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Hansmaennel A, Fakih O, Gerazime A, Prati C, Chouk M, Wendling D, Verhoeven F. Effects of disease-modifying anti-rheumatic drugs on sacroiliac MRI score in axial spondyloarthritis: a systematic review and meta-analysis. Clin Rheumatol 2024; 43:1045-1052. [PMID: 38158505 DOI: 10.1007/s10067-023-06849-5] [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: 07/24/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Sacroiliac bone marrow edema is an important factor in the diagnosis and management of axial spondyloarthritis (axSpA). The aim of this meta-analysis is to assess the effect of the different bDMARDs and tsDMARDs on the SPARCC score at 12-16 and 48-52 weeks. METHODS A systematic review, performed on PubMed (including Medline), Cochrane (CENTRAL) and DOAJ databases, included randomized controlled studies evaluating the sacroiliac joint (SIJ) SPARCC score at 12-16 or 48-52 weeks in patients with axSpA meeting the ASAS 2009 criteria or the modified New York criteria. We included studies evaluating the effects of the different treatments on the SPARCC score of SIJ in axial spondyloarthritis in comparison to a control group. RESULTS Eighteen studies were included in the meta-analysis. Nine studies evaluated the effect of TNFα inhibitors (TNFi), three for IL-17 inhibitors, and four for JAK inhibitors. At 12 and 16 weeks, SIJ SPARCC score was significantly improved by TNFi (WMD: - 3.29 [95% CI - 4.25; - 2, 34]), by IL-17 inhibitors (WMD: - 4.66 [95% CI - 6.22; - 3.09]), and by JAK inhibitors (JAKi) (WMD: - 3.06 [95% CI - 3.24; - 2.89]). There was no difference between the molecule subgroups. At 48-52 weeks, TNFα inhibitors reduced more SIJ SPARCC, but not significantly (WMD: - 2.26 [95% CI - 4.94; 0.42]), than placebo groups who began a TNFi treatment with delay. CONCLUSION Our meta-analysis shows a comparable improvement of the SIJ SPARCC score regarding TNFi, JAKi, and IL-17 inhibitors at three months and suggests the presence of an opportunity window. Key Points • Anti-TNF Ab, anti-IL17 Ab, and JAK inhibitor treatments reduce the sacroiliac joint SPARCC scores. • There is no difference between the different treatments in the reduction of the sacroiliac joint SPARCC score after 3 months in axial spondyloarthritis.
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Affiliation(s)
| | - Olivier Fakih
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Aurélie Gerazime
- Unité de méthodologie clinique, CHU de Besançon, Besançon, France
| | - Clément Prati
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4267 "PEPITE", Université de Bourgogne Franche Comté, Besançon, France
| | - Mickaël Chouk
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Daniel Wendling
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4266 "EPILAB", Université de Bourgogne Franche-Comté, Besançon, France
| | - Frank Verhoeven
- Service de Rhumatologie, CHU de Besançon, Besançon, France.
- EA 4267 "PEPITE", Université de Bourgogne Franche Comté, Besançon, France.
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Mauro D, Forte G, Poddubnyy D, Ciccia F. The Role of Early Treatment in the Management of Axial Spondyloarthritis: Challenges and Opportunities. Rheumatol Ther 2024; 11:19-34. [PMID: 38108992 PMCID: PMC10796311 DOI: 10.1007/s40744-023-00627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic, inflammatory rheumatic disease that primarily affects the axial skeleton, often inflicting severe pain, diminished mobility, and a compromised quality of life. The advent of Assessment of SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis (SpA) have enabled the classification of patients with axSpA in the non-radiographic stage but poorly perform if mistakenly used for diagnostic purposes. Despite notable progress in early diagnosis facilitated by referral strategies and extensive magnetic resonance imaging (MRI) utilization, diagnostic delays persist as a concerning issue. This underscores the urgency to narrow the diagnostic gap and highlights the critical role of early diagnosis in mitigating the long-term structural damage associated with this condition. Research into the impact of non-steroidal anti-inflammatory drugs (NSAIDs) and biologic disease-modifying antirheumatic drugs (bDMARDs) on inflammatory symptoms and radiographic progression has been extensive. A compelling body of evidence suggests that early intervention leads to superior disease outcomes. However, most of these studies have centered on patients with established diseases rather than those in the early stages. Consequently, findings from studies on early pharmacological intervention remain inconclusive, and the potential for modifying the disease trajectory is still debatable. Without precise data from clinical trials, insights from basic science regarding the pathogenic mechanisms might point toward potential targets that warrant early intervention in the disease process. This review underscores the urgency of early diagnosis and intervention in axSpA, highlighting ongoing research gaps and the need for further exploration to improve patient outcomes.
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Affiliation(s)
- Daniele Mauro
- Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giulio Forte
- Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Francesco Ciccia
- Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Via Sergio Pansini 5, 80131, Naples, Italy.
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Lin Y, Chan SCW, Chung HY, Lee KH, Cao P. A deep neural network for MRI spinal inflammation in axial spondyloarthritis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-023-08099-0. [PMID: 38190004 DOI: 10.1007/s00586-023-08099-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/03/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To develop a deep neural network for the detection of inflammatory spine in short tau inversion recovery (STIR) sequence of magnetic resonance imaging (MRI) on patients with axial spondyloarthritis (axSpA). METHODS A total 330 patients with axSpA were recruited. STIR MRI of the whole spine and clinical data were obtained. Regions of interests (ROIs) were drawn outlining the active inflammatory lesion consisting of bone marrow edema (BME). Spinal inflammation was defined by the presence of an active inflammatory lesion on the STIR sequence. The 'fake-color' images were constructed. Images from 270 and 60 patients were randomly separated into the training/validation and testing sets, respectively. Deep neural network was developed using attention UNet. The neural network performance was compared to the image interpretation by a radiologist blinded to the ground truth. RESULTS Active inflammatory lesions were identified in 2891 MR images and were absent in 14,590 MR images. The sensitivity and specificity of the derived deep neural network were 0.80 ± 0.03 and 0.88 ± 0.02, respectively. The Dice coefficient of the true positive lesions was 0.55 ± 0.02. The area under the curve of the receiver operating characteristic (AUC-ROC) curve of the deep neural network was 0.87 ± 0.02. The performance of the developed deep neural network was comparable to the interpretation of a radiologist with similar sensitivity and specificity. CONCLUSION The developed deep neural network showed similar sensitivity and specificity to a radiologist with four years of experience. The results indicated that the network can provide a reliable and straightforward way of interpreting spinal MRI. The use of this deep neural network has the potential to expand the use of spinal MRI in managing axSpA.
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Affiliation(s)
- Yingying Lin
- Department of Diagnostic Radiology, The University of Hong Kong, LG3 Sassoon Road No. 5, Pok Fu Lam, Hong Kong
| | - Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Chiron Medical, Central, Hong Kong
| | - Kam Ho Lee
- Department of Radiology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Peng Cao
- Department of Diagnostic Radiology, The University of Hong Kong, LG3 Sassoon Road No. 5, Pok Fu Lam, Hong Kong.
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Chan SCW, Chung HY. MRI for axial SpA: Diagnosis, disease activity assessment, and recent advances. Int J Rheum Dis 2024; 27:e15014. [PMID: 38287559 DOI: 10.1111/1756-185x.15014] [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: 04/06/2023] [Revised: 11/12/2023] [Accepted: 12/12/2023] [Indexed: 01/31/2024]
Abstract
Magnetic resonance imaging (MRI) is a sensitive imaging modality to detect early inflammatory changes in axial spondyloarthritis (SpA). Over a decade has passed since the inclusion of MRI assessment in the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial SpA. Evidence and clinical experience of MRI in axial SpA have accumulated rapidly since. This has led to a better understanding of the clinical utility of MRI in early diagnosis, disease activity assessment, and monitoring of treatment response in axial SpA. Furthermore, technological advancements have paved the way for the development of novel MRI sequences for the quantification of inflammation and image optimization. The field of artificial intelligence has also been explored to aid medical imaging interpretation, including MRI in axial SpA. This review serves to provide an update on the latest understanding of the evolving roles of MRI in axial SpA.
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Affiliation(s)
- Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Tian H, Li T, Wang Y, Lu H, Lin L, Wu X, Xu H. The correlations between C-reactive protein and MRI-detected inflammation in patients with axial spondyloarthritis: a systematic review and meta-analysis. Clin Rheumatol 2023; 42:2397-2407. [PMID: 37336841 PMCID: PMC10412674 DOI: 10.1007/s10067-023-06658-w] [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: 06/07/2022] [Revised: 04/14/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA. MATERIALS AND METHODS A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models. RESULTS Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I2=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I2=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I2=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I2=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS. CONCLUSIONS In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.
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Affiliation(s)
- Haoran Tian
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Ting Li
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Yuanqiong Wang
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Hongjuan Lu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Li Lin
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Xin Wu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
- Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, 100084, China.
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China.
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Østergaard M, Wu J, Fallon L, Sherlock SP, Wang C, Fleishaker D, Kanik KS, Maksymowych WP. Tofacitinib Reduces Spinal Inflammation in Vertebral Bodies and Posterolateral Elements in Ankylosing Spondylitis: Results from a Phase 2 Trial. Rheumatol Ther 2023; 10:1001-1020. [PMID: 37331992 PMCID: PMC10326231 DOI: 10.1007/s40744-023-00564-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION This post hoc analysis of phase 2 trial data assessed the efficacy of tofacitinib on magnetic resonance imaging (MRI) outcomes with the detailed anatomy-based Canada-Denmark (CANDEN) MRI scoring system and evaluated tofacitinib suppression of spinal inflammation in patients with active ankylosing spondylitis (AS). METHODS Patients with active AS (per modified New York criteria) were randomized 1:1:1:1 to receive tofacitinib 2, 5, or 10 mg twice daily (BID), or placebo, in a 16-week, phase 2, double-blind clinical trial. Spine MRI assessments were performed at baseline and week 12. For post hoc analysis, MRI images from patients receiving tofacitinib 5 or 10 mg BID, or placebo, were re-evaluated by two readers blinded to time point/treatment and assessed by the CANDEN MRI scoring system. Least squares mean changes from baseline to week 12 were reported for CANDEN-specific MRI outcomes, with analysis of covariance used for comparisons of pooled tofacitinib and tofacitinib 5 or 10 mg BID versus placebo. p values without multiplicity adjustment were reported. RESULTS MRI data from 137 patients were analyzed. At week 12, CANDEN spine inflammation score and vertebral body, posterior elements, corner, non-corner, facet joint, and posterolateral inflammation subscores were significantly reduced with pooled tofacitinib versus placebo (p < 0.0001; except non-corner subscore, p < 0.05). Total spine fat score was numerically increased with pooled tofacitinib versus placebo. CONCLUSIONS In patients with AS, tofacitinib treatment was associated with significant reductions in MRI scores of spinal inflammation versus placebo, as assessed by the CANDEN MRI scoring system. Tofacitinib reduced inflammation in posterolateral elements of the spine and facet joints, which has not been described previously. TRIAL REGISTRATION ClinicalTrials.gov registry (NCT01786668).
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Affiliation(s)
- Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Copenhagen, Denmark.
| | | | | | | | | | | | | | - Walter P Maksymowych
- Department of Medicine, University of Alberta, and CARE Arthritis, Edmonton, AB, Canada
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Stal R, Ramiro S, van der Heijde D, van Gaalen FA, Baraliakos X, Machado PM, de Hooge M, van den Berg R, Reijnierse M, Braun J, Landewé R, Sepriano A. Do fatty lesions explain the effect of inflammation on new syndesmophytes in patients with radiographic axial spondyloarthritis? Results from the SIAS cohort and ASSERT trial. RMD Open 2023; 9:e003118. [PMID: 37407237 DOI: 10.1136/rmdopen-2023-003118] [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: 02/28/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To determine how much of the effect of vertebral corner inflammation on development of syndesmophytes is explained by vertebral corner fat deposition. METHODS Patients with radiographic axial spondyloarthritis (r-axSpA) from the SIAS (Sensitive Imaging in Ankylosing Spondylitis) cohort and ASSERT (Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy) trial were assessed at T0, T1 (SIAS: 1 year; ASSERT: 24 weeks) and T2 (2 years). Syndesmophytes assessed in each vertebral corner by whole spine low-dose CT (SIAS) or spinal radiographs (ASSERT) at T0 and T2 were considered present if seen by two of two readers. Inflammation (T0) and fat deposition (T0 and T1) on MRI were present if seen by ≥2 of 3 readers (SIAS) or 2 of 2 readers (ASSERT). Vertebral corners showing fat deposition or a syndesmophyte at baseline were ignored. Mediation analysis was applied to determine what proportion of the total effect of inflammation on syndesmophyte formation could be explained via the path of intermediate fat deposition. RESULTS Forty-nine SIAS patients (with 2667 vertebral corners) and 168 ASSERT patients (with 2918 vertebral corners) were analysed. The presence of inflammation at T0 increased the probability of a new syndesmophyte in the same vertebral corner at T2 by 9.3%. Of this total effect, 0.2% (2% (0.2 of 9.3) of the total effect) went via intermediate new fat deposition. In ASSERT, the total effect was 7.3%, of which 0.8% (10% of the total effect) went via new fat deposition. CONCLUSION In r-axSpA, vertebral corner inflammation may lead to syndesmophyte formation but in a minority of cases via visible fat deposition.
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Affiliation(s)
- Rosalinde Stal
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Pedro M Machado
- Centre for Rheumatology, University College London, London, UK
| | - Manouk de Hooge
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- VIB Center of Inflammation Research, Ghent University, Ghent, Belgium
| | - Rosaline van den Berg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Robert Landewé
- Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Clinical Immunology & Rheumatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Universidade Nova de Lisboa, Lisbon, Portugal
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[History of the treatment of axial spondylarthritis with biologics-Part 1]. Z Rheumatol 2022; 81:888-894. [PMID: 36063166 DOI: 10.1007/s00393-022-01262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 12/13/2022]
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Chung HY, Huang JX, Lee KH, Tsang HHL, Lau CS, Chan SCW. MRI lesions in SpA: a comparison with noninflammatory back pain using propensity score adjustment method. Ther Adv Musculoskelet Dis 2022; 14:1759720X221119250. [PMID: 36051632 PMCID: PMC9425894 DOI: 10.1177/1759720x221119250] [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: 04/07/2022] [Accepted: 07/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Magnetic resonance imaging (MRI) is important in the management of axial spondyloarthritis (SpA). However, many MRI lesions are not exclusive to axial SpA. Further characterization of these lesions may lead to better clinical decisions. Objective: The objective of this study was to compare the frequency of individual spinal MRI lesions between axial SpA and noninflammatory back pain. The factors associated with individual lesions in participants with axial SpA were also determined. Design: This was a cross-sectional observational study. Methods: MRI lesions in 447 participants with axial SpA and 122 participants with noninflammatory back pain were compared using the propensity score adjustment method. Individual lesions included discovertebral lesions (DVL), Modic type 1 lesions, DVL without Modic type 1 lesions, facet joint lesions, costovertebral joint lesions, corner inflammatory lesions (CIL), and fatty corner lesions (FCL). The factors associated with the lesions were determined using regression analyses. Results: Among participants with axial SpA, 81.9% were HLA-B27-positive, 55.0% had radiographic axial SpA, and 60.5% had radiographic features of spinal damage (mSASSS >2). Almost half (48.6% in axial SpA versus 31.1% in noninflammatory back pain) had inflammatory lesions on spinal MRI. In propensity score matching with noninflammatory back pain, axial SpA had an increased occurrence of DVL without Modic type 1 lesion (OR = 3.43, p = 0.01), costovertebral lesion (OR = 11.89, p = 0.02), number of CIL (B = 1.19, p < 0.001), and number of FCL (B = 3.33, p < 0.001). Similar associations were found in the regression models in the radiographic axial SpA subgroup: DVL without Modic type 1 lesion (OR = 2.46, p = 0.001), costovertebral lesion (OR = 3.86, p < 0.001), number of CIL (B = 1.13, p < 0.001), and FCL (B = 2.29, p < 0.01). Conclusion: MRI lesions including DVL without Modic type 1, costovertebral joint lesions, CIL, and FCL were more specific in axial SpA.
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Affiliation(s)
- Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Jin Xian Huang
- Division of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kam Ho Lee
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Helen Hoi Lun Tsang
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong
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Navarro-Compán V, Boel A, Boonen A, Mease PJ, Dougados M, Kiltz U, Landewé RBM, Baraliakos X, Bautista-Molano W, Chiowchanwisawakit P, Dagfinrud H, Fallon L, Garrido-Cumbrera M, Gensler L, ElZorkany BK, Haroon N, Kwan YH, Machado PM, Maksymowych W, Molto A, de Peyrecave N, Poddubnyy D, Protopopov M, Ramiro S, Song IH, van Weely S, van der Heijde D. Instrument selection for the ASAS core outcome set for axial spondyloarthritis. Ann Rheum Dis 2022; 82:763-772. [PMID: 35680390 DOI: 10.1136/annrheumdis-2022-222747] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To define the instruments for the Assessment of SpondyloArthritis international Society-Outcomes Measures in Rheumatology (ASAS-OMERACT) core domain set for axial spondyloarthritis (axSpA). METHODS An international working group representing key stakeholders selected the core outcome instruments following a predefined process: (1) identifying candidate instruments using a systematic literature review; (2) reducing the list of candidate instruments by the working group, (3) assessing the instruments' psychometric properties following OMERACT filter 2.2, (4) selection of the core instruments by the working group and (5) voting and endorsement by ASAS. RESULTS The updated core set for axSpA includes seven instruments for the domains that are mandatory for all trials: Ankylosing Spondylitis Disease Activity Score and Numerical Rate Scale (NRS) patient global assessment of disease activity, NRS total back pain, average NRS of duration and severity of morning stiffness, NRS fatigue, Bath Ankylosing Spondylitis Function Index and ASAS Health Index. There are 9 additional instruments considered mandatory for disease-modifying antirheumatic drugs (DMARDs) trials: MRI activity Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joints and SPARCC spine, uveitis, inflammatory bowel disease and psoriasis assessed as recommended by ASAS, 44 swollen joint count, Maastricht Ankylosing Spondylitis Enthesitis Score, dactylitis count and modified Stoke Ankylosing Spondylitis Spinal Score. The imaging outcomes are considered mandatory to be included in at least one trial for a drug tested for properties of DMARD. Furthermore, 11 additional instruments were also endorsed by ASAS, which can be used in axSpA trials on top of the core instruments. CONCLUSIONS The selection of the instruments for the ASAS-OMERACT core domain set completes the update of the core outcome set for axSpA, which should be used in all trials.
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Affiliation(s)
- Victoria Navarro-Compán
- Department of Rheumatology, La Paz University Hospital, Madrid, Spain .,IdiPaz, Madrid, Spain
| | - Anne Boel
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastrich University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Philip J Mease
- Department of Rheumatology Research, Swedish Medical Center, Seattle, Washington, USA
| | - Maxime Dougados
- Department of Rheumatology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Uta Kiltz
- Department of Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Germany
| | - Robert B M Landewé
- Amsterdam Rheumatology Center, Amsterdam, The Netherlands.,Department of Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | | | - Wilson Bautista-Molano
- School of Medicine, University Hospital Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá, Colombia
| | | | - Hanne Dagfinrud
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lara Fallon
- Inflammation and Immunology - Global Medical Affairs, Pfizer Inc, Montreal, Québec, Canada
| | - Marco Garrido-Cumbrera
- Health and Territory Research, Universidad de Sevilla, Sevilla, Spain.,Axial Spondyloarthritis International Federation, London, UK
| | - Lianne Gensler
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | | | - Nigil Haroon
- Department of Medicine, Schroder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | | | - Pedro M Machado
- Department of Neuromuscular Diseases, Centre for Rheumatology, University College London, London, UK.,National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Walter Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Molto
- Department of Rheumatology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Natasha de Peyrecave
- Department of Rheumatology Global Medical Affairs, UCB Pharma, Brussels, Belgium
| | - Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - In-Ho Song
- Department of Immunology Clinical Development, Abbvie, North Chicago, Illinois, USA
| | - Salima van Weely
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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11
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Evaluating the Impact of High Intensity Interval Training on Axial Psoriatic Arthritis Based on MR Images. Diagnostics (Basel) 2022; 12:diagnostics12061420. [PMID: 35741229 PMCID: PMC9222014 DOI: 10.3390/diagnostics12061420] [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: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022] Open
Abstract
High intensity interval training (HIIT) has been shown to benefit patients with psoriatic arthritis (PsA). However, magnetic resonance (MR) imaging has uncovered bone marrow edema (BME) in healthy volunteers after vigorous exercise. The purpose of this study was to investigate MR images of the spine of PsA patients for changes in BME after HIIT. PsA patients went through 11 weeks of HIIT (N = 19, 4 men, median age 52 years) or no change in physical exercise habits (N = 20, 8 men, median age 45 years). We acquired scores for joint affection and pain and short tau inversion recovery (STIR) and T1-weighted MR images of the spine at baseline and after 11 weeks. MR images were evaluated for BME by a trained radiologist, by SpondyloArthritis Research Consortium of Canada (SPARCC) scoring, and by extraction of textural features. No significant changes of BME were detected in MR images of the spine after HIIT. This was consistent for MR image evaluation by a radiologist, by SPARCC, and by texture analysis. Values of textural features were significantly different in BME compared to healthy bone marrow. In conclusion, BME in spine was not changed after HIIT, supporting that HIIT is safe for PsA patients.
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12
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Maksymowych WP, Østergaard M, Landewé R, Barchuk W, Liu K, Gilles L, Hendrikx T, Besuyen R, Baraliakos X. Filgotinib decreases both vertebral body and posterolateral spine inflammation in ankylosing spondylitis: results from the TORTUGA trial. Rheumatology (Oxford) 2022; 61:2388-2397. [PMID: 34647992 PMCID: PMC9157176 DOI: 10.1093/rheumatology/keab758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/28/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To assess the effects of filgotinib on inflammatory and structural changes at various spinal locations, based on MRI measures in patients with active AS in the TORTUGA trial. METHODS In the TORTUGA trial, patients with AS received filgotinib 200 mg (n = 58) or placebo (n = 58) once daily for 12 weeks. In this post hoc analysis, spine MRIs were evaluated using the Canada-Denmark (CANDEN) MRI scoring system to assess changes from baseline to week 12 in total spine and subscores for inflammation, fat, erosion and new bone formation (NBF) at various anatomical locations. Correlations were assessed between CANDEN inflammation and clinical outcomes and Spondyloarthritis Research Consortium of Canada (SPARCC) MRI scores and between baseline CANDEN NBF and baseline BASFI and BASMI scores. RESULTS MRIs from 47 filgotinib- and 41 placebo-treated patients were evaluated. There were significantly larger reductions with filgotinib vs placebo in total spine inflammation score and most inflammation subscores, including posterolateral elements (costovertebral joints, transverse/spinous processes, soft tissues), facet joints and vertebral bodies. No significant differences were observed for corner or non-corner vertebral body inflammation subscores, spine fat lesion, bone erosion or NBF scores. In the filgotinib group, the change from baseline in the total inflammation score correlated positively with the SPARCC spine score. Baseline NBF scores correlated with baseline BASMI but not BASFI scores. CONCLUSIONS Compared with placebo, filgotinib treatment was associated with significant reductions in MRI measures of spinal inflammation, including in vertebral bodies, facet joints and posterolateral elements. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov), NCT03117270.
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Affiliation(s)
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert Landewé
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - William Barchuk
- Clinical Research, Gilead Sciences, Inc., Foster City, CA, USA
| | - Ke Liu
- Clinical Research, Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | - Robin Besuyen
- Clinical Development, Galapagos BV, Leiden, Netherlands
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13
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Lems W, Miceli-Richard C, Haschka J, Giusti A, Chistensen GL, Kocijan R, Rosine N, Jørgensen NR, Bianchi G, Roux C. Bone Involvement in Patients with Spondyloarthropathies. Calcif Tissue Int 2022; 110:393-420. [PMID: 35066596 DOI: 10.1007/s00223-021-00933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/24/2021] [Indexed: 11/02/2022]
Abstract
Spondyloarthropathies (SpA) are common systemic inflammatory rheumatic diseases, in which, as in other rheumatic diseases, levels of markers of bone resorption are elevated, leading to bone loss and elevated risk of vertebral fractures. However, the diseases are also associated with new bone formation in the spine, the so-called syndesmophytes. We tried to unravel the pathogenesis of formation and growth of syndesmophytes and evaluated new diagnostic and treatment options. After a successful meeting of the Working Group on Rheumatic Diseases at the ECTS 2020, we (WL and CR) were excited about the quality of the speakers (CM, JH, AG, and GL) and their complimentary lectures. Given the relative lack of reviews on spondyloarthropathies and bone, we decided to work together on a comprehensive review that might be interesting for basic scientists and clinically relevant for clinicians. Radiographic progression in axSpA is linked to several risk factors, like male sex, smoking, HLA-B-27, increased levels of CRP, presence of syndesmophytes, and marked inflammation on MRI. The potential role of mechanical stress in the context of physically demanding jobs has been also suggested to promote structural damages. Different treatment options from NSAIDs to biologic agents like TNF inhibitors (TNFi) or IL-17inhibitors (IL-17i) result in a reduction of inflammation and symptoms. However, all these different treatment options failed to show clear and reproducible results on inhibition on syndesmophyte formation. The majority of data are available on TNFi, and some studies suggested an effect in subgroups of patients with ankylosing spondylitis. Less information is available on NSAIDs and IL-17i. Since IL-17i have been introduced quite recently, more studies are expected. IL-17 inhibitors (Il-17i) potently reduce signs and symptoms, but serum level of IL-17 is not elevated, therefore, IL-17 probably has mainly a local effect. The failure of anti-IL-23 in axSpA suggests that IL-17A production could be independent from IL-23. It may be upregulated by TNFα, resulting in lower expression of DKK1 and RANKL and an increase in osteogenesis. In active AS markers of bone resorption are increased, while bone formation markers can be increased or decreased. Bone Turnover markers and additional markers related to Wnt such as DKK1, sclerostin, and RANKL are valuable for elucidating bone metabolism on a group level and they are not (yet) able to predict individual patient outcomes. The gold standard for detection of structural lesions in clinical practice is the use of conventional radiographics. However, the resolution is low compared to the change over time and the interval for detecting changes are 2 years or more. Modern techniques offer substantial advantages such as the early detection of bone marrow edema with MRI, the fivefold increased detection rate of new or growing syndesmophytes with low-dose CT, and the decrease in 18F-fluoride uptake during treatment with TNFα-inhibitors (TNFi) in a pilot study in 12 AS patients. Detection of bone involvement by new techniques, such as low-dose CT, MRI and 18-Fluoride PET-scans, and bone turnover markers, in combination with focusing on high-risk groups such as patients with early disease, elevated CRP, syndesmophytes at baseline, male patients and patients with HLA-B27 + are promising options for the near future. However, for optimal prevention of formation of syndesmophytes we need more detailed insight in the pathogenesis of bone formation in axSpA and probably more targeted therapies.
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Affiliation(s)
- Willem Lems
- Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.
| | - Corinne Miceli-Richard
- INSERM U 1153, Université de Paris-APHP.Centre, Service de Rhumatologie, Hopital Cochin, Paris, France
- Immunoregulation Unit, Department of Immunology, Institut Pasteur, Paris, France
| | - Judith Haschka
- I Medical Department, Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK & Hanusch Hospital Vienna, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
- Karl Landsteiner Institute for Rheumatology and Gastroenterology, Rheuma-Zentrum Wien-Oberlaa, 1100, Vienna, Austria
| | - Andrea Giusti
- Rheumatology Unit, Department of Medical Specialties, Local Health Trust 3, Via Missolungi 14, 16147, Genoa, Italy
| | | | - Roland Kocijan
- Medical Faculty of Bone Diseases, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Nicolas Rosine
- INSERM U 1153, Université de Paris-APHP.Centre, Service de Rhumatologie, Hopital Cochin, Paris, France
- Sorbonne Université, Service de Rhumatologie Hôpital Pitié Salpêtrière, APHP, Paris, France
| | | | - Gerolamo Bianchi
- Rheumatology Unit, Department of Medical Specialties, Local Health Trust 3, Via Missolungi 14, 16147, Genoa, Italy
| | - Christian Roux
- INSERM U 1153, Université de Paris-APHP.Centre, Service de Rhumatologie, Hopital Cochin, Paris, France
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14
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Soós B, Szentpétery Á, Raterman HG, Lems WF, Bhattoa HP, Szekanecz Z. Effects of targeted therapies on bone in rheumatic and musculoskeletal diseases. Nat Rev Rheumatol 2022; 18:249-257. [PMID: 35273387 DOI: 10.1038/s41584-022-00764-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/17/2022]
Abstract
Generalized bone loss (osteoporosis) and fragility fractures can occur in rheumatic and musculoskeletal diseases including rheumatoid arthritis and spondyloarthritis (SpA; including ankylosing spondylitis and psoriatic arthritis). In addition, rheumatoid arthritis can involve localized, periarticular bone erosion and, in SpA, local (pathological) bone formation can occur. The RANK-RANKL-osteoprotegerin axis and the Wnt-β-catenin signalling pathway (along with its inhibitors sclerostin and Dickkopf 1) have been implicated in inflammatory bone loss and formation, respectively. Targeted therapies including biologic DMARDs and Janus kinase (JAK) inhibitors can stabilize bone turnover and inhibit radiographic joint damage, and potentially also prevent generalized bone loss. Targeted therapies interfere at various points in the mechanisms of local and generalized bone changes in systemic rheumatic diseases, and they effect biomarkers of bone resorption and formation, bone mass and risk of fragility fractures. Studies on the effects of targeted therapies on rates of fragility fracture are scarce. The efficacy of biologic DMARDs for arresting bone formation in axial SpA is debated. Improved understanding of the most relevant therapeutic targets and identification of important targeted therapies could lead to the preservation of bone in inflammatory rheumatic and musculoskeletal diseases.
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Affiliation(s)
- Boglárka Soós
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ágnes Szentpétery
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Medical Sciences, Rheumatology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Willem F Lems
- Amsterdam Rheumatology and Immunology Centre, Amsterdam, Netherlands
| | - Harjit P Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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15
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Ruyssen-Witrand A, Rousseau V, Sommet A, Goupille P, Degboe Y, Constantin A. Factors associated with drug-free remission at 5 year in early onset axial spondyloarthritis patients: data from the DESIR cohort. Joint Bone Spine 2022; 89:105358. [DOI: 10.1016/j.jbspin.2022.105358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/27/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022]
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16
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Choida V, Madenidou AV, Sen D, Hall-Craggs MA, Ciurtin C. The role of whole-body MRI in musculoskeletal inflammation detection and treatment response evaluation in inflammatory arthritis across age: A systematic review. Semin Arthritis Rheum 2022; 52:151953. [PMID: 35038643 DOI: 10.1016/j.semarthrit.2022.151953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the relation between whole-body MRI (WBMRI) outcomes and disease activity measures, including clinical examination, composite scores, and other imaging outcomes, and the ability of WBMRI to detect treatment response in patients with inflammatory arthritis (IA) across age. METHODS Human studies published as full text or abstract in the PubMed and MEDLINE and Cochrane databases from inception to 11th April 2021 were systematically and independently searched by two reviewers. Studies including patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondyloarthritis (SpA), juvenile idiopathic arthritis (JIA) or unclassified inflammatory arthritis (UA) who underwent WBMRI and which reported on disease outcomes were included. RESULTS Nineteen full-text studies were eligible for inclusion: 2 interventional, 7 retrospective and 10 prospective observational studies, comprising 540 participants (SpA 38.7%, RA 24.8%, JIA 17.8%, PsA 11.5%, healthy controls 5.9%, UA 1.3%). Abstracts of 6 conference papers were reported separately. Five studies in PsA and SpA and 4 in RA measured the frequency of WBMRI-detected and clinically-detected synovitis, and all found the former to be more frequent. Less enthesitis was detected by WBMRI than clinical examination in 5/8 studies. After biologic treatment, the WBMRI inflammation scores declined in 3 studies in SpA and 2 in RA, whilst in 3 studies the results were equivocal. CONCLUSION The ability of WBMRI to assess disease activity and treatment response in IA was adequate overall. Further studies are needed to corroborate WBMRI findings with IA outcomes and investigate the clinical value of subclinical inflammation.
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Affiliation(s)
- Varvara Choida
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK
| | - Anastasia-Vasiliki Madenidou
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK
| | - Debajit Sen
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK
| | - Margaret A Hall-Craggs
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; Department of Radiology, University College London Hospital, Ground Floor 235 Euston Road, London NW1 2BU, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK.
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17
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Holm Nielsen S, Sun S, Bay-Jensen AC, Karsdal M, Sørensen IJ, Weber U, Loft AG, Kollerup G, Thamsborg G, Madsen OR, Møller J, Østergaard M, Pedersen SJ. Levels of extracellular matrix metabolites are associated with changes in Ankylosing Spondylitis Disease Activity Score and MRI inflammation scores in patients with axial spondyloarthritis during TNF inhibitor therapy. Arthritis Res Ther 2022; 24:279. [PMID: 36564778 PMCID: PMC9783808 DOI: 10.1186/s13075-022-02967-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/PURPOSE In axial spondyloarthritis (axSpA) inflammation of the sacroiliac joints and spine is associated with local extracellular matrix (ECM) remodeling of affected tissues. We aimed to investigate the association of ECM metabolites with treatment response in axSpA patients treated with TNF-α inhibitory therapy for 46 weeks. METHODS In a prospective clinical study of axSpA patients (n=55) initiating a TNF inhibitor (infliximab, etanercept, or adalimumab), serum concentrations of formation of type I (PRO-C1), type III (PRO-C3), and type VI (PRO-C6) collagen; turnover of type IV collagen (PRO-C4), and matrix-metalloproteinase (MMP)-degraded type III (C3M) collagen, MMP-degraded type IV (C4M), type VI (C6M), and type VII (C7M) collagen, and cathepsin-degraded type X collagen (C10C), MMP-mediated metabolite of C-reactive protein (CRPM), citrullinated vimentin (VICM), and neutrophil elastase-degraded elastin (EL-NE) were measured at baseline, week 2, week 22, and week 46. RESULTS Patients were mostly males (82%), HLA-B27 positive (84%), with a median age of 40 years (IQR: 32-48), disease duration of 5.5 years (IQR: 2-10), and a baseline Ankylosing Spondylitis Disease Activity Score (ASDAS) of 3.9 (IQR: 3.0-4.5). Compared to baseline, PRO-C1 levels were significantly increased after two weeks of treatment, C6M levels were significantly decreased after two and 22 weeks (repeated measures ANOVA, p=0.0014 and p=0.0015, respectively), EL-NE levels were significantly decreased after 2 weeks (p=0.0008), VICM levels were significantly decreased after two and 22 weeks (p=0.0163 and p=0.0374, respectively), and CRP were significantly decreased after two and 22 weeks (both p=0.0001). Baseline levels of PRO-C1, PRO-C3, C6M, VICM, and CRP were all associated with ASDAS clinically important and major improvement after 22 weeks (ΔASDAS ≥1.1) (Mann-Whitney test, p=0.006, p=0.008, p<0.001, <0.001, <0.001, respectively), while C6M, VICM and CRP levels were associated with ASDAS clinically important and major improvement after 46 weeks (ΔASDAS ≥2.0) (p=0.002, p=0.044, and p<0.001, respectively). PRO-C1 and C6M levels were associated with a Bath AS Disease Activity Score (BASDAI) response to TNF-inhibitory therapy after 22 weeks (Mann-Whitney test, p=0.020 and p=0.049, respectively). Baseline levels of PRO-C4 and C6M were correlated with the total SPARCC MRI Spine and Sacroiliac Joint Inflammation score (Spearman's Rho ρ=0.279, p=0.043 and ρ=0.496, p=0.0002, respectively). CONCLUSIONS Extracellular matrix metabolites were associated with ASDAS response, MRI inflammation, and clinical treatment response during TNF-inhibitory treatment in patients with axSpA.
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Affiliation(s)
- Signe Holm Nielsen
- grid.436559.80000 0004 0410 881XNordic Bioscience, Herlev, Denmark ,grid.5170.30000 0001 2181 8870Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Shu Sun
- grid.436559.80000 0004 0410 881XNordic Bioscience, Herlev, Denmark
| | | | - Morten Karsdal
- grid.436559.80000 0004 0410 881XNordic Bioscience, Herlev, Denmark
| | - Inge Juul Sørensen
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Weber
- grid.7143.10000 0004 0512 5013Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark ,Practice Buchsbaum, Rheumatology, Schaffhausen, Switzerland
| | - Anne Gitte Loft
- grid.459623.f0000 0004 0587 0347Departments of Rheumatology, Hospital Lillebælt, Vejle, Denmark ,grid.154185.c0000 0004 0512 597XAarhus University Hospital, Aarhus, Denmark
| | - Gina Kollerup
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Thamsborg
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Rintek Madsen
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Møller
- grid.411900.d0000 0004 0646 8325Department of Radiology, Herlev Hospital, Copenhagen, Denmark
| | - Mikkel Østergaard
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Juhl Pedersen
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Garcia-Montoya L, Emery P. Disease modification in ankylosing spondylitis with TNF inhibitors: spotlight on early phase clinical trials. Expert Opin Investig Drugs 2021; 30:1109-1124. [PMID: 34842481 DOI: 10.1080/13543784.2021.2010187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is a chronic inflammatory disease whose main hallmark is involvement of the axial skeleton. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line treatment; however, their use is limited because of side effects. Tumor necrosis factor inhibitors (TNFi) are a safe and effective therapy, and they have been approved for the management of AS. AREAS COVERED This is a review of the efficacy of TNFi in disease modification in AS. It is focused on results from early-phase clinical trials; however, it also discusses the most relevant findings in order to optimize anti-TNF treatment. A literature search was done using PubMed, Medline, Embase, Google Scholar, and Cochrane library, looking for scientific publications from inception to August 2021. Further information was retrieved from ClinicalTrial.gov and Clinicaltrialsregister.eu. EXPERT OPINION TNFi have demonstrated short- and long-term improvements in all aspects of disease activity, as well as physical function in patients with AS. They have drastically revolutionized the management of the disease; and even though new drugs have become available in the market, TNFi has not been displaced for the treatment of AS, and still constitute the best alternative when NSAIDs are no-longer an option.
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Affiliation(s)
- Leticia Garcia-Montoya
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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19
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Czuczman GJ, Mandell JC, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Cassidy RC, Demertzis JL, Garner HW, Klitzke A, Maynard JR, Pierce JL, Reitman C, Thiele R, Yost WJ, Beaman FD. ACR Appropriateness Criteria® Inflammatory Back Pain: Known or Suspected Axial Spondyloarthritis: 2021 Update. J Am Coll Radiol 2021; 18:S340-S360. [PMID: 34794593 DOI: 10.1016/j.jacr.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory back pain is a hallmark feature of axial spondyloarthritis, a heterogeneous group of inflammatory disorders which affects the sacroiliac joints and spine. Imaging plays a key role in diagnosis of this disease and in facilitating appropriate treatment. This document provides evidence-based recommendations on the appropriate use of imaging studies during multiple stages of the clinical evaluation of patients with suspected or known axial spondyloarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jacob C Mandell
- Research Author, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- Musculoskeletal Fellowship Director; and Chair, REiNS Whole Body MRI Committee, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; Executive Board, Kentucky Orthopaedic Society; and American Academy of Orthopaedic Surgeons
| | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York; Board of Directors, American College of Nuclear Medicine; Board of Directors, SNMMI Correlative Imaging Council; and Delegate, American Medical Association House of Delegates
| | - Jennifer R Maynard
- Program Director Sports Medicine Fellowship, Mayo Clinic Florida, Jacksonville, Florida; Primary care physician; Medical Advisor Women's Tennis Association; Vice-Chair, Jacksonville Sports Medicine Program Executive Board; Chair, Florida High School Athletic Association Sports; and Medicine Advisory Committee
| | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina; and Board of Directors, North American Spine Society
| | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, New York, American College of Rheumatology
| | - William J Yost
- UnityPoint Health, Des Moines, Iowa, American College of Physicians
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20
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Braun J, Richter A, Schmidt C, Baraliakos X. [Answering epidemiologic rheumatologic questions by cooperation with the large population-based SHIP cohort-findings with relevance for the diagnosis of axial spondyloarthritis (axSpA)]. Z Rheumatol 2021; 81:150-156. [PMID: 34264363 PMCID: PMC8894149 DOI: 10.1007/s00393-021-01050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/26/2022]
Abstract
This article presents how, based on the availability of new imaging methods and medications, objectives regarding the rheumatic disease axial spondyloarthritis (axSpA) have developed over the course of more than two decades into a rheumatologic research group. During recent years, cooperation with the Study of Health in Pomerania (SHIP) cohort has given rise to new fundamental aspects. This involved intensive cooperation between the Ruhr University Bochum (Rheumazentrum Ruhrgebiet) and the Greifswald University Hospital (Community Medicine research collective). The design of the SHIP cohort was published 10 years ago and the cohort approach presented in the Bundesgesundheitsblatt, which also described central methodologic questions in detail. In 2014, a cooperation project between the Ruhr Rheumatology Center/Ruhr University Bochum and the SHIP Department of Clinical and Epidemiologic Research (Klinisch-Epidemiologische Forschung, KEF; SHIP-KEF) was established, which has already resulted in publication of interesting results in high-ranking journals. In order to stress the potential of such corporations, important contents thereof are presented herein, with a focus on MRI and consideration of historical aspects.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - A Richter
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Schmidt
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
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21
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Madari Q, Sepriano A, Ramiro S, Molto A, Claudepierre P, Wendling D, Dougados M, van der Heijde D, van Gaalen FA. 5-year follow-up of spinal and sacroiliac MRI abnormalities in early axial spondyloarthritis: data from the DESIR cohort. RMD Open 2021; 6:rmdopen-2019-001093. [PMID: 32396521 PMCID: PMC7046942 DOI: 10.1136/rmdopen-2019-001093] [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: 08/28/2019] [Revised: 12/13/2019] [Accepted: 01/05/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To study changes on MRI of the spine and sacroiliac joint (SIJ) in early axial spondyloarthritis (axSpA) over time. Methods In the Devenir des Spondyloarthropathies Indifférenciées Récentes cohort, MRI-spine and MRI-SIJ at baseline and 2 and 5 years were scored by central readers for bone marrow oedema (BME), fatty lesions, erosions, sclerosis, ankylosis and spinal bone spurs. The average mean number of lesions was reported or the agreement of ≥2 out of 3 readers for binary outcomes. Net progression was calculated by subtracting the patients that ‘improved’ from those that ‘worsened’ divided by the total number of patients. Results Over 5 years, in 155 patients with axSpA (mean age 33.5 (SD 8.9) years, symptom duration 1.4 (0.8) years, 63% human leucocyte antigen+, 14% modified New York+), BME on MRI-SIJ decreased by a mean Spondyloarthritis Research Consortium of Canada score of 1.4 (SD 6.5) (p=0.009). The largest BME decrease was observed in patients using biological disease-modifying antirheumatic drugs at 5 years. Spinal BME increased by 0.3 (4.6) (p=0.41). Fatty lesions and/or erosions on MRI-SIJ increased by a mean of 1.0 (SD 2.6) (p<0.001). Spinal fatty lesions and/or erosions increased by 0.2 (SD 0.5) (p<0.001). Compared with baseline, at 5 years, 7.3% less patients had BME on MRI-SIJ according to the Assessment of Spondyloarthritis International Society definition, while 6.6% more patients had ≥5 fatty lesions and/or erosions. At 5 years, 0.7% less patients had ≥5 spinal BME lesions and 0.7% less patients had ≥5 spinal fatty lesions. Conclusion Over 5 years, BME on MRI-SIJ decreased and spinal BME remained similar, but numerically, little progression of structural lesions on MRI of the SIJ and spine was seen.
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Affiliation(s)
- Queeny Madari
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna Molto
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Pascal Claudepierre
- Department of Rheumatology, Henri Mondor Hospital, APHP, and Université Paris Est Créteil, EA, 7379 - EpidermE, F-94010, Créteil, France
| | - Daniel Wendling
- Department of Rheumatology, CHRU de BESANCON, University Teaching Hospital, and Université de Franche-Comté, EA4266 EPILAB, F-25030, Besançon, France
| | - Maxime Dougados
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
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22
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Bagcier F, Yurdakul OV, Ozduran E. Top 100 cited articles on ankylosing spondylitis. Reumatismo 2021; 72:218-227. [PMID: 33677949 DOI: 10.4081/reumatismo.2020.1325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/10/2020] [Indexed: 11/23/2022] Open
Abstract
Ankylosing spondylitis is a global health problem. There are continuous innovations in terms of etiopathogenesis, diagnosis, and treatment. Here, the top 100 most cited articles on ankylosing spondylitis during the last three decades are analyzed. On April 6, 2020, the Web of Science was screened from 1984 to 2020 using the terms ankylosing spondylitis; the top 100 most cited articles were identified. For bibliometric analysis, the name of the article, year of publication, author information, number of citations, name of the publishing journal, H-index, impact factor, countries of the authors, types of articles, and funding sources were recorded. The Altmetric attention was recorded using a program that automatically calculates the score. The total number of citations of the articles in the list ranged from 176 to 3700. Arthritis and Rheumatism (n=31) and Annals of the Rheumatic Diseases (n=27) were the two leading journals in which the majority of the articles were published. Germany produced most of the articles; Braun J was the most cited author. Randomized controlled clinical trials were found to constitute most of the articles (n=35). According to the citation number, studies evaluating classification criteria and disease activity indices and, according to the Altmetric Attention Score, studies addressing the prevalence and biological agents were prominent. We present a perspective on the extent to which the most cited articles on ankylosing spondylitis draw interest in the scientific community and on social media platforms.
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Affiliation(s)
- F Bagcier
- Department of Physical Medicine and Rehabilitation, Biruni University Faculty of Medicine, Istanbul.
| | - O V Yurdakul
- Department of Physical Medicine and Rehabilitation, Bezmialem University Faculty of Medicine, Istanbul.
| | - E Ozduran
- Clinic of Physical Medicine and Rehabilitation, Haseki Training and Research Hospital, Istanbul.
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23
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Li S, Du CZ, Mao SH, Shi BL, Zhu ZZ, Qiu Y. Both structural damage and inflammation of the lumbar spine contribute to the sagittal imbalance in ankylosing spondylitis patients with thoracolumbar kyphosis. Quant Imaging Med Surg 2021; 11:362-370. [PMID: 33392035 DOI: 10.21037/qims-19-990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The relationship between structural damage and inflammation of the spine and the sagittal imbalance in ankylosing spondylitis (AS) is not well understood. The present study aimed to investigate the correlation between structural damage and inflammation of the lumbar spine and the sagittal imbalance in AS patients with thoracolumbar kyphosis. Methods Forty-five AS patients with thoracolumbar kyphosis were retrospectively reviewed. Six sagittal spinal parameters, including the C7 tilt (C7T), spino-sacral angle (SSA), global kyphosis (GK), the sagittal vertical axis (SVA), thoracic kyphosis (TK), and lumbar lordosis (LL), were measured. Structural damage of the lumbar spine was assessed by the modified Stoke AS Spine Score (mSASSS) on radiographs. Lumbar spinal inflammation was evaluated by the AS spinal magnetic resonance imaging (MRI) activity (ASspiMRI-a) on MRI. Correlation analysis was performed using the paired sample t-test. Multivariable linear regression models were constructed to analyze the contributions of mSASSS and ASspiMRI-a to the sagittal parameters. Results The average values of the sagittal parameters C7T, SSA, GK, SVA, TK, and LL were 68.1°, 80.1°, 77.3°, 168.7 mm, 47.7°, and -0.7°, respectively. The average mSASSS and ASspiMRI-a scores were 9.8 and 10.8, respectively. Correlation analysis showed that the mSASSS and ASspiMRI-a were correlated with C7T, SSA, SVA, and LL (the Spearman correlation coefficients were -0.439, -0.390, 0.424, and 0.530 for mSASSS; -0.406, -0.402, 0.378, and 0.486 for ASspiMRI-a; P<0.05). The C7T, SSA, and SVA were significantly correlated with LL (r=-0.696, -0.779, and 0.633, respectively; P<0.05). There was a weak correlation between the mSASSS and ASspiMRI-a (β=0.299, P=0.046). The multivariable regression models indicated that the sagittal imbalance was determined to a greater extent by the mSASSS than ASspiMRI-a (the β values were -1.550 vs. -0.649 for C7T, -1.865 vs. -1.231 for SSA, 9.161 vs. 3.823 for SVA, and 3.128 vs. 1.717 for LL). Conclusions Both structural damage and inflammation of the lumbar spine contributed to the sagittal imbalance in AS patients with thoracolumbar kyphosis. In the late stages of AS, the sagittal imbalance was more attributable to the structural damage than the inflammation of the lumbar spine.
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Affiliation(s)
- Song Li
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Chang-Zhi Du
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Sai-Hu Mao
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ben-Long Shi
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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24
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Marino F, D'Angelo S, Masala IF, Gerratana E, Nucera V, La Corte L, Giallanza M, Sarzi-Puttini P, Atzeni F. Toxicological considerations in the treatment of axial spondylo-arthritis. Expert Opin Drug Metab Toxicol 2020; 16:663-672. [PMID: 32552128 DOI: 10.1080/17425255.2020.1783240] [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] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The first-line treatment of axial spondyloarthritis (SpA) is with non-steroidal anti-inflammatory drugs (NSAIDs) and is followed by tumor necrosis factor (TNF) inhibitors (the main treatment for patients not responding to NSAIDs) or drugs targetting the IL-23/IL-17 pathway. The efficacy of disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate and sulfasalazine (SSZ) has not been demonstrated, although SSZ can be considered in patients with concomitant peripheral arthritis. AREAS COVERED This review describes the beneficial and toxicological effects of the drugs used to treat axial SpA. EXPERT COMMENTARY Growing concerns about the safety of anti-TNF drugs underline the need to ensure that all clinicians are capable of taking appropriate preventive action and adequately treating affected patients.
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Affiliation(s)
- Francesca Marino
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
| | - Salvatore D'Angelo
- Rheumatology Institute of Lucania (Irel) and Rheumatology Department of Lucania, San Carlo Hospital of Potenza , Italy
| | | | - Elisabetta Gerratana
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
| | - Valeria Nucera
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
| | - Laura La Corte
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
| | - Manuela Giallanza
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
| | | | - Fabiola Atzeni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
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25
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Lorenzin M, Ortolan A, Felicetti M, Vio S, Favero M, Polito P, Lacognata C, Scapin V, Doria A, Ramonda R. Spine and Sacroiliac Joints Lesions on Magnetic Resonance Imaging in Early Axial-Spondyloarthritis During 24-Months Follow-Up (Italian Arm of SPACE Study). Front Immunol 2020; 11:936. [PMID: 32499784 PMCID: PMC7243825 DOI: 10.3389/fimmu.2020.00936] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/22/2020] [Indexed: 01/31/2023] Open
Abstract
Objectives: Our study aimed to identify: (1) the prevalence of spine and pelvis magnetic resonance imaging (MRI-spine and MRI-SIJ) inflammatory and structural lesions in patients (pts) with a diagnosis of axial spondyloarthritis (axSpA); (2) the predictive factors for a severe disease pattern with a higher probability of radiographic progression. Materials and Methods: Seventy-five pts with low back pain (LBP) (≥3 months, ≤2 years, onset ≤45 years) underwent physical examination, questionnaires, laboratory tests, X-rays, MRI-spine, and MRI-SIJ at baseline (T0) and during a 24-months follow-up. Two expert rheumatologists made axSpA diagnosis and classification (according ASAS criteria). MRI-spine, MRI-SIJ and X-rays were scored independently by 2 readers following the SPARCC, mSASSS, and mNY-criteria. According to ASAS criteria, 21 pts fulfilled imaging arm only and 29 clinical arm with/without imaging arm; 25 pts did not fulfill ASAS criteria. Results: At T0 the mean ± SD LBP onset was 28.51 ± 8.05 years, 45.3% pts were male, 38.7% were HLA-B27+; 56% showed bone marrow oedema (BMO) at MRI-spine and 64% at MRI-SIJ. Signs of enthesitis were found in 58% pts in the thoracic spine. Eighteen (24%) pts presented BMO at MRI-spine with a negative MRI-SIJ. The prevalence of BMO lesions and the SPARCC SIJ and spine score decreased during the follow-up in the 2 cohorts meeting ASAS criteria. An early onset of LBP, a lower use of NSAIDs, a BASDAI>4 were identified as predictors of spine structural damage; the high SPARCC SIJ score appeared to be a predictor of SIJ structural damage. A higher mSASSS was predicted by a lower age of onset of LBP. Predictor of higher SPARCC spine was a higher NSAIDs and of higher SPARCC SIJ score the HLA-B27 positivity with increased inflammatory biomarkers. Conclusions: At T0 a significant prevalence of BMO lesions was observed both in SIJ and spine, with predominant involvement of thoracic district. Since positive MRI-spine images were observed in the absence of sacroiliitis, these findings seem to be relevant in the axSpA diagnosis. Early age of disease onset, long duration of LBP, increased inflammatory biomarkers, higher use of NSAIDs, male gender, HLA-B27 positivity, SPARCC SIJ score>2 appeared predictors of radiological damage and activity.
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Affiliation(s)
- Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Stefania Vio
- Radiology Unit, University of Padova, Padova, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Pamela Polito
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | | | - Vanna Scapin
- Radiology Unit, University of Padova, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
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26
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Baraliakos X, Kleyer A, Simon D, Köhm M, Ohrndorf S, Sewerin P. [Imaging of psoriatic arthritis and aspects of radiographic progression]. Z Rheumatol 2020; 79:40-52. [PMID: 31822993 DOI: 10.1007/s00393-019-00735-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous multifactorial disease with musculoskeletal involvement, which can be manifested as monoarthritis, oligoarthritis or polyarthritis and in some patients can also affect the axial skeleton. The most frequent indications of inflammation are bone marrow edema and enthesitis. The early and differential diagnosis of PsA is a clinical challenge, particularly as a differential diagnosis from other inflammatory or degenerative diseases of joints. Inflammatory joint and tendon alterations in the region of the extremities and the spine can be visualized with high sensitivity by the use of magnetic resonance imaging (MRI), musculoskeletal sonography (US) and fluorescence optical imaging (FOI). The use of MRI has a prognostic value with respect to the further radiographic course of the disease, particularly in the initial stages of the disease. Structural damage can be specifically and also partially demonstrated 3‑dimensionally in peripheral joints and the spine by the use of computed tomography (CT) and conventional X‑ray imaging. High-resolution peripheral quantitative CT (HR-pQCT) in particular, can visualize pathophysiological processes and the morphological consequences even in early stages of the disease. The values of conventional X‑ray diagnostics, CT, MRI, musculoskeletal US and alternative imaging procedures are presented with respect to the diagnostics and prognosis of the progression of patients with PsA.
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Affiliation(s)
- X Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - A Kleyer
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - D Simon
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - M Köhm
- Rheumatologie und Fraunhofer IME Institutsteil TMP, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - S Ohrndorf
- Med. Klinik mit SP Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - P Sewerin
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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27
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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28
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van der Heijde D, Braun J, Deodhar A, Baraliakos X, Landewé R, Richards HB, Porter B, Readie A. Modified stoke ankylosing spondylitis spinal score as an outcome measure to assess the impact of treatment on structural progression in ankylosing spondylitis. Rheumatology (Oxford) 2020; 58:388-400. [PMID: 29860356 PMCID: PMC6381766 DOI: 10.1093/rheumatology/key128] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/11/2018] [Indexed: 12/17/2022] Open
Abstract
In ankylosing spondylitis (AS), structural damage that occurs as a result of syndesmophyte formation and ankylosis of the vertebral column is irreversible. Structural damage is currently assessed by conventional radiography and scoring systems that reliably assess radiographic structural damage are needed to capture the differential effects of drugs on structural damage progression. The validity of the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) as a primary outcome measure in evaluating the effect of AS treatments on radiographic progression rates was assessed in this review. The mSASSS has not been used, to date, as a primary outcome measure in a prospective randomized controlled clinical trial of biologic therapy in AS. This review of the medical literature confirmed that the mSASSS is the most validated and widely used method for assessing radiographic progression in AS, correlating with worsening measures of disease signs and symptoms, spinal mobility and physical function, with a 2-year interval being required to ensure sufficient sensitivity to change.
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Affiliation(s)
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, and Ruhr University Bochum, Germany
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
| | | | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | | | - Brian Porter
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Aimee Readie
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Krabbe S, Østergaard M, Pedersen SJ, Weber U, Kröber G, Makysmowych W, Lambert RGW. Canada-Denmark MRI scoring system of the spine in patients with axial spondyloarthritis: updated definitions, scoring rules and inter-reader reliability in a multiple reader setting. RMD Open 2019; 5:e001057. [PMID: 31673422 PMCID: PMC6803003 DOI: 10.1136/rmdopen-2019-001057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 01/14/2023] Open
Abstract
Objective To validate the Canada-Denmark (CANDEN) MRI scoring system for the spine in axial spondyloarthritis with updated lesion definitions. Methods Lesion definitions in the CANDEN system were updated and illustrated by a consensus set of reference images. Sagittal spine MRIs of 40 patients with axial spondyloarthritis obtained at baseline and at week 52 after initiation of treatment with the tumour necrosis factor inhibitor golimumab were evaluated in unknown chronology by seven readers blinded to all other data. Results CANDEN MRI spine inflammation score had very good reliability for status scores (single-measure intraclass correlation coefficient (ICC) of 21 reader pairs median of 0.91 (IQR 0.88-0.92)) and change scores (ICC 0.88 (0.86-0.92)). CANDEN MRI spine fat score had good to very good reliability for status scores (ICC 0.79 (0.75-0.86)) and moderate to good reliability for detecting change (ICC 0.59 (0.46-0.73)). CANDEN MRI spine bone erosion score and CANDEN MRI spine new bone formation score had slight to moderate reliability for status scores (ICC 0.38 (0.32-0.52) and 0.39 (0.27-0.49), respectively). Conclusion The CANDEN MRI spine scoring system allows a comprehensive evaluation of inflammation, fat, bone erosion and new bone formation of the spine in patients with axial spondyloarthritis. It demonstrated very good reliability for detecting change in inflammation, moderate to good reliability for detecting change in fat, and slight to moderate reliability for detecting bone erosions and new bone formation. Studies with longer follow-up or patients with more advanced spinal involvement may be needed to reliably detect change in bone erosion and new bone formation scores. Trial registration number NCT02011386.
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Affiliation(s)
- Simon Krabbe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Weber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University Hospital of Southern Denmark, Odense, Denmark
| | - Georg Kröber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Walter Makysmowych
- CaRE Arthritis, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert G W Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
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Hedin CRH, Vavricka SR, Stagg AJ, Schoepfer A, Raine T, Puig L, Pleyer U, Navarini A, van der Meulen-de Jong AE, Maul J, Katsanos K, Kagramanova A, Greuter T, González-Lama Y, van Gaalen F, Ellul P, Burisch J, Bettenworth D, Becker MD, Bamias G, Rieder F. The Pathogenesis of Extraintestinal Manifestations: Implications for IBD Research, Diagnosis, and Therapy. J Crohns Colitis 2019; 13:541-554. [PMID: 30445584 DOI: 10.1093/ecco-jcc/jjy191] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article reports on the sixth scientific workshop of the European Crohn's and Colitis Organisation [ECCO] on the pathogenesis of extraintestinal manifestations [EIMs] in inflammatory bowel disease [IBD]. This paper has been drafted by 15 ECCO members and 6 external experts [in rheumatology, dermatology, ophthalmology, and immunology] from 10 European countries and the USA. Within the workshop, contributors formed subgroups to address specific areas. Following a comprehensive literature search, the supporting text was finalized under the leadership of the heads of the working groups before being integrated by the group consensus leaders.
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Affiliation(s)
- C R H Hedin
- Gastroenterology unit, Patient Area Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - S R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - A J Stagg
- Centre for Immunobiology, Bart's and The London Medical School, Queen Mary University of London, London, UK
| | - A Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - T Raine
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - U Pleyer
- University Eye Clinic, Uveitis Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - J Maul
- Gastroenterologie am Bayerischen Platz, Berlin, Germany.,Department of Medicine (Gastroenterology, Infectious Diseases, Rheumatology), Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Ioannina School of Medical Sciences, Ioannina, Greece
| | - A Kagramanova
- IBD Department, The Loginov Moscow Clinical Scientific Centre, Moscow, Russia
| | - T Greuter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Gastroenterology Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Y González-Lama
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - F van Gaalen
- Department of Rheumatology, Leiden University Medical Center [LUMC], Leiden, Netherlands
| | - P Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - J Burisch
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Abdominal Center K, Medical Section, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - D Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - M D Becker
- Department of Ophthalmology, Triemli Hospital, Zurich, Switzerland & Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - G Bamias
- National and Kapodistrian University of Athens, GI Unit, 3rd Academic Department of Internal Medicine, Sotiria Hospital, Athens, Greece
| | - F Rieder
- Department of Gastroenterology, Hepatology and Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Son SM, Choi SH, Shin JK, Goh TS, Lee JS. Radiologic parameters of ankylosing spondylitis patients treated with anti-TNF-α versus nonsteroidal anti-inflammatory drugs and sulfasalazine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:649-657. [PMID: 30742244 DOI: 10.1007/s00586-019-05912-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/29/2018] [Accepted: 02/06/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Limited data are available on the relationship between treatment agents and sagittal balance in ankylosing spondylitis (AS). We investigated radiological features related to treatment agents and compared sagittal balance between patients treated with anti-tumor necrosis factor-α (anti-TNF-α) and those treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and sulfasalazine (SSZ). METHODS We prospectively enrolled 133 consecutive AS patients. Patients were eligible for the trial if they were under medical treatment with the same treatment agents for at least 1 year. All patients were treated initially with NSAIDs and SSZ. Sixty-nine patients achieved an excellent pain control outcome with these agents (group A). Sixty-four patients who reported of intractable low back pain were switched to anti-TNF-α treatment (group B). Twelve radiographic parameters were measured. Clinical outcome was assessed with the Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). All parameters were measured at enrolment, upon changing treatment agents, and every 6 months during follow-up. RESULTS The mean ESR, CRP, BASDAI, and thoracic kyphosis at baseline were significantly higher in group B. After treatment, group B had significantly higher lumbar lordosis (LL) and significantly better clinical outcomes. Correlation analysis revealed significant relationships between radiologic parameters and BASDAI. On multiple regression analysis, LL was a significant predictor of BASDAI. CONCLUSIONS This study demonstrated a clear association between treatment agents and radiologic parameters in AS. Anti-TNF-α treatment improved LL with improvement in clinical outcomes. Lumbar lordosis was a significant predictor of clinical outcome in AS patients treated with anti-TNF-α. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Seung Min Son
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sung Hoon Choi
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jong Ki Shin
- Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-Gu, Busan, 49241, Republic of Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-Gu, Busan, 49241, Republic of Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-Gu, Busan, 49241, Republic of Korea.
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Guermazi A, Roemer FW. Which Is Better for Characterizing Disease Activity in Axial Spondyloarthritis: Diffusion MRI or T2-weighted/STIR MRI? Radiology 2019; 291:129-130. [PMID: 30735464 DOI: 10.1148/radiol.2019190019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ali Guermazi
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 3, 91054 Erlangen, Germany (F.W.R.)
| | - Frank W Roemer
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 3, 91054 Erlangen, Germany (F.W.R.)
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Lee KH, Chung HY, Xu X, Lau VWH, Lau CS. Apparent Diffusion Coefficient as an Imaging Biomarker for Spinal Disease Activity in Axial Spondyloarthritis. Radiology 2019; 291:121-128. [PMID: 30720403 DOI: 10.1148/radiol.2019180960] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background A quantifiable imaging measure to gauge the intensity of individual inflammatory lesions in axial spondyloarthritis (SpA) has not been well established. Previous studies have shown that diffusion-weighted (DW) MRI reflects disease activity in axial SpA. Purpose To determine the association between apparent diffusion coefficient (ADC) at MRI of discovertebral lesions and disease activity in individuals with axial SpA. Materials and Methods In this prospective study, 243 study participants (mean age ± standard deviation, 43.2 years ± 13.5) with back pain who fulfilled the Assessment of SpondyloArthritis International Society criteria for SpA were recruited from four rheumatology centers between April 2014 and March 2018. There were 132 men (mean age, 41.4 years ± 13.3) and 111 women (mean age, 45.3 years ± 13.4). Clinical, biochemical, and radiologic parameters were collected. All participants underwent whole-spine MRI by using a short inversion time inversion-recovery sequence and DW imaging. Two independent readers identified the presence of discovertebral lesions. ADCs were measured and normalized with normal bone marrow. Regression analysis was performed to determine association between the mean, maximum, and normalized mean and maximum ADCs of the discovertebral lesions and disease activity and functional parameters (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Bath Ankylosing Spondylitis Global Index [BASGI]). Results Ninety-one discovertebral lesions (five cervical, 61 thoracic, 25 lumbar) were present in 55 of the 243 study participants (22.6%). After adjusting for confounding factors, increased maximum ADC was independently associated with increased BASFI (regression coefficient [β] = 1.94 [×10-3 mm2/sec], P = .04). Increased normalized maximum ADC was independently associated with BASDAI question 2 (ie, back pain score) (β = 0.45, P = .01), mean stiffness score (β = 0.41, P = .04), and BASGI (β = 0.43, P = .04). Increased normalized mean ADC was independently associated with BASDAI question 2 (β = 0.61, P = .04). Conclusion Apparent diffusion coefficients at MRI of discovertebral lesions were associated with disease activity, functional impairment, and patient global assessment in axial spondyloarthritis. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Guermazi and Roemer in this issue.
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Affiliation(s)
- Kam Ho Lee
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Ho Yin Chung
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Xiaopei Xu
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Vince W H Lau
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Chak Sing Lau
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
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Ruyssen-Witrand A, Luxembourger C, Cantagrel A, Nigon D, Claudepierre P, Degboe Y, Constantin A. Association between IL23R and ERAP1 polymorphisms and sacroiliac or spinal MRI inflammation in spondyloarthritis: DESIR cohort data. Arthritis Res Ther 2019; 21:22. [PMID: 30646942 PMCID: PMC6332609 DOI: 10.1186/s13075-018-1807-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/28/2018] [Indexed: 01/22/2023] Open
Abstract
Background To investigate the association between 12 single nucleotide polymorphisms (SNPs) located on ERAP1 and IL23R with the presence of inflammation on the sacroiliac joint (SIJ) or spinal magnetic resonance imagery (MRI) in an early onset spondyloarthritis (SpA) cohort. Methods All the patients included in the DESIR cohort with an axial SpA and available DNA at baseline were enrolled in this study (n = 645 patients) and underwent a clinical examination, CRP assay, SIJ and spinal MRI scans. Six SNPs located on ERAP1 (rs30187, rs27044, rs27434, rs17482078, rs10050860, rs2287987) and six SNPs located on IL23R (rs1004819, rs10489629, rs1343151, rs2201841, rs10889677, rs11209032) were genotyped. Univariable analyses were performed to test the association between the genotypes and SIJ and spinal MRI inflammation, as well as disease activity based on Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) and CRP. Results One SNP located on ERAP1 (rs27434) and haplotype CCT of ERAP1 were associated with SIJ inflammation detected by MRI, but these associations were below the Bonferroni corrected threshold of significance. However, one SNP (rs1004819) located on IL23R was associated with SIJ MRI inflammation (rs1004819: TT 42.3%, CT 40.5%, CC 26.5%, p = 0.0005). This locus was also significantly associated with Spondyloarthritis Research Consortium of Canada scores while no association with another inflammatory parameter such as BASDAI, ASDAS-CRP, CRP or Berlin MRI score was identified in this population. Conclusion One locus of the IL23R gene was associated with SIJ MRI inflammation and might be a marker of more active disease in recent onset SpA. Trial registration clinicaltrials.gov, NCTO 164 8907
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Affiliation(s)
- Adeline Ruyssen-Witrand
- Centre de rhumatologie, CHU de Toulouse, UMR 1027, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France.
| | - Cécile Luxembourger
- Centre de rhumatologie, CHU de Toulouse, UMR 1027, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Alain Cantagrel
- Centre de rhumatologie, CHU de Toulouse, UMR 1043, CPTP, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Delphine Nigon
- Centre de rhumatologie, CHU de Toulouse, Toulouse, France
| | - Pascal Claudepierre
- Departement de Rhumatologie, Henri Mondor Hospital, APHP, Université Paris Est Créteil, EA 7379 - EpidermE, F-94010, Créteil, France
| | - Yannick Degboe
- Centre de rhumatologie, CHU de Toulouse, UMR 1043, CPTP, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Arnaud Constantin
- Centre de rhumatologie, CHU de Toulouse, UMR 1043, CPTP, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France
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Abstract
PURPOSE OF REVIEW We review new insights to syndesmophyte growth in axial spondyloarthritis revealed by computed tomography (CT). RECENT FINDINGS CT allows full reliable quantitation of syndesmophytes. About 70% of patients had detectable growth in syndesmophyte volume or height in 1 year. Syndesmophyte growth is not uniform, but can be highly heterogeneous even within the same disc space of the same patient. Syndesmophytes are not randomly distributed around the vertebral rim but have preferred locations (posterolateral and anterolateral) which vary along the spine. The frequency of syndesmophyte involvement also varies along the spine. It is highest at the thoracolumbar junction and higher in the thoracic than lumbar spine. CT syndesmophyte quantitation is a promising tool for studies of medications or biomarkers and their relations with syndesmophyte progression. The localization and growth patterns of syndesmophytes suggest importance for local factors such as mechanical stress.
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Affiliation(s)
- Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 10 CRC, Room 4-1339, 10 Center Drive, Bethesda, MD, 20892, USA.
| | - Sovira Tan
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 10 CRC, Room 4-1339, 10 Center Drive, Bethesda, MD, 20892, USA
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Abstract
Axial spondyloarthritis (AxSpA) is an inflammatory spondyloarthritis (SpA) that has significant impact on a patient's life. Symptoms, including fatigue, sleep problems, depression, and sexual dysfunction, can profoundly impact health-related quality of life (HRQoL) and limit work, leisure, and daily activities. Available therapies effectively manage pain and inflammation in early-stage disease, but patients often continue to experience impaired HRQoL. Thus, there remains a need for new therapies with novel mechanisms that can stop disease progression, potentially reverse damage caused by AxSpA and improve HRQoL in patients with AxSpA. Newer biologic agents, such as those targeting the interleukin 17-interleukin 23 axis, have promising efficacy and may improve HRQoL for patients with AxSpA. The AxSpA has many negative effects on HRQoL. By targeting disease pathways responsible for the development of AxSpA, approved and emerging therapies potentially reduce disease activity and improve the functional status of patients with AxSpA. This narrative review reflects on the findings of studies evaluating HRQoL of individuals with AxSpA and the role of newer therapies.
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de Bruin F, Treyvaud MO, Feydy A, de Hooge M, Pialat JB, Dougados M, Gossec L, Bloem JL, van der Heijde D, Reijnierse M. Prevalence of degenerative changes and overlap with spondyloarthritis-associated lesions in the spine of patients from the DESIR cohort. RMD Open 2018; 4:e000657. [PMID: 29955382 PMCID: PMC6018874 DOI: 10.1136/rmdopen-2018-000657] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/11/2018] [Accepted: 05/01/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives To describe the prevalence of degenerative changes on MRI and conventional radiographs of the spine in a young population with suspicion of axial spondyloarthritis (axSpA) and assess whether it is possible to discriminate between degenerative changes and lesions associated with axSpA. Methods Whole spine MRI and cervical and lumbar radiographs of patients ≥18 years with chronic back pain (≥3 months, ≤3 years, onset <50 years) were assessed for degeneration by two readers, and for SpA lesions by two other readers, all blinded for clinical information and results of the other readers. Degenerative scores were adjudicated in case of disagreement (by a third reader). Patients fulfilling and not fulfilling the Assessment of SpondyloArthritis international Society axSpA criteria were compared for prevalence of degenerative lesions. Scores for degenerative and SpA lesions were compared, and overlap was defined as the presence of both types of lesions in a single vertebral unit (VU). Results In 456/648 (70.4%) patients (46.8% men, mean age 33.6), degenerative lesions were found with similar percentages in patients with no axSpA and with axSpA (72.4% and 69.2%, p=0.45). Modic changes were found more often in patients with no axSpA (29/239, 12.1%) versus patients with axSpA (19/409, 4.6%, p=0.01). Other lesions were evenly distributed. Overlap was minimal in 19 patients (3.0%) and 32/14 674 (0.2%) VUs for SpA reader 1 and in 23 patients (3.6%) and 34/14 674 VUs (0.2%) for SpA reader 2. Conclusion The prevalence of degeneration is high in an early inflammatory back pain cohort. Discrimination between degeneration and axSpA lesions is very well possible with little overlap between degenerative and axSpA readings.
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Affiliation(s)
- Freek de Bruin
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco O Treyvaud
- Service de radiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Antoine Feydy
- Service de radiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Manouk de Hooge
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Baptiste Pialat
- Department of Radiology, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Lyon, Lyon, France
| | - Maxime Dougados
- Service de Rhumatologie B, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Descartes, Paris, France
| | - Laure Gossec
- Department of Rheumatology, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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van der Heijde D, Baraliakos X, Hermann KGA, Landewé RBM, Machado PM, Maksymowych WP, Davies OR, de Peyrecave N, Hoepken B, Bauer L, Nurminen T, Braun J. Limited radiographic progression and sustained reductions in MRI inflammation in patients with axial spondyloarthritis: 4-year imaging outcomes from the RAPID-axSpA phase III randomised trial. Ann Rheum Dis 2018; 77:699-705. [PMID: 29343510 PMCID: PMC5909752 DOI: 10.1136/annrheumdis-2017-212377] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To report 4-year imaging outcomes in the RAPID-axSpA (NCT01087762) study of patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA), treated with certolizumab pegol (CZP). METHODS This phase III, randomised trial was placebo-controlled and double-blind to week 24, dose-blind to week 48 and open-label to week 204. Patients fulfilling the Assessment of Spondyloarthritis International Society (ASAS) axSpA criteria with active disease were stratified (AS/nr-axSpA) according to the modified New York (mNY) criteria at randomisation. Spinal radiographs were assessed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). MRI inflammation used the Spondyloarthritis Research Consortium of Canada (SPARCC) score for sacroiliac joints (SIJ) and the Berlin spinal score (remission defined as SPARCC <2 and Berlin ≤2, respectively). RESULTS MRI improvements from baseline (BL) to week 12 were maintained to week 204 (SPARCC BL: AS=8.5, nr-axSpA=7.5; SPARCC week 204: AS=1.3, nr-axSpA=2.4; Berlin BL: AS=7.4, nr-axSpA=4.4; Berlin week 204: AS=2.6, nr-axSpA=1.9). 66.7% of patients with AS and 69.6% of patients with nr-axSpA with BL SPARCC scores ≥2, and 65.4% of patients with AS and 57.3% of patients with nr-axSpA with BL Berlin score >2, achieved remission at week 204. Mean mSASSS change in AS from BL to week 204 was 0.98 (95% CI 0.34, 1.63); 0.67 (95% CI 0.21,1.13) from BL to week 96; and 0.31 (95% CI 0.02,0.60) from week 96 to week 204. Corresponding nr-axSpA changes were 0.06 (95% CI -0.17,0.28), -0.01 (95% CI -0.19,0.17) and 0.07 (95% CI -0.07,0.20). 4.5% of patients with nr-axSpA fulfilled the mNY criteria at week 204, while 4.3% of patients with AS no longer did so. CONCLUSIONS In patients with CZP-treated axSpA, rapid decreases in spinal and SIJ MRI inflammation were maintained to week 204. Overall, 4-year spinal progression was low, with less progression during years 2-4 than 0-2. Radiographic SIJ grading changes demonstrated limited progression. TRIAL REGISTRATION NUMBER NCT01087762; Post-results.
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Affiliation(s)
| | | | | | - Robert B M Landewé
- Academic Medical Center, Amsterdam and Atrium Medical Center, Heerlen, The Netherlands
| | - Pedro M Machado
- Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
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Abstract
Inflammatory and chronic structural changes are objective signs of axial spondyloarthritis. In the sacroiliac joints (SIJs), inflammation (sacroiliitis) can be visualized as bone marrow edema, whereas chronic structural changes are visualized as fat metaplasia, erosions, sclerosis, or ankylosis in the area of the SIJ. In the spine, bone marrow edema in the vertebral bodies represents spondylitis but can also affect the facet and the costovertebral and costotransverse joints (arthritis), whereas structural changes are visualized as fat metaplasia, sclerosis or syndesmophytes and ankylosis at the vertebral edges.
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Ruyssen-Witrand A, Jamard B, Cantagrel A, Nigon D, Loeuille D, Degboe Y, Constantin A. Relationships between ultrasound enthesitis, disease activity and axial radiographic structural changes in patients with early spondyloarthritis: data from DESIR cohort. RMD Open 2017; 3:e000482. [PMID: 28955496 PMCID: PMC5604709 DOI: 10.1136/rmdopen-2017-000482] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/13/2017] [Accepted: 08/14/2017] [Indexed: 11/06/2022] Open
Abstract
Background To search for association between ultrasound (US) enthesis abnormalities and disease activity, spine and sacro-iliac joints (SIJ) MRI inflammatory lesions and spine structural changes in a cohort of patients suspected for axial spondyloarthritis (SpA). Methods Patients: Of 708 patients included in the DESIR(Devenir des Spondyloarthrites Indifférenciées Récentes) cohort, 402 had an US enthesis assessment and were selected for this study. Imaging: Achilles, lateral epicondyles, superior patellar ligament, inferior patellar ligament entheses were systematically US scanned and abnormalities were summed in US structural and power Doppler (PDUS) scores. Spine radiographs, SIJ and spine MRI scans were centrally scored modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), presence of MRI sacro-iliitis, Spondyloarthritis Research Consortium of Canada and Berlin scores. Analysis: The associations between the US structural/PDUS scores and disease activity, C reactive protein (CRP), MRI SIJ and spine inflammatory lesions and mSASSS were tested by Spearman's correlation tests. Results Among the 402 patients included (median age: 33.5 years, males: 48.5%), 55% had US enthesis structural abnormalities while 14% had PDUS abnormalities. There was no association between US scores and Bath Ankylosing Spondylitis Disease Activity Index, CRP or inflammatory lesions on SIJ and spine MRI. There was a correlation between US structural and PDUS scores and the mSASSS (respectively, r=0.151, p=0.005; r=0.143, p=0.007). The proportion of patients with syndesmophytes was higher in the case of US enthesophytes (26% of syndesmophytes vs 6% in the absence of US enthesophytes, p<0.0001). Conclusion While the US abnormalities do not seem to be a helpful tool for monitoring disease activity in axial SpA, US enthesophytes, strongly associated with axial syndesmophytes, might be a marker of interest for disease severity. Trial registration number NCT01648907, date of registration : 20 July 2012.
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Affiliation(s)
- Adeline Ruyssen-Witrand
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.,Inserm UMR1027, Toulouse, France.,Department of Rheumatology, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Bénédicte Jamard
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France
| | - Alain Cantagrel
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.,Department of Rheumatology, Université Paul Sabatier Toulouse III, Toulouse, France.,Inserm UMR 1043, Toulouse, France
| | - Delphine Nigon
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France
| | | | | | - Arnaud Constantin
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.,Department of Rheumatology, Université Paul Sabatier Toulouse III, Toulouse, France.,Inserm UMR 1043, Toulouse, France
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Ez-Zaitouni Z, Bakker PAC, van Lunteren M, de Hooge M, van den Berg R, Reijnierse M, Fagerli KM, Landewé RBM, Ramonda R, Jacobsson LTH, Saraux A, Lenczner G, Feydy A, Pialat JB, Thévenin F, van Gaalen FA, van der Heijde D. The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts. Ann Rheum Dis 2017; 76:1731-1736. [DOI: 10.1136/annrheumdis-2017-211486] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/08/2017] [Accepted: 06/01/2017] [Indexed: 11/03/2022]
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de Hooge M, Pialat JB, Reijnierse M, van der Heijde D, Claudepierre P, Saraux A, Dougados M, Feydy A. Assessment of typical SpA lesions on MRI of the spine: do local readers and central readers agree in the DESIR-cohort at baseline? Clin Rheumatol 2017; 36:1551-1559. [PMID: 28536822 DOI: 10.1007/s10067-017-3643-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
Comparing local reading (LocR) with central reading (CentR) of typical spondyloarhritis lesions including bone marrow edema (BME) and structural lesions on magnetic resonance imaging of the spine (MRI-spine), in patients with inflammatory back pain (IBP; ≥3 months, <3 years). Baseline data of 667 patients, age 18-50 years, from the Devenir des Spondylarthopathies Indifferenciees Recentes (DESIR)-cohort were used. Two trained central readers scored anterior and posterior corner BME, fatty lesions, erosions and syndesmophytes on MRI-spine. Presences of lesions, based on average scores, were used for CentR. A local radiologist and/or rheumatologist scored MRI-spine on presence/doubt/absence of 'inflammation' and 'structural lesions'. Agreement between central readers and readings was calculated (Cohen's kappa: κ). Agreement between central readers was moderate (BME κ = 0.55, fatty lesions κ = 0.50) to slight (erosions κ = 0.12, syndesmophytes κ = 0.19). Agreement between LocR and CentR was κ = 0.32 (BME) and κ = 0.13 (structural lesions). In 78/160 patients (48.8%) LocR were in doubt while CentR scored BME lesions, for structural lesions this was 17.8% (28/157 patients). Agreement between 2 central readers for scoring spondyloarhritis-like lesions on MRI-spine was moderate but better compared to LocR and CentR agreement. LocR often doubt about the presence of MRI-spine lesions while central trained readers score lesions.
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Affiliation(s)
- Manouk de Hooge
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Baptiste Pialat
- Department of Radiology, Edouard Herriot Hospital, Hospices Civils de Lyon, INSERM (U1033), Université Lyon 1, Lyon, France
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Pascal Claudepierre
- Department of Rheumatology, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France.,Laboratoire d'Investigation Clinique (LIC), Université Paris Est Créteil, Créteil, France
| | - Alain Saraux
- Rheumatology Unit, Hôpital de la Cavale Blanche, Brest University Medical School, 29609, Brest, France
| | - Maxime Dougados
- Rheumatology B Department, Cochin Hôpital, Paris Descartes University, Paris, France.,Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris Descartes University, Paris, France
| | - Antoine Feydy
- Radiology B Department, Cochin Hôpital, Paris Descartes University, Paris, France. .,Service de Radiologie B - Hôpital Cochin, Université Paris Descartes, 27 rue du Fbg St Jacques, 75679, Paris Cedex 14, France.
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The Nonradiographic Axial Spondyloarthritis, the Radiographic Axial Spondyloarthritis, and Ankylosing Spondylitis: The Tangled Skein of Rheumatology. Int J Rheumatol 2017; 2017:1824794. [PMID: 28555158 PMCID: PMC5438843 DOI: 10.1155/2017/1824794] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 01/21/2023] Open
Abstract
Since 1984 the diagnosis of ankylosing spondylitis (AS) has been based upon the modified New York (mNY) criteria with mandatory presence of radiographic sacroiliitis, without which the diagnosis is not tenable. However, it may take years or decades for radiographic sacroiliitis to develop delaying the diagnosis for long periods. It did not matter in the past because no effective treatment was available. However, with the availability of a highly effective treatment, namely, tumour necrosis factor-α inhibitors (TNFi), the issue of early diagnosis of AS acquired an urgency. The Assessment of SpondyloArthritis International Society (ASAS) classification criteria published in 2009 was a significant step towards this goal. These criteria described an early stage of the disease where sacroiliitis was demonstrable only on MRI but not on standard radiograph. Therefore, this stage of the disease was labelled “nonradiographic axial SpA” (nr-axSpA). But questions have been raised if, in search of early diagnosis, specificity was compromised. The Federal Drug Administration (FDA, USA) withheld approval for the use of TNFi in patients with nr-axSpA because of issues related to the specificity of these criteria. This review attempts to clarify some of these aspects of the nr-axSpA-AS relationship and also tries to answer the question whether ASAS classifiable radiographic axial spondyloarthritis (r-axSpA) term can be interchangeably used with the term AS.
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Braun J, Baraliakos X, Hermann KG, Landewé R, Machado PM, Maksymowych WP, Davies O, Hoepken B, Nurminen T, Stach C, van der Heijde D. Effect of certolizumab pegol over 96 weeks of treatment on inflammation of the spine and sacroiliac joints, as measured by MRI, and the association between clinical and MRI outcomes in patients with axial spondyloarthritis. RMD Open 2017; 3:e000430. [PMID: 28848654 PMCID: PMC5566980 DOI: 10.1136/rmdopen-2017-000430] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/08/2017] [Accepted: 03/21/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To report MRI outcomes and explore the relationship between clinical remission and MRI inflammation in patients with axial spondyloarthritis (axSpA) from the RAPID-axSpA trial, including radiographic (r-)axSpA and non-radiographic (nr-)axSpA. METHODS RAPID-axSpA (NCT01087762) was double-blind and placebo-controlled to week 24, dose-blind to week 48 and open-label to week 204. Patients were randomised to certolizumab pegol (CZP) or placebo. Placebo patients entering dose-blind were rerandomised to CZP. MRIs performed at baseline, weeks 12, 48 and 96 were scored by 2 reviewers independently: Spondyloarthritis Research Consortium of Canada (SPARCC) for sacroiliac (SI) joints; Berlin modification of the Ankylosing Spondylitis spine MRI scoring system for disease activity (Berlin) for spine. Inflammation thresholds: SPARCC≥2; Berlin>2. Remission thresholds: SPARCC<2 (SI joints); Berlin≤2 (spine); Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease (<1.3, clinical). RESULTS Across 163 patients in the MRI set (109 CZP; 54 placebo), week 12 mean changes from baseline in MRI scores were greater for CZP versus placebo: SPARCC: -4.8 (SD 8.6) vs -1.6 (7.8; p<0.001); Berlin: -2.9 (4.2) vs 0.2 (4.8; p<0.001). Improvements were maintained to week 96. Week 12 MRI remission was achieved by 52.6% of patients with baseline MRI inflammation in SI joints, 62.0% in the spine and 37.9% of patients with both. MRI remission rates were sustained to week 96, with similar trends in r-axSpA and nr-axSpA. At week 96, 57.5% vs 65.9% of patients achieving versus not achieving clinical remission had MRI remission. CONCLUSIONS CZP reduced inflammation in the spine and SI joints in patients with r-axSpA and nr-axSpA, with improvements maintained over 96 weeks. Substantial proportions of patients achieved MRI remission. Concordance between clinical remission and current definitions of absence of MRI inflammation was limited. TRIAL REGISTRATION NUMBER NCT01087762; Post-results.
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Affiliation(s)
| | | | | | - Robert Landewé
- Academic Medical Center Amsterdam & Atrium Medical Center Heerlen, Amsterdam, The Netherlands
| | - Pedro M Machado
- Centre for Rheumatology Research & MRC Centre for Neuromuscular Diseases, University College London, London, UK
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Herregods N, Dehoorne J, Van den Bosch F, Jaremko JL, Van Vlaenderen J, Joos R, Baraliakos X, Varkas G, Verstraete K, Elewaut D, Jans L. ASAS definition for sacroiliitis on MRI in SpA: applicable to children? Pediatr Rheumatol Online J 2017; 15:24. [PMID: 28399875 PMCID: PMC5387253 DOI: 10.1186/s12969-017-0159-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/04/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The Assessment of Spondyloarthritis International Society (ASAS) definition for a 'positive' Magnetic Resonance Imaging (MRI) for sacroiliitis is well studied and validated in adults, but studies about the value of this definition in children are lacking. The aim of this study is to evaluate whether the adult ASAS definition of a positive MRI of the sacroiliac joints can be applied to children with a clinical suspicion of Juvenile Spondyloarthritis (JSpA). METHODS Two pediatric musculoskeletal radiologists blinded to clinical data independently retrospectively reviewed sacroiliac (SI) joint MRI in 109 children suspected of sacroiliitis. They recorded global impression (sacroiliitis yes/no) and whether the adult ASAS definition for sacroiliitis was met at each joint. This was compared to gold-standard clinical diagnosis of JSpA. Additionally, MRI were scored according to'adapted' ASAS definitions including other features of sacroiliitis on MRI. RESULTS JSpA was diagnosed clinically in 47/109 (43%) patients. On MRI, sacroiliitis was diagnosed by global assessment in 30/109 patients, of whom 14 also fulfilled ASAS criteria. No patients with negative global assessment for sacroiliitis fulfilled ASAS criteria. Sensitivity (SN) for JSpA was higher for global assessment (SN = 49%) than for ASAS definition (SN = 26%), but the ASAS definition was more specific (SP = 97% vs. 89%). Modifying adult ASAS criteria to allow bone marrow edema (BME) lesions seen on only one slice, synovitis or capsulitis, increased SN to 36%, 32% and 32% respectively, only slightly lowering SP. Including structural lesions increased SN to 28%, but lowered specificity to 95%. CONCLUSION The adult ASAS definition for sacroiliitis has low sensitivity in children. A pediatric-specific definition of MRI-positive sacroiliitis including BME lesions visible on one slice only, synovitis and/or capsulitis may improve diagnostic utility, and increase relevance of MRI in pediatric rheumatology practice.
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Affiliation(s)
- Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Joke Dehoorne
- grid.410566.0Department of Pediatric Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Filip Van den Bosch
- grid.410566.0Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Jacob Lester Jaremko
- grid.241114.3Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street, Edmonton, T6G 2B7 AB Canada
| | - Joke Van Vlaenderen
- grid.410566.0Department of Pediatric Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Rik Joos
- grid.410566.0Department of Pediatric Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Xenofon Baraliakos
- grid.5570.7Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Claudiusstr. 45, 44649 Herne, Germany
| | - Gaëlle Varkas
- grid.410566.0Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Koenraad Verstraete
- grid.410566.0Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dirk Elewaut
- grid.410566.0Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Lennart Jans
- grid.410566.0Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Uson J, Loza E, Möller I, Acebes C, Andreu JL, Batlle E, Bueno Á, Collado P, Fernández-Gallardo JM, González C, Jiménez Palop M, Lisbona MP, Macarrón P, Maymó J, Narváez JA, Navarro-Compán V, Sanz J, Rosario MP, Vicente E, Naredo E. Recommendations for the Use of Ultrasound and Magnetic Resonance in Patients With Spondyloarthritis, Including Psoriatic Arthritis, and Patients With Juvenile Idiopathic Arthritis. ACTA ACUST UNITED AC 2017; 14:27-35. [PMID: 28277255 DOI: 10.1016/j.reuma.2016.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging in patients with spondyloarthritis, including psoriatic arthritis, and juvenile idiopathic arthritis. METHODS Recommendations were generated following a nominal group technique. A panel of experts (15 rheumatologists and 3 radiologists) was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of participants voted≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. RESULTS A total of 12 recommendations were proposed for each disease. They include, along with explanations of the validity of US and magnetic resonance imaging regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. CONCLUSIONS These recommendations will help clinicians use US and magnetic resonance imaging in patients with spondyloarthritis and juvenile idiopathic arthritis.
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Affiliation(s)
- Jacqueline Uson
- Servicio de Reumatología, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | | | - Ingrid Möller
- Servicio de Reumatología, Instituto Poal de Reumatología, Barcelona, España
| | - Carlos Acebes
- Servicio de Reumatología, Hospital General de Villalba, Collado Villalba, Madrid, España
| | - Jose Luis Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Enrique Batlle
- Servicio de Reumatología, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España
| | - Ángel Bueno
- Servicio de Radiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Paz Collado
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | | - Carlos González
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Mercedes Jiménez Palop
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Pilar Macarrón
- Servicio de Reumatología, Hospital Universitario Clínico San Carlos, Madrid, España
| | - Joan Maymó
- Servicio de Reumatología, Hospital del Mar, Barcelona, España
| | - Jose Antonio Narváez
- Servicio de Radiodiagnóstico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Jesús Sanz
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Esther Vicente
- Servicio de Reumatología, Hospital Universitario de La Princesa, Madrid, España
| | - Esperanza Naredo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Szentpétery Á, Horváth Á, Gulyás K, Pethö Z, Bhattoa HP, Szántó S, Szücs G, FitzGerald O, Schett G, Szekanecz Z. Effects of targeted therapies on the bone in arthritides. Autoimmun Rev 2017; 16:313-320. [DOI: 10.1016/j.autrev.2017.01.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/07/2016] [Indexed: 12/17/2022]
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Inman RD, Baraliakos X, Hermann KGA, Braun J, Deodhar A, van der Heijde D, Xu S, Hsu B. Serum biomarkers and changes in clinical/MRI evidence of golimumab-treated patients with ankylosing spondylitis: results of the randomized, placebo-controlled GO-RAISE study. Arthritis Res Ther 2016; 18:304. [PMID: 28031053 PMCID: PMC5192572 DOI: 10.1186/s13075-016-1200-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 12/01/2016] [Indexed: 01/01/2023] Open
Abstract
Background In the present study, we evaluated relationships between serum biomarkers and clinical/magnetic resonance imaging (MRI) findings in golimumab-treated patients with ankylosing spondylitis. Methods In the GO-RAISE study, 356 patients with ankylosing spondylitis randomly received either placebo (n = 78) or golimumab 50 mg or 100 mg (n = 278) injections every 4 weeks through week 24 (placebo-controlled); patients continuing GO-RAISE received golimumab through week 252. Up to 139/125 patients had sera collected for biomarkers/serial spine MRI scans (sagittal plane, 1.5-T scanner). Two blinded readers employed modified ankylosing spondylitis spine magnetic resonance imaging score for activity (ASspiMRI-a) and ankylosing spondylitis spine magnetic resonance imaging score for chronicity. Spearman correlations (rs) were assessed between serum biomarkers (n = 73) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), C-reactive-protein (CRP)-based Ankylosing Spondylitis Disease Activity Score (ASDAS), modified Stokes Ankylosing Spondylitis Spine Score (mSASSS), and ASspiMRI scores. Serum biomarkers predicting postbaseline spinal fatty lesion development and inflammation were analyzed by logistic regression. Results Significant, moderately strong correlations were observed between baseline inflammatory markers interleukin (IL)-6, intracellular adhesion molecule-1, complement component 3 (C3), CRP, haptoglobin, and serum amyloid-P and baseline ASDAS (rs = 0.39–0.66, p ≤ 0.01). Only baseline leptin significantly correlated with ASDAS improvement at week 104 (rs = 0.55, p = 0.040), and only baseline IL-6 significantly predicted mSASSS week 104 change (β = 0.236, SE = 0.073, p = 0.002, model R2 = 0.093). By logistic regression, baseline leptin, C3, and tissue inhibitor of metalloproteinase (TIMP)-1 correlated with new fatty lesions per spinal MRI at week 14 and week 104 (both p < 0.01). Changes in serum C3 levels at week 4 (rs = 0.55, p = 0.001) and week 14 (rs = 0.49, p = 0.040) significantly correlated with BASDAI improvement at week 14. Baseline IL-6 and TIMP-1 (rs = −0.63, −0.67; p < 0.05) and reductions at week 4 in IL-6 (rs = 0.61, p < 0.05) and C3 (rs = 0.72; p < 0.05) significantly correlated with week 14 ASspiMRI-a improvement. Conclusions Extensive serum biomarker multiparametric analyses in golimumab-treated patients with ankylosing spondylitis demonstrated few correlations with disease activity or MRI changes; IL-6 weakly correlated with radiographic progression. Trial registration ClinicalTrials.gov identifier: NCT00265083. Registered on 12 December 2005. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1200-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert D Inman
- Department of Immunology, University of Toronto, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Xenofon Baraliakos
- Department of Rheumatology, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | | | - Jürgen Braun
- Department of Rheumatology, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
| | | | - Stephen Xu
- Department of Biostatistics, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Benjamin Hsu
- Department of Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
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Soldatos T, Pezeshk P, Ezzati F, Karp DR, Taurog JD, Chhabra A. Cross-sectional imaging of adult crystal and inflammatory arthropathies. Skeletal Radiol 2016; 45:1173-91. [PMID: 27209200 DOI: 10.1007/s00256-016-2402-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 02/02/2023]
Abstract
This article highlights the key aspects and current perspectives of the role of cross-sectional imaging in adult crystal and inflammatory arthropathies in adults, briefly discussing CT, and particularly focusing on MRI and US imaging as it supplements the conventional radiography. The role of conventional and advanced MR imaging techniques and imaging findings in this domain is discussed and illustrated with case examples. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article contains images and data, which were collected from patients as a part of a retrospective IRB from the institutional teaching files and informed consent was waived.
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Affiliation(s)
| | - Parham Pezeshk
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
| | - Fatemeh Ezzati
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David R Karp
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joel D Taurog
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA. .,Musculoskeletal Radiology, Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Braun J, Baraliakos X, Hermann KGA, Xu S, Hsu B. Serum C-reactive Protein Levels Demonstrate Predictive Value for Radiographic and Magnetic Resonance Imaging Outcomes in Patients with Active Ankylosing Spondylitis Treated with Golimumab. J Rheumatol 2016; 43:1704-12. [PMID: 27422890 DOI: 10.3899/jrheum.160003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Serum C-reactive protein (CRP) associates with radiographic progression in patients with ankylosing spondylitis (AS) untreated with tumor necrosis factor (TNF) antagonists. We assessed correlations between serum CRP and radiographic progression/magnetic resonance imaging (MRI)-detected inflammation after 2 years of anti-TNF therapy. METHODS Patients with active AS receiving golimumab (GOL)/placebo through Week 16 (early escape) or Week 24 (crossover by design), followed by GOL through 4 years, had sera/images obtained through Week 208. Lateral spinal radiographs and spinal MRI were scored with the modified Stoke AS Spine Score (mSASSS) and the AS spine MRI activity (ASspiMRI-a) score, respectively. ANOVA assessed differences based on CRP levels and mSASSS progression. The relationships between CRP levels and mSASSS/ASspiMRI-a were assessed by Spearman correlation and logistic regression. RESULTS Of the randomized GO-RAISE patients, 299 (84.0%) had pre- and posttreatment spinal radiographs. Larger proportions of patients with Week 104 CRP ≥ 0.5 mg/dl (n = 47) versus < 0.5 mg/dl (n = 236, 40.4% vs 22.9%, p = 0.0121) had mSASSS changes ≥ 2 at Week 104. Across several visits, serum CRP demonstrated weak associations with mSASSS change (rs ≤ 0.21, p < 0.05, n = 262-293) and moderate associations with ASspiMRI-a change (rs = -0.33 to 0.54, p < 0.05, n = 65-89). Higher baseline CRP was associated with increased risk for syndesmophytes at Week 104/Week 208, and large, short-term decreases in CRP from baseline to Week 14/Week 24 also yielded increased syndesmophyte formation risk. CONCLUSION Elevated CRP after 2 years of anti-TNF treatment correlated with greater radiographic progression risk at 4 years. Elevated CRP at baseline or Week 14/Week 24 of anti-TNF treatment weakly predicted subsequent radiographic progression and modestly predicted residual spinal inflammation in patients with AS treated with anti-TNF. Findings are useful regarding new treatment options in patients treated with anti-TNF. ClinicalTrials.gov: NCT00265083.
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Affiliation(s)
- Jürgen Braun
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC.
| | - Xenofon Baraliakos
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC
| | - Kay-Geert A Hermann
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC
| | - Stephen Xu
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC
| | - Benjamin Hsu
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC
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