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
- Rheumatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | | | - Denis Poddubnyy
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John Reveille
- Rheumatology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Percival Sampaio-Barros
- Rheumatology, Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Alexandre Sepriano
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Joachim Sieper
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Filip E Van den Bosch
- Rheumatology, Ghent University Hospital, Gent, Belgium
- Internal Medicine and Pediatrics, VIB-UGent Center for Inflammation Research, Ghent University, Gent, Belgium
| | | | - Pedro M Machado
- Rheumatology and Neuromuscular Diseases, University College London, National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
- NHS Foundation Trust, London, UK
- Rheumatology, Norhwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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Proft F, Torgutalp M, Muche B, Rios Rodriguez V, Listing J, Protopopov M, Rademacher J, Haibel H, Spiller L, Weber AK, Verba M, Brandt-Juergens J, Kiltz U, Sieburg M, Jacki S, Sieper J, Poddubnyy D. Comparison of the effect of treatment with NSAIDs added to anti-TNF therapy versus anti-TNF therapy alone on the progression of structural damage in the spine over 2 years in patients with radiographic axial spondyloarthritis from the randomised-controlled CONSUL trial. Ann Rheum Dis 2024; 83:599-607. [PMID: 38228361 DOI: 10.1136/ard-2023-224699] [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: 07/10/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES The study aimed to evaluate the effect of adding a non-steroidal anti-inflammatory drug (NSAID), celecoxib (CEL), to a tumour necrosis factor inhibitor (TNFi), golimumab (GOL), compared with TNFi monotherapy on radiographic spinal progression in patients with radiographic axial spondyloarthritis (r-axSpA) over 2 years. METHODS R-axSpA patients, having risk factors for radiographic progression (high disease activity plus C reactive protein >5 mg/L and/or ≥1 syndesmophyte(s)), underwent a 12-week run-in phase with GOL 50 mg every 4 weeks. In the core phase (96 weeks), only patients with a good clinical response at week 12 were randomised (1:1) to GOL+CEL 200 mg two times per day (combination therapy) or GOL monotherapy. The primary endpoint was radiographic progression assessed by modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change at week 108 in the intent-to-treat population. RESULTS A total of 128 patients were enrolled in the run-in phase; and 109 patients were randomised at week 12 to monotherapy (n=55) or combination therapy (n=54). At week 108, 97 (52 vs 45) patients completed the study. The change in mSASSS at week 108 was 1.7 (95% CI 0.8 to 2.6) in the monotherapy vs 1.1 (95% CI 0.4 to 1.8) in the combination therapy groups (p=0.79). New syndesmophytes occurred in 25% of patients in the monotherapy vs 11% of patients in the combination therapy groups (p=0.12). During the study, no significant differences in adverse events and serious adverse events were observed between the groups. CONCLUSIONS Combination therapy with GOL+CEL did not demonstrate statistically significant superiority over GOL monotherapy in retarding radiographic spinal progression over 2 years in r-axSpA.
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Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Burkhard Muche
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
- Department of Rheumatology CCM, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
- BIH, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Laura Spiller
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Anne-Katrin Weber
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Maryna Verba
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | | | - Swen Jacki
- Rheumatologische Schwerpunktpraxis, Tübingen, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
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Pohlner T, Deppe D, Ziegeler K, Proft F, Protopopov M, Rademacher J, Rios Rodriguez V, Torgutalp M, Braun J, Diekhoff T, Poddubnyy D. Diagnostic accuracy in axial spondyloarthritis: a systematic evaluation of the role of clinical information in the interpretation of sacroiliac joint imaging. RMD Open 2024; 10:e004044. [PMID: 38580341 PMCID: PMC11002347 DOI: 10.1136/rmdopen-2023-004044] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/16/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVES Radiography and MRI of the sacroiliac joints (SIJ) are relevant for the diagnosis and classification of patients with axial spondyloarthritis (axSpA). This study aimed to evaluate the impact of clinical information (CI) on the accuracy of imaging interpretation. METHODS Out of 109 patients referred because of suspicion of axSpA with complete imaging sets (radiographs and MRI of SIJ), 61 were diagnosed with axSpA (56%). Images were independently evaluated by three radiologists in four consecutive reading campaigns: radiographs and radiographs+MRI without and with CI including demographic data, SpA features, physical activity and pregnancy. Radiographs were scored according to the modified New York criteria, and MRIs for inflammatory and structural changes compatible with axSpA (yes/no). The clinical diagnosis was taken as reference standard. The compatibility of imaging findings with a diagnosis of axSpA (precision) before and after the provision of CI and radiologists' confidence with their findings (0-10) were evaluated. RESULTS The precision of radiographs evaluation without versus with CI increased from 70% to 78% (p=0.008), and for radiographs+MRI from 81% to 82% (p=1.0), respectively. For CR alone, the sensitivity and specificity of radiologic findings were 51% and 94% without and 60% and 100% with CI, while, for radiographs+MRI, they were 74% and 90% vs 71% and 98%, respectively. The diagnostic confidence of radiologists increased from 5.2±1.9 to 6.0±1.7 with CI for radiographs, and from 6.7±1.6 to 7.2±1.6 for radiographs+MRI, respectively. CONCLUSION The precision, specificity and diagnostic confidence of radiologic evaluation increased when CI was provided.
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Affiliation(s)
- Tim Pohlner
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Ruhr University Bochum, Bochum, Germany
- RVZ Steglitz, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
- Epidemiology Unit, DRFZ, Berlin, Germany
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7
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Braun J, Poddubnyy D. [Diagnosis and classification of axial spondyloarthritis (axSpA) - the current status]. Dtsch Med Wochenschr 2024; 149:513-520. [PMID: 38621686 DOI: 10.1055/a-2251-6876] [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] [Indexed: 04/17/2024]
Abstract
Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease typically characterized by inflammatory back pain (IBP). The term axSpA has largely replaced the long-used term ankylosing spondylitis (AS). IBP is caused by inflammation in the axial skeleton, with the sacroiliac joints (SIJ) being particularly frequently affected initially. The spine is usually added in later stages, which is then increasingly characterized structurally by the formation of new bone. The overall concept of spondyloarthritis includes other disease manifestations such as uveitis, psoriasis and colitis and comorbidities such as cardiovascular disease and osteoporosis.The ASAS classification criteria for axSpA, in place since 2009, have replaced the 1984 modified New York criteria. In the former, in addition to conventional X-rays, changes in the SIJ detected by magnetic resonance imaging (MRI) and also the detection of HLA B27 have, for the first time, played a role. It is important to note that these are not diagnostic criteria, as they do not exist. This paper outlines 10 points that should be considered when making a diagnosis.
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Affiliation(s)
- Jürgen Braun
- RVZ Steglitz, Berlin, und Ruhr Universität Bochum, Deutschland
| | - Denis Poddubnyy
- Rheumatologie am Campus Benjamin Franklin - Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Berlin, Deutschland
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8
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Baraliakos X, Østergaard M, Poddubnyy D, van der Heijde D, Deodhar A, Machado PM, Navarro-Compán V, Hermann KGA, Kishimoto M, Lee EY, Gensler LS, Kiltz U, Eigenmann MF, Pertel P, Readie A, Richards HB, Porter B, Braun J. Effect of Secukinumab Versus Adalimumab Biosimilar on Radiographic Progression in Patients With Radiographic Axial Spondyloarthritis: Results From a Head-to-Head Randomized Phase IIIb Study. Arthritis Rheumatol 2024. [PMID: 38556921 DOI: 10.1002/art.42852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Spinal radiographic progression is an important outcome in radiographic axial spondyloarthritis (SpA). The objective of the phase IIIb SURPASS study was to compare spinal radiographic progression in patients with radiographic axial SpA treated with secukinumab (interleukin-17A inhibitor) versus adalimumab biosimilar (Sandoz adalimumab [SDZ-ADL]; tumor necrosis factor inhibitor). METHODS Biologic-naive patients with active radiographic axial SpA, at high risk of radiographic progression (high-sensitivity C-reactive protein [hsCRP] ≥5 mg/L and/or ≥1 syndesmophyte[s] on spinal radiographs), were randomized (1:1:1) to secukinumab (150/300 mg) or SDZ-ADL (40 mg). The proportion of patients with no radiographic progression (change from baseline [CFB] in modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS] ≤0.5) on secukinumab versus SDZ-ADL at week 104 (primary endpoint), mean CFB-mSASSS, proportion of patients with ≥1 syndesmophyte(s) at baseline with no new syndesmophyte(s), and safety were evaluated. RESULTS Overall, 859 patients (78.5% male, mSASSS 16.6, Bath Ankylosing Spondylitis Disease Activity Index 7.1, hsCRP 20.4 mg/L, and 73.0% with ≥1 syndesmophyte[s]) received secukinumab 150 mg (n = 287), secukinumab 300 mg (n = 286), or SDZ-ADL (n = 286). At week 104, the proportion of patients with no radiographic progression was 66.1%, 66.9%, and 65.6% (P = not significant, both secukinumab doses) and mean CFB-mSASSS was 0.54, 0.55, and 0.72 in secukinumab 150 mg, secukinumab 300 mg, and SDZ-ADL arms, respectively. Overall, 56.9%, 53.8%, and 53.3% of patients on secukinumab 150 mg, secukinumab 300 mg, and SDZ-ADL, respectively, with ≥1 syndesmophyte(s) at baseline did not develop new syndesmophyte(s) by week 104. There were no unexpected safety findings. CONCLUSION Spinal radiographic progression over two years was low with no significant difference between secukinumab and SDZ-ADL arms. The safety of both treatments was consistent with previous reports.
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Affiliation(s)
| | - Mikkel Østergaard
- Rigshospitalet, Glostrup, Denmark, and University of Copenhagen, Copenhagen, Denmark
| | - Denis Poddubnyy
- Charité Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany
| | | | | | | | | | | | | | - Eun Young Lee
- Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | - Aimee Readie
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | | | - Brian Porter
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Juergen Braun
- Rheuma Praxis Berlin, Berlin, Germany, and Ruhr-Universität Bochum, Bochum, Germany
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9
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Adams LC, Bressem KK, Poddubnyy D. Artificial intelligence and machine learning in axial spondyloarthritis. Curr Opin Rheumatol 2024:00002281-990000000-00111. [PMID: 38533807 DOI: 10.1097/bor.0000000000001015] [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] [Indexed: 03/28/2024]
Abstract
PURPOSE OF REVIEW To evaluate the current applications and prospects of artificial intelligence and machine learning in diagnosing and managing axial spondyloarthritis (axSpA), focusing on their role in medical imaging, predictive modelling, and patient monitoring. RECENT FINDINGS Artificial intelligence, particularly deep learning, is showing promise in diagnosing axSpA assisting with X-ray, computed tomography (CT) and MRI analyses, with some models matching or outperforming radiologists in detecting sacroiliitis and markers. Moreover, it is increasingly being used in predictive modelling of disease progression and personalized treatment, and could aid risk assessment, treatment response and clinical subtype identification. Variable study designs, sample sizes and the predominance of retrospective, single-centre studies still limit the generalizability of results. SUMMARY Artificial intelligence technologies have significant potential to advance the diagnosis and treatment of axSpA, providing more accurate, efficient and personalized healthcare solutions. However, their integration into clinical practice requires rigorous validation, ethical and legal considerations, and comprehensive training for healthcare professionals. Future advances in artificial intelligence could complement clinical expertise and improve patient care through improved diagnostic accuracy and tailored therapeutic strategies, but the challenge remains to ensure that these technologies are validated in prospective multicentre trials and ethically integrated into patient care.
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Affiliation(s)
- Lisa C Adams
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine
| | - Keno K Bressem
- Institute for Radiology and Nuclear Medicine, German Heart Centre Munich, Technical University of Munich, Munich
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Rios Rodriguez V, Torgutalp M, Proft F, Rademacher J, Protopopov M, Spiller L, Haibel H, Sieper J, Poddubnyy D. Impact of body composition on clinical outcomes in patients with active radiographic axial spondyloarthritis under biological therapy. Rheumatology (Oxford) 2024:keae133. [PMID: 38507706 DOI: 10.1093/rheumatology/keae133] [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: 07/15/2023] [Revised: 01/25/2024] [Accepted: 02/09/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE To assess the association of body composition, evaluated by bioimpedance analysis (BIA), with disease activity, physical function, and mobility in patients with axSpA undergoing bDMARD treatment for one year. METHODS Patients with AS (radiographic axSpA) were enrolled in an extension of the German Spondyloarthritis Inception Cohort (GESPIC). Patients were required to be candidates for bDMARD therapy at baseline presenting high disease activity despite previous treatment with nonsteroidal anti-inflammatory drugs. Outcomes (disease activity, function, and mobility) and body composition parameters were assessed at baseline and every 6 months thereafter. Body composition was assessed by BIA. The association between body composition parameters and outcomes over 1 year was analyzed using longitudinal generalized estimating equations. RESULTS Seventy-four patients with radiographic axSpA were included in current analysis with a mean age of 36.5 years, disease duration of 6.2 years and ASDAS-CRP score of 3.4 at baseline. Fat mass value and fat mass index were positively associated with disease activity (ASDAS: ß = 0.01, 95% CI [-0.01, 0.03] and ß = 0.04, 95% CI [-0.01, 0.08], respectively) and functional disability (BASFI). Visceral adipose tissue (VAT) was associated with reduced spine mobility (BASMI: ß = 0.20, 95% CI [0.07, 0.33]). Additionally, increase in VAT and fat mass parameters was linked to worse disease activity and functional disability in women, while they were strongly associated with reduced spinal mobility in men. CONCLUSIONS Higher levels of body fat and VAT were positively associated with increased disease activity, functional disability, and reduced spinal mobility in patients with radiographic axSpA treated with bDMARDs.
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Affiliation(s)
- Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin
| | - Laura Spiller
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin
| | - Joachim Sieper
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany, Berlin
- Epidemiology unit, German Rheumatism Research Centre, Berlin, Germany
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Radny F, Ziegeler K, Eshed I, Greese J, Deppe D, Stelbrink C, Biesen R, Haibel H, Rios Rodriguez V, Rademacher J, Protopopov M, Proft F, Hermann KGA, Poddubnyy D, Diekhoff T, Ulas ST. Learning imaging in axial spondyloarthritis: more than just a matter of experience. RMD Open 2024; 10:e003944. [PMID: 38443089 DOI: 10.1136/rmdopen-2023-003944] [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: 11/25/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Reliable interpretation of imaging findings is essential for the diagnosis of axial spondyloarthritis (axSpA) and requires a high level of experience. We investigated experience-dependent differences in diagnostic accuracies using X-ray (XR), MRI and CT. METHODS This post hoc analysis included 163 subjects with low back pain. Eighty-nine patients had axSpA, and 74 patients had other conditions (mechanical, degenerative or non-specific low back pain). Final diagnoses were established by an experienced rheumatologist before the reading sessions. Nine blinded readers (divided into three groups with different levels of experience) scored the XR, CT and MRI of the sacroiliac joints for the presence versus absence of axSpA. Parameters for diagnostic performance were calculated using contingency tables. Differences in diagnostic performance between the reader groups were assessed using the McNemar test. Inter-rater reliability was assessed using Fleiss kappa. RESULTS Diagnostic performance was highest for the most experienced reader group, except for XR. In the inexperienced and semi-experienced group, diagnostic performance was highest for CT&MRI (78.5% and 85.3%, respectively). In the experienced group, MRI showed the highest performance (85.9%). The greatest difference in diagnostic performance was found for MRI between the inexperienced and experienced group (76.1% vs 85.9%, p=0.001). Inter-rater agreement was best for CT in the experienced group with κ=0.87. CONCLUSION Differences exist in the learnability of the imaging modalities for axSpA diagnosis. MRI requires more experience, while CT is more suitable for inexperienced radiologists. However, diagnosis relies on both clinical and imaging information.
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Affiliation(s)
- Felix Radny
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Department of Hematology, Oncology, Tumor Immunology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Carsten Stelbrink
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
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Al Mohamad F, Rios Rodriguez V, Haibel H, Protopopov M, Rademacher J, Sieper J, Torgutalp M, Käding H, Proft F, Poddubnyy D. Association of nociplastic and neuropathic pain components with the presence of residual symptoms in patients with axial spondyloarthritis receiving biological disease-modifying antirheumatic drugs. RMD Open 2024; 10:e004009. [PMID: 38360039 PMCID: PMC10875534 DOI: 10.1136/rmdopen-2023-004009] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To evaluate the association of nociplastic (NoP) and neuropathic pain (NP) components with residual symptoms in patients with radiographic axial spondyloarthritis (r-axSpA) receiving biological disease-modifying antirheumatic drugs (bDMARDs). METHODS 78 patients with r-axSpA from the GErman SPondyloarthritis Inception Cohort receiving a bDMARD for at least 3 months were included in this analysis. The Widespread Pain Index (WPI) and the PainDETECT (PD) questionnaire were used to quantify the NoP and the NP components, respectively. Axial Spondyloarthritis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used as measures of residual symptoms. C reactive protein (CRP) was used as a measure of systemic inflammatory activity. Univariable and multivariable regression analyses of disease activity were performed. The regions of the WPI score and items of the PD score were used for cluster analyses. RESULTS Linear multivariable regression analysis showed that WPI and PD were independently associated with ASDAS (b=0.1, 95% CI 0.04 to 0.17, and b=0.05, 95% CI 0.02 to 0.08, respectively) and BASDAI (b=0.24, 95% CI 0.08 to 0.39, and b=0.17, 95% CI 0.1 to 0.25, respectively) in r-axSpA patients receiving stable treatment with bDMARDs. Furthermore, WPI and PD were found to be significantly associated with the presence of relevant residual symptoms as defined by BASDAI ≥4 (OR 1.93, 95% CI 1.09 to 4.15, and OR 1.32, 95% CI 1.04 to 1.85, respectively). The effects were present also in patients with normal level of CRP. Cluster analysis revealed three distinct pain distribution profiles and four specific sensory symptom constellations allowing differentiation of different pain subtypes. CONCLUSION Both NoP and NP components seem to be associated with residual symptoms in patients with r-axSpA receiving treatment with bDMARDs.
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Affiliation(s)
- Fares Al Mohamad
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henriette Käding
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Berlin, Germany
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Poddubnyy D, Sieper J, Akar S, Muñoz‐Fernández S, Haibel H, Diekhoff T, Protopopov M, Altmaier E, Ganz F, Inman RD. Radiographic Progression in Sacroiliac Joints in Patients With Axial Spondyloarthritis: Results From a Five-Year International Observational Study. ACR Open Rheumatol 2024; 6:103-110. [PMID: 38111125 PMCID: PMC10867293 DOI: 10.1002/acr2.11642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To evaluate progression from nonradiographic (nr-) to radiographic axial spondyloarthritis (r-axSpA) over 5 years in patients with recently diagnosed (≤1 year) axSpA fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. METHODS A prospsective, observational study (Patients with Axial Spondyloarthritis: Multi-Country Registry of Clinical Characteristics) was conducted in rheumatology practices in 29 countries. Baseline and follow-up radiographs of sacroiliac joints were centrally evaluated by three readers according to the grading system of the modified New York criteria for patients initially classified as nr-axSpA. Radiographic progression from nr-axSpA to r-axSpA was evaluated by Kaplan-Meier analysis. Cox proportional regression analyses for progression from nr-axSpA to r-axSpA were also conducted. RESULTS Among 2,165 patients with axSpA, 1,612 (74%) were classified as having r-axSpA (1,050 [65%]) or nr-axSpA (562 [35%]) by central reading. Of 246 patients with nr-axSpA (mean [SD] symptom duration: 4.4 [6.2] years) who had at least one follow-up sacroiliac joint radiograph, progression from nr-axSpA to r-axSpA at any follow-up visit was observed in 40 patients (16%) over 5 years. Mean time to radiographic progression was 2.4 years (ranging from 0.9 to 5.1 years). Progression to r-axSpA was associated with male sex (hazard ratio [HR] 3.16 [95% CI 1.22-8.17]), fulfillment of the imaging arm of the ASAS classification criteria (HR 6.64 [1.37-32.25]), and good response to nonsteroidal anti-inflammatory drugs (HR 4.66 [1.23-17.71]). CONCLUSION 16% of patients with nr-axSpA progressed to r-axSpA within 5 years. Male sex, fulfillment of the imaging arm of the ASAS criteria, and good response to nonsteroidal anti-inflammatory drugs were predictors of radiographic progression in patients with recently diagnosed axSpA.
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Affiliation(s)
- Denis Poddubnyy
- Charité‐Universitätsmedizin Berlin and German Rheumatism Research CenterBerlinGermany
| | | | | | | | | | | | | | | | | | - Robert D. Inman
- Schroeder Arthritis Institute, University of TorontoTorontoOntarioCanada
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Mauro D, Forte G, Poddubnyy D, Ciccia F. The Role of Early Treatment in the Management of Axial Spondyloarthritis: Challenges and Opportunities. Rheumatol Ther 2024; 11:19-34. [PMID: 38108992 PMCID: PMC10796311 DOI: 10.1007/s40744-023-00627-0] [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: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic, inflammatory rheumatic disease that primarily affects the axial skeleton, often inflicting severe pain, diminished mobility, and a compromised quality of life. The advent of Assessment of SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis (SpA) have enabled the classification of patients with axSpA in the non-radiographic stage but poorly perform if mistakenly used for diagnostic purposes. Despite notable progress in early diagnosis facilitated by referral strategies and extensive magnetic resonance imaging (MRI) utilization, diagnostic delays persist as a concerning issue. This underscores the urgency to narrow the diagnostic gap and highlights the critical role of early diagnosis in mitigating the long-term structural damage associated with this condition. Research into the impact of non-steroidal anti-inflammatory drugs (NSAIDs) and biologic disease-modifying antirheumatic drugs (bDMARDs) on inflammatory symptoms and radiographic progression has been extensive. A compelling body of evidence suggests that early intervention leads to superior disease outcomes. However, most of these studies have centered on patients with established diseases rather than those in the early stages. Consequently, findings from studies on early pharmacological intervention remain inconclusive, and the potential for modifying the disease trajectory is still debatable. Without precise data from clinical trials, insights from basic science regarding the pathogenic mechanisms might point toward potential targets that warrant early intervention in the disease process. This review underscores the urgency of early diagnosis and intervention in axSpA, highlighting ongoing research gaps and the need for further exploration to improve patient outcomes.
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Affiliation(s)
- Daniele Mauro
- Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giulio Forte
- Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Francesco Ciccia
- Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Via Sergio Pansini 5, 80131, Naples, Italy.
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Albrecht K, Binder S, Minden K, Poddubnyy D, Regierer AC, Strangfeld A, Callhoff J. Systematic review to estimate the prevalence of inflammatory rheumatic diseases in Germany. Z Rheumatol 2024; 83:20-30. [PMID: 36749363 PMCID: PMC10879227 DOI: 10.1007/s00393-022-01302-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Accepted: 11/18/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study aimed to update the prevalence estimates of inflammatory rheumatic diseases (IRD) in Germany. METHODS A systematic literature search in PubMed and Web of Science (last search 08 November 2022) identified original articles (regional and nationwide surveys and claims data analyses for arthritides, connective tissue diseases, and vasculitides) on prevalences for the period 2014-2022. Data sources, collection period, case definition, and risk of bias are reported. Prevalences were estimated from available national data, with consideration of international data. RESULTS Screening by two authors yielded 263 hits, of which 18 claims data analyses and 2 surveys met the inclusion criteria. Prevalences ranged from 0.42 to 1.85% (rheumatoid arthritis), 0.32-0.5% (ankylosing spondylitis), 0.11-0.32% (psoriatic arthritis), 0.037-0.14% (systemic lupus erythematosus), 0.07-0.77% (Sjögren's disease/sicca syndrome), 0.14-0.15% (polymyalgia rheumatica, ≥ 40 years), 0.04-0.05% (giant cell arteritis, ≥ 50 years), and 0.015-0.026% (ANCA-associated vasculitis). The risk of bias was moderate in 13 and high in 7 studies. Based on the results, we estimate the prevalence of IRD in Germany to be 2.2-3.0%, which corresponds to approximately 1.5-2.1 million affected individuals. The prevalence of juvenile idiopathic arthritis was reported to be around 0.10% (0.07-0.10%) of 0-18-year-olds, corresponding to about 14,000 children and adolescents in Germany. CONCLUSION This systematic review shows an increase in the prevalence of IRD in Germany, which is almost exclusively based on claims data analyses. In the absence of multistage population studies, the available data are, overall, uncertain sources for prevalence estimates, with a moderate to high risk of bias.
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Affiliation(s)
- Katinka Albrecht
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sebastian Binder
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kirsten Minden
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anne C Regierer
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anja Strangfeld
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Callhoff
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
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Adami G, Alarcon G, Albert D, Allen K, Aringer M, Arkema EV, Ashour HM, Atzeni F, Ayan G, Baer A, Baker J, Barber C, Bautista-Molano W, Beça S, Beamer B, Bergstra SA, Bermas B, Bilgin E, Boers M, Bolster M, Bosco J, Bowden JL, Buttgereit F, Calabrese L, Campochiaro C, Cappelli L, Carmona L, Carvalho J, Castañeda S, Chao Chao CM, Chatterjee S, Cherry L, Christensen R, Coates LC, Cohen SB, Collins JE, Cornec D, D'Agostino MA, Daikeler T, D'Angelo S, de Boysson H, de Jong P, de Wit M, Dellaripa P, Dessein P, Diekhoff T, Doumen M, Eckstein F, Elhai M, Fairley JL, Felson D, Amaro IF, Ferucci E, Fiorentino D, FitzGerald J, Fleischmann R, Galloway J, Salinas RG, Giorgi V, Golightly Y, Gono T, Gonzalez-Gay MA, Goules A, Gravallese E, Griffith M, Grosman S, Gupta L, Hamuryudan V, Hana C, Haschka J, Hawker G, Hervas-Perez JP, Hocevar A, Iudici M, Iyer P, Jasmin M, Judson M, Kerschbaumer A, Kiefer D, Kiltz U, Kivity S, Kremer JM, Kroon FPB, Kviatkovsky S, Lee BS, Liew D, Lim SY, Littlejohn G, Medina CL, Maksymowych W, March L, Marotte H, Navarro OM, Mavragani C, McInnes I, McMahan Z, Meara A, Mecoli C, Merriman T, Mikdashi J, Mikuls T, Misra DP, Mitchell BD, Moore T, Moutsopoulos H, Naredo E, Nash P, Nurmohamed M, Oddis C, Ojaimi S, Oliver M, Ozen S, Ozgocmen S, Palmowski A, Pascart T, Perelas A, Pile K, Pincus T, Poddubnyy D, Ramiro S, Reddy A, Regierer A, Roccatello D, Rookes T, Rosenthal A, Rubinstein T, Rudwaleit M, Rueda-Gotor J, Rus V, Saketkoo LA, Samson M, Schur P, Sepriano A, Shadmanfar S, Shmagel A, Sibbitt WL, de Souza AWS, Sims C, Singh N, Sjöwall C, Smith V, Song JJ, Soriano ER, Sparks J, Studenic P, Sugihara T, Suissa S, Szekanecz Z, Tascilar K, Taylor P, Terkeltaub R, Tiniakou E, Todd N, Vilarino GT, Treemarcki E, Tsuji H, Turesson C, Twilt M, Vassilopoulos D, Vojinovic T, Volkmann E, Vosse D, Wagner-Weiner L, Wallace ZS, Wallace D, Wang GC, Wei J, Weisman MH, Westhovens R, Winthrop K, Wysham KD, Xue J, Yang C, Yau M, Yazici Y, Yazici H, YIM ICW, Young J, Zhang W. Referees. Semin Arthritis Rheum 2024:152375. [PMID: 38245402 DOI: 10.1016/j.semarthrit.2024.152375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
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Dreher M, Witte T, Hoeper K, Assmann G, Proft F, Poddubnyy D, Murawski N, Triantafyllias K, Grodd M, Graf E, Fichtner UA, Binder H, Zeidler J, Hoeper JR, Callhoff J, Karberg K, Trautwein A, Tibyampansha D, Wojnowski L, Schmidt RE, Schwarting A. Rheuma-VOR study: optimising healthcare of rheumatic diseases by multiprofessional coordinating centres. Ann Rheum Dis 2024; 83:184-193. [PMID: 37890976 PMCID: PMC10850684 DOI: 10.1136/ard-2023-224205] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES Early diagnosis of inflammatory arthritis is critical to prevent joint damage and functional incapacities. However, the discrepancy between recommendations of early diagnosis and reality is remarkable. The Rheuma-VOR study aimed to improve the time to diagnosis of patients with early arthritis by coordinating cooperation between primary care physicians, specialists and patients in Germany. METHODS This prospective non-randomised multicentre study involved 2340 primary care physicians, 72 rheumatologists, 4 university hospitals and 4 rheumatology centres in 4 German Federal States. The two coprimary endpoints (time to diagnosis and screening performance of primary care physicians) were evaluated for early versus late implementation phase. Additionally, time to diagnosis and secondary endpoints (decrease of disease activity, increase in quality of life and overall well-being, improvement of fatigue, depression, functional ability, and work ability, reduction in drug and medical costs and hospitalisation) were compared with a reference cohort of the German Rheumatism Research Centre (DRFZ) reflecting standard care. RESULTS A total of 7049 patients were enrolled in the coordination centres and 1537 patients were diagnosed with a rheumatic disease and consented to further participation. A follow-up consultation after 1 year was realised in 592 patients. The time to diagnosis endpoint and the secondary endpoints were met. In addition, the calculation of cost-effectiveness shows that Rheuma-VOR has a dominant cost-benefit ratio compared with standard care. DISCUSSION Rheuma-VOR has shown an improvement in rheumatological care, patient-reported outcome parameters and cost savings by coordinating the cooperation of primary care physicians, rheumatologists and patients, in a nationwide approach.
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Affiliation(s)
- Matthias Dreher
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Torsten Witte
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Kirsten Hoeper
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- Center for Rheumatology Lower Saxony, Hannover, Germany
| | - Gunter Assmann
- Center of Rheumatology and Clinical Immunology, RUB-University Hospital Minden JWK, Minden, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Niels Murawski
- Internal Medicine I Oncology, Haematology, Clinical Immunology and Clinical Rheumatology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Konstantinos Triantafyllias
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Center for Rheumatology Rhineland-Palatinate, Bad Kreuznach, Germany
| | - Marlon Grodd
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Urs A Fichtner
- Institute of Medical Biometry and Statistics, Section of Healthcare Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz Universitat Hannover, Hannover, Germany
| | - Juliana Rachel Hoeper
- Center for Health Economics Research Hannover (CHERH), Leibniz Universitat Hannover, Hannover, Germany
| | - Johanna Callhoff
- Epidemiology and Health Services Research, German Rheumatism Research Centre, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Anna Trautwein
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dativa Tibyampansha
- Department of Pharmacolgy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Leszek Wojnowski
- Department of Pharmacolgy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Reinhold E Schmidt
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Andreas Schwarting
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Center for Rheumatology Rhineland-Palatinate, Bad Kreuznach, Germany
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18
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Essex M, Rios Rodriguez V, Rademacher J, Proft F, Löber U, Markó L, Pleyer U, Strowig T, Marchand J, Kirwan JA, Siegmund B, Forslund SK, Poddubnyy D. Shared and Distinct Gut Microbiota in Spondyloarthritis, Acute Anterior Uveitis, and Crohn's Disease. Arthritis Rheumatol 2024; 76:48-58. [PMID: 37471465 DOI: 10.1002/art.42658] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Spondyloarthritis (SpA) is a group of immune-mediated diseases highly concomitant with nonmusculoskeletal inflammatory disorders, such as acute anterior uveitis (AAU) and Crohn's disease (CD). The gut microbiome represents a promising avenue to elucidate shared and distinct underlying pathophysiology. METHODS We performed 16S ribosomal RNA sequencing on stool samples of 277 patients (72 CD, 103 AAU, and 102 SpA) included in the German Spondyloarthritis Inception Cohort and 62 back pain controls without any inflammatory disorder. Discriminatory statistical methods were used to disentangle microbial disease signals from one another and a wide range of potential confounders. Patients were naive to or had not received treatment with biological disease-modifying antirheumatic drugs (DMARDs) for >3 months before enrollment, providing a better approximation of a true baseline disease signal. RESULTS We identified a shared, immune-mediated disease signal represented by low abundances of Lachnospiraceae taxa relative to controls, most notably Fusicatenibacter, which was most abundant in controls receiving nonsteroidal antiinflammatory drug monotherapy and implied to partially mediate higher serum C-reactive protein. Patients with SpA showed an enrichment of Collinsella, whereas human leukocyte antigen (HLA)-B27+ individuals displayed enriched Faecalibacterium. CD patients had higher abundances of a Ruminococcus taxon, and previous conventional/synthetic DMARD therapy was associated with increased Akkermansia. CONCLUSION Our work supports the existence of a common gut dysbiosis in SpA and related inflammatory pathologies. We reveal shared and disease-specific microbial associations and suggest potential mediators of disease activity. Validation studies are needed to clarify the role of Fusicatenibacter in gut-joint inflammation, and metagenomic resolution is needed to understand the relationship between Faecalibacterium commensals and HLA-B27.
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Affiliation(s)
- Morgan Essex
- Experimental and Clinical Research Center (ECRC; a cooperation of the Max Delbrück Center and Charité-Universitätsmedizin), Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), and Charité-Universitätsmedizin Berlin (a corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany
| | - Valeria Rios Rodriguez
- Medical Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Medical Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, and Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Medical Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Löber
- ECRC, MDC, Charité-Universitätsmedizin Berlin and German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Lajos Markó
- ECRC, MDC, Charité-Universitätsmedizin Berlin and German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Campus Virchow, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Till Strowig
- Helmholtz Center for Infection Research, Braunschweig, Germany, and Cluster of Excellence RESIST (EXC 2155), Hannover Medical School and Center for Individualized Infection Medicine (CiiM; a joint venture between the Helmholtz Center for Infection Research and the Hannover Medical School), Hannover, Germany
| | - Jérémy Marchand
- MDC and BIH Metabolomics Platform at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer A Kirwan
- MDC and BIH Metabolomics Platform at Charité-Universitätsmedizin Berlin, Berlin, Germany, and University of Nottingham School of Veterinary Medicine and Science, Loughborough, UK
| | - Britta Siegmund
- Medical Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sofia K Forslund
- ECRC, MDC, Charité-Universitätsmedizin Berlin, and DZHK, Berlin, and Structural and Computational Biology Unit, EMBL, Heidelberg, Germany
| | - Denis Poddubnyy
- Department of Gastroentergology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin and German Rheumatism Research Center (DRFZ), Berlin, Germany
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19
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Poddubnyy D, Sommerfleck F, Navarro-Compán V, Bundy C, Makri S, Akerkar S, Wermskog L, Karam E, Correa-Fernández J, Siddiqui A, Garrido-Cumbrera M. Regional differences in clinical phenotype of axial spondyloarthritis: results from the International Map of Axial Spondyloarthritis (IMAS). Rheumatology (Oxford) 2023:kead665. [PMID: 38128022 DOI: 10.1093/rheumatology/kead665] [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: 09/04/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES To explore differences in axial spondyloarthritis (axSpA) clinical phenotype around the world in a large sample of patients included in the International Map of Axial Spondyloarthritis (IMAS). METHOD IMAS was a cross-sectional online survey (2017-2022) of 5,557 unselected axSpA patients from 27 countries. We analysed across five geographic regions the age at symptom onset, diagnostic delay, gender, HLA-B27, family history, extra-musculoskeletal manifestations, presence of comorbidities, disease activity (BASDAI), level of spinal stiffness, and treatments. RESULTS Of 5,557 IMAS participants, 3,493 were from Europe, 770 from North America, 600 from Asia, 548 from Latin America, and 146 from South Africa. Age at symptom onset ranged between 25-30 years and was higher in Latin America. Diagnostic delay was longest in South Africa and lowest in Asia. The lowest HLA-B27 positivity was observed in Latin America and the highest in Asia. Extra-musculoskeletal manifestations were the lowest in Europe. Mean disease activity (BASDAI) was 5.4, with highest values in South Africa and lowest in Asia. Most of the patients had used NSAIDs for their condition and less than half had ever taken csDMARDS; both were more frequent in Latin America and South Africa. Almost half of the patients had ever taken bDMARDs, more frequent being in the Americas. CONCLUSIONS There is great heterogeneity of axSpA clinical phenotype presentation around the world. AxSpA manifests differently in different regions, so further understanding of these differences of phenotypes is needed to achieve early diagnosis and initiation of optimal disease treatment in axSpA in the different regions.
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Affiliation(s)
- Denis Poddubnyy
- Rheumatology Department, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Rheumatology Department, German Rheumatism Research Centre, Berlin, Germany
| | | | | | - Christine Bundy
- Rheumatology Department, Cardiff University, Cardiff, United Kingdom
| | - Souzi Makri
- Patient Advocacy, Cyprus League for People with Rheumatism (CYLPER), Nicosia, Cyprus
| | | | - Lillann Wermskog
- Patient Advocacy, Spondyloarthritis Association of Norway (SPAFO), Oslo, Norway
- Patient Advocacy, Axial Spondyloarthritis International Federation (ASIF), London, United Kingdom
| | - Elie Karam
- Patient Advocacy, Canadian Spondylitis Association (CSA), Toronto, Canada
| | | | - Asif Siddiqui
- Patient Engagement, Novartis Pharma AG, Basel, Switzerland
| | - Marco Garrido-Cumbrera
- Health & Territory Research (HTR), Universidad de Sevilla, Seville, Spain
- Patient Advocacy, Spanish Federation of Spondyloarthritis Associations (CEADE), Madrid, Spain
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20
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Mease PJ, Gladman DD, Poddubnyy D, Chakravarty SD, Shawi M, Kollmeier AP, Xu XL, Xu S, Deodhar A, Baraliakos X. Efficacy of Guselkumab on Axial-Related Symptoms Through up to 2 Years in Adults with Active Psoriatic Arthritis in the Phase 3, Randomized, Placebo-Controlled DISCOVER-2 Study. Rheumatol Ther 2023; 10:1637-1653. [PMID: 37819505 PMCID: PMC10654317 DOI: 10.1007/s40744-023-00592-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/03/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Guselkumab previously showed greater improvements versus placebo in axial symptoms in patients with psoriatic arthritis (PsA) (assessed by Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Ankylosing Spondylitis Disease Activity Score [ASDAS]), in post hoc analyses of the phase 3, placebo-controlled, randomized DISCOVER-1 and DISCOVER-2 studies. We now evaluate durability of response in axial-related outcomes through 2 years of DISCOVER-2. METHODS DISCOVER-2 biologic-naive adults with active PsA (≥ 5 tender/ ≥ 5 swollen joints, C-reactive protein ≥ 0.6 mg/dl) were randomized to guselkumab 100 mg every 4 weeks (Q4W) or at week 0, week 4, then Q8W, or placebo → guselkumab Q4W at week 24. Among patients with imaging-confirmed sacroiliitis (investigator-identified), axial symptoms were assessed through 2 years utilizing BASDAI, BASDAI Question #2 (spinal pain), modified BASDAI (mBASDAI; excludes Question #3 [peripheral joint pain]), and ASDAS. Mean changes in scores and proportions of patients achieving ≥ 50% improvement in BASDAI (BASDAI 50) and ASDAS responses, including major improvement (decrease ≥ 2.0), were determined through week 100. Treatment failure rules (through week 24) and nonresponder imputation of missing data (post-week 24) were utilized. Mean BASDAI component scores were assessed through week 100 (observed data). Exploratory analyses evaluated efficacy by sex and HLA-B*27 status. RESULTS Among 246 patients with PsA and imaging-confirmed sacroiliitis, guselkumab-treated patients had greater mean improvements in BASDAI, mBASDAI, spinal pain, and ASDAS scores, lower mean BASDAI component scores, and greater response rates in achieving BASDAI 50 and ASDAS major improvement vs. placebo at week 24. Differences from placebo were observed for guselkumab-treated patients in selected endpoints regardless of sex or HLA-B*27 status. At week 100, mean improvements were ~ 3 points for all BASDAI scores and 1.6-1.7 for ASDAS; 49-54% achieved BASDAI 50 and 39% achieved ASDAS major improvement at week 100. CONCLUSIONS Guselkumab treatment provided durable and meaningful improvements in axial symptoms and disease activity in substantial proportions of patients with active PsA and imaging-confirmed sacroiliitis. TRIAL REGISTRATION Clinicaltrials.gov NCT03158285.
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Affiliation(s)
- Philip J Mease
- Department of Rheumatology, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Rheumatology Research, 601 Broadway, Ste 600, Seattle, WA, 98122, USA.
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada
| | | | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - May Shawi
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | - Xie L Xu
- Janssen Research & Development, LLC, San Diego, CA, USA
| | - Stephen Xu
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA
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21
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Poddubnyy D. [Dealing with NSAID in the treatment of axial spondylarthritis]. Z Rheumatol 2023; 82:882-884. [PMID: 37947827 DOI: 10.1007/s00393-023-01449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Denis Poddubnyy
- Medizinische Klinik m.S. Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
- Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland.
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22
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Diekhoff T, Poddubnyy D, Proft F, Ziegeler K, Deppe D, Niedermeier C, Hermann KGA. New bone formation at the sacroiliac joint in axial spondyloarthritis: characterization of backfill in MRI and CT. Rheumatology (Oxford) 2023; 62:3893-3898. [PMID: 37018132 PMCID: PMC10691921 DOI: 10.1093/rheumatology/kead142] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE MRI findings of the SI joint space in axial SpA (axSpA) include inflammation and fat metaplasia inside an erosion; the latter is also termed 'backfill'. We compared such lesions with CT to better characterize whether they represent new bone formation. METHODS We identified patients with axSpA who underwent both CT and MRI of the SI joints in two prospective studies. MRI datasets were jointly screened by three readers for joint space-related findings and grouped into three categories: type A-high short tau inversion recovery (STIR) and low T1 signal; type B-high signal in both sequences; type C-low STIR and high T1 signal. Image fusion was used to identify MRI lesions in CT before we measured Hounsfield units (HU) in each lesion and surrounding cartilage and bone. RESULTS Ninety-seven patients with axSpA were identified and we included 48 type A, 88 type B, and 84 type C lesions (maximum 1 lesion per type and joint). The HU values were 73.6 (s.d. 15.0) for cartilage, 188.0 (s.d. 69.9) for spongious bone, 1086.0 (s.d. 100.3) for cortical bone, 341.2 (s.d. 96.7) for type A, 359.3 (s.d. 153.5) for type B and 446.8 (s.d. 123.0) for type C lesions. Lesion HU values were significantly higher than those for cartilage and spongious bone, but lower than those for cortical bone (P < 0.001). Type A and B lesions showed similar HU values (P = 0.93), whereas type C lesions were denser (P < 0.001). CONCLUSION All joint space lesions show increased density and might contain calcified matrix, suggesting new bone formation, with a gradual increase in the proportion of calcified matrix towards type C lesions (backfill).
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Christoph Niedermeier
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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Torgutalp M, Gladman DD, FitzGerald O, Mease PJ, Poddubnyy D. Project Highlights From the GRAPPA 2022 Annual Meeting: Education Initiatives and Axial Involvement in Psoriatic Arthritis. J Rheumatol 2023; 50:33-35. [PMID: 37419620 DOI: 10.3899/jrheum.2023-0523] [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] [Accepted: 05/30/2023] [Indexed: 07/09/2023]
Abstract
A core mission of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is to provide education about psoriasis and psoriatic arthritis globally. This is a multifaceted endeavor involving in-person and virtual lectures, discussions, podcasts, and archived videos directed toward clinicians and researchers who are involved with psoriatic disease (PsD) care. In partnership with patient service leagues, we also aim to provide education to patients with PsD. At the 2022 annual meeting, an update of the ongoing and expected educational initiatives was presented. A project with a high educational and research value is the Axial Involvement in Psoriatic Arthritis (AXIS) cohort established in collaboration with the Assessment of Spondyloarthritis international Society (ASAS). Here we summarize the status of the project.
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Affiliation(s)
- Murat Torgutalp
- M. Torgutalp, MD, D. Poddubnyy, MD, Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dafna D Gladman
- D.D. Gladman, MD, Division of Rheumatology, Department of Medicine, University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Oliver FitzGerald
- O. FitzGerald, MD, Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Philip J Mease
- P.J. Mease, MD, Division of Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington, USA
| | - Denis Poddubnyy
- M. Torgutalp, MD, D. Poddubnyy, MD, Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany;
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24
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Song K, Webb L, Eder L, FitzGerald O, Goel N, Helliwell PS, Katz A, Merola JF, Rosen CF, Coates LC, Poddubnyy D. Screening and Referral Strategies for the Early Recognition of Psoriatic Arthritis Among Patients With Psoriasis: Results of a GRAPPA Survey. J Rheumatol 2023; 50:1439-1445. [PMID: 37582554 DOI: 10.3899/jrheum.2023-0424] [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] [Accepted: 07/13/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE This study aimed to explore the experiences of dermatologists and rheumatologists in the early recognition of psoriatic arthritis (PsA) and to identify potential improvements to the current shared-care model. METHODS A 24-question survey addressing referral strategies was constructed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) project steering committee and sent to all members (n = 927). Questions addressed the use of screening tools, frequency of PsA in patients with psoriasis, therapeutic decision making, and suggestions for earlier PsA recognition and current unmet needs. RESULTS There were 149 respondents (16.1% response rate), which included 113 rheumatologists from 37 countries and 26 dermatologists from 16 countries. Of the dermatologists, 81% use PsA-specific screening instruments. Conversely, rheumatologists reported that only 26.8% of patients referred to them from all sources had been assessed with screening tools. Although dermatologists reported that a mean of 67% of suspected PsA cases were confirmed, rheumatologists reported a mean of 47.9% of confirmed cases. Both specialties reported similar views regarding optimization of the diagnostic process and indicated that the best approach involved combining patient-reported (ie, screening tools) and physician-confirmed findings. Moreover, both specialties identified the education of primary care physicians (PCPs) and dermatologists as the greatest priority to improve PsA screening. CONCLUSION The survey indicated the current unmet needs in the early recognition of PsA. Important areas to address include improving the use of screening instruments, increasing the education of community-based dermatologists and PCPs, and using a combination of patient-reported and physician-confirmed findings in the screening approach.
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Affiliation(s)
| | - Louisa Webb
- L. Webb, BA, L.C. Coates, PhD, MBChB, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lihi Eder
- L. Eder, MD, PhD, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Oliver FitzGerald
- O. FitzGerald, MD, School of Medicine, UCD Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Niti Goel
- N. Goel, MD, Duke University School of Medicine, Durham, North Carolina, USA
| | - Philip S Helliwell
- P.S. Helliwell, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Chapel Allerton Hospital, Leeds, UK
| | - Arnon Katz
- A. Katz, BSc, MSc, Patient Research Partner, Haifa, Israel
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cheryl F Rosen
- C.F. Rosen, MD, Division of Dermatology, Toronto Western Hospital and University Health Network Hospitals, Toronto, Ontario, Canada
| | - Laura C Coates
- L. Webb, BA, L.C. Coates, PhD, MBChB, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Denis Poddubnyy
- D. Poddubnyy, MD, PhD, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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25
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Coates LC, Eder L, Poddubnyy D, Rosen CF. Identification of Psoriatic Arthritis in Patients With Psoriasis. J Rheumatol 2023; 50:25-26. [PMID: 37419623 DOI: 10.3899/jrheum.2023-0520] [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] [Accepted: 05/30/2023] [Indexed: 07/09/2023]
Abstract
People with psoriasis (PsO) are at increased risk of developing psoriatic arthritis (PsA). Screening patients with PsO for PsA may be helpful in diagnosing PsA early. Dermatologists play a role in assessing their patients with PsO for musculoskeletal symptoms and referring them to a rheumatologist for diagnosis and treatment.
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Affiliation(s)
- Laura C Coates
- L.C. Coates, MD, PhD, Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lihi Eder
- L. Eder, MD, PhD, Department of Medicine, University of Toronto, and Women's College Hospital Research Institute, Toronto, Ontario, Canada
| | - Denis Poddubnyy
- D. Poddubnyy, MD, PhD, Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Cheryl F Rosen
- C.F. Rosen, MD, Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
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Albrecht K, Binder S, Minden K, Poddubnyy D, Regierer AC, Strangfeld A, Callhoff J. [Systematic review to estimate the prevalence of inflammatory rheumatic diseases in Germany. German version]. Z Rheumatol 2023; 82:727-738. [PMID: 36592211 PMCID: PMC10627889 DOI: 10.1007/s00393-022-01305-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Accepted: 11/18/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To update the estimated prevalence of inflammatory rheumatic diseases (IRD) in Germany. METHODS A systematic literature search in PubMed and Web of Science (last search 8 November 2022) identified original articles (regional and nationwide surveys and routine data analyses for arthritides, connective tissue diseases, and vasculitides) on the prevalence for the period 2014-2022. Data sources, collection period, case definition, and risk of bias are reported. The prevalences were estimated from available national data, with consideration of international data. RESULTS Screening by 2 authors yielded 263 hits, of which 18 routine data analyses and 2 surveys met the inclusion criteria. Prevalence data ranged from 0.42% to 1.85% (rheumatoid arthritis), 0.32-0.5% (ankylosing spondylitis), 0.11-0.32% (psoriatic arthritis), 0.037-0.14% (systemic lupus erythematosus), 0.07-0.77% (Sjoegren's disease/sicca syndrome), 0.14-0.15% (polymyalgia rheumatica, ≥ 40 years), 0.04-0.05% (giant cell arteritis, ≥ 50 years), and 0.015-0.026% (ANCA-associated vasculitis). The risk of bias was moderate in 13 and high in 7 studies. Based on the results, we estimate the prevalence of IRD in Germany to be 2.2-3.0%, which corresponds to approximately 1.5-2.1 million affected individuals. Prevalence data of juvenile idiopathic arthritis was reported to be around 0.10% (0.07-0.10%) of patients 0-18 years old, corresponding to about 14,000 children and adolescents in Germany. CONCLUSION This systematic review shows an increase in the prevalence of IRD in Germany, which is almost exclusively based on routine data analyses. In the absence of multistage population studies, the available data are overall uncertain sources for prevalence estimates at moderate to high risk of bias.
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Affiliation(s)
- Katinka Albrecht
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Sebastian Binder
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Kirsten Minden
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Klinik für Pädiatrie mit SP Pneumologie, Immunologie und Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Denis Poddubnyy
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Rheumatologie am Campus Benjamin Franklin - Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Anne C Regierer
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Anja Strangfeld
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Johanna Callhoff
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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Ulas ST, Radny F, Ziegeler K, Eshed I, Greese J, Deppe D, Stelbrink C, Biesen R, Haibel H, Rios Rodriguez V, Rademacher J, Protopopov M, Proft F, Poddubnyy D, Diekhoff T. Self-reported diagnostic confidence predicts diagnostic accuracy in axial spondyloarthritis imaging. Rheumatology (Oxford) 2023:kead564. [PMID: 37882740 DOI: 10.1093/rheumatology/kead564] [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: 07/30/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES Reporting diagnostic confidence (DC) in axial spondyloarthritis (axSpA) imaging is recommended by the ASAS guidelines. Our aim was to investigate whether self-reported DC predicts diagnostic accuracy in axSpA imaging using X-ray (XR), computed tomography (CT) and magnetic resonance imaging (MRI). METHODS We performed a post hoc analysis including 163 patients with low back pain (89 axSpA and 56 non-axSpA). Nine blinded readers with different experience levels (inexperienced (< 1 year), semi-experienced (3-8 years) and experienced (> 12 years)) scored the sacroiliac joint images for compatibility with axSpA. DC was reported on a scale from 1 (not sure) to 10 (very sure). Mean DC scores and standard deviations were calculated for correct and incorrect responses using XR, CT, MRI, XR+MRI and CT+MRI. Differences in DC were assessed using the Mann-Whitney U test. RESULTS DC scores were higher for correct axSpA diagnoses and differed significantly between correct and incorrect responses for all modalities (p< 0.001), with a mean DC of 7.1 ± 2.1 and 6.3 ± 2.1 for XR, 8.3 ± 1.8 and 6.7 ± 2.0 for CT, 8.1 ± 1.9 and 6.2 ± 1.9 for MRI, 8.2 ± 1.8 and 6.7 ± 1.8 for XR+MRI and 8.4 ± 1.8 and 6.8 ± 1.8 for CT+MRI, respectively. This was also the case when looking at the results by experience group, except for XR in the inexperienced group. CONCLUSION Providing self-reported DC in radiological reports is useful information to predict diagnostic reliability in axSpA imaging.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Radny
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Juliane Greese
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Carsten Stelbrink
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Hildrun Haibel
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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Ulas ST, Proft F, Diekhoff T, Rios V, Rademacher J, Protopopov M, Greese J, Eshed I, Adams LC, Hermann KGA, Ohrndorf S, Poddubnyy D, Ziegeler K. Sex-specific diagnostic efficacy of MRI in axial spondyloarthritis: challenging the 'One Size Fits All' notion. RMD Open 2023; 9:e003252. [PMID: 37899091 PMCID: PMC10619004 DOI: 10.1136/rmdopen-2023-003252] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Sex-specific differences in the presentation of axial spondyloarthritis (axSpA) may contribute to a diagnostic delay in women. The aim of this study was to investigate the diagnostic performance of MRI findings comparing men and women. METHODS Patients with back pain from six different prospective cohorts (n=1194) were screened for inclusion in this post hoc analysis. Two blinded readers scored the MRI data sets independently for the presence of ankylosis, erosion, sclerosis, fat metaplasia and bone marrow oedema. Χ2 tests were performed to compare lesion frequencies. Contingency tables were used to calculate markers for diagnostic performance, with clinical diagnosis as the standard of reference. The positive and negative likelihood ratios (LR+/LR-) were used to calculate the diagnostic OR (DOR) to assess the diagnostic performance. RESULTS After application of exclusion criteria, 526 patients (379 axSpA (136 women and 243 men) and 147 controls with chronic low back pain) were included. No major sex-specific differences in the diagnostic performance were shown for bone marrow oedema (DOR m: 3.0; f: 3.9). Fat metaplasia showed a better diagnostic performance in men (DOR 37.9) than in women (DOR 5.0). Lower specificity was seen in women for erosions (77% vs 87%), sclerosis (44% vs 66%), fat metaplasia (87% vs 96%). CONCLUSION The diagnostic performance of structural MRI markers is substantially lower in female patients with axSpA; active inflammatory lesions show comparable performance in both sexes, while still overall inferior to structural markers. This leads to a comparably higher risk of false positive findings in women.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health, Berlin, Germany
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lisa C Adams
- Department of Radiology, Technische Universität München, Munich, Germany
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Ulas ST, Proft F, Diekhoff T, Rios Rodriguez V, Rademacher J, Poddubnyy D, Ziegeler K. HLA-B27 status and inflammatory MRI lesions of the sacroiliac joints: a post hoc analysis in patients without axial spondyloarthritis. RMD Open 2023; 9:e003357. [PMID: 37739448 PMCID: PMC10533781 DOI: 10.1136/rmdopen-2023-003357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/01/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The assessment of inflammatory and structural lesions in the sacroiliac joint (SIJ) is crucial in axial spondyloarthritis (axSpA). HLA-B27 status plays an important role in axSpA diagnosis and has been linked to MRI lesion burden in the general population. We aimed to investigate the sex-specific influence of HLA-B27 status on inflammatory and structural MRI findings in patients with low back pain of non-inflammatory origin. METHODS This post hoc analysis included 139 non-axSpA patients (90 women) with chronic low back pain. Two readers scored MRIs of the SIJ for the presence of sclerosis, erosion, fat metaplasia, bone marrow oedema (BMO) and ankylosis. Frequencies and extent of lesions were compared regarding the HLA-B27 status using χ2 tests and t-tests. Regression models to assess the sex-dependent influence of HLA-B27 on lesion burden were computed. RESULTS HLA-B27 was positive in 33 women (36.7%) and 23 men (46.9%). The overall occurrence of all SIJ lesions did not differ in HLA-B27 negative and positive individuals. There were no significant differences in the extent of lesions considering the HLA-B27 positivity, for erosion (mean sum score (MSS) of 0.91 vs 0.48; p=0.144), sclerosis (MSS 1.65 vs 1.88; p=0.576), fat metaplasia (MSS 0.56 vs 0.27; p=0.425), BMO (MSS 0.75 vs 0.59; p=0.460) and ankylosis (MSS 0.06 vs 0.04; p=0.659). CONCLUSION HLA-B27 status has no significant influence on the occurrence and extent of SIJ lesions in patients with low back pain of non-inflammatory origin in either men or women.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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de Hooge M, Diekhoff T, Poddubnyy D. Magnetic resonance imaging in spondyloarthritis: Friend or Foe? Best Pract Res Clin Rheumatol 2023; 37:101874. [PMID: 37953121 DOI: 10.1016/j.berh.2023.101874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/06/2023] [Revised: 09/06/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Magnetic resonance imaging (MRI) has emerged as a valuable tool for early detection and of axial spondyloarthritis (axSpA). A standardized imaging acquisition protocol, aligned with the current state-of-the-art, is crucial to obtain MRI scans that meet the diagnostic quality requirements. It is important to note that certain lesions, particularly bone marrow edema (BME), can be induced by mechanical stress or be a manifestation of another non-inflammatory disorder and may mimic the characteristic findings of axSpA on MRI. Therefore, a thorough assessment of MRI lesions, considering their localization and presence of highly specific features such as erosions and backfill, becomes imperative. Additionally, the application of additional imaging modalities, when necessary, can contribute to the differentiation of axSpA from other conditions that may exhibit similar MRI findings. This review provides recommendations on how to perform MRI in daily clinical practice and how to interpret finding from the differential diagnostic point of view.
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Affiliation(s)
- Manouk de Hooge
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.
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Deodhar A, Gladman D, Bolce R, Sandoval D, Park SY, Leage SL, Nash P, Poddubnyy D. The effect of ixekizumab on axial manifestations in patients with psoriatic arthritis from two phase III clinical trials: SPIRIT-P1 and SPIRIT-P2. Ther Adv Musculoskelet Dis 2023; 15:1759720X231189005. [PMID: 37645684 PMCID: PMC10462424 DOI: 10.1177/1759720x231189005] [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: 03/23/2023] [Accepted: 07/04/2023] [Indexed: 08/31/2023] Open
Abstract
Background Psoriatic arthritis (PsA) is a chronic inflammatory condition predominantly affecting the peripheral joints. However, some patients with PsA can experience axial involvement which is manifested with back pain and associated with increased burden of illness. Objectives The aim of this post hoc analysis was to determine the efficacy of ixekizumab (IXE) up to 52 weeks in reducing axial symptoms in PsA patients, presenting with axial manifestations. Design This was a post hoc analysis of two pooled phase III clinical trials. Methods Patients with axial manifestations, from two placebo-controlled, randomized, double-blind, phase III trials (SPIRIT-P1 and SPIRIT-P2), were defined as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Question 2 (Q2; back pain)] total score ⩾4 and average of BASDAI Q5 + Q6 (morning stiffness) ⩾4 at baseline. For this post hoc analysis, the efficacy of IXE was evaluated at weeks 16, 24, and 52 using separate BASDAI questions (including back pain and morning stiffness), total BASDAI and modified BASDAI (mBASDAI; without Q3), Ankylosing Spondylitis Disease Activity Score (ASDAS), and 50% improvement in BASDAI (BASDAI50) response. Treatment comparisons were performed using logistic regression and analysis of covariance model for categorical and continuous end points, respectively. Results In the post hoc analysis among PsA patients with axial manifestations at baseline (N = 313), improvements in back pain and morning stiffness at weeks 16 and 24 were significantly greater in patients receiving IXE versus placebo (both p < 0.001). Improvements in BASDAI individual scores and total scores, mBASDAI, and ASDAS were significantly greater in patients receiving IXE compared with placebo. Similarly, significantly more IXE-treated patients achieved BASDAI50 at weeks 16 and 24 versus placebo. The effect of IXE was sustained at week 52. Similar effects were observed in sensitivity analyses subgroups. Conclusion IXE is effective in improving axial symptoms in patients with active PsA presenting with axial manifestations.
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Affiliation(s)
- Atul Deodhar
- Division of Arthritis & Rheumatic Diseases (OP09), Oregon Health & Science University, Portland, OR 97239, USA
| | - Dafna Gladman
- Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Peter Nash
- School of Medicine, Griffith University, Brisbane, Australia
| | - Denis Poddubnyy
- German Rheumatism Research Centre, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Kahn M, Papukchieva S, Fehr A, Eberl M, Rösler B, Veit J, Friedrich B, Poddubnyy D. Drug switching in axial spondyloarthritis patients in Germany - a social listening analysis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231187189. [PMID: 37565049 PMCID: PMC10411271 DOI: 10.1177/1759720x231187189] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023] Open
Abstract
Background Axial spondyloarthritis (axSpA) is a chronic inflammatory disease which primarily affects the axial skeleton resulting in chronic back pain and stiffness. According to the guideline, the first-line treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and non-pharmacological treatment. Second line treatment involves biological disease-modifying antirheumatic drugs (bDMARDs) such as tumour necrosis factor and interleukin-17 inhibitors. Objectives The aim of this social media listening research project was to analyse switches of medication and the reasons thereof to gain valuable insights into real-life journeys of patients suffering from axSpA. Methods Publicly available posts in German-speaking disease-specific forums were scanned for disease-specific keywords and commonly used drugs by axSpA patients on the Permea platform. Posts containing at least two key words were selected and switches between medications were manually labelled. A total of 287 scraped posts between 01 July 2010 and 04 Feb 2022 were analysed. Results The largest group of described medication switches was initially using bDMARDs. Switches to a different bDMARD, termination of medication and switches to glucocorticoids were most frequently named. Patients on NSAIDs switched to glucocorticoids, a different NSAID or bDMARD, whereas patients on csDMARDs most frequently changed to bDMARDs. In all medication groups the main reason for switching was insufficient efficacy and side effects. Additionally, for the medication groups bDMARDs, csDMARDs and corticosteroids, pregnancy and lactation were given as a reason for switching, whereas patients in the NSAID group never mentioned pregnancy and breastfeeding as a reason for switching treatment. Conclusion Our analysis shows medication switches based on real-life patient experiences shared with peers in a social listening setting. We also show medication switches differing from advised guidelines. Gathering real-life insights into patients' journey dealing with chronic diseases allows us to understand, and thereby improve patient care and treatment.
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Affiliation(s)
| | | | | | | | | | - Justyna Veit
- Immunology Franchise, Novartis GmbH, Nuremberg, Germany
| | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Reich A, Weiß A, Lindner L, Baraliakos X, Poddubnyy D, Zinke S, Stille C, Strangfeld A, Regierer AC. Depressive symptoms are associated with fatigue, poorer functional status and less engagement in sports in axSpA and PsA: an analysis from the RABBIT-SpA cohort. Arthritis Res Ther 2023; 25:136. [PMID: 37533077 PMCID: PMC10394807 DOI: 10.1186/s13075-023-03127-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND In patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA), concomitant depression might have a negative impact on the course of disease and treatment outcomes. The aims of this analysis are to determine the prevalence of depressive symptoms in axSpA and PsA patients in a real-world cohort study and to identify sociodemographic and clinical associated factors for moderate or severe depressive symptoms in both diseases. METHODS Patients from the RABBIT-SpA cohort with an axSpA or PsA diagnosis and a valid WHO-5 Well-Being Index score at baseline were included. A descriptive analysis of baseline and outcome parameters by category of depressive symptoms was performed and factors associated with the presence of depressive symptoms (moderate or severe) were examined in a logistic regression. RESULTS Two thousand four hundred seventy patients (1,245 axSpA; 1,225 PsA) were included in the analysis. In both diagnoses, the proportion of patients with moderate depressive symptoms was 8% and 21% with severe symptoms. Patients with moderate or severe depressive symptoms were less likely to engage in sports than those with no or mild depressive symptoms, had more comorbidities and higher scores for disease activity, functional limitations, fatigue, and pain and took more analgesics. In axSpA, patients with a higher disease activity, a greater functional impairment and more severe fatigue were more likely to experience depressive symptoms, while patients with more years in education and engaging in sports for at least 1 h/week were less likely to experience depressive symptoms. PsA patients with a greater functional impairment and more severe fatigue were more likely to experience depressive symptoms while those engaging in sports for at least 1 h/week were less likely to experience depressive symptoms. CONCLUSION We confirmed a high prevalence of depressive symptoms in both PsA and axSpA. Factors negatively associated with the presence of depressive symptoms were fatigue, not engaging in sports, and greater functional limitations. Depressive symptoms may affect the perception of disease activity / severity by patients. Thus, depressive symptoms are an important condition in axSpA and PsA that should be considered when evaluating disease activity and treatment outcomes.
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Affiliation(s)
- Andreas Reich
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Anja Weiß
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Lisa Lindner
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Xenofon Baraliakos
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Denis Poddubnyy
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Department of Gastroenterology, Infectiology and Rheumatology, Berlin, Germany
| | | | | | - Anja Strangfeld
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anne C. Regierer
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
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Kiltz U, Kishimoto M, Walsh JA, Sampaio-Barros P, Mittal M, Saffore CD, Wung P, Ganz F, Biljan A, Poddubnyy D. Effect of Upadacitinib on Quality of Life and Work Productivity in Active Non-radiographic Axial Spondyloarthritis: Results From Randomized Phase 3 Trial SELECT-AXIS 2. Rheumatol Ther 2023; 10:887-899. [PMID: 37191738 PMCID: PMC10186301 DOI: 10.1007/s40744-023-00550-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION To evaluate the effect of upadacitinib vs. placebo on health-related quality of life (HRQoL) and work productivity in patients with active non-radiographic axial spondyloarthritis (nr-axSpA) enrolled in the SELECT-AXIS 2 phase 3 randomized controlled trial. METHODS Adult patients with active nr-axSpA and an inadequate response to non-steroidal anti-inflammatory drugs were randomized 1:1 to receive upadacitinib 15 mg once daily or placebo. Mean changes from baseline in measures of HRQoL (Ankylosing Spondylitis QoL [ASQoL], Assessment of SpondyloArthritis international Society Health Index [ASAS HI], Short-Form 36 Physical Component Summary [SF-36 PCS] score) and Work Productivity and Activity Impairment (WPAI) were assessed through 14 weeks based on mixed-effects repeated measures or analysis of covariance models. The proportions of patients with improvements ≥ minimum clinically important differences (MCID) were assessed in HRQoL measures at week 14 using non-responder imputation with multiple imputation. RESULTS At week 14, upadacitinib- vs. placebo-treated patients reported greater improvements from baseline in ASQoL and ASAS HI (ranked, P < 0.001) and in SF-36 PCS and WPAI overall work impairment (nominal P < 0.05). Improvements were observed as early as week 2 in ASAS HI. Greater proportions of upadacitinib vs. placebo-treated patients reported improvements ≥ MCID in ASQoL (62.6 vs. 40.9%), ASAS HI (44.8 vs. 28.8%), and SF-36 PCS (69.3 vs. 52.0%), with numbers needed to treat < 10 for all (nominal P ≤ 0.01). Improvements ≥ MCID were consistently observed irrespectively of prior exposure to tumor necrosis factor inhibitors. CONCLUSIONS Upadacitinib provides clinically meaningful improvements in HRQoL and work productivity in patients with active nr-axSpA. CLINICAL REGISTRATION NUMBER NCT04169373, SELECT-AXIS 2.
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Affiliation(s)
- Uta Kiltz
- Ruhr-Universität Bochum, Bochum, Germany.
- Rheumazentrum Ruhrgebiet, Department of Rheumatology, Claudiusstr. 45, 44649, Herne, Germany.
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Jessica A Walsh
- University of Utah and Salt Lake City Veterans Affairs Health, Salt Lake City, UT, USA
| | - Percival Sampaio-Barros
- Division of Rheumatology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (Including Nutrition Medicine), Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Navarro-Compán V, Benavent D, Capelusnik D, van der Heijde D, Landewé RB, Poddubnyy D, van Tubergen A, Baraliakos X, Van den Bosch FE, van Gaalen FA, Gensler L, López-Medina C, Marzo-Ortega H, Molto A, Pérez-Alamino R, Rudwaleit M, van de Sande M, Sengupta R, Weber U, Ramiro S. ASAS consensus definition of early axial spondyloarthritis. Ann Rheum Dis 2023:ard-2023-224232. [PMID: 37321799 DOI: 10.1136/ard-2023-224232] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 03/30/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To develop a consensual definition for the term 'early axial spondyloarthritis-axSpA'-and 'early peripheral spondyloarthritis-pSpA'. METHODS The ASAS (Assessment of SpondyloArthritis international Society-Spondyloarthritis EARly definition) steering committee convened an international working group (WG). Five consecutive steps were followed: (1) systematic literature review (SLR); (2) discussion of SLR results within the WG and ASAS community; (3) a three-round Delphi survey inviting all ASAS members to select the items that should be considered for the definition; (4) presentation of Delphi results to the WG and ASAS community and (5) ASAS voting and endorsement (2023 annual meeting). RESULTS Following the SLR, consensus was to proceed with an expert-based definition for early axSpA (81% in favour) but not for pSpA (54% against). Importantly, early axSpA should be based on symptom duration taking solely axial symptoms into account. 151-164 ASAS members participated in the Delphi surveys. Consensus was achieved for considering the following items within early axSpA definition: duration of symptoms ≤2 years; axial symptoms defined as cervical/thoracic/back/buttock pain or morning stiffness; regardless of the presence/absence of radiographic damage. The WG agreed that in patients with a diagnosis of axSpA 'early axSpA' should be defined as a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA. The ASAS community endorsed this proposal (88% in favour). CONCLUSIONS Early axSpA has newly been defined, based on expert consensus. This ASAS definition should be adopted in research studies addressing early axSpA.
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Affiliation(s)
| | - Diego Benavent
- Rheumatology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - Dafne Capelusnik
- Universiteit Maastricht Care and Public Health Research Institute, Maastricht, The Netherlands
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Robert Bm Landewé
- Department of Rheumatology & Clinical Immunology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charite Universitatsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Center, Berlin, Germany
| | - Astrid van Tubergen
- Maastricht University Care and Public Health Research Institute, Maastricht, The Netherlands
- Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Xenofon Baraliakos
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
- Ruhr-Universitat Bochum, Bochum, Germany
| | - Filip E Van den Bosch
- Internal Medicine and Pediatrics, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
- Ghent University, Gent, Belgium
| | | | - Lianne Gensler
- Medicine, Division of Rheumatology, University of California, San Francisco, California, USA
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Helena Marzo-Ortega
- Rheumatology, Leeds Biomedical Research Centre, Leeds, UK
- University of Leeds Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Anna Molto
- APHP, INSERM U-1158, Rheumatology, Hospital Cochin, Paris, France
- Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
| | | | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhohe, Bielefeld, Germany
| | - Marleen van de Sande
- Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Raj Sengupta
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulrich Weber
- Practice Buchsbaum, Rheumatology, Schaffhausen Hospitals, Schaffhausen, Switzerland
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
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Braun J, Blanco R, Marzo-Ortega H, Gensler LS, Van den Bosch F, Hall S, Kameda H, Poddubnyy D, van de Sande M, van der Heijde D, Zhuang T, Stefanska A, Readie A, Richards HB, Deodhar A. Two-year imaging outcomes from a phase 3 randomized trial of secukinumab in patients with non-radiographic axial spondyloarthritis. Arthritis Res Ther 2023; 25:80. [PMID: 37194094 DOI: 10.1186/s13075-023-03051-5] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Radiographic progression and course of inflammation over 2 years in patients with non-radiographic axial spondyloarthritis (nr-axSpA) from the phase 3, randomized, PREVENT study are reported here. METHODS In the PREVENT study, adult patients fulfilling the Assessment of SpondyloArthritis International Society classification criteria for nr-axSpA with elevated CRP and/or MRI inflammation received secukinumab 150 mg or placebo. All patients received open-label secukinumab from week 52 onward. Sacroiliac (SI) joint and spinal radiographs were scored using the modified New York (mNY) grading (total sacroiliitis score; range, 0-8) and modified Stoke Ankylosing Spondylitis Spine Score (mSASSS; range, 0-72), respectively. SI joint bone marrow edema (BME) was assessed using the Berlin Active Inflammatory Lesions Scoring (0-24) and spinal MRI using the Berlin modification of the AS spine MRI (ASspiMRI) scoring (0-69). RESULTS Overall, 78.9% (438/555) of patients completed week 104 of the study. Over 2 years, minimal changes were observed in total radiographic SI joint scores (mean [SD] change, - 0.04 [0.49] and 0.04 [0.36]) and mSASSS scores (0.04 [0.47] and 0.07 [0.36]) in the secukinumab and placebo-secukinumab groups. Most of the patients showed no structural progression (increase ≤ smallest detectable change) in SI joint score (87.7% and 85.6%) and mSASSS score (97.5% and 97.1%) in the secukinumab and placebo-secukinumab groups. Only 3.3% (n = 7) and 2.9% (n = 3) of patients in the secukinumab and placebo-secukinumab groups, respectively, who were mNY-negative at baseline were scored as mNY-positive at week 104. Overall, 1.7% and 3.4% of patients with no syndesmophytes at baseline in the secukinumab and placebo-secukinumab group, respectively, developed ≥ 1 new syndesmophyte over 2 years. Reduction in SI joint BME observed at week 16 with secukinumab (mean [SD], - 1.23 [2.81] vs - 0.37 [1.90] with placebo) was sustained through week 104 (- 1.73 [3.49]). Spinal inflammation on MRI was low at baseline (mean score, 0.82 and 1.07 in the secukinumab and placebo groups, respectively) and remained low (mean score, 0.56 at week 104). CONCLUSION Structural damage was low at baseline and most patients showed no radiographic progression in SI joints and spine over 2 years in the secukinumab and placebo-secukinumab groups. Secukinumab reduced SI joint inflammation, which was sustained over 2 years. TRIAL REGISTRATION ClinicalTrials.gov, NCT02696031.
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Affiliation(s)
- Juergen Braun
- Department of Rheumatology, Ruhr-University Bochum, Bochum, Germany.
- Rheuma Praxis, Berlin, Germany.
| | - Ricardo Blanco
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, LIRMM, University of Leeds, Leeds, UK
| | | | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
| | - Stephen Hall
- Department of Medicine, Monash University, Melbourne, Australia
| | | | - Denis Poddubnyy
- German Rheumatism Research Centre, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marleen van de Sande
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Aimee Readie
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Atul Deodhar
- Oregon Health & Science University, Division of Arthritis and Rheumatic Diseases, Portland, USA
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37
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Deodhar A, Poddubnyy D, Rahman P, Ermann J, Tomita T, Bolce R, Leage SL, Kronbergs A, Johnson C, Araújo J, Leung A, van der Heijde D. Long-Term Safety and Efficacy of Ixekizumab in Patients With Axial Spondyloarthritis: 3-year Data From the COAST Program. J Rheumatol 2023; 50:718. [PMID: 37127315 DOI: 10.3899/jrheum.221022.c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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van der Heijde D, Deodhar A, Baraliakos X, Brown MA, Dobashi H, Dougados M, Elewaut D, Ellis AM, Fleurinck C, Gaffney K, Gensler LS, Haroon N, Magrey M, Maksymowych WP, Marten A, Massow U, Oortgiesen M, Poddubnyy D, Rudwaleit M, Shepherd-Smith J, Tomita T, Van den Bosch F, Vaux T, Xu H. Efficacy and safety of bimekizumab in axial spondyloarthritis: results of two parallel phase 3 randomised controlled trials. Ann Rheum Dis 2023; 82:515-526. [PMID: 36649967 PMCID: PMC10086273 DOI: 10.1136/ard-2022-223595] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 11/07/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Axial spondyloarthritis (axSpA) is a complex disease with diverse manifestations, for which new treatment options are warranted. BE MOBILE 1 (non-radiographic (nr)-axSpA) and BE MOBILE 2 (radiographic axSpA (r-axSpA)) are double-blind, phase 3 trials designed to evaluate efficacy and safety of bimekizumab, a novel dual interleukin (IL)-17A and IL-17F inhibitor, across the axSpA spectrum. METHODS In parallel 52-week trials, patients with active disease were randomised 1:1 (nr-axSpA) or 2:1 (r-axSpA) to bimekizumab 160 mg every 4 weeks:placebo. From week 16, all patients received bimekizumab 160 mg every 4 weeks. Primary (Assessment of SpondyloArthritis international Society ≥40% improvement (ASAS40)) and secondary endpoints were assessed at week 16. Here, efficacy and treatment-emergent adverse events (TEAEs) are reported up to week 24. RESULTS 254 patients with nr-axSpA and 332 with r-axSpA were randomised. At week 16, primary (ASAS40, nr-axSpA: 47.7% bimekizumab vs 21.4% placebo; r-axSpA: 44.8% vs 22.5%; p<0.001) and all ranked secondary endpoints were met in both trials. ASAS40 responses were similar across TNFi-naïve and TNFi-inadequate responder patients. Improvements were observed in Ankylosing Spondylitis Disease Activity Score (ASDAS) states and objective measures of inflammation, including high-sensitivity C-reactive protein (hs-CRP) and MRI of the sacroiliac joints and spine. Most frequent TEAEs with bimekizumab (>3%) included nasopharyngitis, upper respiratory tract infection, pharyngitis, diarrhoea, headache and oral candidiasis. More fungal infections (all localised) were observed with bimekizumab vs placebo; no major adverse cardiovascular events (MACE) or active tuberculosis were reported. Incidence of uveitis and adjudicated inflammatory bowel disease was low. CONCLUSIONS Dual inhibition of IL-17A and IL-17F with bimekizumab resulted in significant and rapid improvements in efficacy outcomes vs placebo and was well tolerated in patients with nr-axSpA and r-axSpA.
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Affiliation(s)
| | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Maxime Dougados
- Department of Rheumatology, Hôpital Cochin, University Paris Cité, Paris, France
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
| | | | | | - Karl Gaffney
- Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK
| | - Lianne S Gensler
- Department of Medicine/Rheumatology, University of California, San Francisco, California, USA
| | - Nigil Haroon
- University Health Network, Schroeder Arthritis Institute, Department of Medicine/Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Marina Magrey
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Tetsuya Tomita
- Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka City, Osaka, Japan
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University and VIB Center for Inflammation Research, Ghent, Belgium
| | | | - Huji Xu
- Affiliated to Second Military Medical University, Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Shanghai, China
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Wurm LM, Andresen JR, Reinke J, Poddubnyy D, Ertel W, Jagielski MW. A rare case of severely elevated septic parameters caused by intercurrent juvenile rheumatoid arthritis despite dual trauma surgery. J Surg Case Rep 2023; 2023:rjad168. [PMID: 37064073 PMCID: PMC10097544 DOI: 10.1093/jscr/rjad168] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/04/2023] [Indexed: 04/18/2023] Open
Abstract
Procalcitonin (PCT) and C-reactive protein (CRP) are considered markers used in clinical practice to differentiate bacterial infections from autoimmune origin. Here we evaluate a rare case of a male patient diagnosed with juvenile idiopathic arthritis. The patient presented repeatedly to our department with atraumatic femoral head necrosis, traumatic medial femoral neck fracture and peri-implant femoral fracture. While undergoing repeated surgical interventions including a removal of osteosynthesis material and total endoprosthesis of his right hip including double subtrochanteric osteotomy, the patient developed drastically increasing infection parameters of PCT and CRP. After a completely inconspicuous revision we revealed the untypical genesis of a rheumatic cause. Consequently, we emphasize this etiology to be considered in further decision making for trauma surgery.
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Affiliation(s)
- Lennard M Wurm
- Correspondence address. Department of Traumatology and Reconstructive Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany. E-mail:
| | - Julian R Andresen
- Department of Traumatology and Reconstructive Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Justyna Reinke
- Department of Traumatology and Reconstructive Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Ertel
- Department of Traumatology and Reconstructive Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Michal W Jagielski
- Department of Traumatology and Reconstructive Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Abstract
Axial symptoms (i.e., back pain) are common in the general population. At the same time 25-70% of patients with psoriatic arthritis (PsA) exhibit signs of inflammatory axial involvement (axial PsA). The presence of unexplained chronic (duration ≥ 3 months) back pain in a patient with psoriasis or PsA should trigger evaluation of the presence of axial involvement. Evaluation of axial involvement normally involves imaging of the axial skeleton (sacroiliac joints and/or spine) in addition to clinical and laboratory evaluation. Symptomatic patients with confirmed axial PsA are treated with a combination of non-pharmacologic and pharmacologic methods including the use of non-steroidal anti-inflammatory drugs, tumour necrosis factor, interleukin 17, and Janus kinase inhibitors. Interleukin 23 blockade might also be effective in the axial domain of PsA; a dedicated clinical study is ongoing at present. Safety considerations, patient preference, as well as the presence of other disease manifestations (especially of extra-musculoskeletal manifestations-clinically relevant psoriasis, acute anterior uveitis, inflammatory bowel disease), define the choice of a specific drug or drug class.
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Affiliation(s)
- Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.
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41
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Ziegeler K, Ulas ST, Poddubnyy D, Proft F, Rios Rodriguez V, Rademacher J, Hermann KGA, Diekhoff T. Anatomical variation of the sacroiliac joint carries an increased risk for erosion and bone marrow oedema in axial spondyloarthritis. Rheumatology (Oxford) 2023; 62:1117-1123. [PMID: 35532084 DOI: 10.1093/rheumatology/keac282] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the impact of joint shape variations on inflammatory lesions on SI joint MRIs in patients with axial spondyloarthritis (axSpA). METHODS A total of 1194 patients from four different prospective cohorts were evaluated, with 684 (57.3%) having sufficient imaging data for inclusion (379 axSpA, 305 controls). All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. Logistic regression analyses were used to assess the association of joint form and lesions on imaging for axSpA patients and controls. RESULTS Atypical joint forms were common in both axSpA (43.5% [154/354]) and control patients (44.2% [134/303]); both intra-articular variants and a crescent joint shape were significantly more common in axSpA patients (18.4% vs 11.6% and 11.0% vs 5.3.%, respectively; P < 0.001). The axSpA patients with intra-articular joint form variants had 2-fold higher odds of exhibiting erosions [odds ratio (OR) 2.09 (95% CI 1.18, 3.69)] and BMO [OR 1.79 (95% CI 1.13, 2.82)]; this association was not observed in controls. Accessory joints increased the odds for sclerosis in axSpA patients [OR 2.54 (95% CI 1.10, 5.84)] and for sclerosis [OR 17.91 (95% CI 6.92, 46.37)] and BMO [OR 2.05 (95% CI 1.03, 4.07)] in controls. CONCLUSIONS Joint form variations are associated with the presence of inflammatory lesions on SI joint MRIs of axSpA patients. This should be taken into consideration in future research on the interplay of mechanical strain and inflammation in axSpA.
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Affiliation(s)
| | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin.,Berlin Institute of Health, Berlin, Germany
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42
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Regierer AC, Weiß A, Proft F, Baraliakos X, Behrens F, Poddubnyy D, Schett G, Lorenz HM, Worsch M, Strangfeld A. Comparison of patients with axial PsA and patients with axSpA and concomitant psoriasis: an analysis of the German register RABBIT-SpA. RMD Open 2023; 9:rmdopen-2022-002837. [PMID: 36898762 PMCID: PMC10008170 DOI: 10.1136/rmdopen-2022-002837] [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: 11/03/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) show certain overlaps: A subset of patients with PsA can develop axial involvement (axial PsA, axPsA), while a subset of patients with axSpA presents with psoriasis (axSpA+pso). Treatment strategy for axPsA is mostly based on axSpA evidence. OBJECTIVES To compare demographic and disease-specific parameters of axPsA and axSpA+pso. METHODS RABBIT-SpA is a prospective longitudinal cohort study. AxPsA was defined based on (1) clinical judgement by rheumatologists; (2) imaging (sacroiliitis according to modified New York criteria in radiographs or signs of active inflammation in MRI or syndesmophytes/ankylosis in radiographs or signs of active inflammation in spine MRI). axSpA was stratified into axSpA+pso and axSpA without pso. RESULTS Psoriasis was documented in 181/1428 axSpA patients (13%). Of 1395 PsA patients, 359 (26%) showed axial involvement. 297 patients (21%) fulfilled the clinical definition and 196 (14%) the imaging definition of axial manifestation of PsA. AxSpA+pso differed from axPsA regardless whether clinical or imaging definition was used. axPsA patients were older, more often female and less often HLA-B27+. Peripheral manifestations were more often present in axPsA than in axSpA+pso, whereas uveitis and inflammatory bowel disease were more common in axSpA+pso. Burden of disease (patient global, pain, physician global) was similar among axPsA and axSpA+pso patients. CONCLUSIONS AxPsA differs from axSpA+pso in its clinical manifestations, irrespective of whether axPsA is defined clinically or by imaging. These findings support the hypothesis that axSpA and PsA with axial involvement are distinct entities, so extrapolation of treatment data from randomised controlled trials in axSpA should be performed with caution.
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Affiliation(s)
| | - Anja Weiß
- Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité Universitätsmedizin, Berlin, Germany
| | | | - Frank Behrens
- Institute for Translational Medicine & Pharmacology ITMP, Frankfurt am Main, Germany
| | - Denis Poddubnyy
- Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany.,Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité Universitätsmedizin, Berlin, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hanns-Martin Lorenz
- Department of Internal Medicine V Hematology Oncology Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany.,Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
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Deppe D, Ziegeler K, Hermann KGA, Proft F, Poddubnyy D, Radny F, Makowski MR, Muhle M, Diekhoff T. Dual-Energy-CT for Osteitis and Fat Lesions in Axial Spondyloarthritis: How Feasible Is Low-Dose Scanning? Diagnostics (Basel) 2023; 13:diagnostics13040776. [PMID: 36832264 PMCID: PMC9955853 DOI: 10.3390/diagnostics13040776] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND To assess the ability of low-dose dual-energy computed tomography (ld-DECT) virtual non-calcium (VNCa) images for detecting bone marrow pathologies of the sacroiliac joints (SIJs) in patients with axial spondyloarthritis (axSpA). Material and Methods: Sixty-eight patients with suspected or proven axSpA underwent ld-DECT and MRI of the SIJ. VNCa images were reconstructed from DECT data and scored for the presence of osteitis and fatty bone marrow deposition by two readers with different experience (beginner and expert). Diagnostic accuracy and correlation (Kohen's k) with magnetic resonance imaging (MRI) as the reference standard were calculated for the overall and for each reader separately. Furthermore, quantitative analysis was performed using region-of-interest (ROI) analysis. Results: Twenty-eight patients were classified as positive for osteitis, 31 for fatty bone marrow deposition. DECT's sensitivity (SE) and specificity (SP) were 73.3% and 44.4% for osteitis and 75% and 67.3% for fatty bone lesions, respectively. The expert reader achieved higher diagnostic accuracy for both osteitis (SE 93.33%; SP: 51.85%) and fatty bone marrow deposition (SE: 65%; SP: 77.55%) than the beginner (SE: 26.67%; SP: 70.37% for osteitis; SE: 60%; SP: 44.9% for fatty bone marrow deposition). Overall correlation with MRI was moderate (r = 0.25, p = 0.04) for osteitis and fatty bone marrow deposition (r = 0.25, p = 0.04). Fatty bone marrow attenuation in VNCa images (mean: -129.58 HU; ±103.61 HU) differed from normal bone marrow (mean: 118.84 HU, ±99.91 HU; p < 0.01) and from osteitis (mean: 172 HU, ±81.02 HU; p < 0.01) while osteitis did not differ significantly from normal bone marrow (p = 0.27). Conclusion: In our study, low-dose DECT failed to detect osteitis or fatty lesions in patients with suspected axSpA. Thus, we conclude that higher radiation might be needed for DECT-based bone marrow analysis.
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Affiliation(s)
- Dominik Deppe
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kay Geert A. Hermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Radny
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Marcus R. Makowski
- Department of Radiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Maximilian Muhle
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-627-176; Fax: +49-30-450-7-527941
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Deodhar A, Poddubnyy D, Rahman P, Ermann J, Tomita T, Bolce R, Liu Leage S, Kronbergs A, Johnson C, Araújo J, Leung A, van der Heijde D. Long-term Safety and Efficacy of Ixekizumab in Patients With Axial Spondyloarthritis: 3-year Data From the COAST Program. J Rheumatol 2023:jrheum.221022. [PMID: 36792107 DOI: 10.3899/jrheum.221022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To report safety and efficacy of ixekizumab (IXE) from the COAST program at 3 years, including 1 year from the originating studies (COAST-V, COAST-W, and COAST-X), and 2 years from COAST-Y. METHODS In COAST-Y, patients continued with the dose received at the end of the originating study at week 52: 80 mg IXE either every 4 weeks (Q4W) or every 2 weeks (Q2W). Placebo-treated patients from COAST-X received IXE Q4W in COAST-Y. Starting at week 116 (week 64 of COAST-Y), patients receiving IXE Q4W could be escalated to Q2W. Safety for patients receiving ≥ 1 dose of IXE and efficacy for patients receiving ≥ 1 dose of IXE Q4W was assessed. Data are summarized as observed. RESULTS For the 932 patients who received ≥ 1 dose of IXE (Q2W or Q4W) through 3 years, treatment-emergent adverse events (TEAEs) occurred at an incidence rate (IR) of 38.0 per 100 patient-years (PYs). The most frequently reported were infections (IR 25.7 per 100 PYs) and injection site reactions (IR 7.4 per 100 PYs); the majority of TEAEs were mild or moderate in severity. In total, 7.1% of TEAEs led to discontinuation (IR 3.1 per 100 PYs). All patient groups receiving IXE Q4W assessed through 3 years saw sustained improvements in Ankylosing Spondylitis Disease Activity Score, clinically important improvement, and other efficacy end points. CONCLUSION The 3-year safety profile of IXE in the COAST program is consistent with the previously established long-term safety profile. IXE Q4W provided sustained improvement of disease activity in patients who received treatment through 3 years. (ClinicalTrials.gov: NCT02696785 [COAST-V], NCT02696798 [COAST-W], NCT02757352 [COAST-X], and NCT03129100 [COAST-Y]).
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Affiliation(s)
- Atul Deodhar
- A. Deodhar, MD, Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Denis Poddubnyy
- D. Poddubnyy, MD, Rheumatology Department, Charité - Universitätsmedizin Berlin, Berlin, Germany. and German Rheumatism Research Centre, Berlin, Germany
| | - Proton Rahman
- P. Rahman, MD, Department of Medicine, Memorial University of Newfoundland, Newfoundland and Labrador, Canada
| | - Jeorg Ermann
- J. Ermann, MD, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tetsuya Tomita
- T. Tomita, MD, Department of Orthopedic Surgery, Osaka University Hospital, Osaka, Japan
| | - Rebeca Bolce
- R. Bolce, MSN, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Soyi Liu Leage
- S. Liu Leage, MD, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Andris Kronbergs
- A. Kronbergs, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Caroline Johnson
- C. Johnson, MD, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Joana Araújo
- J. Araújo, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ann Leung
- A. Leung, MS, Syneos Health Inc., Morrisville, North Carolina, USA
| | - Désirée van der Heijde
- D. van der Heijde, MD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
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Kristensen LE, Strober B, Poddubnyy D, Leung YY, Jo H, Kwok K, Vranic I, Fleishaker DL, Fallon L, Yndestad A, Gladman DD. Association between baseline cardiovascular risk and incidence rates of major adverse cardiovascular events and malignancies in patients with psoriatic arthritis and psoriasis receiving tofacitinib. Ther Adv Musculoskelet Dis 2023; 15:1759720X221149965. [PMID: 36777695 PMCID: PMC9909057 DOI: 10.1177/1759720x221149965] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023] Open
Abstract
Background Tofacitinib is a Janus kinase inhibitor for the treatment of psoriatic arthritis (PsA) and has been investigated for psoriasis (PsO). Objectives This post hoc analysis examined baseline cardiovascular (CV) disease risk and its association with the occurrence of major adverse cardiovascular events (MACE) and malignancies in tofacitinib-treated patients with PsA and PsO. Design Included three phase III/long-term extension (LTE) PsA trials and seven phase II/phase III/LTE PsO trials of patients receiving ⩾ 1 dose of tofacitinib. Methods Incidence rates (IRs: patients with events/100 patient-years) for MACE and malignancies (excluding non-melanoma skin cancer) were determined in subgroups according to history of atherosclerotic CV disease (ASCVD), baseline 10-year risk of ASCVD (in patients without history of ASCVD), and baseline metabolic syndrome (MetS). Results For patients with PsA (N = 783) and PsO (N = 3663), respectively, tofacitinib exposure was 2038 and 8950 patient-years (median duration: 3.0 and 2.4 years), and 40.9% and 32.7% had MetS. Excluding missing CV risk profile data, 51/773 (6.6%) and 144/3629 (4.0%) patients had history of ASCVD, and in patients without history of ASCVD, around 20.0% had intermediate/high baseline 10-year ASCVD risk. For PsA and PsO, IRs of MACE were greatest in those with history of ASCVD or high baseline 10-year ASCVD risk. For PsA, five of six patients with MACE had baseline MetS. Malignancy IRs in patients with PsA were greatest in those with intermediate/high baseline 10-year ASCVD risk. Of these, eight of nine patients with malignancies had baseline MetS. In the PsO cohort, IR of malignancies was notably greater with high versus low/borderline/intermediate baseline 10-year ASCVD risk. Conclusion In tofacitinib-treated patients with PsA/PsO, increased ASCVD risk and baseline MetS were associated with higher IRs for MACE and malignancies. Our results support assessing CV risk in patients with PsA/PsO and suggest enhanced cancer monitoring in those with increased ASCVD risk. Registration ClinicalTrialsgov NCT01877668/NCT01882439/NCT01976364/NCT00678210/NCT01710046/NCT01241591/NCT01186744/NCT01276639/NCT01309737/NCT01163253. Plain Language Summary People who have psoriatic arthritis or psoriasis may have more heart-related problems and cancer if they have a higher risk of cardiovascular disease: A study in people with psoriatic arthritis or psoriasis receiving tofacitinib Why was this study done? • People with psoriatic arthritis (PsA) and psoriasis (PsO) are more likely than the general population to have a disease affecting the heart and blood vessels [cardiovascular (CV) disease].• People who are more likely to have CV disease may also be more likely to have certain types of cancer.• Tofacitinib is a medicine to treat people with PsA and has been tested in people with PsO.• We wanted to know if the risk of CV disease affects the number of heart-related problems (including heart attack, stroke, or death) and cancer in people with PsA and PsO. What did the researchers do? • We used results from 10 clinical trials.• In these trials, people with PsA and PsO were taking tofacitinib 5 or 10 mg twice a day.• After the trials had ended, we measured people's risk of CV disease using a risk calculator. This risk calculator showed if they had a low, borderline, intermediate, or high risk of CV disease over the next 10 years. We also checked if they had had CV disease before treatment.• We checked if people had a group of conditions linked to CV disease: diabetes, high blood pressure, and obesity.• We counted the cases of heart-related problems and cancer in people once they started taking tofacitinib. What did the researchers find? In people with PsA and PsO taking tofacitinib:• There were more cases of heart-related problems and cancer in people who had intermediate or high risk of CV disease.• There were more cases of heart-related problems in people who had had CV disease before.• More people with diabetes, high blood pressure, and obesity had heart-related problems and cancer than people without those conditions. What do the findings mean? • It is important to measure risk and assess history of CV disease in people with PsA and PsO, including those taking tofacitinib.• We should test for cancer in people with high risk of CV disease.
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Affiliation(s)
- Lars E. Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg, Copenhagen, and Copenhagen University, Copenhagen, Denmark
| | - Bruce Strober
- Central Connecticut Dermatology Research, Cromwell, CT, USA,Yale University, New Haven, CT, USA
| | - Denis Poddubnyy
- Department of Rheumatology, Infectious Diseases and Rheumatology, Charité–Universitätsmedizin Berlin, Berlin, Germany,Epidemiology, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore,Duke-NUS Medical School, Singapore
| | | | | | | | | | | | | | - Dafna D. Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
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Landewé RBM, Poddubnyy D, Rahman P, Van den Bosch FE, Bolce R, Liu Leage S, Lisse JR, Park SY, Gensler L. Recapture and retreatment rates with ixekizumab after withdrawal of therapy in patients with axial spondyloarthritis: results at week 104 from a randomised placebo-controlled withdrawal study. Ann Rheum Dis 2023; 82:212-216. [PMID: 36100350 PMCID: PMC9887347 DOI: 10.1136/ard-2022-222731] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the recapture of response with open-label (OL) ixekizumab (IXE) retreatment at week 104 in patients with axial spondyloarthritis who flared after withdrawal of IXE therapy. METHODS COAST-Y (NCT03129100) is a phase III extension study that included a double-blind, placebo-controlled, randomised withdrawal-retreatment period (RWRP). Patients who achieved remission (Ankylosing Spondylitis Disease Activity Score (ASDAS) <1.3 (inactive disease, ID) at least once at week 16 or 20 and <2.1 (low disease activity, LDA) at both visits) were randomised 2:1 at week 24 to continue IXE or withdraw to placebo. Patients who subsequently flared were switched to OL IXE every 2 or 4 weeks (Q2W or Q4W) at the next visit. The proportions of patients who recaptured ASDAS LDA and ID were summarised for those who experienced flare. RESULTS Of the 155 patients who entered the RWRP (placebo, n=53; IXE Q4W, n=48; IXE Q2W, n=54), 138 (89%) completed week 104. Of the placebo-treated patients (n=53), 28 (53%) experienced a flare during weeks 24-104; of these, 4 (14%) recaptured ASDAS LDA before retreatment with OL IXE, and 23 (82%) recaptured ASDAS LDA and 19 (68%) met ASDAS ID after retreatment. Of the continuously treated IXE patients (n=102), 13 experienced flare; 7 of 13 (54%) recaptured ASDAS LDA before switching to OL IXE retreatment, while 5 of 13 (38%) recaptured ASDAS LDA and 4 of 13 (31%) met ID after switching. CONCLUSIONS Ninety-six per cent of patients withdrawn to placebo recaptured at least ASDAS LDA and 71% recaptured ASDAS ID with IXE retreatment at week 104. This may provide support to patients who may require a brief interruption in therapy.
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Affiliation(s)
- Robert B M Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Denis Poddubnyy
- Rheumatology Department, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Rheumatism Research Centre, Berlin, Germany
| | - Proton Rahman
- Division of Rheumatology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, Gent, Belgium.,VIB Center for Inflammation Research, Ghent, Belgium
| | | | | | | | | | - Lianne Gensler
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
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Lubrano E, Chan J, Queiro-Silva R, Cauli A, Goel N, Poddubnyy D, Nash P, Gladman DD. Management of Axial Disease in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol 2023; 50:279-284. [PMID: 36318999 DOI: 10.3899/jrheum.220309] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Axial involvement in patients with psoriatic arthritis (PsA) is a common subset of this condition, but a unanimous definition has yet to be established. It has been defined by using different criteria, ranging from the presence of at least unilateral grade 2 sacroiliitis to those used for ankylosing spondylitis (AS), or simply the presence of inflammatory low back pain (IBP). Our aim was to identify and evaluate the efficacy of therapeutic interventions for treatment of axial disease in PsA. METHODS This systematic review is an update of the axial PsA (axPsA) domain of the treatment recommendations project by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). RESULTS The systematic review of the literature showed that new biologic and targeted synthetic disease-modifying antirheumatic drug classes, namely interleukin (IL)-17A and Janus kinase inhibitors, could be considered for the treatment of axPsA. This would be in addition to previously recommended treatments such as nonsteroidal antiinflammatory drugs, physiotherapy, simple analgesia, and tumor necrosis factor inhibitors. Conflicting evidence still remains regarding the use of IL-12/23 and IL-23 inhibitors. CONCLUSION Further studies are needed for a better understanding of the treatment of axPsA, as well as validated outcome measures.
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Affiliation(s)
- Ennio Lubrano
- E. Lubrano, MD, PhD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy;
| | - Jon Chan
- J. Chan, MD, Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ruben Queiro-Silva
- R. Queiro-Silva, MD, PhD, Rheumatology Division, and ISPA Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alberto Cauli
- A. Cauli, MD, PhD, Rheumatology Unit, Department of Medicine and Public Health, AOU and University of Cagliari, Monserrato, Italy
| | - Niti Goel
- N. Goel, MD, Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Denis Poddubnyy
- D. Poddubnyy, MD, PhD, Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Peter Nash
- P. Nash, MBBS, School of Medicine, Griffith University, Queensland, Australia
| | - Dafna D Gladman
- D.D. Gladman, MD, University of Toronto, and Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
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Rademacher J, Müllner H, Diekhoff T, Haibel H, Igel S, Pohlmann D, Proft F, Protopopov M, Rios Rodriguez V, Torgutalp M, Pleyer U, Poddubnyy D. Keep an Eye on the Back: Spondyloarthritis in Patients With Acute Anterior Uveitis. Arthritis Rheumatol 2023; 75:210-219. [PMID: 35905288 DOI: 10.1002/art.42315] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/02/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study was undertaken to analyze the prevalence of spondyloarthritis (SpA) in patients with acute anterior uveitis (AAU), to identify parameters associated with the presence of SpA, and to evaluate the performance of referral algorithms for identifying patients with a high probability of having SpA. METHODS Prospectively recruited consecutive patients with noninfectious AAU underwent structured rheumatologic assessment including magnetic resonance imaging of the sacroiliac joints, allowing a definitive diagnosis/exclusion of concomitant SpA. Fisher's exact test and Mann-Whitney U test were used to compare AAU patients with SpA and AAU patients without SpA. Furthermore, logistic regression analyses were performed. The predictive performance of SpA referral strategies was analyzed by calculating the sensitivity, specificity, positive predictive value, and positive and negative likelihood ratios. RESULTS Among the 189 AAU patients evaluated, 106 (56%) were diagnosed as having SpA. The majority of SpA patients (93%) had predominantly axial SpA and 7 patients had peripheral SpA. In 74 patients (70%), the SpA diagnosis was established for the first time. In multivariable logistic regression analysis, psoriasis (odds ratio [OR] 12.5 [95% confidence interval (95% CI) 1.3-120.2]), HLA-B27 positivity (OR 6.3 [95% CI 2.4-16.4]), elevated C-reactive protein level (OR 4.8 [95% CI 1.9-12.4]), and male sex (OR 2.1 [95% CI 1.1-4.2]) were associated with the presence of SpA. None of the ophthalmologic parameters were found to be predictive of SpA. The Dublin Uveitis Evaluation Tool (DUET) showed higher specificity for SpA recognition than the Assessment of SpondyloArthritis international Society (ASAS) tool for the early referral of patients with a suspected diagnosis of axial SpA (specificity for SpA 42% versus 28%), whereas the sensitivity of the ASAS tool was slightly higher than the DUET tool (sensitivity for SpA 80% versus 78%). However, more than 20% of the AAU patients in this study who were diagnosed as having SpA would have been missed by both referral strategies. CONCLUSION Our study revealed a high prevalence of SpA in AAU patients overall, as well as a high prevalence of previously undiagnosed SpA in AAU patients. Therefore, we propose rheumatologic evaluation for all AAU patients with musculoskeletal symptoms.
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Affiliation(s)
- Judith Rademacher
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Epidemiology unit, German Rheumatism Research Centre, Berlin, Germany
| | - Hanna Müllner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Berlin, Germany
| | - Torsten Diekhoff
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Hildrun Haibel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Berlin, Germany
| | - Sabrina Igel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Berlin, Germany
| | - Dominika Pohlmann
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Ophthalmology, Berlin, Germany
| | - Fabian Proft
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Berlin, Germany
| | - Mikhail Protopopov
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Berlin, Germany
| | - Valeria Rios Rodriguez
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Berlin, Germany
| | - Murat Torgutalp
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Berlin, Germany
| | - Uwe Pleyer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Ophthalmology, Berlin, Germany
| | - Denis Poddubnyy
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Epidemiology unit, German Rheumatism Research Centre, Berlin, Germany
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Regierer AC, Weiß A, Kiltz U, Sieper J, Schwarze I, Bohl-Bühler M, Kellner H, Poddubnyy D, Zink A, Braun J, Listing J, Strangfeld A. The Sensitivity to Change of the ASAS Health Index in an Observational Real-Life Cohort Study. J Rheumatol 2023; 50:185-191. [PMID: 35914790 DOI: 10.3899/jrheum.220212] [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] [Accepted: 07/20/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The Assessment of Spondyloarthritis international Society Health Index (ASAS HI) measures global functioning and health in patients with axial spondyloarthritis (axSpA) covering domains of physical, emotional, and social functioning. The main aim of this study was to investigate the sensitivity to change of ASAS HI in comparison with established variables of disease activity, function, and mental health. METHODS Patients with axSpA from the disease register RABBIT-SpA with follow-up time of at least 12 months and available ASAS HI questionnaires were included. Patients received questionnaires addressing disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score [ASDAS]), physical function (Bath Ankylosing Spondylitis Functional Index [BASFI]), mental health (5-item World Health Organization Well-Being Index [WHO-5]), and global functioning (ASAS HI). Standardized response means (SRMs) were calculated to compare the sensitivity to change of different variables. RESULTS Six hundred and sixty-seven patients were included, 552 treated with biologic disease-modifying antirheumatic drugs (bDMARDs) and 115 with conventional synthetic DMARDs and/or nonsteroidal antiinflammatory drugs (control group). Between baseline and month 12, the mean ASAS HI declined from 6.9 to 5.1 in the bDMARD group and from 5.9 to 5.6 in the conventionally treated group. In the bDMARD group, the SRM of ASAS HI was 0.52, compared to 0.59 for BASFI, 0.65 for WHO-5, 0.73 for BASDAI, and 0.90 for ASDAS. The following ASAS HI domains were most frequently affected: pain (78% agreed), maintaining body position (75%), and energy/drive (73%). In the patients receiving bDMARDs, there was an improvement in all items. In the control group, the largest improvement was seen in pain. CONCLUSION As expected, ASDAS and BASDAI as disease activity scores showed high sensitivity to change, whereas changes in physical function (BASFI), mental health (WHO-5), and the broader concept of functioning and health (ASAS HI) were moderate.
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Affiliation(s)
- Anne C Regierer
- A.C. Regierer, MD, PhD, A. Weiß, PhD, J. Listing, PhD, German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Care Research, Berlin;
| | - Anja Weiß
- A.C. Regierer, MD, PhD, A. Weiß, PhD, J. Listing, PhD, German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Care Research, Berlin
| | - Uta Kiltz
- U. Kiltz, MD, PhD, J. Braun, MD, PhD, Rheumazentrum Ruhrgebiet, Herne, and Ruhr-University Bochum
| | - Joachim Sieper
- J. Sieper, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin
| | - Ilka Schwarze
- I. Schwarze, MD, Private Rheumatology Practice, Leipzig
| | | | | | - Denis Poddubnyy
- D. Poddubnyy, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, and German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Care Research, Berlin
| | - Angela Zink
- A. Zink, PhD, A. Strangfeld, MD, PhD, German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Care Research, Berlin, and Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- U. Kiltz, MD, PhD, J. Braun, MD, PhD, Rheumazentrum Ruhrgebiet, Herne, and Ruhr-University Bochum
| | - Joachim Listing
- A.C. Regierer, MD, PhD, A. Weiß, PhD, J. Listing, PhD, German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Care Research, Berlin
| | - Anja Strangfeld
- A. Zink, PhD, A. Strangfeld, MD, PhD, German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Care Research, Berlin, and Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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50
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Müller ML, Poller W, Skurk C, Poddubnyy D, Siegmund B, Schneider T, Landmesser U, Heidecker B. Cardiac sarcoidosis presenting with complex conduction abnormalities as the first manifestation of widespread systemic sarcoidosis: a case report. Eur Heart J Case Rep 2023; 7:ytad017. [PMID: 36733684 PMCID: PMC9887667 DOI: 10.1093/ehjcr/ytad017] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/11/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Background Sarcoidosis is a granulomatous multi-organ disease of unknown aetiology. Despite being relatively rare, cardiac sarcoidosis constitutes a very important manifestation of sarcoidosis, as its symptoms regularly precede or occur in isolation of more prevalent ones, and as it is the main driver of mortality in systemic sarcoidosis. Case summary We present the case of a 37-year-old woman, in which clinically isolated cardiac sarcoidosis revealed widespread systemic sarcoidosis. Apart from constitutional symptoms and strong recurrent dizziness (i.e. near-syncopes), which persisted for multiple years already, our patient initially presented with complex conduction abnormalities, including a right bundle branch block, left anterior hemi-block, and atrioventricular block °1. Following inconclusive endomyocardial biopsies, performed due to detection of focal septal scarring on cardiac magnetic resonance imaging, an 18F-FDG-PET-CT, performed upon admission to our clinic, showed distinct hypermetabolic lesions indicative of active inflammation in various organs and raised suspicion of systemic sarcoidosis. Eventually, histopathological evidence of non-caseating granulomas in affected lymph nodes, extracted by bronchoscopy, confirmed the diagnosis of systemic sarcoidosis after reasonable exclusion of other granulomatous diseases. Immediate initiation of long-term immunosuppressive therapy led to almost complete remission, as monitored by consequential 18F-FDG-PET-CT scans. Discussion Unexplained complex conduction abnormalities in young patients may be a sign of sarcoidosis, even in isolation of more prevalent symptoms. Correct interpretation and prompt initiation of a structured interdisciplinary diagnostic workup, including 18F-FDG-PET-CT as the imaging modality of choice, are essential to initiate specific treatment and obviate the major risk of mortality resulting from cardiac sarcoidosis.
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Affiliation(s)
- Maximilian L Müller
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wolfgang Poller
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Britta Siegmund
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Thomas Schneider
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Bettina Heidecker
- Corresponding author. Tel: +49 30 450 513 756, Fax: +49 30 450 7 513 984,
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