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Garcia-Salinas R, Reyes Jara G, Arguello J, Ruta S, Almada F, Aguerre D. Clinical, Laboratory, and Imaging Features Between Men and Women With Axial Spondyloarthritis in a Specialized Center in Argentina. J Clin Rheumatol 2024; 30:e105-e107. [PMID: 38509033 DOI: 10.1097/rhu.0000000000002063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The aims were to estimate the frequency of axial spondyloarthritis (axSpA) in women and to analyze the clinical, laboratory, and imaging differences with respect to men at the time of diagnosis. METHODS Consecutive patients older than 18 years with a diagnosis of axSpA admitted to the "Reumacheck" SpA program were included between 2017 and 2022. At baseline, all patients underwent clinical assessment, laboratory tests including C-reactive protein and human leukocyte antigen B27, and imaging (plain radiography and magnetic resonance imaging of sacroiliac joints, and ultrasound of heel entheses). All evaluators were blinded to the results of the other evaluations. RESULTS One hundred sixteen patients with a diagnosis of axSpA were included. The frequency at diagnosis in women was 61.55%. In the univariate analysis, the significant differences between women and men at diagnosis of axSpA were good response to nonsteroidal anti-inflammatory drugs, elevated C-reactive protein, New York Criteria (+), enthesis ultrasound (+), years of education, number of swollen joints, erythrosedimentation rate, and the very low frequency of bone bridges in the magnetic resonance imaging of the sacroiliac joints. In the logistic regression analysis, the dependent variable was "men," and the only feature that was independently associated was having radiographic compromise according to the New York criteria (odds ratio, 2.6). CONCLUSIONS The frequency of axSpA in women was 61.55%; clinical, laboratory, and imaging differences were observed. Women experienced less radiographic compromise.
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Affiliation(s)
| | | | | | | | | | - Dario Aguerre
- Radiology Unit, Hospital Italiano de La Plata, La Plata, Argentina
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Londono J, Pacheco-Tena C, Santos AM, Cardiel MH, Rodríguez-Salas G, Rueda I, Arias-Correal S, Mesa C, Marta Juliana M, Santacruz JC, Rueda JC, Vargas-Alarcón G, Burgos-Vargas R. Differences between radiographic and non-radiographic axial spondyloarthritis patients in a Mexican cohort. Sci Rep 2024; 14:10342. [PMID: 38710901 DOI: 10.1038/s41598-024-61001-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024] Open
Abstract
To compare the demographic, clinical, and laboratory characteristics, disease onset, and clinical features of radiographic axial Spondyloarthritis (r-axSpA) and non-radiographic axial Spondyloarthritis (nr-axSpA) patients. All patients who attended outpatient spondylarthritis (SpA) clinics at Hospital General de Mexico and the Instituto Nacional de la Nutrición from 1998 to 2005 and met the rheumatologist diagnostic criteria for SpA were selected. Then the SpA patients were classified by European Spondyloarthropathy Study Group criteria (ESSG). We selected SpA patients with axial presentation as axial SpA (axSpA), and they were classified as r-axSpA if they met modified New York (mNY) criteria for sacroiliitis and as nr-axSpA if they did not meet mNY criteria; to compared clinical, demographic, and laboratory test between the subgroups. It included 148 SpA patients; 55 (37.2%) patients had r-axSpA, and 70 (47.3%) had nr-axSpA. The nr-axSpA patients had a lower proportion of males (58.6% vs 78.2%, P < 0.05), lower HLA-B27 frequency (54.3%. vs. 92.7%, P < 0.05), were older at disease onset (21 vs 16 years; P < 0.01) and had a higher frequency of infections at disease onset (9.1% vs 32.9, P < 0.05) than r-axSpA. BASFI (2.9 vs 4.8; P < 0.0001), Dougados functional index (7 vs. 14; P < 0.05), and BASDAI (4.1 vs. 5.2; P < 0.001) were lower in patients with nr-axSpA than r-axSpA, respectively. The factors that most influenced the presentation of r-axSpA were history of uveitis (OR 14, 95% CI 2.3-85), HLA-B27 (OR 7.97, 95% CI, 2.96-122), male sex (OR 6.16, 95% CI, 1.47-25.7), axial enthesopathy count (OR 1.17 95% CI, 1.03-1.33). This study provides insight into the differences between nr-axSpA and r-axSpA in Mexico. Patients with r-axSpA were mainly male, with a younger presentation age, a higher prevalence of HLA-B27, more history of uveitis, fewer episodes of dactylitis, more axial enthesopathy, and higher disease activity than nr-axSpA.
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Affiliation(s)
- John Londono
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia.
| | - Cesar Pacheco-Tena
- PABIOM Laboratory, Faculty of Medicine and Biomedical Sciences, Autonomous University of Chihuahua, 31125, Chihuahua, Mexico
| | - Ana Maria Santos
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Mario Humberto Cardiel
- 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, Morelia, Mexico
| | - Gustavo Rodríguez-Salas
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Igor Rueda
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
- Aspirante a Doctorado en Biociencias, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - Sofía Arias-Correal
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Cristian Mesa
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Mantilla Marta Juliana
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Juan Camilo Santacruz
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Juan Camilo Rueda
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Gilberto Vargas-Alarcón
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Rubén Burgos-Vargas
- Rheumatology Department, Hospital General de México Eduardo Liceaga, Mexico City, Mexico
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Yıldırım NO, Balcı Ş, Tamer L. Reduced expression of miRNAs as potential biomarkers in axial spondyloarthritis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231521. [PMID: 38716952 PMCID: PMC11068378 DOI: 10.1590/1806-9282.20231521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study aimed to investigate the value of miR-29a-3p, miR-27a, miR126-3p, miR-146a-5p, miR-625-3p, miR-130a, miR-32, miR-218, miR-131, and miR5196 in the diagnosis of axial spondyloarthritis and to determine whether there is a difference in miRNA expression levels between radiographic axial spondyloarthritis and non-radiographic axial spondyloarthritis, as well as the relationship between miRNA expression levels, disease activity, and uveitis history. METHODS This study included 50 patients with axial spondyloarthritis (25 with radiographic axial spondyloarthritis and 25 with non-radiographic axial spondyloarthritis) and 25 healthy individuals. The fold change of miRNA expression for each miRNA was calculated using the 2-ΔΔCt method. RESULTS The expression of all miRNAs except miR-130a was downregulated in axial spondyloarthritis patients (miR-27a: fold regulation: -11.21, p<0.001; miR-29a-3p: fold regulation: -2.63, p<0.001; miR-32: fold regulation: -2.94, p=0.002; miR-126-3p: fold regulation -10.94, p<0.001; miR-132: fold regulation: -2.18, p<0.001; miR-146-5p: fold regulation: -9.78, p<0.001; miR-218: fold regulation: -2.65, p<0.001; miR-625-3p: fold regulation: -2.01, p=0.001; miR-5196-3p: fold regulation: -7.04, p<0.001). The expression levels of these miRNAs did not differ significantly between non-radiographic axial spondyloarthritis and radiographic axial spondyloarthritis patients (p>0.05 for all). CONCLUSION Particularly, miR-27a, miR-126-3p, miR-146-5p, and miR-5196-3p were found to be substantially downregulated in both non-radiographic axial spondyloarthritis and radiographic axial spondyloarthritis patients, suggesting their potential as diagnostic biomarkers for axial spondyloarthritis.
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Affiliation(s)
- Nurdan Oruçoğlu Yıldırım
- Mersin University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology – Mersin, Turkey
| | - Şenay Balcı
- Mersin University, Faculty of Medicine, Department of Medical Biochemistry – Mersin, Turkey
| | - Lülüfer Tamer
- Mersin University, Faculty of Medicine, Department of Medical Biochemistry – Mersin, Turkey
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Shentu H, Sha S, He Y, He M, Dong N, Huang Z, Lai H, Chen M, Huang J, Huang X. Efficacy of TNF-α Inhibitors in the Treatment of nr-axSpA: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials. Int Arch Allergy Immunol 2024; 185:590-599. [PMID: 38432201 DOI: 10.1159/000536601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION A growing number of randomized controlled trials (RCTs) have demonstrated the effectiveness of tumor necrosis factor-α (TNF-α) inhibitors in treating non-radiographic axial spondyloarthritis (nr-axSpA). This study aimed to evaluate the efficacy of TNF-α inhibitors in the treatment of nr-axSpA. METHODS PubMed, EMBASE, Web of Science, and the Cochrane Library databases were systematically searched for relevant RCTs using specific keywords up to June 2023. The primary outcome was the proportion of patients who achieved Assessment in SpondyloArthritis international Society 40% (ASAS40). Secondary outcomes included ASAS20, Bath Ankylosing Spondylitis Disease Activity Index 50% (BASDAI50), ASAS partial remission, and ASAS5/6. RESULTS A total of eight RCTs involving 1,376 patients were included. Patients receiving anti-TNF therapy exhibited a higher rate of ASAS40 (pooled RR = 2.36; 95% CI: 1.63-3.42; p < 0.001). In addition, the TNF-α inhibitor group showed higher BASDAI50 rates (pooled RR = 2.06; 95% CI: 1.48-2.89), ASAS20 rates (pooled RR = 1.48; 95% CI: 1.31-1.67), ASAS partial remission rates (pooled RR = 2.33; 95% CI: 1.58-3.43), and ASAS5/6 rates (RR = 3.46; 95% CI: 2.05-5.83) than the placebo group. CONCLUSION The TNF-α inhibitors were effective in treating nr-axSpA.
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Affiliation(s)
- Haojie Shentu
- The Medical Imaging College, Hangzhou Medical College, Hangzhou, China
| | - Suyong Sha
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Minyang He
- Zhejiang University School of Medicine, Hangzhou, China
| | - Nan Dong
- The Medical Imaging College, Hangzhou Medical College, Hangzhou, China
| | - Zhenwei Huang
- The Medical Imaging College, Hangzhou Medical College, Hangzhou, China
| | - Haijia Lai
- The Medical Imaging College, Hangzhou Medical College, Hangzhou, China
| | - Meiling Chen
- The Public Health College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianing Huang
- The Public Health College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaojing Huang
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
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Kiefer D, Schneider L, Braun J, Kiltz U, Kolle N, Andreica I, Tsiami S, Buehring B, Sewerin P, Herbold S, Baraliakos X. Impact of daily physical therapy over 2 weeks on spinal mobility including objective electronic measurements and function in patients with axial spondyloarthritis. Ther Adv Musculoskelet Dis 2024; 16:1759720X231224212. [PMID: 38404654 PMCID: PMC10894534 DOI: 10.1177/1759720x231224212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/11/2023] [Indexed: 02/27/2024] Open
Abstract
Background Patients with axial spondyloarthritis (axSpA) are often compromised by impaired function and mobility. The standardized 2-week inpatient program 'multimodal rheumatologic complex treatment' (MRCT) was designed for patients with axSpA. The Epionics SPINE (ES) is an objective tool validated to assess mobility. Objective To investigate the impact of MRCT on physical function and mobility including range of motion (RoM) and kinematics (RoK). Design Single-center interventional, observational trial. Methods Patients with axSpA presenting with high disease activity and impaired physical function were consecutively recruited to undergo MRCT. Assessments performed before (V1) and after (V2) the intervention included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis functional index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), the ankylosing spondylitis physical performance index (ASPI), the Short Physical Performance Battery (SPPB), and ES measurements. Results At baseline, the 80 patients included had: BASDAI 5.5 ± 1.5, BASFI 5.6 ± 2.0, BASMI 4.2 ± 1.8, SPPB 13.8 ± 1.8, and ASPI 37.3 ± 18.1 s. Clinically relevant improvements between V1 versus V2 were noted for BASFI, BASMI, and all other assessments (p < 0.001), and also for ES measures of RoK (all p < 0.003) and RoM (all p < 0.04), while a positive trend was seen for flexion and extension (RoM). There was no significant effect of changes in medication (all p > 0.05). Conclusion The 2-weeks MRCT was associated with definite improvements of function and mobility. Importantly, the effect of this extensive physical activity was confirmed by using the ES as an objective tool to assess spinal mobility. The ES demonstrated for the first time that the RoK of spinal mobility can significantly improve related to an exercise intervention. Trial registration Ethical Committee: Ruhr-Universität (reference-number: 19-6735-BR).
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Affiliation(s)
- David Kiefer
- Ruhr-University Bochum, Bochum, Rheumazentrum Ruhrgebiet, Claudiusstrasse 45, Herne 44649, Germany
| | - Lucia Schneider
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Juergen Braun
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Uta Kiltz
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Niklas Kolle
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Ioana Andreica
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Styliani Tsiami
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Bjoern Buehring
- Bergisches Rheuma-Zentrum Wuppertal, Ruhr-Universität Bochum, Herne, Nordrhein-Westfalen, Germany
| | - Philipp Sewerin
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Germany Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Germany
| | - Susanne Herbold
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
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Quinn S, Maguire S, O'Shea F, O'Neill L, Molloy E, Fearon U, Gallagher P, Veale DJ. Characteristics and burden of disease in patients with radiographic versus non-radiographic axial spondyloarthritis in the ASRI cohort. Ir J Med Sci 2024; 193:443-448. [PMID: 37418106 DOI: 10.1007/s11845-023-03439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) comprises patients with both radiographic and non-radiographic features. Previous studies have shown similar burden of disease between these two groups. AIMS The Ankylosing Spondylitis Registry of Ireland (ASRI) was formed with the objective to measure the burden of axial spondyloarthritis in the population and identify early predictors of a poor outcome. For this analysis, the ASRI database was used to compare the characteristics and burden of disease in patients with radiographic versus non-radiographic axial spondyloarthritis. METHODS Patients with radiographic axial spondyloarthritis (r-axSpA) were defined as those with X-ray evidence of sacroiliitis. Patients with non-radiographic axial spondyloarthritis (nr-axSpA) were defined as having MRI evidence of sacroiliitis but no X-ray evidence of sacroiliitis. RESULTS In total, 764 patients were included. Analysis of radiographic status showed 88.1% (n = 673) of patients with r-axSpA and 11.9% (n = 91) with nr-axSpA (Table 1). Patients with nr-axSpA were younger (41.3 vs. 46.6 years, p < 0.01), had shorter disease duration (14.8 vs. 20.2 years, p < 0.01) and had lower proportion of males (66.6% vs. 78.4%, p = 0.02) with lower frequency of HLA-B27 positivity (73.6% vs. 90.5%, p < 0.01). The nr-axSpA group had lower BASDAI (3.37 vs. 4.05, p = 0.01), BASFI (2.46 vs. 3.88, p < 0.01), BASMI (2.33 vs. 4.34, p < 0.01), ASQoL (5.2 vs. 6.67, p = 0.02) and HAQ scores (0.38 vs. 0.57, p < 0.01). There were no significant differences in the prevalence of extra-musculoskeletal manifestations or use of medications. CONCLUSIONS This study provides evidence to suggest that the burden of disease is less in patients with non-radiographic axial spondyloarthritis than radiographic axial spondyloarthritis.
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Affiliation(s)
- Sean Quinn
- Rheumatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Sinead Maguire
- Rheumatology Department, St James' Hospital, Dublin 8, Ireland
| | - Finbar O'Shea
- Rheumatology Department, St James' Hospital, Dublin 8, Ireland
| | - Lorraine O'Neill
- Rheumatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Eamonn Molloy
- Rheumatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ursula Fearon
- Molecular Rheumatology, Trinity Biomedical Sciences Institute, Pearse St., Dublin 2, Ireland
| | - Phil Gallagher
- Rheumatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Douglas J Veale
- The EULAR Centre for Arthritis and Rheumatic Disease, St Vincent's University Hospital, Elm Park and University College Dublin, Dublin 4, Ireland
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McGonagle D, Ramonda R, Scagnellato L, Scriffignano S, Weddell J, Lubrano E. A strategy towards disentangling treatment refractory from misdiagnosed axial Spondyloarthritis. Autoimmun Rev 2024; 23:103405. [PMID: 37543288 DOI: 10.1016/j.autrev.2023.103405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
Axial spondyloarthritis (axSpA) encompasses radiographic axial SpA (r-axSpA), formally designated as ankylosing spondylitis (AS) and non-radiographic axial SpA (nr-axSpA). The advent of MRI permitted the description of the "pre-radiographic" (nr-AxSpA) stage characterized by bone marrow oedema lesions, histologically an osteitis, not yet visible on X-rays. Most subjects with a diagnosis of nr-axSpA do not progress to r-axSpA and the risk of misdiagnosis of nr-axSpA is considerable because back pain related to malalignment, degenerative conditions or biomechanical stress including intense exercise may lead to positive MRI scans. Even when nr-axSpA or r-axSpA are accurately diagnosed only about 40-50% achieve the ASAS40 responses with licensed therapies. It is likely that spinal enthesitis/osteitis leading to structural damage and associated damage contributes to post inflammatory disc territory secondary pain responses. Things are complicated as the concept of refractory axSpA itself is not well defined since there is no gold standard test to capture the full burden of inflammatory disease and, in any event, MRI has not been systematically applied. Nevertheless, there is sufficient evidence to borrow from the refractory rheumatoid arthritis field to propose two types of refractory axial SpA- a persistent inflammatory refractory ax-SpA (PIRaxSpA) and non-inflammatory refractory ax-SpA (NIRaxSpA). Both axSpA refractoriness and misdiagnosis need careful considerations when evaluating treatment failure. The immunological basis for axSpA immunotherapeutics non-responses is still rudimentary beyond the knowledge of HLA-B27 positivity status, CRP elevation, and MRI bone oedema that represents osteitis being equated with responder status.
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Affiliation(s)
- Dennis McGonagle
- University of Leeds, Leeds Institute of Rheumatic and Musculosckeletal Medicine, Leeds, United Kingdom.
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy.
| | - Laura Scagnellato
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Silvia Scriffignano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy; Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven University, Leuven, Belgium
| | - Jake Weddell
- University of Leeds, Leeds Institute of Rheumatic and Musculosckeletal Medicine, Leeds, United Kingdom
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy; Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven University, Leuven, Belgium
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Deshpande G, Sonawale A, Mulkalwar A, Jain H, Goyal A. Short-Term Efficacy and Adverse Effects of Sulfasalazine in the Management of Axial Spondyloarthropathy. Cureus 2023; 15:e49978. [PMID: 38179353 PMCID: PMC10766130 DOI: 10.7759/cureus.49978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is an inflammatory spondyloarthropathy that involves the sacroiliac joints and the axial skeleton. Sulfasalazine's efficacy in treating the axial symptoms of AS has been a subject of controversy. METHODS This prospective observational study recruited AS patients and categorized them into two groups: the first group had AS for less than or equal to four years and the second group had AS for more than four years. Erythrocytic sedimentation rate (ESR) and C-reactive protein (CRP) levels were recorded at baseline and at six-month follow-up. Disease severity was assessed using the ankylosing spondylitis disease activity score (ASDAS), Bath ankylosing spondylitis disease activity index (BASDAI) score, and Bath ankylosing spondylitis functional index (BASFI) score. RESULTS A total of 33 patients diagnosed with AS were recruited in this study, mostly males (88%) and within 21-30 years of age. ESR and CRP values were measured at baseline and at six months post-treatment with sulfasalazine. Mean ESR and mean CRP values showed a statistically significant reduction of 43.5% (p=0.001) and 58.45% (p=0.0012) respectively, at the 6-month follow-up. Four patients (12.12%) reported gastrointestinal intolerance. The mean reduction in the ASDAS score was 24% (p=0.002), the BASDAI score was 40.08% (p=0.001), and the BASFI score was 39.54% (p=0.01). Additionally, the duration of symptoms did not appear to influence with efficacy of sulfasalazine. DISCUSSION Sulfasalazine is a safe alternative therapy for patients with AS who cannot afford biologics, due to its reasonable short-term efficacy, good tolerability, cost-effective nature, and low incidence of adverse effects.
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Affiliation(s)
- Gauravi Deshpande
- Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Archana Sonawale
- Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Alhad Mulkalwar
- Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Hritvik Jain
- Internal Medicine, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, IND
| | - Aman Goyal
- Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
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Bekaryssova D, Mruthyunjaya Vijaya P, Ahmed S, Sondur S, Zimba O. Revisiting articular syndrome in the peri-pandemic COVID-19 era. Rheumatol Int 2023; 43:2157-2166. [PMID: 37747562 DOI: 10.1007/s00296-023-05459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
Articular syndrome is often the presentation of a person's various rheumatic or related diseases. It includes both arthralgia and arthritis, with objective signs of joint inflammation defining the latter. This syndromic approach to joint pain enables a scientific method for early diagnosis of common rheumatic conditions without compromising the recognition of uncommon conditions. This review explores common rheumatic conditions associated with articular syndrome, including osteoarthritis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE). It supports the early differentiation of uncommon but emerging entities such as reactive arthritis (ReA). The aim of the review is to comprehensively overview various forms of articular syndrome to update rheumatologists' and allied health specialists' knowledge. Epidemiology, clinical presentations, diagnostic approaches, and therapeutic strategies are discussed in the context of articular syndrome. The challenges emerging in the peri-pandemic COVID-19 era are highlighted. The improved understanding of the spectrum of clinical conditions and disease states presenting with articular syndrome may facilitate early diagnosis, optimal management, and enhanced patient outcomes within the realm of rheumatology.
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Affiliation(s)
- Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.
| | - Prakashini Mruthyunjaya Vijaya
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Suhas Sondur
- Department of Orthopedics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Kraków, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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Šegota A, Schnurrer-Luke-Vrbanić T, Avancini-Dobrović V, Mirić F. Clinical significance of possible HLA biomarkers in axial spondyloarthritis beyond HLA-B27 positivity. Rheumatol Int 2023; 43:2073-2079. [PMID: 37450032 DOI: 10.1007/s00296-023-05391-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
The aim of this study is to compare four forms of axial spondyloarthritis (axSpA): non-radiographic axial spondyloarthritis (nr-axSpA), ankylosing spondylitis (AS), non-radiographic axial psoriatic arthritis (nr-axPsA) and radiographic axial psoriatic arthritis (r-axPsA). In a cross-sectional retrospective study, gender difference, human leukocyte antigen (HLA) typing, laboratory C-reactive protein (CRP) and erythrocyte sedimentation (SE) values, and radiographic and magnetic resonance scans were analyzed. One hundred and thirty-seven patients were included in the study: 45 AS, 51 nr-axSpA, 32 r-axPsA and 9 nr-axPsA; 74 women and 63 men. Most of the gender, laboratory and radiological findings confirmed the results of previously conducted studies about each group of the investigated axSpA. The key findings of our study are the newly detected findings of HLA typing beyond HLA-27 positivity: HLA-DR16 in AS, HLA-DR11 in nr-axSpA, HLA-B13, HLA-B57, HLA-Cw12 and HLA-DR7 in r-axPsA, and HLA-B18 in nr-axPsA. Our study also confirmed some of the results of previously conducted studies on predominant genes of HLA typing in axSpA: HLA-B27 in AS, HLA-B39 and HLA-Cw6 in r-axPsA, and HLA-Cw7 in nr-axPsA. Important conclusions about the nr-axPsA group cannot be drawn because of the very small number of subjects included in this group of axSpA. Our results suggest that the newly detected HLA typing findings beyond HLA-B27 positivity could be possible biomarkers of early detection of axSpA, but further studies on larger samples are needed.
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Affiliation(s)
- Adelmo Šegota
- School of Medicine Rijeka, Clinical Hospital Centre Rijeka, University Department of Physical and Rehabilitation Medicine, Krešimirova 42, 51000, Rijeka, Croatia.
| | - Tea Schnurrer-Luke-Vrbanić
- School of Medicine Rijeka, Clinical Hospital Centre Rijeka, University Department of Physical and Rehabilitation Medicine, Krešimirova 42, 51000, Rijeka, Croatia
| | - Viviana Avancini-Dobrović
- School of Medicine Rijeka, Clinical Hospital Centre Rijeka, University Department of Physical and Rehabilitation Medicine, Krešimirova 42, 51000, Rijeka, Croatia
| | - Filip Mirić
- Clinic of Internal Medicine, School of Medicine Rijeka, Clinical Hospital Centre Rijeka, University Department of Rheumatology and Clinical Immunology, Krešimirova 42, 51000, Rijeka, Croatia
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11
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Kiefer D, Braun J, Kiltz U, Kolle N, Schneider L, Andreica I, Buehring B, Sewerin P, Herbold S, Baraliakos X. Patients' awareness towards physical activity in the treatment of axial spondyloarthritis. Joint Bone Spine 2023; 90:105585. [PMID: 37127259 DOI: 10.1016/j.jbspin.2023.105585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The course of axial spondyloarthritis (axSpA) is often characterized by impairments in physical function and mobility. Regular physical activity (PA) is a cornerstone of axSpA management. Recent European League Against Rheumatism (EULAR) recommendations for PA have stressed the importance of their implementation. OBJECTIVE Cohort study to investigate the awareness on and individual implementation of axSpA patients towards PA. METHODS Patients with axSpA and impaired physical function (Bath AS Functional Index [BASFI] score≥2.0) were recruited consecutively. All patients underwent a clinical examination including assessments of disease activity, physical function, mobility and global functioning. Patients also had to fill out structured questionnaires on knowledge, awareness and individual attitudes to PA. RESULTS Out of a total of 100 patients enrolled, 96 were included. Most respondents (n=82, 85.4%) were aware that PA has significant health benefits for patients with axSpA. Even though less than half of the patients (n=44, 42.7%) were aware that actual EULAR recommendations do exist, 45 patients (46.9%) did already fulfill these in terms of frequency/week. The majority of patients (n=61, 67.7%) had been informed about the benefits of PA by their physician, and physiotherapy had often been prescribed (n=61, 63.3%). Many patients (n=51, 53.1%) reported to perform individual exercise programs, and some (n=22, 22.9) supervised PA. CONCLUSION Even though the majority of axSpA patients are not aware of the recent EULAR recommendations for PA, many understand and agree that PA is beneficial for their health status. Health care providers should concentrate on the patients who are not active and do not know about the benefits of PA.
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Affiliation(s)
- David Kiefer
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Niklas Kolle
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Lucia Schneider
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Ioana Andreica
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Bjoern Buehring
- Bergisches Rheuma-Zentrum Wuppertal, Ruhr-University Bochum, Wuppertal, Germany
| | - Philipp Sewerin
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany; Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Susanne Herbold
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
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12
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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] [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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13
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Thompson KN, Bonham KS, Ilott NE, Britton GJ, Colmenero P, Bullers SJ, McIver LJ, Ma S, Nguyen LH, Filer A, Brough I, Pearson C, Moussa C, Kumar V, Lam LH, Jackson MA, Pawluk A, Kiriakidis S, Taylor PC, Wedderburn LR, Marsden B, Young SP, Littman DR, Faith JJ, Pratt AG, Bowness P, Raza K, Powrie F, Huttenhower C. Alterations in the gut microbiome implicate key taxa and metabolic pathways across inflammatory arthritis phenotypes. Sci Transl Med 2023; 15:eabn4722. [PMID: 37494472 DOI: 10.1126/scitranslmed.abn4722] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/22/2023] [Indexed: 07/28/2023]
Abstract
Musculoskeletal diseases affect up to 20% of adults worldwide. The gut microbiome has been implicated in inflammatory conditions, but large-scale metagenomic evaluations have not yet traced the routes by which immunity in the gut affects inflammatory arthritis. To characterize the community structure and associated functional processes driving gut microbial involvement in arthritis, the Inflammatory Arthritis Microbiome Consortium investigated 440 stool shotgun metagenomes comprising 221 adults diagnosed with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis and 219 healthy controls and individuals with joint pain without an underlying inflammatory cause. Diagnosis explained about 2% of gut taxonomic variability, which is comparable in magnitude to inflammatory bowel disease. We identified several candidate microbes with differential carriage patterns in patients with elevated blood markers for inflammation. Our results confirm and extend previous findings of increased carriage of typically oral and inflammatory taxa and decreased abundance and prevalence of typical gut clades, indicating that distal inflammatory conditions, as well as local conditions, correspond to alterations to the gut microbial composition. We identified several differentially encoded pathways in the gut microbiome of patients with inflammatory arthritis, including changes in vitamin B salvage and biosynthesis and enrichment of iron sequestration. Although several of these changes characteristic of inflammation could have causal roles, we hypothesize that they are mainly positive feedback responses to changes in host physiology and immune homeostasis. By connecting taxonomic alternations to functional alterations, this work expands our understanding of the shifts in the gut ecosystem that occur in response to systemic inflammation during arthritis.
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Affiliation(s)
- Kelsey N Thompson
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Kevin S Bonham
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Nicholas E Ilott
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - Graham J Britton
- Marc and Jennifer Lipschultz Precision Immunology Institute and Department of Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Paula Colmenero
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - Samuel J Bullers
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - Lauren J McIver
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Siyuan Ma
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Long H Nguyen
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Andrew Filer
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TT, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research Into Inflammatory Arthritis Centre Versus Arthritis, University of Birmingham, Chesterfield S41 7TD, UK
| | - India Brough
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Claire Pearson
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - Caroline Moussa
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - Vinod Kumar
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - Lilian H Lam
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - Matthew A Jackson
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - April Pawluk
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Serafim Kiriakidis
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Lucy R Wedderburn
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, UCLH, and GOSH, Chesterfield S41 7TD, UK
- NIHR Great Ormond Street Biomedical Research Centre, University College London, London WC1N 1EH, UK
- UCL GOS Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Brian Marsden
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - Stephen P Young
- Department of Rheumatology, Sandwell & West Birmingham NHS Trust, West Bromwich B71 4HJ, UK
| | - Dan R Littman
- Howard Hughes Medical Institute and the Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY 10016, USA
| | - Jeremiah J Faith
- Marc and Jennifer Lipschultz Precision Immunology Institute and Department of Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Arthur G Pratt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Research into Inflammatory Arthritis Centre Versus Arthritis, Newcastle Birmingham, Glasgow, and Oxford, Chesterfield S41 7TD, UK
- Department of Rheumatology, Musculoskeletal Services Directorate, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Paul Bowness
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TT, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research Into Inflammatory Arthritis Centre Versus Arthritis, University of Birmingham, Chesterfield S41 7TD, UK
- Department of Rheumatology, Sandwell & West Birmingham NHS Trust, West Bromwich B71 4HJ, UK
| | - Fiona Powrie
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford OX3 7FY, UK
| | - Curtis Huttenhower
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
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14
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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] [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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15
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Braun J, Coates LC. Axial spondyloarthritis and psoriatic arthritis: mostly overlapping or substantially different diseases? RMD Open 2023; 9:rmdopen-2023-003063. [PMID: 37208031 DOI: 10.1136/rmdopen-2023-003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- Juergen Braun
- Rheumapraxis Berlin, Ruhr Universität Bochum, Bochum, Germany
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Ak T, Mustafayeva L, Celik Y, Ayla AY, Ugurlu S. When to start secukinumab treatment in patients with axial spondyloarthropathy: Before or after anti-TNFα treatment? REUMATOLOGIA CLINICA 2023; 19:175-179. [PMID: 37061278 DOI: 10.1016/j.reumae.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/24/2022] [Indexed: 04/17/2023]
Abstract
INTRODUCTION AND OBJECTIVES This study aimed to evaluate the efficacy of secukinumab (SEC) in axial spondyloarthropathy (axSpA) in anti-TNFα naïve and anti-TNFα experienced patients. It also focused on the duration of SEC treatment and its side effects. PATIENTS AND METHODS The patients with axSpA treated with SEC and followed up in our outpatient clinic from May 2018 through October 2021 were included in this study. All patients in the study also fulfilled the ASAS classification criteria for axSpA. Patients were separated into two groups according to whether they received prior anti-TNFα therapy. While anti-TNFα naïve patients comprised group 1, anti-TNFα experienced patients were included in group 2. Pre- and post-treatment BASDAI scores were reported and compared. RESULTS Eighty-four axSpA patients (42 men; duration of the disease: 86.86±65.35 months in group 1 and 160.65±97.4 months in group 2) were treated with SEC. 45.5% of anti-TNFα naïve patients and 56.5% of anti-TNFα experienced patients were still on SEC therapy in October 2021. Duration of SEC treatment was 12.5±7.9 months in group 1 and 17.19±12 months in group 2 (p=0.098). The differences between pre-and post-treatment BASDAI scores were statistically significant in both groups (p<0.001). While patients in group 1 did not develop any adverse effects, three patients in group 2 experienced alopecia, uveitis, and recurrent pneumonia after SEC treatment. CONCLUSION Our study's efficacy and safety data on the use of SEC were reassuring in both anti-TNFα naïve and anti-TNFα experienced patients. However, further studies are still needed to determine the appropriate timing to begin SEC treatment.
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Affiliation(s)
- Tumay Ak
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Istanbul, Turkey
| | - Leyla Mustafayeva
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Physical Therapy and Rehabilitation, Istanbul, Turkey
| | - Yeliz Celik
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Ali Yagiz Ayla
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Serdal Ugurlu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey.
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Akkoç N, Arteaga CH, Auteri SE, Betts M, Fahrbach K, Kim M, Kiri S, Neupane B, Gaffney K, Mease PJ. Comparative Efficacy of Biologic Disease-Modifying Anti-Rheumatic Drugs for Non-Radiographic Axial Spondyloarthritis: A Systematic Literature Review and Bucher Indirect Comparisons. Rheumatol Ther 2023; 10:307-327. [PMID: 36633815 PMCID: PMC10011375 DOI: 10.1007/s40744-022-00522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Biologic disease-modifying anti-rheumatic drugs (bDMARDs), including certolizumab pegol (CZP), are effective treatment options for the management of non-radiographic spondyloarthritis (nr-axSpA). In the absence of head-to-head comparisons in nr-axSpA, we conducted a systematic literature review (SLR) and indirect treatment comparison (ITC) to better understand the comparative efficacy of CZP vs. other bDMARDs. METHODS Literature searches were conducted in October 2020 in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials in patients with nr-axSpA who had failed at least one non-steroidal anti-inflammatory drug and were treated with bDMARDs. Outcomes of interest included the Assessment of Spondyloarthritis international Society (ASAS), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI) and Disease Activity Index (BASDAI), and spinal pain score. Comparative efficacy was examined using a series of Bucher ITCs in subgroups matched by prior exposure to bDMARDs, disease duration, baseline C-reactive protein (CRP) levels/magnetic resonance imaging (MRI) status, and timepoints, to ensure comparability between studies. RESULTS At 12-16 weeks, treatment with CZP was significantly more likely to achieve ASAS20/40 response and ASDAS-inactive disease status vs. etanercept (ETN), ixekizumab (IXE), and secukinumab (SEC). CZP showed statistically significant improvement in BASDAI, BASFI, and total spine pain score over adalimumab (ADA), ETN, and IXE, and in BASFI over SEC. Among patients with objective signs of inflammation (OSI; elevated CRP levels and/or inflammation on MRI at baseline), CZP had a statistically significant advantage over ETN and SEC (with or without loading dose) in achieving ASAS40, whereas the comparisons with other bDMARDs did not show any statistically significant differences. CONCLUSION In the overall matched population, CZP performed significantly better than most comparators in improving the clinical outcomes. Among patients with OSI, CZP was found to be superior to SEC (in the MRI-/CRP + and MRI + /CRP- subgroups) and ETN (in the MRI + /CRP- subgroup) and it was comparable to golimumab and IXE across the different OSI subgroups.
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Affiliation(s)
- Nurullah Akkoç
- Division of Rheumatology, Department of Medicine, Manisa Celal Bayar University School of Medicine, Mimar Sinan Blv. No: 173, 45030, Yunusemre/Manisa, Turkey.
| | | | | | - Marissa Betts
- Evidence Synthesis, Modeling & Communication, Evidera, Waltham, MA, USA
| | - Kyle Fahrbach
- Evidence Synthesis, Modeling & Communication, Evidera, Waltham, MA, USA
| | | | | | - Binod Neupane
- Evidence Synthesis, Modeling & Communication, Evidera, Waltham, MA, USA
| | - Karl Gaffney
- Rheumatology Department, Norfolk & Norwich University Hospital, Norwich, UK
| | - Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
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18
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Öztürk Ö, Feyzioğlu Ö, Sarıtaş F. Identifying frailty and its associated factors in patients with axial spondyloarthritis. Int J Rheum Dis 2023; 26:519-530. [PMID: 36737413 DOI: 10.1111/1756-185x.14591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/16/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Frailty is an elderly people phenomenon; however, younger adults with comorbidities may show a higher trajectory of frailty toward older age. The frailty status of middle-aged patients with axial spondyloarthritis (axSpA) remains little researched. We aimed to identify frailty status and to investigate the association of clinical, sociodemographic, and psychosocial factors with frailty. METHODS This study included 114 patients aged between 40 and 65 years. The patients were classified as frail, pre-frail, and robust according to Fried's phenotype and the Kihon Checklist (KCL). Physical function, quality of life, depression, anxiety, and disease-related factors were assessed. Between-group comparisons and multinomial logistic regression analysis were performed. RESULTS Frailty and pre-frailty prevalences were 20.2% and 49.1% for Fried's phenotype and 36.0% and 33.3% for the KCL. Frail adults had impaired physical function and increased disease activity compared to pre-frail and robust patients. Adjusted multinomial logistic regression analysis revealed that disease activity (odds ratio [OR] = 1.62, 95% CI = 1.12-2.34) and Short Physical Performance Battery (OR = 0.32, 95% CI = 0.18-0.56) were associated with Fried's phenotype-determined frailty. Disease activity (OR = 1.91, 95% CI = 1.11-3.26), Bath Ankylosing Spondylitis Functional Index (OR = 2.70, 95% CI = 1.56-4.67), and depression (OR = 1.55, 95% CI = 1.18-2.02) were associated with the KCL determined frailty. CONCLUSION Frailty and pre-frailty are commonly detected in middle-aged individuals with axSpA. Our findings highlight a possible need for frailty screening and preventive programs targeting middle-aged axSpA patients.
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Affiliation(s)
- Özgül Öztürk
- Department of Physiotherapy and Rehabilitation, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Özlem Feyzioğlu
- Department of Physiotherapy and Rehabilitation, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Fatih Sarıtaş
- Department of Rheumatology, University of Health Sciences, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
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19
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Hayashi H, Sun J, Yanagida Y, Yoshida S, Baba S, Tenma A, Toyoura M, Kawabata S, Ehara T, Asaki R, Sakaguchi M, Tomioka H, Shimamura M, Morishita R, Rakugi H, Tomita T, Nakagami H. Peptide-based vaccine targeting IL17A attenuates experimental spondyloarthritis in HLA-B27 transgenic rats. RMD Open 2023; 9:rmdopen-2022-002851. [PMID: 36737108 PMCID: PMC9900070 DOI: 10.1136/rmdopen-2022-002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Spondyloarthritis (SpA) is known as series of immune-mediated inflammatory disease of the axial and peripheral joints. Human leucocyte antigen (HLA)-B27 is a genetic risk factor for SpA. Recent evidence suggests that the interleukin -17 (IL17) axis strongly contributes to SpA. This study aimed to assess the efficacy of an IL17A peptide-based vaccine on SpA manifestations in model rats. METHODS HLA-B27/human β2-microglobulin (hβ2M) transgenic rats were immunised with heat-inactivated Mycobacterium tuberculosis (MT) to develop spondylitis and arthritis as an experimental SpA model after immunisation with a keyhole limpet hemocyanin-conjugated IL17A peptide-based vaccine with an alum adjuvant three times. The IL17A antibody titre was assessed using ELISA, and arthritis score and joint thickness were monitored two times a week. Enzyme-linked immunospot (ELISpot) assays for IL4- and interferon-γ-secreting splenocytes were conducted to evaluate IL17A-specific T cell activation. We also evaluated the effect of IL17A vaccine in SpA therapeutic model. RESULTS The IL17A peptide-based vaccine with alum adjuvant successfully induced antibody production and suppressed the arthritis score and joint thickness. X-ray and histological analyses showed that enthesitis, bone destruction and new bone formation were inhibited by the IL17A vaccine. The ELISpot assay showed that the IL17A peptide-based vaccine did not elicit any IL17A-reactive T cell responses. IL17A vaccine tends to mitigate, but not significant, in SpA treatment model. These data showed that the peptide-based vaccine targeting IL17A alleviated the SpA phenotype in a heat-inactivated MT-induced SpA model in HLA-B27/hβ2M transgenic rats. CONCLUSIONS IL17A peptide-based vaccine may be a therapeutic option for SpA treatment.
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Affiliation(s)
- Hiroki Hayashi
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Jiao Sun
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuka Yanagida
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shota Yoshida
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Satoshi Baba
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | | | | | | | | | | | | | | | - Munehisa Shimamura
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Department of Neurology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryuichi Morishita
- Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Tomita
- Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka, Osaka, Japan
| | - Hironori Nakagami
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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20
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Girbash EF, Abdelwahab SM, Atef RM, Sherif HE, Abdeldayem HM, Atta DS, Radwan AM. Maternal Interleukin-17 and disease activity influence pregnancy outcomes in women with psoriatic arthritis and ankylosing spondylitis. BMC Pregnancy Childbirth 2023; 23:35. [PMID: 36650451 PMCID: PMC9847183 DOI: 10.1186/s12884-023-05364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE We aimed in this study to evaluate the impact of maternal interleukin -17A and the activity of the illness on pregnancy outcomes in Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients. METHODS This prospective cohort research was carried out on 48 Psoriatic arthritis and ankylosing spondylitis pregnant women attending the inpatient and outpatient clinics of the Rheumatology & Rehabilitation and Obstetrics & Gynecology Departments, Faculty of Medicine, Zagazig University Hospitals in Egypt and 30 apparently healthy age- and sex-matched pregnant women between January 1,2018, and December 31, 2019. RESULTS The study group patients had a higher risk of preterm labour (32-36 weeks gestation) (aRR 1.80, 95% CI 0.79-4.17), oligohydramnios (aRR 3.15, 95% CI 1.26-8.42), Caesarean delivery (aRR 1.57, 95% CI 1.41-2.68), and delivering infants small for gestational age (aRR 7.04, 95% CI 2.36-12.42). There was significant difference between the control group and the study groups regarding the level of IL-17A. CONCLUSION Many females with PsA and AS have uninhibited pregnancy with regard to adverse events, but in comparison with normal pregnancies particularly with high IL-17A during the third trimester we noticed a growing risk of preterm labour, oligohydramnios and cesarean section. Further studies are needed to evaluate high maternal IL-17A levels and fetal outcomes.
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Affiliation(s)
- Ehab F. Girbash
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Shaimaa M. Abdelwahab
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt ,grid.31451.320000 0001 2158 2757Rheumatology and Rehabilitation department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Rehab M. Atef
- grid.31451.320000 0001 2158 2757 Clinical and Chemical Pathology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Hala E. Sherif
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Hussein M. Abdeldayem
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Doaa S. Atta
- grid.31451.320000 0001 2158 2757Rheumatology and Rehabilitation department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Ahmed M. Radwan
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
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21
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De Vicente Delmás A, Sanchez-Bilbao L, Calvo-Río V, Martínez-López D, Herrero-Morant A, Galíndez-Agirregoikoa E, Gonzalez-Mazon I, Barroso-García N, Palmou-Fontana N, Gonzalez-Gay MA, Hernández JL, Blanco R. Uveitis in psoriatic arthritis: study of 406 patients in a single university center and literature review. RMD Open 2023; 9:rmdopen-2022-002781. [PMID: 36635002 PMCID: PMC9843218 DOI: 10.1136/rmdopen-2022-002781] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/16/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/PURPOSE The manifestations of uveitis are well established in axial spondyloarthritis (ax-SpA), but not in psoriatic arthritis (PsA). We aimed to assess, in a large unselected series of PsA: (A) the frequency and clinical features of uveitis; (B) its association with PsA activity, the impact of disease and functional disability, and (C) its relationship with the biological treatment. In addition, a literature review was performed. METHODS Retrospective longitudinal study of PsA patients from a single referral hospital. PsA was classified according to the CASPAR criteria, and uveitis was diagnosed by experienced ophthalmologists. RESULTS We studied 406 patients with PsA (46.3±12.3 years). Uveitis was observed in 20 (4.9%). Uveitis was acute in all cases, anterior (80%), unilateral (80%) and recurrent (50%). Patients with uveitis had a higher prevalence of HLA-B27 (45% vs 7.5%, p<0.0001), sacroiliitis on MRI (25% vs 8.3% p=0.027), ocular surface pathology (10% vs 0.8%, p=0.021), and median PsA impact of Disease Score (5.9 (2.1-6.8) vs 1.25 (0.0-3.0), p=0.001) and Bath Ankylosing Spondylitis Functional Index (4 (1.6-5) vs 1.0 (0.0-3.5), p=0.01) than patients without uveitis.The exposure adjusted incidence rate (episodes/100 patients-year) of uveitis before versus after biological treatment decreased with anti-TNFα monoclonal antibodies (56.3 vs 9.4) and increased with etanercept (ETN) (6.03 vs 24.2) and secukinumab (SECU) (0 vs 50) (including only one patient treated in the last two cases). CONCLUSION The prevalence of uveitis in patients with PsA was about 5%. The pattern was similar to that observed in ax-SpA. Uveitis was associated with a worse quality of life and greater functional disability. The uveitis exposure adjusted incidence rate decreased with anti-TNFα monoclonal antibodies and increased with ETN and SECU.
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Affiliation(s)
- Ana De Vicente Delmás
- Rheumatology, Hospital General Santa María del Puerto, El Puerto de Santa María, Spain
| | - Lara Sanchez-Bilbao
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Vanesa Calvo-Río
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Alba Herrero-Morant
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | - José L Hernández
- Medicine and Psychiatry.University of Cantabria. Internal Medicine Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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22
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Min HK, Kim HR, Lee SH, Hong YS, Kim MY, Park SH, Kang KY. Clinical efficacy of alternative TNF inhibitor and secukinumab between primary non-responder and secondary non-responder of prior TNF inhibitor in ankylosing spondylitis. Mod Rheumatol 2023; 33:194-201. [PMID: 35107167 DOI: 10.1093/mr/roac005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/25/2021] [Accepted: 12/25/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To compare the drug retention times and clinical efficacy of alternative tumour necrosis factor inhibitors (TNFi) and secukinumab in primary and secondary non-responders with ankylosing spondylitis (AS). METHODS AS patients treated with biologics and enrolled in the Korean College of Rheumatology Biologics registry were examined. Patients who did not respond to previous TNFi treatment were defined as primary and secondary non-responders. Data regarding drug discontinuation and clinical efficacy were collected after 1 year. Kaplan-Meier and Cox regression analyses were performed to compare drug survival and associated factors. Logistic regression analyses were conducted to compare the clinical efficacy secukinumab with that of alternative TNFi. RESULTS In total, 124 patients (83 receiving alternative TNFi and 41 receiving secukinumab) had biologic changes due to clinical inefficacy. Drug retention rates in the alternative TNFi and secukinumab groups were similar (P = 0.096). However, subgroup analyses including only secondary non-responders revealed that secukinumab users showed a higher hazard ratio (HR) for drug discontinuation (HR = 3.77, P = 0.045). In addition, secukinumab was negatively associated with achieving BASDAI50 or a major improvement in the ASDAS. CONCLUSION Alternative TNFi showed better drug retention and clinical efficacy in AS patients experiencing previous TNFi failure, in secondary non-responders. Therefore, alternative TNFi may be a more suitable treatment for secondary non-responders.
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Affiliation(s)
- Hong Ki Min
- Department of Internal Medicine, Division of Rheumatology, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea
| | - Hae-Rim Kim
- Department of Internal Medicine, Division of Rheumatology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea
| | - Sang-Heon Lee
- Department of Internal Medicine, Division of Rheumatology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea
| | - Yeon Sik Hong
- Department of Internal Medicine, Division of Rheumatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Internal Medicine, Division of Rheumatology, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Moon-Young Kim
- Department of Internal Medicine, Division of Rheumatology, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Department of Internal Medicine, Division of Rheumatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Department of Internal Medicine, Division of Rheumatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Internal Medicine, Division of Rheumatology, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
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23
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Poddubnyy D. Challenges in non-radiographic axial spondyloarthritis. Joint Bone Spine 2023; 90:105468. [PMID: 36182035 DOI: 10.1016/j.jbspin.2022.105468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/22/2022] [Indexed: 01/19/2023]
Abstract
Non-radiographic axial spondyloarthritis (nr-axSpA) is part of the spectrum or continuum of axSpA and is characterized by the absence of definite structural damage in the sacroiliac joints. The introduction of the concept of axSpA with two - non-radiographic and radiographic - stages stimulated activities related to the improvement of early diagnosis and treatment of this disease, but also opened a number of controversial topics in the field. In this article, we are discussing several challenges related to the concept of nr-axSpA, the diagnosis, and the treatment in the historical context and in the light of the recent data.
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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, Berlin, Germany; Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.
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24
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Kilic G, Senol S, Baspinar S, Kilic E, Ozgocmen S. Degenerative changes of lumbar spine and their clinical implications in patients with axial spondyloarthritis. Clin Rheumatol 2023; 42:111-116. [PMID: 35922576 DOI: 10.1007/s10067-022-06321-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/16/2022] [Accepted: 07/27/2022] [Indexed: 01/11/2023]
Abstract
The objective of this study was to assess degenerative changes (DCs) on magnetic resonance imaging (MRI) of lumbar spine in axial spondyloarthritis (axSpA) and non-specific mechanical low back pain (mLBP). Patients were consecutively recruited and all underwent MRI of the lumbar spine in this cross-sectional study. Disk degeneration (DD, Pfirrmann classification), endplate changes (Modic, types 1, 2, and 3), annular fissure, disk bulging, and protrusion or extrusion at each lumbar spinal level were assessed using anonymized images. Patients with axSpA were assessed for disease activity, functioning, and quality of life. Univariate and subsequent multivariate logistic regression analyses with adjustments of various covariates were used to assess association between MRI findings and clinical variables. One hundred twenty-three patients had non-radiographic (nr-axSpA) and 144 had radiographic axSpA/ankylosing spondylitis (AS). Degenerative changes were more prevalent in patients with mLBP (n = 105) than axSpA. Disk degeneration was the most prevalent MRI finding, followed by annular fissure, disk herniation (protrusion or extrusion), and Modic changes (MCs) in axSpA. Disk herniation was more prevalent in patients with nr-axSpA compared to AS. Modic changes (OR = 6.455), lumbar disk herniation (OR = 2.278), annular fissure (OR = 2.842), conventional synthetic or biologic disease-modifying antirheumatic drugs (csDMARDs) non-users (OR = 2.225), and advanced age (OR = 31.556) were factors associated with an increased risk of DD in axSpA. Coexisting DD increased the burden of disease in axSpA. A considerable proportion of patients with axSpA had DD at the lumbar spine. These degenerative changes might explain some of the complaints and should not been overlooked in patients with axSpA. Key Points • Lumbar herniated nucleus pulposus (LHNP) is more frequent in nr-axSpA while MC is more frequent in AS. • DD may cause an increase in BASFI and BASMI scores in axSpA. • Spinal DCs might be an alternative explanation for low back complaints and should not been overlooked in patients with axSpA.
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Affiliation(s)
- Gamze Kilic
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey.
| | - Serkan Senol
- Department of Radiology, Sevgi Hospital, Kayseri, Turkey
| | - Sevgi Baspinar
- Department of Physical Medicine and Rehabilitation, Ministry of Health Kayseri City Hospital, Kayseri, Turkey
| | - Erkan Kilic
- Department of Rheumatology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Salih Ozgocmen
- Department of Rheumatology, Gaziosmanpasa Hospital, Istinye University, Istanbul, Turkey.,Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Trakya University, Edirne, Turkey
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25
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Scott IC, Whittle R, Bailey J, Twohig H, Hider SL, Mallen CD, Muller S, Jordan KP. Rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis epidemiology in England from 2004 to 2020: An observational study using primary care electronic health record data. THE LANCET REGIONAL HEALTH. EUROPE 2022; 23:100519. [PMID: 36246147 PMCID: PMC9557034 DOI: 10.1016/j.lanepe.2022.100519] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Contemporary data on rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritits (SpA) epidemiology in England are lacking. This knowledge is crucial to planning healthcare services. We updated algorithms defining patients with diagnoses of RA, PsA, and axial SpA in primary care and applied them to describe their incidence and prevalence in the Clinical Practice Research Datalink Aurum, an electronic health record (EHR) database covering ∼20% of England. METHODS Algorithms for ascertaining patients with RA, axial SpA, and PsA diagnoses validated in primary care EHR databases using Read codes were updated (to account for the English NHS change to SNOMED CT diagnosis coding) and applied. Updated diagnosis and synthetic disease-modifying anti-rheumatic drug code lists were devised by rheumatologists and general practitioners. Annual incidence/point-prevalence of RA, PsA, and axial SpA diagnoses were calculated from 2004 to 2020 and stratified by age/sex. FINDINGS Point-prevalence of RA/PsA diagnoses increased annually, peaking in 2019 (RA 0·779% [95% confidence interval (CI) 0·773, 0·784]; PsA 0·287% [95% CI 0·284, 0·291]) then falling slightly. Point-prevalence of axial SpA diagnoses increased annually (except in 2018/2019), peaking in 2020 (0·113% [95% CI 0·111, 0·115]). RA diagnosis annual incidence was higher between 2013-2019 (after inclusion in the Quality and Outcomes Framework, range 49·1 [95% CI 47·7, 50·5] to 52·1 [95% CI 50·6, 53·6]/100,000 person-years) than 2004-2012 (range 34·5 [95% CI 33·2, 35·7] to 40·0 [95% CI 38·6, 41·4]/100,000 person-years). Increases in the annual incidence of PsA/axial SpA diagnosis occurred following new classification criteria publication. Annual incidence of RA, PsA and axial SpA diagnoses fell by 40·1%, 67·4%, and 38·1%, respectively between 2019 and 2020, likely reflecting the COVID-19 pandemic's impact on their diagnosis. INTERPRETATION Recorded RA, PsA, and axial SpA diagnoses are increasingly prevalent in England, underlining the importance of organising healthcare services to provide timely, treat-to-target care to optimise the health of >1% of adults in England. FUNDING National Institute for Health and Care Research (NIHR300826).
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Affiliation(s)
- Ian C. Scott
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK
| | - Rebecca Whittle
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - James Bailey
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Helen Twohig
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Samantha L. Hider
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK
| | - Sara Muller
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Kelvin P. Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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Baraliakos X, Kuehn A, Tsiami S, Kiltz U, Fruth M, Braun J. The influence of age on the prevalence of inflammatory and structural MRI lesions in the SIJ of patients with and without axSpA. Rheumatology (Oxford) 2022; 62:1519-1525. [PMID: 36083015 DOI: 10.1093/rheumatology/keac505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the influence of age on inflammatory (bone marrow oedema. BME) and structural (fat lesions (FL), erosions and ankylosis) MRI lesions in the SIJ of patients with and without axial spondyloarthritis (axSpA). METHODS In a retrospective study, SIJ MRI (STIR/T1 sequences) of consecutive patients with chronic back pain diagnosed with axSpA or non-SpA were evaluated based on SIJ quadrants (SIJ-Q). Two blinded readers evaluated BME and structural lesions. Reader agreement was evaluated for prevalence of MRI lesions related to age. RESULTS MRIs of 309 (175 axSpA, 134 non-SpA) patients were evaluated. Their mean age was 38.5 ± 11.4 vs 43.4 ± 13.8 years (y), 67% and 36% were male, CRP 1.6 ± 2.4 vs 1.1 ± 2.1 mg/dl, median symptom duration 48 and 60 months, respectively. SIJ-Q with BME and erosions were significantly more frequent in axSpA vs non-SpA patients independent of age, while this difference was seen for FL only in patients ≥50 y. The proportion of patients with ≥1 or ≥ 3 BME or chronic lesions except for FL increased with age in both groups, and was constantly higher in axSpA vs non-SpA. In univariate analyses, only female sex was significantly associated with more FL. CONCLUSIONS The proportion of patients with MRI lesions was high in both, axSpA and non-SpA patients. However, the prevalence of BME and erosions was significantly more frequent in patients with axSpA, was independent of age and also allowed for discrimination. FL occurred more frequently only in older age groups and were less reliable for discrimination vs. non-SpA patients.
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Affiliation(s)
| | - Anna Kuehn
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany
| | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany
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Robinson PC, Maksymowych WP, Gensler LS, Hall S, Rudwaleit M, Hoepken B, Bauer L, Kumke T, Kim M, de Peyrecave N, Deodhar A. Certolizumab Pegol Efficacy in Patients With
Non‐Radiographic
Axial Spondyloarthritis Stratified by Baseline
MRI
and
C‐Reactive
Protein Status: An Analysis From the
C‐axSpAnd
Study. ACR Open Rheumatol 2022; 4:794-801. [PMID: 35733363 PMCID: PMC9469479 DOI: 10.1002/acr2.11469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Tumor necrosis factor inhibitors (TNFi) are an effective treatment for non‐radiographic axial spondyloarthritis (nr‐axSpA). To be eligible, however, many authorities require patients with nr‐axSpA to show active sacroiliitis on magnetic resonance imaging (MRI) and/or an elevated C‐reactive protein (CRP) level, possibly resulting in a perception that patients with nr‐axSpA without both factors have only low responses to TNFi treatment. We evaluated clinical responses to certolizumab pegol (CZP) in patients with nr‐axSpA stratified by baseline MRI/CRP status. Methods C‐axSpAnd was a phase 3, multicenter study on CZP in adult patients with active nr‐axSpA and objective signs of inflammation. This analysis assessed efficacy of CZP over the 52‐week randomized, double‐blind, placebo‐controlled period in patients stratified into subgroups based on the presence of active sacroiliitis on MRI and CRP level at baseline. Results CZP‐treated patients across all MRI/CRP subgroups achieved clinical responses greater than placebo. Across outcome measures, CZP‐treated MRI+/CRP+ patients demonstrated the greatest clinical responses, but substantial improvements were also observed in CZP‐treated MRI+/CRP− and MRI−/CRP+ patients. Ankylosing Spondylitis Disease Activity Score Major Improvement response rates at week 52 among CZP‐treated patients (75.6% MRI+/CRP+; 47.5% MRI−/CRP+; and 29.7% MRI+/CRP−) were higher than rates in placebo groups (range: 3.9%‐12.5%). Assessment of SpondyloArthritis international Society 40% response, Bath Ankylosing Spondylitis Disease Activity Index, and Bath Ankylosing Spondyloarthritis Functional Index had similar response patterns, although differences between the CZP‐treated MRI/CRP subgroups were smaller. Clinical responses among CZP‐treated patients were also observed in additional subgroups, including those with low Spondyloarthritis Research Consortium of Canada MRI sacroiliac joint inflammation scores and those with normal baseline CRP levels. Conclusion Our findings indicate that CZP treatment benefits patients with nr‐axSpA across MRI+/CRP+, MRI−/CRP+, and MRI+/CRP− subgroups.
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Affiliation(s)
- Philip C. Robinson
- University of Queensland School of Clinical Medicine Brisbane Queensland Australia
| | | | | | - Stephen Hall
- Monash University and Emeritus Research Melbourne Victoria Australia
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28
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Maksymowych WP, Baraliakos X, Lambert RG, Landewé R, Sandoval D, Carlier H, Lisse J, Li X, Hojnik M, Østergaard M. Effects of ixekizumab treatment on structural changes in the sacroiliac joint: MRI assessments at 16 weeks in patients with non-radiographic axial spondyloarthritis. THE LANCET. RHEUMATOLOGY 2022; 4:e626-e634. [PMID: 38288892 DOI: 10.1016/s2665-9913(22)00185-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2024]
Abstract
BACKGROUND There is limited understanding regarding the inhibition of structural damage in the sacroiliac joint of patients with non-radiographic axial spondyloarthritis. This study evaluated the effect of the interleukin-17A inhibitor ixekizumab versus placebo on structural lesions in the sacroiliac joints as assessed by MRI at week 16 in patients with non-radiographic axial spondyloarthritis from the COAST-X study. METHODS COAST-X was a 52-week, randomised, double-blind, placebo-controlled, parallel-group study done at 107 sites in 15 countries in Europe, Asia, North America, and South America. Eligible participants were adults (aged ≥18 years) with active axial spondyloarthritis without definite radiographic sacroiliitis (non-radiographic axial spondyloarthritis), objective signs of inflammation (via MRI or C-reactive protein), and an inadequate response or intolerance to non-steroidal anti-inflammatory drugs. Patients were randomly allocated to placebo or double-blind ixekizumab 80 mg every 4 weeks (Q4W) or 2 weeks (Q2W), with an 80 mg or 160 mg starting dose. We report a post-hoc analysis of 266 patients with available MRI scans from baseline and week 16. MRI scans were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint structural score (SSS) method independently by two masked readers. Treatment comparisons used analysis of covariance based on observed cases. Correlations were evaluated among changes in SPARCC SSS for erosion, fat lesions, and backfill, and between changes in SPARCC SSS and sacroiliac joint inflammation scores and clinical measures. COAST-X was registered with ClinicalTrials.gov, NCT02757352. FINDINGS Between Aug 2, 2016, and Jan 29, 2018, 303 patients were enrolled to the COAST-X study. 290 (96%) of 303 participants completed the week 16 visit (95 in the ixekizumab Q4W group, 98 in the ixekizumab Q2W group, and 97 in the placebo group), and MRI scans were available for 266 patients at baseline and week 16 (85 in the ixekizumab Q4W group, 91 in the ixekizumab Q2W group, and 90 in the placebo group). Changes from baseline to week 16 in mean SPARCC SSS for erosion were -0·39 for ixekizumab Q4W (p=0·003 vs placebo), -0·40 for ixekizumab Q2W (p=0·002), and 0·16 for placebo; for fat lesions: 0·16 for ixekizumab Q4W (p=0·013), 0·10 for ixekizumab Q2W (p=0·067), and -0·04 for placebo; and for backfill: 0·21 for ixekizumab Q4W (p=0·011), 0·22 for ixekizumab Q2W (p=0·006), and -0·10 for placebo. Ankylosis did not change. Effects of ixekizumab versus placebo on structural changes were most pronounced in patients with baseline inflammation in the sacroiliac joints. Changes from baseline at week 16 in erosion, fat lesions, and backfill were correlated. INTERPRETATION Although the clinical relevance is not yet clear, patients with non-radiographic axial spondyloarthritis receiving ixekizumab had significant reductions in erosions and increases in fat lesions and backfill in the sacroiliac joints versus placebo at week 16, suggesting an early repair process with ixekizumab treatment. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton, AB, Canada; CARE Arthritis, Edmonton, AB, Canada
| | | | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada; Medical Imaging Consultants, Edmonton, AB, Canada
| | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Xiaoqi Li
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Maja Hojnik
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, and Center of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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29
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Baraliakos X, Østergaard M, Lambert RG, Eshed I, Machado PM, Pedersen SJ, Weber U, de Hooge M, Sieper J, Poddubnyy D, Rudwaleit M, van der Heijde D, Landewé RB, Maksymowych WP. MRI lesions of the spine in patients with axial spondyloarthritis: an update of lesion definitions and validation by the ASAS MRI working group. Ann Rheum Dis 2022; 81:1243-1251. [PMID: 35609977 DOI: 10.1136/annrheumdis-2021-222081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Spinal MRI is used to visualise lesions associated with axial spondyloarthritis (axSpA). The ASAS MRI working group (WG) updated and validated the definitions for inflammatory and structural spinal lesions in the context of axSpA. METHODS After review of the existing literature on all possible types of spinal MRI pathologies in axSpA, the group (12 rheumatologists and two radiologists) consented on the required revisions of lesion definitions compared with the existing nomenclature of 2012. In a second step, using 62 MRI scans from the ASAS classification cohort, the proposed definitions were validated in a multireader campaign by global (absent/present) and detailed (inflammation and structural) lesion assessment at the vertebral corner (VC), vertebral endplate, facet joints, transverse processes, lateral and posterior elements. Intraclass correlation coefficient (ICC) was used for analysis. RESULTS Revisions were made for both inflammatory (bone marrow oedema, BMO) and structural (fat, erosion, bone spur and ankylosis) lesions, including localisation (central vs lateral), extension (VC vs vertebral endplate) and extent (minimum number of slices needed), while new definitions were suggested for the type of lesion based on lesion maturity (VC monomorphic vs dimorphic). The most reliably assessed lesions were VC fat lesion and VC monomorphic BMO (ICC (mean of all 36 reader pairs/overall 9 readers): 0.91/0.92; 0.70/0.67, respectively. CONCLUSIONS The lesion definitions for spinal MRI lesions compatible with SpA were updated by consensus and validated by a group of experienced readers. The lesions with the highest frequency and best reliability were fat and monomorphic inflammatory lesions at the VC.
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Affiliation(s)
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert Gw Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada and Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler school of medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Pedro M Machado
- Department of Rheumatology, University College London, London, UK
- Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Weber
- Practice Buchsbaum, Rheumatology, Schaffhausen, Switzerland
| | - Manouk de Hooge
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium and Rheumatology Department, Ghent University Hospital, Gent, Belgium
| | - Joachim Sieper
- Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany
| | - Denis Poddubnyy
- Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany
| | | | | | - Robert Bm Landewé
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, and Atrium Medical Center, Heerlen, The Netherlands
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Canada; CARE Arthritis, Edmonton, Alberta, Canada
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Garcia Salinas R, Jaldin Cespedes R, Gomez RA, Aguerre D, Sommerfleck F. Non-radiographic axial spondyloarthritis in South America. Burden of disease and differential features with respect to ankylosing spondylitis at time of diagnosis. A comprehensive analysis with a focus on images. Int J Rheum Dis 2022; 25:1169-1175. [PMID: 35891615 DOI: 10.1111/1756-185x.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/25/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-radiographic axial spondyloarthritis (nr-axSpA) data from South America are scarce, especially regarding image features. Objective To estimate the frequency of nr-axSpA and ankylosing spondylitis (AS) in a cohort of Argentinian patients with chronic low back pain (LBP) and to analyze the difference between both, with focus on magnetic resonance imaging (MRI) lesions, at diagnosis. METHODS Patients with LBP and a diagnosis of axSpA who participated in a reuma-check program were included. All patients with a suspicion of SpA were evaluated using blood analytics, HLA-B27, and images (MRI). Sociodemographic data, SpA features, diagnostic dela,y and clinimetrics were assessed by an operator who was blinded to the patient's test results. On MRI, the presence of SpA lesions was assessed and a concordance exercise was carried out between rheumatologists and radiologist. RESULT Of 198 LBP patients, 97 had axSpA, 54% of whom were nr-axSpA. A positive MRI was found in 50%. No difference in terms of disease activity, functional impact, laboratory or treatments between nr-axSpA and AS were found. Higher frequencies of male sex and chronic lesions on sacroiliac MRI were found in AS patients. In the logistic regression, an independent association with AS diagnosis was found: male (odds ratio [OR] 4.8), MRI fat replacement (OR 4.6), MRI sclerosis (OR 7.6), and diagnostic delay of more than 2 years (OR 10). The concordance between rheumatologists and radiologists was considered good to very good (κ 0.7-0.8). CONCLUSION The frequency of nr-axSpA was 54%. We found a higher frequency of being male, more SpA features, and a longer diagnostic delay in patients with AS. Patients with AS had more structural lesions, with a good concordance between rheumatologist and radiologist.
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Affiliation(s)
| | | | | | - Dario Aguerre
- Radiology Department, Hospital Italiano de La Plata, La Plata, Argentina
| | - Fernando Sommerfleck
- Rheumatology Unit, Sanatorio Mendez, PANLAR: SPA Study Group, Ciudad Autonoma de Buenos Aires, Argentina
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Zhang Y, Guo Z, Zhan Y, Qu J, Lei X. Evaluation of active inflammation, chronic structural damage, and response to treatment of sacroiliitis in axial spondyloarthritis using the Spondyloarthritis research consortium of Canada scoring system. BMC Musculoskelet Disord 2022; 23:654. [PMID: 35804360 PMCID: PMC9270766 DOI: 10.1186/s12891-022-05609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting the spine and sacroiliac joints. To investigate whether there are differences in inflammatory and chronic structural damages, as assessed by a semiquantitative MRI scoring method, between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) patients with active inflammation at baseline, and to evaluate the treatment response in these patients after 3 months of tumor necrosis factor-alpha (TNF-α) inhibitor treatment. Methods Fifty-eight axSpA patients with active inflammation were included in the study. The patients were divided into nr-axSpA group and AS group. MRI examinations of the sacroiliac joints were performed before and after treatment. Inflammatory and structural damages in these patients were assessed using the established Spondyloarthritis Research Consortium of Canada (SPARCC) inflammation and sacroiliac joint structural (SSS) scoring methods, which are two MRI-based scoring methods. The SPARCC score, SSS score, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were compared between the two groups. Results At baseline, SPARCC scores for patients in the nr-axSpA and AS groups did not differ significantly (P > 0.05); however, SSS scores for fat metaplasia, erosion, and backfill for patients in the AS group were significantly higher (P < 0.001). Compared with baseline, SPARCC scores were significantly decreased in both groups after treatment (P < 0.001); however, after treatment, no statistically significant difference was found regarding SPARCC scores between the AS and nr-axSpA groups. Compared with baseline, a significant increase in the SSS scores for fat metaplasia and backfill (P < 0.001) and a significant decrease in the SSS scores for erosion (P < 0.001) were observed in all axSpA patients. Changes in the SPARCC score was inversely correlated with the changes in the SSS score for fat metaplasia (r = − 0.634, P < 0.001). Changes in the SSS score for backfill were positively correlated with the changes in the SSS score for fat metaplasia (r = 0.277, P < 0.05) and inversely correlated with those for erosion (r = − 0.443, P < 0.001). Conclusion The SPARCC and SSS scoring systems can be used to assess inflammatory and chronic structural damages as well as treatment responses in patients with axSpA. More severe structural damages were seen in AS patients. TNF-α inhibitor treatment for 3 months could effectively reduce inflammation in axSpA patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05609-x.
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Affiliation(s)
- Yimeng Zhang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300070, China.,Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Zikang Guo
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300070, China.,Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Ying Zhan
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Jin Qu
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Xinwei Lei
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China.
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Braun J, Kiltz U, Deodhar A, Tomita T, Dougados M, Bolce R, Sandoval D, Lin CY, Walsh J. Efficacy and safety of ixekizumab treatment in patients with axial spondyloarthritis: 2-year results from COAST. RMD Open 2022; 8:rmdopen-2021-002165. [PMID: 35853675 PMCID: PMC9301795 DOI: 10.1136/rmdopen-2021-002165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/23/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study the efficacy and safety of ixekizumab (IXE) in patients with radiographic (r-) and non-radiographic (nr-)axial spondyloarthritis (axSpA) for up to 116 weeks. METHODS COAST-Y (NCT03129100) is the 2-year extension study following COAST-V, COAST-W and COAST-X. Patients were treated with either 80 mg IXE every 4 weeks or 2 weeks, as assigned in the originating studies. Efficacy was assessed in all participants continuously treated with IXE through week 116 and in subgroups based on disease subtype and dosing. Missing data were handled by non-responder imputation for categorical variables and modified baseline observation carried forward for continuous variables. Safety data were analysed in all patients having received ≥1 IXE dose. RESULTS Of 932 patients who received ≥1 IXE dose, 773 enrolled in COAST-Y (82.9%); 665 of which (86.0%) completed week 116. Of 352 continuously treated patients, the proportion achieving Assessment of Spondyloarthritis International Society (ASAS40) at week 52 was 51.4%, which increased to 56.0% at week 116. The proportion of patients achieving ASAS40 at week 116 was 64.9% and 57.7% for biological disease-modifying antirheumatic drug (bDMARD)-naïve patients with r-axSpA and nr-axSpA, respectively, and 47.0% for TNFi-experienced patients. The proportion of patients achieving Ankylosing Spondylitis Disease Activity Score <2.1 through week 116 was 57.0% and 52.9% for bDMARD-naïve patients with r-axSpA and nr-axSpA, respectively, and 33.6% for TNFi-experienced patients. Incidences of treatment-emergent adverse events and serious adverse events were consistent with previous reports. CONCLUSION IXE treatment led to sustained long-term improvements in patients with axSpA, with similar efficacy for r-axSpA and nr-axSpA, and for patients receiving the approved every 4 weeks dose. The safety profile of IXE was consistent with previous reports. No new safety signals were identified.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, and Department of Biochemistry, Ruhr Universität, Bochum, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, and Department of Biochemistry, Ruhr Universität, Bochum, Germany
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Tetsuya Tomita
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | | | - Chen-Yen Lin
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Jessica Walsh
- Division of Rheumatology, University of Utah, Salt Lake City, Utah, USA
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Lindqvist E, Olofsson T, Jöud A, Geijer M, Wallman JK, Mogard E. How good is the agreement between clinical diagnoses and classification criteria fulfilment in axial spondyloarthritis? Results from the SPARTAKUS cohort. Scand J Rheumatol 2022:1-10. [PMID: 35695036 DOI: 10.1080/03009742.2022.2064183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To study the agreement between clinical axial spondyloarthritis (axSpA) diagnoses and fulfilment of the Assessment of SpondyloArthritis international Society (ASAS) axSpA and modified New York (mNY) classification criteria, and to compare disease/health status between axSpA subtypes. METHOD Patients with prevalent, clinical axSpA attending a rheumatology clinic were enrolled in a cross-sectional study. Assessments included physical evaluation, laboratory testing, questionnaires, and appropriate imaging, allowing classification. Standard axSpA outcome measures were compared between patients fulfilling mNY/radiographic versus non-radiographic axSpA (r-axSpA/nr-axSpA) criteria. RESULTS Of 239 consecutively included patients, 141 fulfilled ASAS r-axSpA and/or mNY criteria, while 57 fulfilled nr-axSpA criteria. The agreement between r-axSpA and mNY criteria fulfilment was 94%. The positive predictive value (PPV) of a clinical ankylosing spondylitis (AS) diagnosis for mNY criteria fulfilment was 71%; the PPV of an undifferentiated axSpA (u-axSpA) diagnosis for fulfilment of nr-axSpA criteria was 30% and 40% for mNY criteria. Patients with r-axSpA/AS were older, more often men, and had longer disease duration, more uveitis, and worse spinal mobility than nr-axSpA patients, who had more enthesitis and dactylitis. CONCLUSION We found an overall good concordance between clinical axSpA diagnoses and classification criteria fulfilment, with 83% fulfilling ASAS axSpA and/or mNY criteria. Regarding axSpA subtypes, the concordance was weaker, and although the ICD-10 code for AS correctly identified patients meeting mNY criteria in 71% of cases, one-third of mNY-positive patients lacked an AS diagnosis. Moreover, clinical u-axSpA diagnoses could not serve as a proxy to identify nr-axSpA, highlighting the importance of thorough classification in research on axSpA subtypes.
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Affiliation(s)
- Elisabet Lindqvist
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, lägg till a Sweden
| | - Tor Olofsson
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, lägg till a Sweden
| | - Anna Jöud
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Mats Geijer
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan K Wallman
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, lägg till a Sweden
| | - Elisabeth Mogard
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, lägg till a Sweden
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Li Z, van der Linden SM, Khan MA, Baumberger H, Zandwijk HV, Khan MK, Villiger PM, Brown MA. Heterogeneity of axial spondyloarthritis: genetics, sex and structural damage matter. RMD Open 2022; 8:rmdopen-2022-002302. [PMID: 35523521 PMCID: PMC9083385 DOI: 10.1136/rmdopen-2022-002302] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/06/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) comprises both radiographic and non-radiographic disease. However, the paucity of specific objective measures for the disease and current classification criteria showing suboptimal specificity contribute to disease heterogeneity observed in clinical practice and research. We used a historical cohort of patients with axSpA to assess sources of heterogeneity. METHODS The study involved 363 axSpA probands recruited from membership of the Swiss Ankylosing Spondylitis Patient Society. Participants underwent examination by a rheumatologist, completed questionnaires and provided blood samples for HLA typing. Patients underwent radiography of sacroiliac joints and were categorised according to the New York (NY) criteria (ankylosing spondylitis (AS) or non-radiographic axSpA (nr-axSpA)) and HLA-B27 status. Genetic characterisation by single nucleotide polymorphism microarray was performed and AS polygenic risk scores (PRS) were calculated. RESULTS Considerable heterogeneity was observed. The male to female ratio for AS (NY+) was 3:1, but 1:1 for nr-axSpA. For HLA-27(+) AS, the ratio was 2.5:1, but nearly 1:1 for HLA-B27(-) disease. Women with nr-axSpA had strikingly lower mean PRS and lower HLA-B27 prevalence than men with nr-axSpA or NY(+) male and female patients with AS. PRS was able to distinguish male but not female patients with nr-axSpA from related healthy first-degree relatives. Radiographic sacroiliitis was strongly associated with HLA-B27, especially in men. CONCLUSION Women clinically diagnosed with axSpA but without radiographic sacroiliitis as a group have a disease that is distinct from AS by the modified New York criteria overall and from nr-axSpA in men. Given the high degree of heterogeneity, stratified or adjusted analysis of effectiveness studies is indicated, taking genetics, sex and radiographic damage (sacroiliitis) into account.
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Affiliation(s)
- Zhixiu Li
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Genomics and Personalised Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Sjef M van der Linden
- University of Bern, Bern, Switzerland.,Department of Internal Medicine, University of Maastricht, Maastricht, The Netherlands
| | - Muhammad Asim Khan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | | | | | - Peter M Villiger
- Medical Center Monbijou, Meikirch, Switzerland.,Rheumatology and Clinical Immunology, Medical Center Monbijou, Meikirch, Switzerland
| | - Matthew A Brown
- Department of Medical and Molecular Genetics, King's College London, London, UK .,Genomics England, London, UK
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Magrey M, Schwartzman S, de Peyrecave N, Sloan VS, Stark JL. Nonradiographic axial spondyloarthritis: expanding the spectrum of an old disease: A narrative review. Medicine (Baltimore) 2022; 101:e29063. [PMID: 35475794 PMCID: PMC9276084 DOI: 10.1097/md.0000000000029063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/24/2022] [Indexed: 01/04/2023] Open
Abstract
Nonradiographic axial spondyloarthritis (nr-axSpA) represents a distinct phenotype within the spectrum of axial spondyloarthritis (axSpA), which is characterized by a range of clinical manifestations. Despite a high disease burden that is comparable to ankylosing spondylitis (also known as radiographic axSpA), there is an unmet need to recognize and effectively manage patients with active nr-axSpA.A targeted literature search was conducted in OVID (MEDLINE and Embase databases) to identify articles on nr-axSpA, including its definition, demographics, epidemiology, burden, diagnosis, clinical presentation, and treatment guidelines.The lack of adequate epidemiological data and incomplete understanding of nr-axSpA among rheumatologists and nonrheumatologists contributes to delayed referrals and diagnosis. This delay results in a substantial burden on patients, physically and psychologically, and the healthcare system. Targeted therapies, such as biologics, including inhibitors of tumor necrosis factor or interleukin-17A, have been approved and utilized for the management of nr-axSpA, and other novel therapeutics with different mechanisms of action are in development. Raising awareness among US internists regarding the prevalence of nr-axSpA, disease burden, clinical presentation, diagnostic tools, and available treatments is important for improved disease management.Future clinical investigations focusing on the development of markers that aid early diagnosis and predict treatment response may also improve the management of nr-axSpA. This review provides an overview of nr-axSpA with the aim of raising awareness of the disease among US internists, with an overarching goal to contribute toward the improved recognition and timely referral of these patients to rheumatologists for diagnosis and management.
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Affiliation(s)
- Marina Magrey
- Case Western Reserve University School of Medicine at MetroHealth Medical Center, Department of Medicine, Division of Rheumatology, Cleveland, OH
- University Hospitals Cleveland Medical Center School of Medicine, Division of Rheumatology, Cleveland, OH
| | | | | | - Victor S. Sloan
- Sheng Consulting LLC, Flemington, NJ
- Rutgers Robert Wood Johnson Medical School, Division of Rheumatology and Connective Tissue Research, New Brunswick, NJ
- The Peace Corps, Washington, DC
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Kiltz U, Wiatr T, Redeker I, Baraliakos X, Fedorov K, Braun J. Effects of patient and disease characteristics on global functioning in patients with axial spondyloarthritis in routine care. Semin Arthritis Rheum 2022; 55:152006. [DOI: 10.1016/j.semarthrit.2022.152006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
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García-Salinas R, Ruta S, Chichande JT, Magri S. The Role of HLA-B27 in Argentinian Axial Spondyloarthritis Patients. J Clin Rheumatol 2022; 28:e619-e622. [PMID: 34145202 DOI: 10.1097/rhu.0000000000001763] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of human leukocyte antigen B27 (HLA-B27) is variable around the world. Our objectives were to estimate the frequency of HLA-B27 in an Argentinian cohort of axial spondyloarthritis (axSpA), to evaluate the differences between HLA-B27-positive and HLA-B27-negative patients, and to analyze its performance as a diagnostic biomarker. METHODS Observational study including patients older than 18 years, with axSpA diagnosis assessed in a fast track program (Reuma-Check SpA). All patients underwent the following: blood tests, HLA-B27, sacroiliac images, and enthesitis ultrasound. Sociodemographic data and SpA symptoms were also collected. The clinical assessor was blinded to complementary studies. For the sensitivity and specificity analysis, patients with chronic low back pain without axSpA who performed the same circuit in the same period were used as control, paired 1:1 (sex and age). RESULTS One hundred fifty patients were included, 75 axSpA and 75 controls. The frequency of HLA-B27 was 43% (95% confidence interval [CI], 30-53). The differences between HLA-B27-positive and HLA-B27-negative patients were observed in age of low back pain onset (36 vs 46 years), BASFI (Bath Ankylosing Spondylitis Functional Index) (4 vs 5), and extra-articular SpA features such as uveitis and inflammatory bowel disease (29% vs 50%). When this frequency was compared (low back pain control group), the difference was 43% versus 9% (odds ratio, 7.7; 95% CI, 2.8-24), and HLA-B27 had a sensitivity of 43%, specificity of 91%, positive predictive value of 85%, negative predictive value of 58%, and likelihood ratio of 4.9 (95% CI, 3-8). CONCLUSIONS The frequency of HLA-B27 in axSpA was 43%; positive patients had an earlier age of onset (36), a higher BASFI, and more SpA features. For the diagnosis of SpA, HLA-B27 had a good specificity but low sensitivity.
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Garrido-Cumbrera M, Gratacos J, Collantes-Estevez E, Zarco P, Sastre C, Sanz-Gómez S, Navarro-Compán V. Similarities and differences between non-radiographic and radiographic axial spondyloarthritis: The patient perspective from the Spanish atlas. REUMATOLOGIA CLINICA 2022; 18:169-176. [PMID: 35277214 DOI: 10.1016/j.reumae.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/15/2020] [Indexed: 06/14/2023]
Abstract
AIM Although non-radiographic axial spondyloarthritis (EspAax-nr) is well understood within health institutions, being considered along with radiographic EspAax (EspAax-r) as part of the same disease spectrum, patient understanding is unknown. The aim is to describe the patient's knowledge of the EspAax-nr entity. METHODS Atlas 2017, promoted by the Spanish Federation of Spondylarthritis Associations (CEADE), aims to comprehensively understand the reality of EspAax patients from a holistic approach. A cross-sectional on-line survey of unselected patients with self-reported EspAax diagnosis from Spain was conducted. Participants were asked to report their diagnosis. Socio-demographic, disease characteristics and patient-reported outcomes (PROs) were compared between those patients self-reporting as EspAax-nr and EspAax-r. RESULTS 634 EspAax patients participated. Mean age 45.7±10.9 years, 50.9% female and 36.1% university-educated. 35 (5.2%) self-reported as EspAax-nr. Compared to EspAax-r patients, those with EspAax-nr were more frequently women (48.6% vs 91.4%, p<0.001), had longer diagnostic delay (10.1±8.9 vs 8.5±7.6 years), higher psychological distress (GHQ-12: 7.5±4.9 vs 5.6±4.4) and similar degree of disease activity (BASDAI: 5.7±2.1 vs 5.7±2.0), and unemployment rates (20.0% vs 21.6%). 20.0% of EspAax-nr received biologics vs 36.9% of EspAax-r, p=0.043. Visits to the rheumatologist in the past year were similar in both groups (3.8±4.5 vs 3.2±3.8), while GP visits were much higher within EspAax-nr (8.0±10.7 vs 4.9±13.3 p=0.003). CONCLUSION For the first time, EspAax-nr characteristics and PROs have been analyzed from the patient's perspective. Both groups reported similar trends with the exception of EspAax-nr being more frequently women, younger, having longer diagnostic delay and lower use of biologic therapy.
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Affiliation(s)
- Marco Garrido-Cumbrera
- Health & Territory Research, Universidad de Sevilla, Seville, Spain; Spanish Federation of Spondyloarthritis Associations (CEADE), Madrid, Spain.
| | - Jordi Gratacos
- Hospital Universitari Parc Taulí, I3PT, UAB, Barcelona, Spain
| | - Eduardo Collantes-Estevez
- Reina Sofia University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Braun J, Baraliakos X, Bülow R, Schmidt CO, Richter A. Striking sex differences in magnetic resonance imaging findings in the sacroiliac joints in the population. Arthritis Res Ther 2022; 24:29. [PMID: 35057838 PMCID: PMC8772059 DOI: 10.1186/s13075-021-02712-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In patients with axial spondyloarthritis (axSpA), magnetic resonance imaging (MRI) is used to detect bone marrow edema (BME) in sacroiliac joints (SIJ) but SIJ BME are also detected in the population. Not much is known about sex differences in that regard.
Objective
To explore sex-specific differences associated with the extent of BME in the SIJ suggestive of axSpA in a general population cohort study.
Methods
Taking advantage of 793 recently evaluated MRIs of subjects < 45 years taking part in the SHIP cohort, we used negative-binomial (NB) count data regression to analyze factors associated with the extent of SIJ BME. Predictors were explored by model-based boosting (MBB), a machine learning approach.
Results
Estimates of NB regression showed strong effects of sex in interaction with age, BMI, back pain, and particularly HLA-B27. The NB regression model showed incidence rate ratios (IRR) for the main effect of sex (females vs. males): 0.94 [95% CI: 0.63; 1.41], HLA-B27: 4.32 [2.09; 9.8], and for the interaction of sex to HLA-B27: 0.22 [0.06; 0.75]. According to MBB, HLA-B27 positivity, BMI, current smoking, back pain in the last 3 months, the interaction of sex and HLA-B27, and delivery in the last 12 months were of highest importance to explain the extent of SIJ BME.
Conclusions
Different factors were associated with the extent of SIJ BME in females and males. Most importantly, HLA-B27 was relevant only in males but not in females in whom a postpartal state was important. This finding may be relevant for the pathogenesis of axSpA.
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40
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Hospach T, Horneff G, Poddubnyy D. [Spondyloarthritis in childhood and adulthood]. Z Rheumatol 2022; 81:14-21. [PMID: 34985566 DOI: 10.1007/s00393-021-01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
Axial spondylarthritis in adulthood (SpAA) is frequently initially manifested as a sacroiliitis, whereas this not true for enthesitis-related arthritis (EAA), which begins in childhood and adolescence. Classically, EAA begins with peripheral arthritis and only a part transitions into a juvenile SpA (jSpA) or SpAA. The criteria used for classification of SpAA and EAA are currently being validated and revised. For the first time imaging is included for EAA. For both diseases nonsteroidal anti-inflammatory drugs (NSAID) are initially used therapeutically, followed by biologicals or synthetic targeted disease-modifying drugs in refractory courses. Steroids should be avoided in long-term treatment. For optimal transition and further care in adulthood, a close cooperation between internistic and pediatric rheumatologists is necessary.
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Affiliation(s)
- Toni Hospach
- Zentrum für pädiatrische Rheumatologie, am Klinikum Stuttgart (ZEPRAS), Kriegsbergstr 62, 70176, Stuttgart, Deutschland.
| | - Gerd Horneff
- Rheumazentrum für Kinder und Jugendliche, St. Augustin, Deutschland
| | - Denis Poddubnyy
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité, Berlin, Deutschland
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Karoli R, Karoli Y, Avasthi S, Mahapatra S. Clinical profile of ankylosing spondylitis at a teaching hospital. Ann Afr Med 2022; 21:204-207. [DOI: 10.4103/aam.aam_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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42
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Schwartzman S, Ruderman EM. A Road Map of the Axial Spondyloarthritis Continuum. Mayo Clin Proc 2022; 97:134-145. [PMID: 34801248 DOI: 10.1016/j.mayocp.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/17/2022]
Abstract
Axial spondyloarthritis (axSpA) is a chronic, immune-mediated inflammatory disease characterized by inflammatory low back pain, inflammation in peripheral joints and entheses, and other extra-articular or systemic manifestations. Although our understanding of the natural history of axSpA has been limited by incomplete knowledge of disease pathogenesis, axSpA is increasingly understood as a spectrum of axial, peripheral, and extra-articular inflammatory conditions that includes nonradiographic axSpA and radiographic axSpA, also known as ankylosing spondylitis. In this narrative review, we present a road map of this axSpA continuum, highlighting genetic risk factors for the development of axSpA, triggers of disease, and reasons for and implications of diagnostic delay. We present a detailed overview of the spectrum of axSpA clinical manifestations and highlight factors known to influence the risk of disease progression. Finally, we provide some expert commentary on the practical use of this road map to assist health care providers in the identification of axSpA in clinical practice.
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Affiliation(s)
| | - Eric M Ruderman
- Northwestern University Feinberg School of Medicine, Chicago, IL
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43
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Poddubnyy D, Sieper J, Akar S, Muñoz-Fernández S, Haibel H, Hojnik M, Ganz F, Inman RD. Characteristics of Patients With Axial Spondyloarthritis by Geographic Regions: PROOF Multicountry Observational Study Baseline Results. Rheumatology (Oxford) 2021; 61:3299-3308. [PMID: 34897381 PMCID: PMC9348765 DOI: 10.1093/rheumatology/keab901] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/29/2021] [Indexed: 01/20/2023] Open
Abstract
Objectives To compare demographic and clinical characteristics of patients with axial SpA (axSpA) across geographic regions. Methods Patients With Axial Spondyloarthritis: Multicountry Registry of Clinical Characteristics (PROOF) is an observational study that enrolled recently diagnosed (≤1 year) axSpA patients fulfilling the Assessment of SpondyloArthritis international Society classification criteria from rheumatology clinical practices in 29 countries across six geographic regions. Demographics and disease-related parameters were collected. Here we present baseline data for patients who were classified as radiographic axSpA (r-axSpA) or non-radiographic axSpA (nr-axSpA) confirmed by central reading. Results Of the 2170 patients enrolled, 1553 were classified based on central evaluation of sacroiliac radiographs [r-axSpA: 1023 (66%); nr-axSpA: 530 (34%)]. Patients with nr-axSpA had a significantly higher occurrence of enthesitis (40% vs 33%), psoriasis (10% vs 5%) and IBD (4% vs 2%) vs r-axSpA patients. Significant differences in axSpA characteristics were observed between geographic regions. The highest occurrence of peripheral arthritis (60%), enthesitis (52%) and dactylitis (12%) was in Latin America, and the lowest was in Canada (9%, 9% and 2%, respectively). The occurrence of uveitis and psoriasis was highest in Canada (18% and 14%, respectively) and lowest in China (6% and <1%, respectively). IBD was highest in Arabia (21%), and no cases were observed in China. In multivariable analysis adjusted for factors potentially affecting peripheral and extramusculoskeletal manifestations, geographic regions still exhibited significant differences in frequencies of uveitis (P < 0.01), psoriasis (P < 0.0001) and peripheral arthritis (P < 0.0001). Conclusion The multinational PROOF study of axSpA patients showed significant regional differences in peripheral and extramusculoskeletal manifestations of SpA, which could be considered in management guidelines and clinical trials.
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Affiliation(s)
- Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Joachim Sieper
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Servet Akar
- Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University, Izmir, Turkey
| | - Santiago Muñoz-Fernández
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, Universidad Europea, Madrid, Spain
| | - Hildrun Haibel
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maja Hojnik
- Global Medical Affairs Rheumatology, AbbVie Inc., Ljubljana, Slovenia
| | - Fabiana Ganz
- Global Medical Affairs, AbbVie Inc., Baar, Switzerland
| | - Robert D Inman
- Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is a chronic, rheumatic disease characterized by inflammation of the sacroiliac joint, spine, and entheses. Axial spondyloarthritis affects up to 1.4% of adults in the United States and is associated with decreased quality of life, increased mortality, and substantial health care-related costs, imposing a high burden on patients, their caregivers, and society. SUMMARY OF WORK Diagnosing axSpA can be difficult. In this review, we seek to help rheumatologists in recognizing and diagnosing axSpA. MAJOR CONCLUSIONS A discussion of challenges associated with diagnosis is presented, including use and interpretation of imaging, reasons for diagnostic delays, differences in disease presentation by sex, and differential diagnoses of axSpA. FUTURE RESEARCH DIRECTIONS The early diagnosis of axSpA and advances in available therapeutic options have improved patient care and disease management, but delays in diagnosis and treatment remain common. Additional research and education are critical for recognizing diverse axSpA presentations and optimizing management early in the course of disease.
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Affiliation(s)
- Jessica A. Walsh
- From the University of Utah School of Medicine and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT
| | - Marina Magrey
- The MetroHealth System and School of Medicine, Case Western Reserve University, Cleveland, OH
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Kim SH, Kim HR, Lee SH, Shin K, Kim HA, Min HK. Effectiveness and drug retention of biologic disease modifying antirheumatic drugs in Korean patients with late onset ankylosing spondylitis. Sci Rep 2021; 11:21555. [PMID: 34732807 PMCID: PMC8566570 DOI: 10.1038/s41598-021-01132-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022] Open
Abstract
The clinical data on the biologic disease-modifying antirheumatic drug (bDMARD) use in late-onset ankylosing spondylitis (LOAS) is limited. Thus, this study aimed to evaluate the drug efficacy and retention rate of bDMARDs in LOAS and compare it to young-onset ankylosing spondylitis (YOAS). Data of patients with AS receiving bDMARDs were extracted from the Korean College of Rheumatology Biologics and Targeted Therapy registry. Patients whose age of onset was > 50 years and ≤ 50 years were classified as having LOAS and YOAS, respectively. Their baseline characteristics and disease-associated parameters were evaluated. Drug efficacy [Ankylosing Spondylitis Disease Activity Score (ASDAS)-clinically important improvement (CII), ASDAS-major improvement (MI), Assessment of SpondyloArthritis International Society (ASAS) 20, and ASAS 40] at 1-year follow-up and drug retention rates were assessed. A total of 1708 patients (comprising 1472 patients with YOAS and 236 patients with LOAS) were included in this analysis. The LOAS group had a lower prevalence among males, lower HLA-B27 positivity and a higher prevalence of peripheral arthritis. Patients with LOAS were more likely to have higher disease-associated parameters (inflammatory reactants, patient global assessment, ASDAS-erythrocyte sedimentation rate, and ASDAS-C-reactive protein). LOAS was negatively associated with achieving ASDAS-CII, ASAS 20, and ASAS 40. The drug retention rate was lower in LOAS; however, the propensity score-matched and covariate-adjusted hazard ratios for bDMARD discontinuation were comparable to YOAS. There were no differences in the drug retention rates based on the type of bDMARD used in LOAS. Inferior clinical efficacy and shorter drug retention time were found in patients with LOAS receiving bDMARDs using real-world nationwide data. There were no differences among each bDMARD type.
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Affiliation(s)
- Se Hee Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea.
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Hayward RJ, Machado PM. Classification Criteria in Axial Spondyloarthritis: What Have We Learned; Where Are We Going? Rheum Dis Clin North Am 2021; 46:259-274. [PMID: 32340700 DOI: 10.1016/j.rdc.2020.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Spondyloarthritis (SpA) is a chronic inflammatory condition that can have a predominately peripheral or axial presentation. Axial SpA (axSpA) affects the axial skeleton with either radiographic (r-axSpA) or nonradiographic (nr-axSpA) changes. Radiographic changes are a late disease feature and earlier disease stages can be identified by incorporating other imaging methods. The diagnosis of axSpA is a clinical diagnosis and classification criteria are not aimed to be diagnostic tools. The split between r-axSpA and nr-axSpA is artificial and we should move toward the unifying concept of axSpA. Our understanding of genetics, biomarkers, and immunopathophenotypes will drive further refinement of classification criteria.
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Affiliation(s)
- Rhys J Hayward
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, Middlesex HA1 3UJ, London, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor, 250 Euston Road, NW1 2PG, London, UK
| | - Pedro M Machado
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, Middlesex HA1 3UJ, London, UK; Department of Neuromuscular Diseases, University College London, 1st Floor, Russell Square House, 10-12 Russell Square, WC1B 5EH, London, UK; Centre for Rheumatology, University College London, Room 415, 4th Floor, Rayne Institute, 5 University St, Bloomsbury, London WC1E 6JF.
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Braun J, Kiltz U, Bühring B, Baraliakos X. Secukinumab in axial spondyloarthritis: a narrative review of clinical evidence. Ther Adv Musculoskelet Dis 2021; 13:1759720X211041854. [PMID: 34471428 PMCID: PMC8404628 DOI: 10.1177/1759720x211041854] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease characterized by inflammation and new bone formation in the axial skeleton. AxSpA is considered a spectrum of disease that includes two subtypes identified by the Assessment in SpondyloArthritis International Society classification criteria, namely, radiographic (r-axSpA usually referred to as ankylosing spondylitis) and non-radiographic axSpA (nr-axSpA). Although the burden of disease appears similar between the two classified subtypes, the degree of inflammation, as assessed by magnetic resonance imaging and C-reactive protein, and the degree of new bone formation are significantly higher in r-axSpA than in nr-axSpA. Nevertheless, axSpA is considered one disease with different courses. International guidelines for the management of axSpA have outlined treatment goals focused on control of signs and symptoms, inflammation, prevention of progressive structural damage, preservation of physical function, normalization of social participation and improvement of quality of life. The pathogenesis of axSpA has not been completely elucidated to date. A strong link between human leukocyte antigen B27 and axSpA, however, has been identified, and the success of anti-tumour necrosis factor and anti-interleukin (IL)-17A therapy has highlighted some of the key pro-inflammatory cytokines involved. The anti-IL-17A monoclonal antibody secukinumab is approved for the treatment of ankylosing spondylitis and nr-axSpA in the European Union and United States. In this narrative review, we discuss data for secukinumab in axSpA from randomized controlled trials, including MEASURE trials in AS and PREVENT in nr-axSpA, and real-world evidence.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Landgrafenstrasse 15, D-44652 Herne, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University, Bochum, Germany
| | - Björn Bühring
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University, Bochum, Germany
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Exarchou S, Turesson C, Lindström U, Ramonda R, Landewé RBM, Dagfinrud H, van Gaalen F, van der Heijde D, Jacobsson LTH. Lifestyle Factors and Disease Activity over Time in Early Axial Spondyloarthritis - The SPondyloArthritis Caught Early (SPACE) Cohort. J Rheumatol 2021; 49:365-372. [PMID: 34470793 DOI: 10.3899/jrheum.210046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our aim was to study the importance of baseline Body Mass Index (BMI), smoking and alcohol consumption (AC) for disease activity (DA) over one year in early axial spondyloarthritis (axSpA), stratified by sex. METHODS In the SPondyloArthritis Caught Early cohort (patients with chronic back pain for ≥3 months, ≤2 years and onset <45 years), ASDAS was recorded at inclusion, 3 and 12 months. All patients included in the analysis had axSpA based on a high physician's level of confidence at baseline. Differences in ASDAS over 1 year by BMI (normal <25, overweight 25-29.9, obese ≥30 kg/m2), smoking history (never/previous/current) and AC (none, 0.1-2, 3-5, ≥6 units/week) at baseline were estimated using mixed linear regression models. RESULTS There were 344 subjects (mean age 30 years; 49% men). In women, obesity was associated with 0.60 (95% CL 0.28, 0.91) higher ASDAS compared to normal BMI. In both sexes, AC tended to be associated with lower DA over one year, with a significant association only in women with the highest AC (mean difference -0.55 (96% CL-1.05, -0.04). Smoking was associated with higher ASDAS over one year compared to never smoking in both sexes, albeit the difference reached statistical significance only in female former smokers. Results were similar in multivariable analysis, adjusted for all lifestyle factors and other confounders. CONCLUSION In early axSpA, BMI and smoking are associated with higher DA over one year, and AC with lower DA. The magnitude of the modest associations may differ between men and women.
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Affiliation(s)
- Sofia Exarchou
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Ulf Lindström
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Roberta Ramonda
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Robert B M Landewé
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Hanne Dagfinrud
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Floris van Gaalen
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Désirée van der Heijde
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Lennart T H Jacobsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
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A single center experience: physician related diagnostic delay and demographic and clinical differences between patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis. ACTA ACUST UNITED AC 2021; 59:278-285. [PMID: 33544548 DOI: 10.2478/rjim-2021-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Indexed: 12/12/2022]
Abstract
Background. A large number of comparative studies have been conducted for ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA), including disease burden, treatment modalities and patient characteristics. The aim of this study was to compare physician related diagnostic delay time between patients with AS and nr-axSpA. Methods. In our retrospective study we included 266 patients with axSpA. Patients were classified into two subgroups, AS and nr-axSpA. The time from back pain onset until diagnosis of axSpA was defined as the diagnostic delay. The first specialist referred to and the first diagnosis for each patient was noted in detail. Patient characteristics, clinical manifestations and laboratory and imaging results at diagnosis were also compared between subgroups. Results. The diagnostic delay time was significantly longer for AS patients [6 ± 8.14 years vs 1.62 ± 2.54 years]. 40.9% of all patients were initially consulted by specialists in physical therapy and rehabilitation, followed by 29.7% consulted by a neurosurgeon and 19.9% by a rheumatologist. The most common initial diagnosis was fibromyalgia, 52.6% (140), followed by ankylosing spondylitis, 28.9% (77), and lumbar disc hernia, 12.7% (34). Conclusion. The vast majority of patients were initially evaluated by healthcare providers other than rheumatologists and mostly diagnosed with fibromyalgia. Efforts to increase awareness and to educate first healthcare providers may shorten the diagnostic delay time.
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Tu L, Lin C, Xie Y, Wang X, Wei Q, Zhang Y, Gu J. Active Inflammatory and Chronic Structural Damages of Sacroiliac Joint in Patients With Radiographic Axial Spondyloarthritis and Non-Radiographic Axial Spondyloarthritis. Front Immunol 2021; 12:700260. [PMID: 34386008 PMCID: PMC8353186 DOI: 10.3389/fimmu.2021.700260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/12/2021] [Indexed: 01/31/2023] Open
Abstract
Objective Evaluate the MRI evidence of active inflammatory and chronic structural damages in radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA). Methods A retrospective review of 253 patients who underwent sacroiliac joint (SIJ) MRI between June 2014 and December 2019 was performed. MRI images including short tau inversion recovery scan and T1-weighted spin echo scans were assessed using the Spondyloarthritis Research Consortium of Canada (SPARCC) score and SPARCC MRI SIJ structural score by two independent readers. Results Higher mean score of inflammatory (SPARCC) was seen in r-axSpA patients when compared with nr-axSpA patients (8.08 vs 4.37, P<0.05). Frequencies of MRI structural lesions in r-axSpA patients and nr-axSpA patients were as follows: erosion (65.84 vs 88.23%, P=0.002), backfill (33.17 vs 13.73%, P<0.001), fat metaplasia (79.21 vs 60.78%, P=0.01), and ankylosis (37.13 vs 1.96%, P<0.001). Patients with r-axSpA had a higher mean score for fat metaplasia (8.93 vs 4.06, P=0.0003) and ankylosis (4.49 vs 0.04, P<0.001). Conclusion More active inflammatory and chronic structural damages except for erosion were seen in r-axSpA patients than nr-axSpA patients, while higher percentage of nr-axSpA patients presented with erosion in MRI.
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Affiliation(s)
- Liudan Tu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Churong Lin
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ya Xie
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaohong Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiujing Wei
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanli Zhang
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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