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Enrique CP, María SA, Gustavo RS, Igor R, Magali CM, Diana PO, Sofia AC, Juliana MM, Camilo SJ, Camilo RJ, Mesa C, Marlon P, Sebastián SCJ, Luis F GC, Cesar PT, Humberto CM, Pedro SM, John L. Assessment of enthesopathy in conventional pelvis radiography: Another tool for spondyloarthritis diagnosis beyond sacroiliitis. Semin Arthritis Rheum 2024; 67:152435. [PMID: 38642418 DOI: 10.1016/j.semarthrit.2024.152435] [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: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION/OBJECTIVES Enthesitis is a cardinal feature of spondylarthritis (SpA), and the pelvis is a common site of enthesitis. This study aimed to establish the association between pelvic enthesis involvement on pelvic X-ray and SpA diagnosis through a radiographic enthesis index (REI) and to assess the reliability and accuracy of this REI. MATERIALS AND METHODS The participants were SpA patients and a control group composed of patients with chronic lumbar pain without SpA. Three blinded observers assessed each pelvic radiography three times. Three zones were used: Zone I (ZI), the iliopubic ramus; Zone II (ZII), the pubic symphysis, and Zone III (ZIII), the ischiopubic ramus. A grading system was created from 0 to 3 [Grade 0, normal; Grade 1, minimal changes (subcortical bone demineralization and/or periosteal wishkering, seen as radiolucency and trabeculation of the cortical bone upon tendon insertion); Grade 2, destructive changes (Grade 1 findings and erosions at the enthesis site); and Grade 3, findings of Grade 2 plus >2 mm whiskering out of the cortical bone) for the REI. The sum of the results of the three zones was called the total REI. For statistical analysis, we used the weighted kappa statistic adjusted for prevalence and bias using Gwet's agreement coefficient. RESULTS We enrolled 161 patients, 111 of them with SpA (39.6 % with axial SpA and 47.7 % with peripheral SpA) and 50 without SpA. In the SpA group, 36.7 % and 25.7 % had REI Grades 2 and 3 in ZIII, respectively, while only 6 % of the controls had these grades. For ZI, the frequency of Grades 1 to 3 was 42.3 % in the SpA group (8.1 %, 14.4 %, and 19.8 %, respectively), compared to only 2 % in the controls. ZII was unaffected in most of the patients with SpA (82.9 %) and in the controls (98 %). In the control group, Grade 0 was the most common REI grade in all three zones. The agreement was almost perfect for each zone and between the independent readers. The ROC-curve analysis showed that the highest performance areas were the total REI, ZIII, and ZI. Most (75 %) of the SpA patients without sacroiliitis on X-ray were REI-positive. The sensitivity of the REI for SpA diagnosis was 82 %, while the sensitivity of sacroiliitis on X-ray was 38.7 %. CONCLUSIONS The assessment of pelvic enthesis using the REI on pelvic radiography may be useful for SpA diagnosis. Total REI, ZIII, and ZI had the highest accuracy and almost perfect reliability. The REI is especially helpful in patients without sacroiliitis on imaging.
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Affiliation(s)
| | - Santos Ana María
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Rodríguez-Salas Gustavo
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Rueda Igor
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia; Bioscience programme, faculty of Medicine and Engineering, Universidad de La Sabana, Chía, Colombia
| | | | - Padilla-Ortiz Diana
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia
| | - Arias-Correal Sofia
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Mantilla Marta Juliana
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Santacruz Juan Camilo
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Rueda Juan Camilo
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia; Bioscience programme, faculty of Medicine and Engineering, Universidad de La Sabana, Chía, Colombia
| | - Cristian Mesa
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Porras Marlon
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia
| | | | - Giraldo-Cadavid Luis F
- Universidad de La Sabana - Interventional Pulmonology, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Pacheco-Tena Cesar
- PABIOM Laboratory, Faculty of Medicine and Biomedical Sciences, Autonomous University of Chihuahua, 31125 Chihuahua, Mexico
| | - Cardiel Mario Humberto
- Hospital General "Dr. Miguel Silva", Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, McMaster University, Universidad Michoacana de San Nicolas de Hidalgo Instituto de Física y Matemáticas
| | | | - Londono John
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia.
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Abstract
"Disease modification" in axial spondyloarthritis (axSpA) seeks to not only alleviate clinical symptoms but also alter the disease's natural course by impeding new bone formation. Recent years have witnessed the effectiveness of treatments, including biologics and nonsteroidal anti-inflammatory drugs, in managing axSpA symptoms. Emerging evidence points toward their potential impact on slowing structural disease progression. This comprehensive review centers on the pivotal role of inhibiting new bone formation in axSpA disease modification. It delves into the significance of imaging techniques for assessing disease progression and explores the disease-modifying properties of available axSpA treatments, encompassing NSAIDs, TNF inhibitors, IL-17 inhibitors, and JAK inhibitors. This article offers valuable insights into the evolving landscape of disease modification strategies in axial spondyloarthritis, highlighting the multifaceted approaches used to attain these objectives.
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Affiliation(s)
- Brona Dinneen
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.
| | - Finbar O'Shea
- Department of Rheumatology, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lianne Gensler
- Department of Rheumatology, University of California, San. Francisco (UCSF) Medical Centre, California, United States
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Madsen CMT, Primdahl J, Bremander A, Eggen L, Christensen JR. Developing a complex vocational rehabilitation intervention for patients with inflammatory arthritis: the WORK-ON study. BMC Health Serv Res 2023; 23:739. [PMID: 37422649 DOI: 10.1186/s12913-023-09780-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND People with inflammatory arthritis often experience challenges at work and balancing paid work and energy in everyday life. Low work ability is common, and people with inflammatory arthritis face high risks of losing their jobs and permanent exclusion from the labour market. Context-specific tailored rehabilitation targeting persons with inflammatory arthritis is limited. The aim of this study is to describe the development of WORK-ON - a vocational rehabilitation for people with inflammatory arthritis. METHODS Following the Medical Research Council's framework for complex interventions, WORK-ON was developed based on existing evidence, interviews with patients and rehabilitation clinicians, a workshop, and an iterative process. RESULTS The six-month vocational rehabilitation, WORK-ON, consists of 1) an initial assessment and goal setting by an occupational therapist experienced in rheumatology rehabilitation, 2) coordination by the same occupational therapist and individual support, including navigating across the primary and secondary health sectors, as well as social care, 3) group sessions for peer support, and 4) optionally individually tailored consultations with physiotherapists, nurses, or social workers. CONCLUSION WORK-ON is ready to be tested in a feasibility study. TRIAL REGISTRATION The Regional Committees on Health Ethics for Southern Denmark stated that no formal ethical approval was necessary in this study (20,192,000-105).
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Affiliation(s)
- Christina Merete Tvede Madsen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Sygehus Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Linda Eggen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
| | - Jeanette Reffstrup Christensen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Department of Public Health, User Perspectives and Community-Based Interventions, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
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Çağlar Yağcı H, Yağcı İ, Özdamar Oİ, Tosyalı Salman C, Ertuğrul Ö. Hearing loss can also be seen in patients with nonradiographic axial spondyloarthropathies as well as radiographic axial spondyloarthropathies. Arch Rheumatol 2023; 38:257-266. [PMID: 37680508 PMCID: PMC10481684 DOI: 10.46497/archrheumatol.2023.10186] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 09/09/2023] Open
Abstract
Objectives Hearing loss has been described in patients with radiographic axial spondyloarthropathies (R-AxSpA) but has not been studied in patients with non-radiographic axial spondyloarthropathies (NR-AxSpA); accordingly, the aim of the study was to compare hearing loss in patients with NR-AxSpA, R-AxSpA, and healthy individuals. Patients and methods This cross-sectional observational study was conducted with 68 participants (30 males, 38 females; mean age: 39.8±7.4 years) between March 2021 and March 2022. Of the participants, 16 were patients with NR-AxSpA, 15 were patients with R-AxSpA, and 37 were healthy controls. Disease activity and radiological and audiological features were analyzed. The audiological assessment included pure-tone audiometric tests at octave frequencies of 250 to 8000 Hz and transient evoked otoacoustic emissions. Results Hearing loss was found in three (8%) in the healthy group, five (31.3%) in the NR-AxSpA group, and 10 (66.7%) in the R-AxSpA group. The chi-square analysis showed a statistical significance (p=0.001). Values of audiometric tests yielded significant differences between the control and R-AxSpA group and also the control and NR-AxSpA group. For the air conduction studies, the statistical significance began at 1000 Hz in the R-AxSpA group. It was found that in the NR-AxSpA group, the statistical difference started in higher frequencies. The bone conduction audiometric studies were similar to air conduction studies. Transient evoked otoacoustic emission studies showed that the R-AxSpA group was significantly affected compared to the control and NR-AxSpA groups. There was no statistical difference between the control and NR-AxSpA groups. Conclusion Both NR-AxSpA and R-AxSpA patients had hearing loss; however, in pure-tone audiometric tests, the abnormalities began in lower frequencies in the R-AxSpA group than in the NR-AxSpA group.
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Affiliation(s)
- Hanife Çağlar Yağcı
- Department of Physical Medicine and Rehabilitation, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - İlker Yağcı
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Osman İlkay Özdamar
- Department of Otorhinolaryngology-Head and Neck Surgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Cansu Tosyalı Salman
- Department of Audiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Özlem Ertuğrul
- Department of Audiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
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Wilk M, Pripp AH, Korkosz M, Haugeberg G. Exploring pain catastrophizing and its associations with low disease activity in rheumatic inflammatory disorders. Rheumatol Int 2023; 43:687-694. [PMID: 36624289 DOI: 10.1007/s00296-023-05271-z] [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: 11/23/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
Pain catastrophizing is a maladaptive mechanism associated with the exaggerated experience of pain, increased rumination and feelings of helplessness. The main objective of this study was to explore whether increased pain catastrophizing is independently associated with a lower proportion of low disease activity (LDA) in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). Demographics, comorbidities, treatment, disease activity measures and patient-reported outcome data were recorded in RA, PsA and axSpA patients. Pain catastrophizing score (PCS) was assessed using a standardised questionnaire. For each diagnosis, composite disease activity scores with distinct cut-off values for LDA, i.e. DAS28-CRP (RA), DAPSA (PsA) and ASDAS-CRP (axSpA) were calculated and used as the dependent variable in logistic regression reflecting LDA achieved. A total of one thousand two hundred and twenty nine patients were included: 580 with RA, 394 with PsA and 255 with axSpA. In the multivariable analysis, pain catastrophizing was independently associated with LDA rates in axSpA (OR 0.33, 95% CI [0.12, 0.88]) amongst tested groups. In RA (OR 0.90, 95% CI [0.64, 1.28]) and PsA (OR 0.77, 95% CI [0.55, 1.07]), a statistically significant association was not observed. Higher PCS was independently associated with not achieving LDA in axSpA. Our data, however, indicate that pain catastrophizing, which also reflects a patient's personality traits and coping abilities, plays a less important role for the patient than general pain perception.
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Affiliation(s)
- Mateusz Wilk
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland.
| | - Are H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mariusz Korkosz
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Rahimi H, Guermazi A, Roemer FW, Teytelboym OM, Carlier RY, Jarraya M. Beyond the sacro-Iliac joints: Vertebral involvement in axial spondylarthritis. Eur J Radiol 2021; 144:109982. [PMID: 34717188 DOI: 10.1016/j.ejrad.2021.109982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/01/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022]
Abstract
Imaging plays a central role in the diagnosis of axial spondylarthritis (axSpA). Commonly the sacroiliac joints are involved but vertebral involvement can occur in isolation in 1 out of 4 patients. Recognizing vertebral involvement patterns in axSpA can help establishing a diagnosis early and initiate therapy before irreversible changes have occurred. Magnetic resonance imaging (MRI) is considered the reference standard for early detection of inflammatory changes of the disease. Aims of this review are to present an overview of the imaging findings of vertebral involvement in axSpA, and to detail the current recommendations on the role of imaging in the diagnosis of axSpA in patients with isolated vertebral involvement.
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Bayraktar D, Yuksel Karsli T, Ozer Kaya D, Sarac DC, Gucenmez S, Gercik O, Kabadayi G, Kurut I, Solmaz D, Akar S. Is the international physical activity questionnaire (IPAQ) a valid assessment tool for measuring physical activity of patients with axial spondyloartritis? Musculoskelet Sci Pract 2021; 55:102418. [PMID: 34171605 DOI: 10.1016/j.msksp.2021.102418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 05/03/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Determining the level of physical activity (PA) is an essential part of patient evaluation in axial spondylarthritis (axSpA). Subjective and objective methods are both frequently used methods for evaluating PA. Although subjective methods are cost-effective and easy to use, their accuracy for measuring PA is still questionable. OBJECTIVE To investigate the concurrent criterion validity of a self-reported questionnaire (IPAQ-Short Form) when compared to an accelerometer (Actigraph wGT3X-BT) for measuring PA level in patients with axSpA. DESIGN Cross-sectional design. METHODS Fifty-eight patients with axSpA with a median age of 39.0 (IQR 25/75: 30.0/46.0) years were included in the study. An accelerometer (Actigraph wGT3X-BT) was attached to the waist of patients at their first visits and was removed at their second visits, seven days later. Patients were asked to complete the International Physical Activity Questionnaire Short Form (IPAQ) at their second visits. RESULTS No significant correlations were determined between IPAQ and accelerometer (p > 0.05), except for the moderate PA (rho: 0.367, p < 0.05), and total PA (rho: 0.330, p < 0.05). It was also observed that IPAQ was underestimating energy expenditure for all types of PA. CONCLUSION IPAQ might not be a valid tool for measuring PA level in patients with axSpA. Disease-specific subjective methods for determining the PA should be developed and validated for those patients.
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Affiliation(s)
- Deniz Bayraktar
- Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Tugce Yuksel Karsli
- Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
| | - Derya Ozer Kaya
- Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Devrim Can Sarac
- Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Sercan Gucenmez
- Department of Internal Medicine, Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Onay Gercik
- Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
| | - Gokhan Kabadayi
- Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
| | - Idil Kurut
- Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
| | - Dilek Solmaz
- Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
| | - Servet Akar
- Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
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Harrison SR, Ansell R, Mathieson HR, Merashli M, Busquets-Péez N, McGonagle D, Marzo-Ortega H. Subjective loss of clinical response to TNFi in axSpA relates to recurrence of MRI bone marrow oedema particularly with long-acting agents. Rheumatology (Oxford) 2021; 61:SI86-SI91. [PMID: 34273162 DOI: 10.1093/rheumatology/keab571] [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: 04/11/2021] [Revised: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Subjective loss of response immediately prior to routine TNFi therapy can occur in axial spondyloarthritis (axSpA). We investigated clinical outcomes in patients taking the first 3 licenced TNFis and correlated this with recurrence of MRI bone marrow oedema (MRI-BMO). METHODS Proof-of-concept study including axSpA patients established on etanercept (ETA), adalimumab (ADA) or infliximab (IFX) reporting symptom deterioration prior to next dose. MRI/clinical data were collected prior to scheduled dose (v1), 4 days post-dose (v2) and at the time of patient-reported symptom return (v3). MRI spine/sacroiliac joints utilising 3 T were scored using the semi-quantitative Leeds MRI scoring system. RESULTS 113 clinical assessments and MRIs were performed in 38 participants (ADA = 16, ETA = 12, IFX = 10), mean age 42.1 years ± 24.4(2SD, n = 38), 71.1% male (n = 27/38), 69.7% HLA-B27 positive (n = 23/33). At v1 all patients had high disease activity [ASDAS-CRP = 3 (2.7-3.7)] and 57.9% had MRI-BMO (number of MRI-BMO: ETA = 26, ADA = 59, IFX = 28). Improved clinical responses were seen at v2 [ASDAS-CRP -0.41(-0.81-0.30), p= 0.018; BASDAI -0.58(-2.2-0.52), p= 0.024]. Despite just a 4-day interval between v1 and v2, a numerical reduction in MRI-BMO lesions between v1/v2 was observed (ETA=-6, ADA=-10, IFX=-3). By v3 comparatively fewer new BMO lesions were detected in the ETA and ADA groups compared with IFX (ETA=-1, ADA = +3, IFX = +8), although the numbers were too small to enable testing for statistical significance. CONCLUSIONS Short-lived fluctuations in MRI-BMO were commoner with longer-acting agents and corresponded with subjective loss of clinical response before next scheduled TNFi dose. Larger studies are need to confirm the possible pathogenic implications of this phenomenon.
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Affiliation(s)
- Stephanie R Harrison
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Rebecca Ansell
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Department of Rheumatology, Bradford Teaching Hospitals, St Luke's Hospital, Bradford, UK
| | - Hannah R Mathieson
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Department of Rheumatology, Bradford Teaching Hospitals, St Luke's Hospital, Bradford, UK
| | - Mira Merashli
- American University Hospital, Department of Internal Medicine, Division of Rheumatology, Beirut, Lebanon
| | | | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
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Abstract
The aim of this study is to evaluate the density of retinal vascular structures and their relationship with disease duration and activity in patients with axial spondylarthritis (axSpA) using optical coherence tomography angiography (OCT-A). In this case-control study, 56 eyes of 29 axSpA patients and 61 eyes of 31 healthy controls (HCs) were evaluated using OCT-A. The capillary plexus density (CPD) of vessels in the parafovea and perifovea regions was evaluated from the superficial capillary plexus (SCP) and deep capillary plexus (DPC) flow areas. The CPD of vessels in the fundus was evaluated from the radial peripapillary capillary (RPC) flow area. Foveal avascular zone (FAZ) size was measured. In axSpA patients and HCs, the mean CPD (%) in the whole retina was 50.75 ± 2.59 and 52.43 ± 2.10 (p < 0.001) in SCP, 54.00 ± 5.83 and 58.37 ± 4.36 (p < 0.001) in DCP, and 50.13 ± 2.32 and 50.13 ± 2.26 (p = 0.984) in RPC flow areas, respectively, and the mean FAZ (mm) was 0.275 ± 0.10 and 0.294 ± 0.07 (p = 0.281), respectively. A significant negative correlation was detected between the CPD and disease duration in the parafovea (ρ: - 0.306, p = 0.022), parafovea superior-hemi (ρ = - 0299, p = 0.025), parafovea inferior-hemi (ρ = - 0.270, p = 0.044), parafovea temporal (ρ = - 0.349, p = 0.008) and parafovea nasal regions (ρ = - 0.356, p = 0.007) in the DCP flow area. CPD was found to be lower in the macula, while similar in the fundus region in axSpA patients compared to HCs. The decrease in CPD was correlated with disease duration, but not with disease activity in axSpA. Small vessel structures may be affected in axSpA. OCT-A may be used to detect subclinical vasculitis in axSpA patients.
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Affiliation(s)
- Nizameddin Koca
- Department of Internal Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Koray Ayar
- Department of Internal Medicine, Division of Rheumatology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Mehmet Erol Can
- Department of Ophthalmology, Bursa Sehir Training and Research Hospital, Bursa, Turkey
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Redeker I, Callhoff J, Hoffmann F, Saam J, Haibel H, Sieper J, Zink A, Poddubnyy D. [Cost of illness in axial spondylarthritis for patients with and without tumor necrosis factor inhibitor treatment: results of a routine data analysis]. Z Rheumatol 2020; 79:85-94. [PMID: 31359143 DOI: 10.1007/s00393-019-0678-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tumour necrosis factor-alpha inhibitors (TNFi) are an effective but expensive treatment option in axial spondylarthritis (axSpA) patients who fail to achieve disease control under conventional treatment. OBJECTIVE The aim of this study was to assess the cost of illness in axSpA patients treated with and without TNFi. METHODS Using German health insurance data, patients with axSpA who newly received TNFi between 2011 and 2015 were identified and matched by age and sex to a reference group of patients with axSpA without TNFi treatment. Costs for services performed in an outpatient setting, inpatient care, pharmacotherapy and for productivity loss due to absence from paid work were analyzed over a 2-year period. In patients treated with TNFi , the 2‑year period included 1 year before and 1 year after the initiation of TNFi. RESULTS Data from 1455 axSpA patients who received TNFi treatment were included in the analyses. Costs for services performed in an outpatient setting, inpatient care, pharmacotherapy (excluding TNFi) as well as productivity loss significantly decreased after initiation of TNFi. Mean total costs increased from € 6075 in the year prior to TNFi initiation to € 27,871 in the year after TNFi initiation. Excluding costs for TNFi, total costs decreased by 22% to € 4761. Mean total costs among the reference group of 1455 age and sex-matched axSpA patients who did not receive TNFi remained stable over 2 years: € 3939 in the first year vs. € 3832 in the second year. CONCLUSION Initiation of TNFi treatment led to a sharp increase in the total costs of axSpA patients. Part of this increase was offset by a decrease of costs for services performed in an outpatient setting, inpatient care, pharmacotherapy (excluding TNFi) as well as productivity loss. In patients who did not receive TNFi, the costs remained stable over 2 years.
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Abstract
BACKGROUND Early detection of patients with axial spondylarthritis (axSpA) in primary care is difficult. The combination of various parameters indicative of inflammatory back pain (AWARE criteria) was found to be beneficial in an initial study. OBJECTIVE Review of the criteria for the identification of young patients with axSpA and chronic back pain (≥3 months of back pain). MATERIAL AND METHODS In adult patients with chronic back pain and age at onset of symptoms <45 years, orthopedic surgeons documented various possible axSpA characteristics before referral to the rheumatologist. RESULTS Overall, the data from 1306 patients were recorded. Of these, ultimately 500 patients were also seen by rheumatologists, 199 patients (39.8%) were diagnosed with axSpA while 301 (60.2%) had non-specific back pain. A total of 87 patients had ankylosing spondylitis (44%) and 112 non-radiographic axSpA (56%). The ASAS classification criteria were fulfilled by 226 patients (45.2%). The mean age of axSpA patients was 38 years, 56% were male with a mean duration of back pain of 98 months. The AWARE criteria had a sensitivity and specificity of 69.3% and 40.3% (n = 343), respectively, when ≥4/5 criteria were chosen. Positive imaging for sacroiliitis using magnetic resonance imaging (MRI) or X‑ray was present in 77% of patients and positive HLA-B27 was identified in 59% of axSpA patients. The combination of positive imaging and HLA-B27 had the highest likelihood ratio for diagnosis of axSpA. CONCLUSION Although the study design used here led to a preselection and thus to a bias in the statistical evaluation, the study confirmed the benefit of the AWARE criteria for the early detection of patients with axSpA. In further studies, the 2‑stage approach with initially 3 clinical questions and then an optional HLA-B27 test is currently being investigated further.
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12
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Abstract
Rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis are the most common chronic autoimmune rheumatic diseases. For all three diseases an early diagnosis and initiation of treatment is crucial. The proof of concept network study "Rheuma-VOR" is a further developed version of the predecessor project ADAPTHERA and was extended to several federal states. The aim of this prospective study is to improve the early diagnosis of rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis and thus positively impact the quality of care for patients with the help of multidisciplinary coordinating centers. To date 3710 disease-specific questionnaires from patients with the suspected diagnosis of rheumatoid arthritis, psoriatic arthritis or axial spondylarthritis from 1298 different primary care providers were registered in the multidisciplinary coordination centers. A total of 1958 appointments were made with 1 of the 53 participating rheumatology specialists. In 876 patients, 1 of the 3 rheumatic diseases was diagnosed in an early stage. The waiting period was on average 42.5 days depending on the federal state, which is well below the nationwide average. It should also be noted that the coordinated cooperation and risk stratification of the Rheuma-VOR coordination centers relieved the capacity of rheumatology specialists by 1281 appointments (34.5%). In addition, the 2‑week Rheuma Bus Tour and the accompanying initiatives in Rhineland-Palatinate (Rheuma-VOR screening app and the triage consultation) are showing first promising positive results.
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Affiliation(s)
- A Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland. .,ACURA Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland.
| | - M Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - G Assmann
- Rheumatologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - T Witte
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Hoeper
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland.,Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - R E Schmidt
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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13
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Kiefer D, Baraliakos X, Bühring B, Kiltz U, Braun J. [Epionics SPINE-use of an objective method to examine spinal mobility in patients with axial spondyloarthritis]. Z Rheumatol 2019; 79:143-152. [PMID: 31468167 DOI: 10.1007/s00393-019-00692-3] [Citation(s) in RCA: 5] [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] [Indexed: 12/17/2022]
Abstract
Axial spondylarthritis (axSpA) is a chronic inflammatory disease of the spine that can be associated with loss of physical function, mobility and upright postural impairment. Established tools for the assessment of function that are largely based on subjective perception are semiquantitatively recorded by standardized questionnaires (Bath ankylosing spondylitis functional index, BASFI), while measurement of spinal mobility of patients with axSpA is based on physical examination of various movement regions particularly the axial skeleton (Bath ankylosing spondylitis metrology index, BASMI). Recently, a performance test has been added to assess the range of motion and speed of certain tasks (AS performance-based improved test, ASPI); however, since these tests have limited reliability and reproducibility, more objective tests would be desirable. In this study the spinal mobility of patients with axSpA was quantified using the Epionics SPINE device (ES) and data were evaluated using the outcome measures in rheumatology (OMERACT) criteria. The ES automatically measures various patterns of spinal movements using electronic sensors, which also assess the range and speed of carrying out movements. Patients with back pain from other causes and persons without back pain served as controls. The measurement results obtained with ES differed between the groups and correlated with BASMI values (r = 0.53-0.82, all p = <0.03). Patients with radiographically detectable axSpA had more limited and slower mobility than those with non-radiographically detectable axSpA. Overall, the results presented here suggest that ES measurements represent a valid and objective measurement procedure of spinal mobility for axSpA patients.
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Affiliation(s)
- D Kiefer
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - B Bühring
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
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14
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Michaud J, Vittecoq O, Michelin P, Lequerré T, Banse C. Atlantooccipital arthritis inaugurating axial spondyloarthritis. Joint Bone Spine 2016; 83:751-752. [PMID: 26987265 DOI: 10.1016/j.jbspin.2016.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Julien Michaud
- CHU de Rouen, Hôpitaux de Rouen, Inserm U905, CRB CIC 1404, service de rhumatologie, 147, rue du Maréchal-Juin, 76230 Bois-Guillaume, France; Université de Rouen, Institute for Research and Innovation in Biomedicine (IRIB), 76031 Rouen, France
| | - Olivier Vittecoq
- CHU de Rouen, Hôpitaux de Rouen, Inserm U905, CRB CIC 1404, service de rhumatologie, 147, rue du Maréchal-Juin, 76230 Bois-Guillaume, France; Université de Rouen, Institute for Research and Innovation in Biomedicine (IRIB), 76031 Rouen, France
| | - Paul Michelin
- CHU de Rouen, Hôpitaux de Rouen, service de radiologie, 76031 Rouen, France
| | - Thierry Lequerré
- CHU de Rouen, Hôpitaux de Rouen, Inserm U905, CRB CIC 1404, service de rhumatologie, 147, rue du Maréchal-Juin, 76230 Bois-Guillaume, France; Université de Rouen, Institute for Research and Innovation in Biomedicine (IRIB), 76031 Rouen, France
| | - Christopher Banse
- CHU de Rouen, Hôpitaux de Rouen, Inserm U905, CRB CIC 1404, service de rhumatologie, 147, rue du Maréchal-Juin, 76230 Bois-Guillaume, France; Université de Rouen, Institute for Research and Innovation in Biomedicine (IRIB), 76031 Rouen, France.
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