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Zimba O, Kocyigit BF, Korkosz M. Diagnosis, monitoring, and management of axial spondyloarthritis. Rheumatol Int 2024:10.1007/s00296-024-05615-3. [PMID: 38758383 DOI: 10.1007/s00296-024-05615-3] [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: 03/27/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
Axial spondyloarthritis (axSpA) is a chronic condition predominantly affecting the spine and sacroiliac joints. This article provides an in-depth overview of the current approaches to diagnosing, monitoring, and managing axSpA, including insights into developing terminology and diagnostic difficulties. A substantial portion of the debate focuses on the challenging diagnostic procedure, noting the difficulty of detecting axSpA early, particularly before the appearance of radiologic structural changes. Despite normal laboratory parameters, more than half of axSpA patients experience symptoms. X-ray and magnetic resonance imaging (MRI) are essential for evaluating structural damage and inflammation. MRI can be beneficial when there is no visible structural damage on X-ray as it can help unravel bone marrow edema (BME) as a sign of ongoing inflammation. The management covers both non-pharmacological and pharmacological approaches. Lifestyle modifications, physical activity, and patient education are essential components of the management. Pharmacological therapy, including nonsteroidal anti-inflammatory drugs (NSAIDs) and biologic disease-modifying anti-rheumatic drugs (bDMARDs), are explored, emphasizing individualized treatment. To effectively manage axSpA, a comprehensive and well-coordinated approach is necessary, emphasizing the significance of a multidisciplinary team. Telehealth applications play a growing role in axSpA management, notably in reducing diagnostic delays and facilitating remote monitoring. In conclusion, this article underlines diagnostic complexities and emphasizes the changing strategy of axSpA treatment. The nuanced understanding offered here is designed to guide clinicians, researchers, and healthcare providers toward a more comprehensive approach to axSpA diagnosis and care.
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Affiliation(s)
- Olena Zimba
- Department of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Burhan Fatih Kocyigit
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Türkiye
| | - Mariusz Korkosz
- Department of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Krakow, Poland.
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland.
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Ivanova M, Zimba O, Dimitrov I, Angelov AK, Georgiev T. Axial Spondyloarthritis: an overview of the disease. Rheumatol Int 2024:10.1007/s00296-024-05601-9. [PMID: 38689098 DOI: 10.1007/s00296-024-05601-9] [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: 03/28/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
Axial Spondyloarthritis (axSpA) is a chronic, inflammatory, immune-mediated rheumatic disease that comprises two subsets, non-radiographic and radiographic axSpA, and belongs to a heterogeneous group of spondyloarthritides (SpA). Over the years, the concept of SpA has evolved significantly, as reflected in the existing classification criteria. Considerable progress has been made in understanding the genetic and immunological basis of axSpA, in studying the processes of chronic inflammation and pathological new bone formation, which are pathognomonic for the disease. As a result, new medication therapies were developed, which bring more effective ways for disease control. This review presents a brief overview of the literature related to these aspects of disease after summarising the available information on the topic that we considered relevant. Specifically, it delves into recent research illuminating the primary pathological processes of enthesitis and associated osteitis in the context of inflammation in axSpA. The exploration extends to discussion of inflammatory pathways, with a particular focus on Th1/Th17-mediated immunity and molecular signaling pathways of syndesmophyte formation. Additionally, the review sheds light on the pivotal role of cytokine dysregulation, highlighting the significance of the IL-23/17 axis and TNF-α in this intricate network of immune responses which is decisive for therapeutic approaches in the disease.
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Affiliation(s)
- Mariana Ivanova
- Medical Faculty, Medical University-Sofia, Sofia, Bulgaria.
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", 13, Urvich St., Sofia, 1612, Bulgaria.
| | - Olena Zimba
- Department of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Kraków, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Ivan Dimitrov
- Clinic of Orthopedics and Traumatology, University Hospital "Prof. Dr. St. Kirkovich", Stara Zagora, Bulgaria
- Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | | | - Tsvetoslav Georgiev
- First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, Varna, Bulgaria
- Rheumatology Clinic, St. Marina University Hospital-Varna, Varna, Bulgaria
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Braun J, Poddubnyy D. [Diagnosis and classification of axial spondyloarthritis (axSpA) - the current status]. Dtsch Med Wochenschr 2024; 149:513-520. [PMID: 38621686 DOI: 10.1055/a-2251-6876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease typically characterized by inflammatory back pain (IBP). The term axSpA has largely replaced the long-used term ankylosing spondylitis (AS). IBP is caused by inflammation in the axial skeleton, with the sacroiliac joints (SIJ) being particularly frequently affected initially. The spine is usually added in later stages, which is then increasingly characterized structurally by the formation of new bone. The overall concept of spondyloarthritis includes other disease manifestations such as uveitis, psoriasis and colitis and comorbidities such as cardiovascular disease and osteoporosis.The ASAS classification criteria for axSpA, in place since 2009, have replaced the 1984 modified New York criteria. In the former, in addition to conventional X-rays, changes in the SIJ detected by magnetic resonance imaging (MRI) and also the detection of HLA B27 have, for the first time, played a role. It is important to note that these are not diagnostic criteria, as they do not exist. This paper outlines 10 points that should be considered when making a diagnosis.
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Affiliation(s)
- Jürgen Braun
- RVZ Steglitz, Berlin, und Ruhr Universität Bochum, Deutschland
| | - Denis Poddubnyy
- Rheumatologie am Campus Benjamin Franklin - Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Berlin, Deutschland
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4
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Braun J, Rudwaleit M, Sieper J. [The role of HLA-B27 in the pathogenesis and diagnosis of axial spondyloarthritis : 50 years after discovery of the strong genetic association]. Z Rheumatol 2024; 83:125-133. [PMID: 38112753 DOI: 10.1007/s00393-023-01460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The association of the human lymphocyte antigen B27 (HLA-B27) with ankylosing spondylitis (AS), also now called axial spondylarthritis (axSpA), was first described 50 years ago. OBJECTIVE This article gives an overview of the available knowledge on the topic. MATERIAL AND METHODS This is a narrative review based on the experience of the authors. RESULTS The HLA-B27 is a member of the HLA class I family of genes of the major histocompatibility complex (MHC). The prevalence of HLA-B27 in the central European population is approximately 8 %, i.e., the vast majority of carriers of HLA-B27+ remain healthy. The frequency of HLA-B27 shows a decline from north to south. The HLA-B27 explains only 30 % of the genetic burden of axSpA. The prevalence of the disease correlates with the frequency of HLA-B27 in the population, i.e., there are geographic differences. Approximately 60-90 % of patients with axSpA worldwide are HLA-B27+. Some 200 subtypes of HLA-B27 can be differentiated using the polymerase chain reaction (PCR). In Thailand and Sardinia two subtypes were found that are not associated with axSpA. The physiological function of HLA class I molecules is the defence of the organism against microbes. Microbial peptides are presented to the immune system, which can be specifically attacked by CD8+ T‑cells. Genetic polymorphisms of the enzyme endoplasmic reticulum aminopeptidase 1 (ERAP1), which breaks down peptides in the endoplasmic reticulum, are associated only with HLA-B27+ diseases. DISCUSSION The pathogenesis of axSpA is unclear but a major hypothesis is that of the arthritogenic peptides. In this it is assumed that potentially pathogenic foreign or autologous peptides can be presented by HLA-B27. If nothing else, HLA-B27 plays an important role in the diagnosis, classification and determination of the severity of axSpA.
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Affiliation(s)
- Jürgen Braun
- Rheumatologisches Versorgungszentrum Steglitz, Berlin, Deutschland.
- Ruhr Universität Bochum, Bochum, Deutschland.
- , Berlin, Deutschland.
| | - Martin Rudwaleit
- Klinikum Bielefeld, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld, Deutschland
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Arnbak B, Jensen TS, Hendricks O, Østergaard M, Zejden A, Jurik AG, Manniche C. Prognostic value of the clinical and imaging arm of the ASAS criteria for progression of structural sacroiliac joint lesions. Mod Rheumatol 2024; 34:391-398. [PMID: 36508308 DOI: 10.1093/mr/roac154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/27/2022] [Accepted: 12/08/2022] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To investigate the prognostic value of the two arms of the Assessment of SpondyloArthritis international Society (ASAS) criteria regarding the progression of structural lesions in the sacroiliac joints (SIJs). METHODS Information on baseline fulfilment of the ASAS criteria and baseline and follow-up magnetic resonance imaging of the SIJ in 603 patients aged 18-40 years referred with low back pain to an outpatient spine were collected. Magnetic resonance imaging positivity was defined as bone marrow oedema (BMO) in two or more consecutive slices or two or more lesions in one slice, as described in the ASAS definition of sacroiliitis. RESULTS Of 71 participants fulfilling the ASAS criteria at baseline, 66 (93%) fulfilled the 'imaging arm' and 14 (20%) fulfilled the 'clinical arm'. The 'clinical arm' predicted the progression of erosions with an odds ratio of 55 (compared with not fulfilling the ASAS criteria), while the 'imaging arm' predicted the progression of erosions with an odds ratio of 8. Moreover, in 24% of the patients in the 'imaging arm', all having BMO at the SIJ at baseline, the BMO disappeared without neither erosions nor ankylosis emerging. CONCLUSION We found that the 'clinical arm' was a strong predictor for the progression of SIJ erosion, while the 'imaging arm' had a more modest prognostic value for structural progression.
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Affiliation(s)
- Bodil Arnbak
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Hospital Lillebaelt, Vejle, Denmark
| | - Tue Secher Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Department, Chiropractic Knowledge Hub, Odense, Denmark
- Diagnostic Centre - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, Soenderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anna Zejden
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Claus Manniche
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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McGonagle D, David P, Macleod T, Watad A. Predominant ligament-centric soft-tissue involvement differentiates axial psoriatic arthritis from ankylosing spondylitis. Nat Rev Rheumatol 2023; 19:818-827. [PMID: 37919337 DOI: 10.1038/s41584-023-01038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
Since the original description of spondyloarthritis 50 years ago, results have demonstrated similarities and differences between ankylosing spondylitis (AS) and axial psoriatic arthritis (PsA). HLA-B27 gene carriage in axial inflammation is linked to peri-fibrocartilaginous sacroiliac joint osteitis, as well as to spinal peri-entheseal osteitis, which is often extensive and which provides a crucial anatomical and immunological differentiation between the AS and PsA phenotypes. Specifically, HLA-B27-related diffuse bone marrow oedema (histologically an osteitis) and bone marrow fatty corners detected via magnetic resonance imaging, as well as radiographic changes such as sacroiliitis, vertebral squaring, corner erosions and Romanus lesions, all indicate initial bone phenotypes in HLA-B27+ axial disease. However, in much of PsA with axial involvement, enthesitis primarily manifests in ligamentous soft tissue as 'ligamentitis', with characteristic lesions that include para-syndesmophytes and sacroiliac joint bony sparing. Like axial PsA, diffuse idiopathic skeletal hyperostosis phenotypes, which can be indistinguishable from PsA, exhibit a thoracic and cervical spinal ligamentous soft-tissue tropism, clinically manifesting as syndesmophytosis that is soft-tissue-centric, including paravertebral soft-tissue ossification and sacroiliac soft-ligamentous ossification instead of joint-cavity fusion. The enthesis bone and soft tissues have radically different immune cell and stromal compositions, which probably underpins differential responses to immunomodulatory therapy, especially IL-23 inhibition.
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Affiliation(s)
- Dennis McGonagle
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
| | - Paula David
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Tom Macleod
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Abdulla Watad
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Lorenzin M, Cozzi G, Scagnellato L, Ortolan A, Vio S, Striani G, Scapin V, De Conti G, Doria A, Ramonda R. Relationship between sex and clinical and imaging features of early axial spondyloarthritis: results from a 48 month follow-up (Italian arm of the SPondyloArthritis Caught Early (SPACE) study). Scand J Rheumatol 2023; 52:519-529. [PMID: 36847124 DOI: 10.1080/03009742.2023.2169990] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/15/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES To assess the association between sex and clinical and disease activity indices, and X-rays and magnetic resonance imaging (MRI) features, in early-stage axial spondyloarthritis (axSpA). METHOD Baseline data analysis was conducted on the Italian SPACE cohort, including patients with chronic back pain (duration ≥ 3 months and ≤ 2 years; onset < 45 years). Patients underwent MRI and X-rays of the sacroiliac joints (SIJs) to establish the diagnosis of axSpA, according to Assessment of SpondyloArthritis international Society criteria and physician's judgement. Clinical features, disease activity and functional indices, and images were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRI images were scored by two readers following Spondyloarthritis Research Consortium of Canada (SPARCC), modified Stoke Ankylosing Spondylitis Spinal Score, and modified New York criteria. Characteristics of axSpA patients according to sex (male/female) were compared over time using descriptive statistics. RESULTS Ninety-one patients had axSpA (83.5% non-radiographic; 16.5% radiographic); 47.3% were male. Males were younger, with shorter duration of axial symptoms, and more frequently had HLA-B27 positivity, radiographic sacroiliitis with a bilateral/symmetric pattern, and more signs of spondylitis. Females more frequently showed peripheral/entheseal involvement and the non-radiographic phenotype. Males showed increased pelvic/spinal radiographic progression and more often had active sacroiliitis on MRI. Although the frequency of inflammatory corner lesions did not differ between males and females, localization varied, with more cervical/thoracic MRI-spine lesions in females and more lumbar lesions in males. We observed a significant downward trend of SPARCC SIJ/spine scores in all patients, irrespective of sex. More fat lesions were observed on MRI-spine in females and on MRI-SIJ in males. CONCLUSION Sex was associated with distinct axSpA features: females showed low-grade radiographic sacroiliitis and spinal progression, and a higher prevalence of cervical and thoracic spine MRI signs.
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Affiliation(s)
- M Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - G Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - L Scagnellato
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - A Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - S Vio
- Radiology Unit, Padova University Hospital, Padova, Italy
| | - G Striani
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - V Scapin
- Radiology Unit, Padova University Hospital, Padova, Italy
| | - G De Conti
- Radiology Unit, Padova University Hospital, Padova, Italy
| | - A Doria
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - R Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
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Braun J, Sieper J. Fifty years after the discovery of the association of HLA B27 with ankylosing spondylitis. RMD Open 2023; 9:e003102. [PMID: 37652557 PMCID: PMC10476136 DOI: 10.1136/rmdopen-2023-003102] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
The human lymphocyte antigen B27 (HLA B27) is a member of the HLA class I family of genes in the major histocompatibility complex whose name goes back to its discovery in studies of transplanted tissue compatibility. Its prevalence in the mid-European population is about 8%. The association of HLA B27 alleles with ankylosing spondylitis (AS), a highly heritable disease, which is part of the spectrum of axial spondyloarthritis (axSpA), was discovered 50 years ago. HLA B27 explains less than 30% of the total genetic load. About 60%-90% of axSpA patients worldwide carry HLA B27. The prevalence of the disease is linked to the frequency of HLA B27 in the population which implies that there are relevant differences. Among the roughly 200 subtypes known there are two which are not disease associated. The function of HLA class I molecules is to present peptides to the immune system to defend the organism against microbes targeted by CD8+T cells. This is much supported by the role of the endoplasmic reticulum aminopeptidase 1 (ERAP 1) in AS, an enzyme that is responsible for the intracellular trimming of peptides, since polymorphisms of this gene are only associated with HLA-B27+ disease. The arthritogenic peptide hypothesis trying to explain the pathogenesis of AS is based on that very immune function assuming that also self peptides can be presented. HLA-B27 also plays an important role in classification, diagnosis and severitiy of axSpA.
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Affiliation(s)
| | - Joachim Sieper
- Department of Rheumatology, Charite Universitatsmedizin Berlin, Berlin, Germany
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Mauro D, Gandolfo S, Tirri E, Schett G, Maksymowych WP, Ciccia F. The bone marrow side of axial spondyloarthritis. Nat Rev Rheumatol 2023:10.1038/s41584-023-00986-6. [PMID: 37407716 DOI: 10.1038/s41584-023-00986-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
Spondyloarthritis (SpA) is characterized by the infiltration of innate and adaptive immune cells into entheses and bone marrow. Molecular, cellular and imaging evidence demonstrates the presence of bone marrow inflammation, a hallmark of SpA. In the spine and the peripheral joints, bone marrow is critically involved in the pathogenesis of SpA. Evidence suggests that bone marrow inflammation is associated with enthesitis and that there are roles for mechano-inflammation and intestinal inflammation in bone marrow involvement in SpA. Specific cell types (including mesenchymal stem cells, innate lymphoid cells and γδ T cells) and mediators (Toll-like receptors and cytokines such as TNF, IL-17A, IL-22, IL-23, GM-CSF and TGFβ) are involved in these processes. Using this evidence to demonstrate a bone marrow rather than an entheseal origin for SpA could change our understanding of the disease pathogenesis and the relevant therapeutic approach.
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Affiliation(s)
- Daniele Mauro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Saviana Gandolfo
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Enrico Tirri
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Francesco Ciccia
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Braun J. Significance of structural changes in the axial skeleton in patients with axial spondyloarthritis: how important are lesions in the sacroiliac joint? RMD Open 2022; 8:e002822. [PMID: 36517187 PMCID: PMC9756280 DOI: 10.1136/rmdopen-2022-002822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022] Open
Abstract
Inflammatory back pain (IBP) is a characteristic clinical symptom of patients with axial spondyloarthritis (axSpA) that is caused by inflammation in the axial skeleton. In early disease stages the sacroiliac joints (SIJ) are most often affected, the spine usually at later stages. In many but clearly not all cases of axSpA new bone formation in form of syndesmophytes and ankylosis occur in the further course of the disease. Function and mobility may be impaired by both, inflammation and structural changes. In clinical trials outcome parameters most often used refer to pain, disease activity, function, mobility and global health but many researchers are also interested in radiographic progression in the axial skeleton of patients with axSpA. This viewpoint discusses the relevance of structural changes in the SIJ in comparison to the spine and in relation to functional outcomes and mobility.
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Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Herne, NRW, Germany
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11
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Artamonova OG, Karamova AE, Chikin VV, Kubanov AA. HLA-B27 and its role of the pathogenesis of psoriatic arthritis. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The literature review presents the characteristics of the human leukocyte antigen (HLA)-B27 as a factor contributing to the development of psoriatic arthritis. HLA-B27 is a class I surface antigen encoded by the major histocompatibility complex (MHC) B locus located on chromosome 6. The main function is to present antigenic peptides to the CD8+ T-cells. HLA-B27 is the most important genetic biomarker for psoriatic arthritis, as it provides phenotypic differentiation in the patient population. The prevalence of HLA-B27 in various population groups are presented. The structural features of the HLA-B27 molecule are described. The characteristics of methods for detecting HLA-B27 status and determining its subtypes are given. The main mechanisms of the HLA-B27 polymorphism influence on the development of psoriatic arthritis are considered, and hypotheses are analyzed that explain the pathogenic effect of HLA-B27: the arthritogenic peptide hypothesis, the misfolding hypothesis, the HLA-B27 heavy chain homodimer formation hypothesis. The features of the clinical manifestations and course of HLA-B27-positive psoriatic arthritis are presented, allowing the use of HLA-B27 to predict the development of psoriatic joint damage.
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12
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Renson T, de Hooge M, De Craemer AS, Deroo L, Lukasik Z, Carron P, Herregods N, Jans L, Colman R, Van den Bosch F, Elewaut D. Progressive increase in sacroiliac joint and spinal mri lesions in healthy individuals in relation to age. Arthritis Rheumatol 2022; 74:1506-1514. [PMID: 35436391 DOI: 10.1002/art.42145] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/27/2022] [Accepted: 04/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES MRI plays a pivotal role in spondyloarthritis (SpA) diagnosis. However, detailed description of MRI findings of the sacroiliac joints (SIJ) and spine in healthy individuals is currently lacking. We therefore sought to evaluate the occurrence of MRI-SIJ/spine lesions in healthy individuals in relation to age. METHODS Ninety-five healthy subjects (20-49 years) underwent MRI-SIJ and -spine. BME and structural lesions of the SIJ were scored using the SPARCC method. Spinal inflammatory and structural lesions were evaluated using the SPARCC MRI spine inflammation index and the CANDEN MRI scoring system, respectively. Fulfillment of the ASAS definition of a positive MRI for sacroiliitis/spondylitis was reviewed. Findings were compared with MRI of axial SpA patients from the Be-GIANT cohort. RESULTS 17.2% of subjects aged ≥30 fulfilled the definition of a positive MRI for sacroiliitis, but this occurred rarely in younger subjects. SIJ erosions (20.0%) and fat metaplasia (13.7%) were detected across all age groups. Erosions were more frequently visualized in subjects aged ≥40 (39.3%). Spinal BME (35.7%) and fat metaplasia (28.6%) were common in subjects older than 40 years. Nonetheless, only one subject had ≥3 corner inflammatory lesions. SIJ and spinal SPARCC scores and total structural lesions scores increased progressively with age. CONCLUSION Contrary to what is commonly believed, structural MRI-SIJ lesions are frequently seen in healthy individuals. Especially in older subjects, the high occurrence of inflammatory and structural MRI lesions impacts their specificity for SpA, which has important implications for the interpretation of MRI in patients with clinical suspicion of SpA.
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Affiliation(s)
- Thomas Renson
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Manouk de Hooge
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Liselotte Deroo
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Zuzanna Lukasik
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Roos Colman
- Department of Biostatistics, Ghent University, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
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13
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Seyman Civelek Ü, Baykal Selcuk L, Arica DA, Capkin E, Yayli S. Isotretinoin‐induced inflammatory back pain and sacroiliitis in patients with moderate to severe acne vulgaris. J Cosmet Dermatol 2022; 21:4846-4851. [PMID: 35092165 DOI: 10.1111/jocd.14807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Isotretinoin has been reported to induce inflammatory back pain (IBP) and sacroiliitis in the patients with acne vulgaris. The aim of this study is to investigate the incidence of IBP and sacroiliitis in patients receiving isotretinoin treatment compared with oral antibiotics for acne vulgaris. MATERIALS AND METHODS A total of 201 patients with moderate-to-severe acne vulgaris who received isotretinoin (n = 100) or oral antibiotics (n = 101) were included in the study. All patients were monthly questioned for IBP symptoms during their treatment. Patients described IBP were also evaluated for sacroiliitis by c-reactive protein, sedimentation rate, HLAB27, and sacroiliac magnetic resonance imaging (MRI). Isotretinoin was discontinued in all patients diagnosed as sacroiliitis, and these patients were reevaluated after 3 months. RESULTS IBP was observed in 21 (10.4%), and sacroiliitis was detected in 11 (11%) patients on isotretinoin treatment; in oral antibiotic group, we did not observe IBP or sacroiliitis. The incidence of IBP and sacroiliitis differed significantly between the isotretinoin and oral antibiotic groups (p < 0.0001, p = 0.02). Complete regression was observed in the great majority of patients following cessation of isotretinoin. CONCLUSIONS Our study is the largest prospective controlled study that investigated the incidence of sacroiliitis in patients receiving isotretinoin and compared with patients using oral antibiotics.
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Affiliation(s)
- Ünzüle Seyman Civelek
- Karadeniz Technical University Faculty of Medicine , Dermatology and Venereology Trabzon
| | - Leyla Baykal Selcuk
- Karadeniz Technical University Faculty of Medicine , Dermatology and Venereology Trabzon
| | - Deniz Aksu Arica
- Karadeniz Technical University Faculty of Medicine , Dermatology and Venereology Trabzon
| | - Erhan Capkin
- Karadeniz Technical University Physical Therapy and Rehabilitation Trabzon 61080
| | - Savas Yayli
- Koc University School of Medicine, Dermatology Trabzon 61080
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14
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Diekhoff T, Lambert R, Hermann KG. MRI in axial spondyloarthritis: understanding an 'ASAS-positive MRI' and the ASAS classification criteria. Skeletal Radiol 2022; 51:1721-1730. [PMID: 35199195 PMCID: PMC9283193 DOI: 10.1007/s00256-022-04018-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
In 2009, the Assessment of SpondyloArthritis international Society (ASAS) published a definition of 'active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis'. This new definition of an 'ASAS-positive MRI' was integral to new classification criteria for axial spondyloarthritis that were published in the same year. The ASAS MRI definition had the considerable advantage of simplicity and the definition gained popularity as guidance for interpreting MRI of the sacroiliac joints in clinical practice. However, classification criteria are not designed for use in clinical practice with the consequence that overreliance on the presence of bone marrow edema, which is the principal determinant of an 'ASAS-positive MRI', may result in a tendency to overcall inflammatory sacroiliitis in the clinical setting. This article aims to inform the reader about the rationale behind the ASAS definition of a positive MRI and ASAS classification criteria, their proper use in research and why they should not be used in clinical practice. The article also contains guidance for an updated imaging protocol and interpretation of images including typical imaging findings, differential diagnosis, and common pitfalls.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Lambert
- Department of Radiology & Diagnostic Imaging, University of Alberta, 2A2.41MC, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
- Medical Imaging Consultants, 202-11010 - 101 Street, Edmonton, AB, T5H 4B9, Canada
| | - Kay Geert Hermann
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
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15
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Li HG, Wang DM, Shen FC, Huang SX, Hou ZD, Lin L, Xiao ZY. Risk factors for progression of juvenile-onset non-radiographic axial spondyloarthritis to juvenile-onset ankylosing spondylitis: a nested case-control study. RMD Open 2021; 7:rmdopen-2021-001867. [PMID: 34862311 PMCID: PMC8647561 DOI: 10.1136/rmdopen-2021-001867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To evaluate the clinical characteristics of juvenile-onset non-radiographic axial spondyloarthritis (nr-axSpA) and to investigate risk factors associated with progression to juvenile-onset ankylosing spondylitis (JoAS). Methods A nested case–control study was conducted using the retrospectively collected data of 106 patients with juvenile-onset nr-axSpA (age at disease onset, <16 years) in the Clinical characteristic and Outcome in Chinese Axial Spondyloarthritis study cohort. Baseline demographic and clinical characteristics and prognosis were reviewed. Logistic regression analyses were performed to investigate risk factors associated with progression to JoAS. Results Overall, 58.5% of patients with juvenile-onset nr-axSpA presented with peripheral symptoms at disease onset. In 82.1% of these patients, axial with peripheral involvement occurred during the disease course. The rate of disease onset at >12 years and disease duration of ≤10 years were significantly higher in those with progression to JoAS than in those without progression to JoAS (83.0% vs 52.8%, p=0.001; 92.5% vs 56.6%, p<0.001, respectively). Multivariable logistic regression analysis revealed that inflammatory back pain (IBP) (OR 13.359 (95% CI 2.549 to 70.013)), buttock pain (OR 10.171 (95% CI 2.197 to 47.085)), enthesitis (OR 7.113 (95% CI 1.670 to 30.305)), elevated baseline C reactive protein (CRP) levels (OR 7.295 (95% CI 1.984 to 26.820)) and sacroiliac joint-MRI (SIJ-MRI) positivity (OR 53.821 (95% CI 9.705 to 298.475)) were significantly associated with progression to JoAS. Conclusion Peripheral involvement was prevalent in juvenile-onset nr-axSpA. IBP, buttock pain, enthesitis, elevated baseline CRP levels and SIJ-MRI positivity in patients with the disease are associated with higher risk of progression to JoAS.
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Affiliation(s)
- Hao-Guang Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.,Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Dan-Min Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.,Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Feng-Cai Shen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.,Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Shu-Xin Huang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.,Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhi-Duo Hou
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China .,Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Ling Lin
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.,Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zheng-Yu Xiao
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.,Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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16
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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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17
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Nygaard A, Hendricks O, Loft AG, Christiansen AA, Brandslund I, Jurik AG, Schiøttz-Christensen B. Complement C3d is not associated with axial spondyloarthritis and magnetic resonance imaging changes at the sacroiliac joint. Scand J Rheumatol 2021; 51:382-389. [PMID: 34470588 DOI: 10.1080/03009742.2021.1946255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To investigate the associations between complement C3d and inflammatory and structural changes by magnetic resonance imaging (MRI) at the sacroiliac joints (SIJ) suggestive of axial spondyloarthritis, according to the Assessment of SpondyloArthritis international Society (ASAS) criteria, in patients with low back pain.Method: This was a cross-sectional study of patients referred to the Spine Centre of Southern Denmark owing to unspecified low back pain (Spines of Southern Denmark cohort). The patients were divided into three groups: group 1: patients fulfilling the ASAS criteria for axial spondyloarthritis (axSpA, n = 96); group 2: patients with either a positive MRI of the SIJ and no spondyloarthritis features, or a negative MRI of the SIJ but positive human leucocyte antigen-B27 and one spondyloarthritis feature (non-axSpA, n = 38); group 3: patients with unspecified low back pain for > 3 months (control group, n = 82). Complement C3d was measured with double-decker rocket immunoelectrophoresis and evaluated in relation to the group division and baseline findings by SIJ MRI.Results: In total, 184 C3d analyses were performed. The mean ± sd level of C3d was 33.8 ± 8.1 AU/mL. There were no differences in C3d levels between the three patient groups, mean values being: axSpA = 34.3 ± 7.9 AU/mL, non-axSpA = 33.5 ± 6.9 AU/mL, and controls = 33.4 ± 9.2 AU/mL. The level of C3d was not related to MRI findings.Conclusions: In these patients, complement C3d was not associated with active or structural SIJ changes on MRI suggestive of axial spondyloarthritis.
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Affiliation(s)
- A Nygaard
- Lillebaelt Hospital, University Hospital of Southern Denmark, Middelfart, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - O Hendricks
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Rheumatology, The Danish Hospital for Rheumatology, Sonderborg, Denmark
| | - A G Loft
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - A A Christiansen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Rheumatology, The Danish Hospital for Rheumatology, Sonderborg, Denmark
| | - I Brandslund
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - A G Jurik
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - B Schiøttz-Christensen
- Lillebaelt Hospital, University Hospital of Southern Denmark, Middelfart, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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18
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Makino T, Ihn H, Nakagawa M, Urano M, Okuyama R, Katoh N, Tateishi C, Masuda K, Ogawa E, Nishida E, Nishimoto S, Muramoto K, Tsuruta D, Morita A. Effect of adalimumab on axial manifestations in Japanese patients with psoriatic arthritis: a 24 week prospective, observational study. Rheumatology (Oxford) 2021; 60:3669-3678. [PMID: 33394051 DOI: 10.1093/rheumatology/keaa829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES PsA is characterized by enthesitis, synovitis and osseous involvement in the peripheral and axial joints. Few studies have examined axial involvement in PsA using imaging techniques. Here we examined axial involvement in PsA patients using MRI. In addition, we determined the efficacy of 24 week adalimumab treatment in improving the MRI findings of spondylitis and sacroiliitis. METHODS This was a prospective, open-label, single-arm study in patients with PsA. Adalimumab was administered to patients for a total of 24 weeks. MRI examinations were conducted at baseline and at week 24 of adalimumab treatment. RESULTS Thirty-seven patients with PsA were included in this study. Spondylitis was observed in at least one site of the positive scan in 91% (n = 31) of patients with PsA. The number of arthritic sites in the cervical, thoracic and lumbar regions of the spine was 48, 67 and 53, respectively. All patients had MRI-determined sacroiliitis of grade ≥1 severity while 28 patients (82%) had grade ≥2 sacroiliitis in at least one sacroiliac region. Sacroiliac arthritis was statistically more severe on the right side than on the left side (P < 0.05). In 34 patients with PsA, the thoracic spine was the most common site of spondylitis. In addition, 24 week adalimumab treatment led to an improvement in the mean number of spondylitis sites and the mean grade of sacroiliitis. CONCLUSION Treatment with adalimumab for 24 weeks resulted in improvement in spondylitis and sacroiliitis.
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Affiliation(s)
- Takamitsu Makino
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Motoo Nakagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Misugi Urano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryuhei Okuyama
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Sciences, Kyoto, Japan
| | - Chiharu Tateishi
- Department of Dermatopathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Masuda
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Sciences, Kyoto, Japan
| | - Eisaku Ogawa
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Emi Nishida
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | - Daisuke Tsuruta
- Department of Dermatopathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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19
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Harrison SR, Marzo-Ortega H. Ixekizumab: an IL-17A inhibitor for the treatment of axial Spondylarthritis. Expert Rev Clin Immunol 2021; 17:1059-1071. [PMID: 34407705 DOI: 10.1080/1744666x.2021.1970534] [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: 10/20/2022]
Abstract
INTRODUCTION Axial spondyloarthritis (axSpA) is an inflammatory arthritis which affects primarily the entheses of the spine and sacroiliac joints with peripheral joint synovitis and extra-articular manifestations. In 2017, the first IL-17A inhibitor (IL-17Ai) secukinumab was approved for the treatment of radiographic axSpA not responding adequately to conventional therapies, and this was followed in 2019 by a second IL-17Ai, ixekizumab. These agents represent the first alternative class of biological treatments after the TNF inhibitor which dominated the therapeutic landscape of axSpA for over a decade. AREAS COVERED This review discusses the role of IL-17Ais in the treatment in axSpA focusing on the newest IL-17Ai ixekizumab. It provides a detailed overview of the drug pharmacodynamic, pharmacokinetics, and clinical trial data, including areas of future research needed in the post-marketing era. EXPERT OPINION Early trials of ixekizumab for axSpA have shown encouraging results and an acceptable safety profile. Future phase IV trials should focus on direct head-to-head comparisons between ixekizumab and other biologic drugs, and stratify patients according to important disease characteristics known to affect treatment response including sex, HLA-B27 status, presence of MRI bone marrow edema at baseline, disease duration and any extra-articular manifestations.
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Affiliation(s)
- Stephanie R Harrison
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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20
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Ebrahimiadib N, Berijani S, Ghahari M, Pahlaviani FG. Ankylosing Spondylitis. J Ophthalmic Vis Res 2021; 16:462-469. [PMID: 34394873 PMCID: PMC8358754 DOI: 10.18502/jovr.v16i3.9440] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/21/2020] [Indexed: 01/06/2023] Open
Abstract
The seronegative spondyloarthropathies are a group of autoimmune inflammatory diseases lacking rheumatoid factor or antinuclear antibody in their serum. They include ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, spondylitis associated with Crohn's disease and ulcerative colitis, and undifferentiated spondyloarthropathies. Inflammation mostly affects the axial joints, entheses, and extra-articular structures such as uveal tract, gastrointestinal tract, mucocutaneous tissue, and heart. Uveitis is the most common extra-articular manifestation. Spondyloarthropathies, especially AS, have a strong association with the presence of Human Leukocyte Antigen (HLA)-B27 gene. AS happens earlier in HLA-B27 patients and men are more prone to the disease. Uveitis, typically unilateral non-granulomatous acute anterior uveitis, occurs in up to 50% of the patients with AS. HLA-B27 positivity correlates with more frequent flare-ups. Conjunctivitis and scleritis are rare ocular manifestations of AS. To establish the diagnosis of AS, at least one clinical and one radiologic parameter are required for definitive diagnosis. Magnetic resonance imaging (MRI) or bone scan can help early detection of the axial skeleton inflammation. The course of eye and joint involvement are not correlated. Short-term treatment with topical corticosteroids and cycloplegic agents control the uveitis attack. In resistant cases, local or systemic therapy with corticosteroids are recommended. NSAIDs, disease-modifying anti-rheumatic drugs (DMARDs), methotrexate, azathioprine, anti-IL-17A monoclonal antibodies, and TNF-α antagonists are effective treatments for ocular and systemic manifestations of AS. If not treated adequately, uveitis may become recalcitrant and extend posteriorly. Functional impairment due to joint destruction can also occur as a result of under-treatment.
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Affiliation(s)
- Nazanin Ebrahimiadib
- Retina Service, Ocular Immunology and Uveitis Foundation, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Berijani
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Ghahari
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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21
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Harrison SR, Ansell R, Mathieson HR, Merashli M, Busquets-Péez N, McGonagle D, Marzo-Ortega H. Subjective loss of clinical response to TNFi in axSpA relates to recurrence of MRI bone marrow oedema particularly with long-acting agents. Rheumatology (Oxford) 2021; 61:SI86-SI91. [PMID: 34273162 DOI: 10.1093/rheumatology/keab571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Subjective loss of response immediately prior to routine TNFi therapy can occur in axial spondyloarthritis (axSpA). We investigated clinical outcomes in patients taking the first 3 licenced TNFis and correlated this with recurrence of MRI bone marrow oedema (MRI-BMO). METHODS Proof-of-concept study including axSpA patients established on etanercept (ETA), adalimumab (ADA) or infliximab (IFX) reporting symptom deterioration prior to next dose. MRI/clinical data were collected prior to scheduled dose (v1), 4 days post-dose (v2) and at the time of patient-reported symptom return (v3). MRI spine/sacroiliac joints utilising 3 T were scored using the semi-quantitative Leeds MRI scoring system. RESULTS 113 clinical assessments and MRIs were performed in 38 participants (ADA = 16, ETA = 12, IFX = 10), mean age 42.1 years ± 24.4(2SD, n = 38), 71.1% male (n = 27/38), 69.7% HLA-B27 positive (n = 23/33). At v1 all patients had high disease activity [ASDAS-CRP = 3 (2.7-3.7)] and 57.9% had MRI-BMO (number of MRI-BMO: ETA = 26, ADA = 59, IFX = 28). Improved clinical responses were seen at v2 [ASDAS-CRP -0.41(-0.81-0.30), p= 0.018; BASDAI -0.58(-2.2-0.52), p= 0.024]. Despite just a 4-day interval between v1 and v2, a numerical reduction in MRI-BMO lesions between v1/v2 was observed (ETA=-6, ADA=-10, IFX=-3). By v3 comparatively fewer new BMO lesions were detected in the ETA and ADA groups compared with IFX (ETA=-1, ADA = +3, IFX = +8), although the numbers were too small to enable testing for statistical significance. CONCLUSIONS Short-lived fluctuations in MRI-BMO were commoner with longer-acting agents and corresponded with subjective loss of clinical response before next scheduled TNFi dose. Larger studies are need to confirm the possible pathogenic implications of this phenomenon.
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Affiliation(s)
- Stephanie R Harrison
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Rebecca Ansell
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Department of Rheumatology, Bradford Teaching Hospitals, St Luke's Hospital, Bradford, UK
| | - Hannah R Mathieson
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Department of Rheumatology, Bradford Teaching Hospitals, St Luke's Hospital, Bradford, UK
| | - Mira Merashli
- American University Hospital, Department of Internal Medicine, Division of Rheumatology, Beirut, Lebanon
| | | | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
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22
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Jeong H, Kim YG, Kim TH, Kim TJ, Park MC, Seo MR, Shin K, Oh JS, Lee SH, Lee YA, Lee EY, Baek HJ, Cha HS. Clinical characteristics of non-radiographic axial spondyloarthritis: Results of the Korean Nonradiographic Axial SPondyloArthritis (KONASPA) data. Int J Rheum Dis 2021; 24:1137-1147. [PMID: 34250745 DOI: 10.1111/1756-185x.14175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
AIM To evaluate clinical characteristics and natural history of non-radiographic axial spondyloarthritis (nr-axSpA) using KOrean Nonradiographic Axial SPondyloArthritis (KONASPA) data. METHODS Data were collected from 11 centers in South Korea. A total of 278 patients with nr-axSpA from January 2018 to July 2020 were included. Demographic data, clinical features, comorbidities, disease activity, medications, and laboratory results were collected. RESULTS Mean age at symptom onset was 28.2 ± 14.2 years. Of 278 patients, 152 (54.7%) were male. Mean Bath Ankylosing Spondylitis Disease Activity Index at diagnosis was 3.5 ± 2.1. Dyslipidemia was the most common comorbidity (8.4%), followed by hypertension (6.1%). Mean age at diagnosis of nr-axSpA was older in female patients than in male patients (31.8 ± 15.8 years vs 24.9 ± 12.0 years, P < 0.001). Enthesitis and uveitis were more frequently found in female patients than in male patients. Thirty-one (11.1%) participants with nr-axSpA progressed to ankylosing spondylitis. The median follow-up duration was 48 months. In multivariable Cox regression analysis, age at symptom onset (hazard ratio [HR] 0.93, 95% confidence interval (CI) 0.88-0.97, P = 0.006), body mass index (BMI) (HR 1.24, 95% CI 1.06-1.44, P = 0.005) and sacroiliitis grade (HR 1.86, 95% CI 1.19-2.92, P = 0.006) were associated with progression to ankylosing spondylitis. CONCLUSIONS Results of nationwide data revealed that women with nr-axSpA showed a late disease onset and more extra-articular manifestations than men. Young age at symptom onset, high BMI, and presence of radiographic sacroiliitis at diagnosis were risk factors for progression to AS.
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Affiliation(s)
- Hyemin Jeong
- Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, South Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Tae-Jong Kim
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Mi Ryoung Seo
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ji Seon Oh
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Hoon Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Yeon-Ah Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Han Joo Baek
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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23
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Imaging in Axial Spondyloarthritis: What is Relevant for Diagnosis in Daily Practice? Curr Rheumatol Rep 2021; 23:66. [PMID: 34218356 DOI: 10.1007/s11926-021-01030-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW To explore how imaging may assist diagnosing axial spondyloarthritis in rheumatology practice. RECENT FINDINGS A diagnosis of axial spondyloarthritis is based on pattern recognition by synthesizing clinical, laboratory, and imaging findings. In health care settings providing low threshold access to advanced imaging, sacroiliac joint MRI is the preferred imaging modality in clinically suspected axial spondyloarthritis. In daily routine, the optimum protocol to assess suspected inflammatory back pain combines sacroiliac joint and spine MRI fitting a 30-min slot. Contextual assessment of concomitant structural and active MRI lesions is key to enhance diagnostic utility. In women with postpartum back pain suggestive of axial spondyloarthritis, recent reports advocate waiting 6-12 months after delivery before acquiring sacroiliac joint MRI. Major unmet needs are consistent MRI protocols, standardized training modules on how to evaluate axial MRI, and timely dissemination of imaging advances into mainstream practice both in rheumatology and in radiology. In rheumatology practice, MRI has become indispensable to help diagnose early axial spondyloarthritis. However, major gaps in training and knowledge transfer to daily care need to be closed.
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24
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Profaizer T, Dibb K, Bethers H, Monds C, Andreasen J, Delgado JC, Lázár-Molnár E. Comparison of Next-Generation Sequencing-Based Human Leukocyte Antigen Typing with Clinical Flow Cytometry and Allele-Specific PCR Melting Assays for HLA-B27 Genotyping. J Appl Lab Med 2021; 6:1221-1227. [PMID: 34151972 DOI: 10.1093/jalm/jfab046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to the strong association between ankylosing spondylitis and Human Leukocyte Antigen (HLA)-B27, accurate identification of HLA-B27 is important in the diagnosis of patients with suspected spondyloarthritides. For this study, we compared a high-resolution HLA-B typing method to the clinical flow cytometry and allele-specific PCR melting assays to determine clinical benefits of high-resolution testing. METHODS Residual clinical samples submitted for HLA-B27 testing by flow cytometry were tested by single-locus HLA-B genotyping using next-generation sequencing (NGS), and PCR with melting curve analysis, currently used as a reflex test for indeterminate flow cytometry results. RESULTS Fifty out of the 51 samples (98%) positive by flow cytometry confirmed as HLA-B27 positive by PCR melting assay and by NGS. The sample that did not confirm was genotyped as HLA-B*07:02. All the samples negative by flow cytometry were confirmed as HLA-B27 negative by both PCR melting assay and NGS. For the group that was indeterminate by flow cytometry, 84.5% (n = 49) typed as positive for HLA-B27, while 15.5% (n = 9) were negative for HLA-B27 but positive for HLA-B*07:02. NGS was the only method able to distinguish between pathogenic and nonpathogenic HLA-B27 variants, in contrast to the flow cytometry or the PCR melting assays. CONCLUSIONS Single-locus NGS is superior to flow cytometry and PCR melting assay for the unambiguous identification of HLA-B27 variants, and uniquely able to distinguish between pathogenic and nonpathogenic B27 alleles. Due to its high accuracy, it may be a feasible superior alternative to flow cytometry and traditional molecular methods for clinical HLA-B27 testing.
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Affiliation(s)
- Tracie Profaizer
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Kimberly Dibb
- Histocompatibility & Immunogenetics Laboratory, University of Utah Health, Salt Lake City, UT
| | - Holly Bethers
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Cassandra Monds
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - John Andreasen
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Julio C Delgado
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | - Eszter Lázár-Molnár
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
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25
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Fisher C, Ciurtin C, Leandro M, Sen D, Wedderburn LR. Similarities and Differences Between Juvenile and Adult Spondyloarthropathies. Front Med (Lausanne) 2021; 8:681621. [PMID: 34136509 PMCID: PMC8200411 DOI: 10.3389/fmed.2021.681621] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Spondyloarthritis (SpA) encompasses a broad spectrum of conditions occurring from childhood to middle age. Key features of SpA include axial and peripheral arthritis, enthesitis, extra-articular manifestations, and a strong association with HLA-B27. These features are common across the ages but there are important differences between juvenile and adult onset disease. Juvenile SpA predominantly affects the peripheral joints and the incidence of axial arthritis increases with age. Enthesitis is important in early disease. This review article highlights the similarities and differences between juvenile and adult SpA including classification, pathogenesis, clinical features, imaging, therapeutic strategies, and disease outcomes. In addition, the impact of the biological transition from childhood to adulthood is explored including the importance of musculoskeletal and immunological maturation. We discuss how the changes associated with adolescence may be important in explaining age-related differences in the clinical phenotype between juvenile and adult SpA and their implications for the treatment of juvenile SpA.
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Affiliation(s)
- Corinne Fisher
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Division of Medicine, Department of Rheumatology (Bloomsbury), University College London, London, United Kingdom
| | - Maria Leandro
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Division of Medicine, Department of Rheumatology (Bloomsbury), University College London, London, United Kingdom
| | - Debajit Sen
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Lucy R Wedderburn
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children, London, United Kingdom.,Infection, Immunity & Inflammation Teaching and Research Department University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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26
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Levine I, Malik F, Castillo G, Jaros B, Alaia E, Ream J, Scher JU, Hudesman D, Axelrad J. Prevalence, Predictors, and Disease Activity of Sacroiliitis Among Patients with Crohn's Disease. Inflamm Bowel Dis 2021; 27:809-815. [PMID: 32793977 DOI: 10.1093/ibd/izaa198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sacroiliitis is an inflammatory arthritis of the sacroiliac joints and is associated with inflammatory bowel disease (IBD). Yet, sacroiliitis often goes undiagnosed in IBD, and the clinical association between IBD disease activity and sacroiliitis is not well established. Patients with Crohn's disease (CD) often receive magnetic resonance enterography (MRE) to assess disease activity, affording clinicians the opportunity to evaluate for the presence of sacroiliitis. We aimed to identify the prevalence and disease characteristics associated with sacroiliitis in CD patients undergoing MRE. METHODS All CD patients undergoing MRE for any indication between 2014 and 2018 at an IBD referral center were identified. The MREs were reviewed for the presence of sacroiliitis based on bone marrow edema (BME) and structural lesions. We analyzed demographics, IBD characteristics, clinical and endoscopic disease activity, and management between CD patients with and without sacroiliitis. RESULTS Two hundred fifty-eight patients with CD underwent MRE during the study period. Overall, 17% of patients had MR evidence of sacroiliitis, of whom 73% demonstrated bone marrow edema. Female gender, back pain, and later age of CD diagnosis were associated with sacroiliitis (P = 0.05, P < 0.001, P = 0.04, respectively). Disease location and CD therapy were not associated with sacroiliitis on MRE. Clinical, endoscopic, and radiographic disease activity were not associated with sacroiliitis on MRE. CONCLUSION Sacroiliitis is a common comorbid condition in CD. With limited clinical clues and disease characteristics to suggest sacroiliitis, physicians may utilize MRE to identify sacroiliitis, especially in CD patients with back pain.
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Affiliation(s)
- Irving Levine
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Fardina Malik
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - Gabriel Castillo
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Brian Jaros
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Erin Alaia
- NYU Langone Health, Department of Radiology, New York, NY, USA
| | - Justin Ream
- NYU Langone Health, Department of Radiology, New York, NY, USA
| | - Jose U Scher
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - David Hudesman
- NYU Langone Health, Department of Medicine, Division of Gastroenterology, New York, NY, USA
| | - Jordan Axelrad
- NYU Langone Health, Department of Medicine, Division of Gastroenterology, New York, NY, USA
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27
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Baraliakos X, Richter A, Schmidt CO, Braun J. Response to: 'Correspondence on 'Which factors are associated with bone marrow oedema suspicious of axial spondyloarthritis as detected by MRI in the sacroiliac joints and the spine in the general population?' by Su et al. Ann Rheum Dis 2021:annrheumdis-2021-220632. [PMID: 34001516 DOI: 10.1136/annrheumdis-2021-220632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Adrian Richter
- University of Greifswald Institute of Community Medicine, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Carsten O Schmidt
- University of Greifswald Institute of Community Medicine, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
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28
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Kepp FH, Huber FA, Wurnig MC, Mannil M, Kaniewska M, Guglielmi R, Del Grande F, Guggenberger R. Differentiation of inflammatory from degenerative changes in the sacroiliac joints by machine learning supported texture analysis. Eur J Radiol 2021; 140:109755. [PMID: 33989966 DOI: 10.1016/j.ejrad.2021.109755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare the diagnostic performance of texture analysis (TA) against visual qualitative assessment in the differentiation of spondyloarthritis (SpA) from degenerative changes in the sacroiliac joints (SIJ). METHOD Ninety patients referred for suspected inflammatory lower back pain from the rheumatology department were retrospectively included at our university hospital institution. MRI at 3 T of the lumbar spine and SIJ was performed with oblique coronal T1-weighted (w), fluid-sensitive fat-saturated (fs) TIRM and fsT1w intravenously contrast-enhanced (CE) images. Subjects were divided into three age- and gender-matched groups (30 each) based on definite clinical diagnosis serving as clinical reference standard with either degenerative, inflammatory (SpA) or no changes of the SIJ. SIJ were rated qualitatively by two independent radiologists and quantitatively by region-of-interest-based TA with 304 features subjected to machine learning logistic regression with randomized ten-fold selection of training and validation data. Qualitative and quantitative results were evaluated for diagnostic performance and compared against clinical reference standard. RESULTS Agreement of radiologist's diagnose with clinical reference was fair for both readers (κ = 0.32 and 0.44). ROC statistics revealed significant outperformance of TA compared to qualitative ratings for differentiation of SpA from remainder (AUC = 0.89 vs. 0.75), SpA from degenerative (AUC = 0.91 vs. 0.67) and TIRM-positive SpA (i.e. with bone marrow edema) from remainder cases (AUC = 0.95 vs. 0.76). T1w-CE images were the most important discriminator for detection of SpA. CONCLUSIONS TA is superior to qualitative assessment for the differentiation of inflammatory from degenerative changes of the SIJ. Intravenous CE-images increase diagnostic yield in quantitative TA.
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Affiliation(s)
- Felix H Kepp
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
| | - Florian A Huber
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Faculty of Medicine, University of Zurich, Switzerland.
| | - Moritz C Wurnig
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
| | - Manoj Mannil
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
| | - Malwina Kaniewska
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
| | - Riccardo Guglielmi
- Institute of Radiology, Spital Thurgau AG, Cantonal Hospital Münsterlingen, Spitalcampus 1, 8596 Münsterlingen, Switzerland
| | - Filippo Del Grande
- Istituto di imaging della Svizzera Italiana, Regional Hospital of Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
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29
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Zhu L, Chen P, Sun X, Zhang S. Musculoskeletal ultrasound for ankylosing spondylitis: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25822. [PMID: 33950988 PMCID: PMC8104287 DOI: 10.1097/md.0000000000025822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/13/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To clarify if musculoskeletal ultrasound (US) would give additional information for the clinical examination to diagnose and evaluate the activity of ankylosing spondylitis (AS). METHODS A literature search was performed in PubMed, Embase, Web of Science, the Cochrane Library, Sinomed, Chinese National Knowledge Infrastructure (CINK), and Wanfang databases from their inceptions to May 15, 2020. Studies that examined the musculoskeletal US, which detected sacroiliac joints in people with AS were included. The pooled analyses were performed using Meta Disc version 1.4 software. RESULTS A total of 9 studies encompassing 984 participants were included. Statistical analysis suggested an area under the curve (AUC) of 0.9259 (sensitivity 0.86, specificity 0.54) indicating that US had excellent diagnostic test accuracy for AS, an AUC of 0.6441 (sensitivity 0.87, specificity 0.51) indicating that the US did not have a good diagnostic test accuracy for AS activity. A subgroup analysis revealed that the AUC of power Doppler US (PDUS) and color Doppler US (CDUS) was 0.5000 and 0.9274, respectively, indicating that CDUS was superior to PDUS. CONCLUSION US, especially CDUS, is a valid and reproducible technique for the diagnosis of AS. While the accuracy of AS activity evaluation of the US is not ideal. It may be considered for routine use as part of the standard diagnostic tools in AS.
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30
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Abstract
PURPOSE OF REVIEW MRI has, as the only imaging modality, the ability to visualize both the inflammatory and destructive aspects of sacroiliitis and is a crucial element in the diagnosis and classification of axial spondyloarthritis (axSpA). However, the MRI appearance of several potential differential diagnoses may resemble axSpA sacroiliitis. RECENT FINDINGS The appearances of sacroiliac joint (SIJ) MRIs of various diseased and healthy populations have recently been intensively studied. BME, the key requirement in the Assessment of Spondyloarthritis international Society (ASAS) definition of a 'MRI positive of sacroiliitis' may also be found in degenerative disease, athletes and healthy persons, and, particularly, postpartum women. Certain pattern of BME (high extent, large depth from articular surface, close relation to other lesion types) as well as the presence of structural lesions, particularly bone erosion, backfill or ankylosis increase the likelihood/specificity of being axSpA. Furthermore, old and novel MRI approaches to best distinguish the sacroiliitis of early axSpA from differential diagnoses have recently been tested and compared. SUMMARY Significant new and clinically relevant knowledge has been gained, but further research is still needed to optimally distinguish what is and what isn't sacroiliitis.
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31
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Li Z, Wu X, Leo PJ, De Guzman E, Akkoc N, Breban M, Macfarlane GJ, Mahmoudi M, Marzo-Ortega H, Anderson LK, Wheeler L, Chou CT, Harrison AA, Stebbings S, Jones GT, Bang SY, Wang G, Jamshidi A, Farhadi E, Song J, Lin L, Li M, Wei JCC, Martin NG, Wright MJ, Lee M, Wang Y, Zhan J, Zhang JS, Wang X, Jin ZB, Weisman MH, Gensler LS, Ward MM, Rahbar MH, Diekman L, Kim TH, Reveille JD, Wordsworth BP, Xu H, Brown MA. Polygenic Risk Scores have high diagnostic capacity in ankylosing spondylitis. Ann Rheum Dis 2021; 80:1168-1174. [PMID: 34161253 PMCID: PMC8364478 DOI: 10.1136/annrheumdis-2020-219446] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022]
Abstract
Objective We sought to test the hypothesis that Polygenic Risk Scores (PRSs) have strong capacity to discriminate cases of ankylosing spondylitis (AS) from healthy controls and individuals in the community with chronic back pain. Methods PRSs were developed and validated in individuals of European and East Asian ethnicity, using data from genome-wide association studies in 15 585 AS cases and 20 452 controls. The discriminatory values of PRSs in these populations were compared with other widely used diagnostic tests, including C-reactive protein (CRP), HLA-B27 and sacroiliac MRI. Results In people of European descent, PRS had high discriminatory capacity with area under the curve (AUC) in receiver operator characteristic analysis of 0.924. This was significantly better than for HLA-B27 testing alone (AUC=0.869), MRI (AUC=0.885) or C-reactive protein (AUC=0.700). PRS developed and validated in individuals of East Asian descent performed similarly (AUC=0.948). Assuming a prior probability of AS of 10% such as in patients with chronic back pain under 45 years of age, compared with HLA-B27 testing alone, PRS provides higher positive values for 35% of patients and negative predictive values for 67.5% of patients. For PRS, in people of European descent, the maximum positive predictive value was 78.2% and negative predictive value was 100%, whereas for HLA-B27, these values were 51.9% and 97.9%, respectively. Conclusions PRS have higher discriminatory capacity for AS than CRP, sacroiliac MRI or HLA-B27 status alone. For optimal performance, PRS should be developed for use in the specific ethnic groups to which they are to be applied.
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Affiliation(s)
- Zhixiu Li
- Queensland University of Technology, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Xin Wu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China
| | - Paul J Leo
- Queensland University of Technology, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Erika De Guzman
- Australian Translational Genomics Centre, Queensland University of Technology (QUT), Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Nurullah Akkoc
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Maxime Breban
- UMR 1173, Inserm, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France.,Service de Rhumatologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.,Laboratoire d'Excellence Inflamex, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gary J Macfarlane
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Mahdi Mahmoudi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Lisa K Anderson
- Australian Translational Genomics Centre, Queensland University of Technology (QUT), Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Lawrie Wheeler
- Australian Translational Genomics Centre, Queensland University of Technology (QUT), Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Chung-Tei Chou
- Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Andrew A Harrison
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Simon Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gareth T Jones
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - So-Young Bang
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea (the Republic of)
| | - Geng Wang
- University of Queensland Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Ahmadreza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Elham Farhadi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Jing Song
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China
| | - Li Lin
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China
| | - Mengmeng Li
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - MinJae Lee
- Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yuqin Wang
- State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian Zhan
- Institute for Glycomics, Griffith University, Nathan, Queensland, Australia
| | - Jin-San Zhang
- Center for Precision Medicine, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Institute of Life Sciences, Wenzhou University, Wenzhou, Zhejiang, China
| | - Xiaobing Wang
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, Beijing, China
| | - Michael H Weisman
- Department of Medicine/Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lianne S Gensler
- Division of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Mohammad Hossein Rahbar
- Internal Medicine, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USA
| | - Laura Diekman
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA
| | - Tae-Hwan Kim
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea (the Republic of)
| | - John D Reveille
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA
| | - Bryan Paul Wordsworth
- NIHR Oxford Musculoskeletal Biomedical Research Unit, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China .,School of Clinical Medicine, Tsinghua University, Beijing, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, China
| | - Matthew A Brown
- Center for Precision Medicine, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China .,NIHR Biomedical Research Centre at Guy's and Saint Thomas' NHS Foundation Trust and King's College London, London, UK
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32
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Hwang MC, Ridley L, Reveille JD. Ankylosing spondylitis risk factors: a systematic literature review. Clin Rheumatol 2021; 40:3079-3093. [PMID: 33754220 DOI: 10.1007/s10067-021-05679-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 12/16/2022]
Abstract
Radiographic axial spondyloarthritis (also known as ankylosing spondylitis [AS]) is a chronic immune-mediated arthritis characterized by inflammation of the axial skeleton, peripheral joints, and entheses. It is estimated that 1 in every 200 people are affected by AS, making it an important healthcare and socioeconomic issue. In this review, we aim to explore the current understanding of AS risk factors and provide a comprehensive update. Multiple search strings were used to identify articles of interest published in PubMed between January 1, 2013, and February 1, 2021. On the basis of the literature review and analysis, we present up-to-date information on the risk factors of developing AS and our viewpoints on disease onset and progression. Multiple genetic and nongenetic risk factors have been suggested in the onset of AS. HLA-B27 is known to have a strong association with the disease, but other genes have been implicated in disease development. Aside from genetics, other factors are thought to be involved; up to 70% of patients with AS have subclinical intestinal inflammation, suggesting that the origin of the disease may be in the gut. The exact mechanism by which AS onset begins is most likely complex and multifactorial. Key Points • It remains unclear how interactions between genes, microbes, mechanical stress, gender, and other environmental and lifestyle factors predispose patients to the development of ankylosing spondylitis (AS). • The exact mechanisms of AS are complex and multifactorial which will require much future research • Recognizing the risk factors, as well as understanding gene-environment interactions, may offer valuable insights into the etiology of AS and have important implications for diagnosis and treatment strategies.
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Affiliation(s)
- Mark C Hwang
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center, 6431 Fannin, MSB 1.150, Houston, TX, 77030, USA
| | - Lauren Ridley
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center, 6431 Fannin, MSB 1.150, Houston, TX, 77030, USA
| | - John D Reveille
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center, 6431 Fannin, MSB 1.150, Houston, TX, 77030, USA.
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33
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Deepak P, Ludwig DR, Fidler JL, Guglielmo FF, Bruining DH. Medical and Endoscopic Management of Crohn Disease. Top Magn Reson Imaging 2021; 30:43-61. [PMID: 33528211 DOI: 10.1097/rmr.0000000000000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT In this review, through a series of questions and answers, we explore the current approach to classifying patients with Crohn disease into low-risk (mild-moderate) and high-risk (moderate-severe) categories with the recommended treatment approaches per guidelines from the International Organization for the Study of Inflammatory Bowel Diseases, American Gastroenterological Association, the American College of Gastroenterology, and the European Crohn's and Colitis Organization detailed here. The development pipeline of potential therapies is also summarized. We also review key information from magnetic resonance enterography and pelvis imaging studies that the abdominal radiologist can communicate to a multidisciplinary treatment team that includes gastroenterologists and colorectal surgeons, with a goal of achieving optimal patient outcomes. Lastly, endoscopic and radiological treatment targets in a treat-to-target approach in Crohn disease are explored.
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Affiliation(s)
- Parakkal Deepak
- Washington University Inflammatory Bowel Diseases Center, Division of Gastroenterology, Washington University in Saint Louis School of Medicine, St. Louis, MO
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
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34
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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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35
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Robinson PC, van der Linden S, Khan MA, Taylor WJ. Axial spondyloarthritis: concept, construct, classification and implications for therapy. Nat Rev Rheumatol 2020; 17:109-118. [PMID: 33361770 DOI: 10.1038/s41584-020-00552-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/17/2022]
Abstract
The axial spondyloarthritis (axSpA) disease concept has undergone substantial change from when the entity ankylosing spondylitis was defined by the modified New York criteria in 1984. Developments in imaging, therapy and genetics have all contributed to changing the concept of axSpA from one of erosions in the sacroiliac joints to a spectrum of disease with and without changes evident on plain radiographs. Changes to the previously held concept and construct of the disease have also necessitated new classification criteria. The use of MRI, primarily of the sacroiliac joints, has substantially altered the diagnosis and differential diagnosis of axSpA. Many in the axSpA community believe that the current classification criteria lack specificity, and the CLASSIC study is underway to examine this area. Although much about the evolving axSpA disease concept is universally agreed, there remains disagreement about operationalizing aspects of it, such as the requirement for the objective demonstration of axial inflammation for the classification of axSpA. New imaging technologies, biomarkers and genetics data will probably necessitate ongoing revision of axSpA classification criteria. Advances in our knowledge of the biology of axSpA will settle some differences in opinion as to how the disease concept is applied to the classification and diagnosis of patients.
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Affiliation(s)
- Philip C Robinson
- School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia. .,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.
| | - Sjef van der Linden
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Rheumatology, Immunology and Allergology, Inselspital, University of Bern, Bern, Switzerland
| | | | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
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36
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Aouad K, Maksymowych WP, Baraliakos X, Ziade N. Update of imaging in the diagnosis and management of axial spondyloarthritis. Best Pract Res Clin Rheumatol 2020; 34:101628. [PMID: 33257146 DOI: 10.1016/j.berh.2020.101628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Imaging of the spine and sacroiliac joints has acquired a central role in the diagnosis and classification of axial spondyloarthritis (axSpA) in the earliest phases of the disease. New definitions of specific imaging lesions, particularly in magnetic resonance imaging (MRI), have been recently updated and revised by the ASAS MRI working group to reach a standardized understanding and diagnosis of axSpA among rheumatologists. Recognizing the misleading pitfalls of MRI lesions and differential diagnosis also represents an essential issue in clinical practice to avoid false-positive findings and establish the diagnosis of axSpA with careful regard to the clinical context, clinical signs, and biological tests. This review summarizes the current evidence on the different imaging modalities of the sacroiliac joints and the spine with their application in the clinical setting of SpA and their main pitfalls; it also highlights the newest emerging imaging techniques.
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Affiliation(s)
- Krystel Aouad
- Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon.
| | - Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, 568A Heritage Medical Research Centre, Edmonton, Alberta T6G2R3, Canada.
| | - Xenofon Baraliakos
- Department of Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Claudiusstr. 45, 44649 Herne, Germany.
| | - Nelly Ziade
- Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon; Department of Rheumatology, Hotel-Dieu de France Hospital, Beirut, Lebanon.
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37
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Marzo-Ortega H, Tan AL, McGonagle D, Pickles D, Dubash S, Vandevelde CY, Coates LC, Siebert S, Helliwell PS. BSR Spondyloarthritis Course, 27 February 2020. Spondyloarthritis: pathogenesis, diagnosis and management. Rheumatol Adv Pract 2020; 4:rkaa043. [PMID: 33005861 PMCID: PMC7519775 DOI: 10.1093/rap/rkaa043] [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: 06/18/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
High-quality continuous medical education is essential to maintain excellence in health-care delivery, upskilling professionals and improving patient outcomes. This is particularly relevant when addressing rare disease groups, such as the spondyloarthritides, a group of heterogeneous inflammatory conditions that affect joints and other organs, such as the skin, bowel and eye. Professional bodies, such as the British Society for Rheumatology (BSR), are well placed to deliver this type of education. In 2020, the BSR ran a dedicated SpA course aimed at rheumatology health-care professionals wishing to update their basic knowledge of SpA with a review of the latest advances in the field. Here, we summarize the proceedings of the meeting and discuss the value of such an initiative.
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Affiliation(s)
- Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - David Pickles
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
| | - Sayam Dubash
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Claire Y Vandevelde
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Philip S Helliwell
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
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38
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Fauny M, Cohen N, Morizot C, Leclerc-Jacob S, Wendling D, Lux G, Laurent V, Blum A, Netter P, Baumann C, Chary-Valckenaere I, Peyrin-Biroulet L, Loeuille D. Low Back Pain and Sacroiliitis on Cross-Sectional Abdominal Imaging for Axial Spondyloarthritis Diagnosis in Inflammatory Bowel Diseases. Inflamm Intest Dis 2020; 5:124-131. [PMID: 32999885 DOI: 10.1159/000507930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background Joint damage is the most frequent extraintestinal manifestation in inflammatory bowel disease (IBD). Aims The aim of the study was to assess the value of low back pain (LBP) associated with sacroiliitis on abdominal imaging for the diagnosis of spondyloarthritis (SpA) in IBD. Methods We used a questionnaire assessing rheumatological symptoms for all patients with abdominal computed tomography (CT) and magnetic resonance enterography (MRE). Sacroiliitis was assessed on available CT and MRE. Patients were classified as axial SpA according to the Assessment of SpondyloArthritis International Society criteria. Results Fifty-one patients completed the questionnaire and performed both exams. LBP was present in 27 patients (52.9%), and 10 (19.6%) had an inflammatory component. Sacroiliitis was reported in 12 patients (23.5%), and 6 of them suffered from LBP. Among the 20 patients referred to the rheumatologist, 11 patients suffered from LBP. One patient was HLA-B27 positive and presented sacroiliitis. For the last 10 patients, none of them had a sacroiliitis, and 2 patients were negative for HLA-B27. Conclusion An axial SpA has been diagnosed in 11.8% of IBD patients undergoing cross-sectional imaging, whereas one-fifth had inflammatory LBP, and sacroiliitis was observed in one-quarter of them. To optimize the diagnosis of axial SpA, HLA-B27 testing might be required for patients with both IBD and LBP, but this will require further investigation before its implementation in routine practice.
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Affiliation(s)
- Marine Fauny
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Nicolas Cohen
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Caroline Morizot
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Sophie Leclerc-Jacob
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Daniel Wendling
- Department of Rheumatology, University Hospital of Besancon, Besancon, France
| | - Guillaume Lux
- Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Valérie Laurent
- Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Alain Blum
- Department of Radiology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Cédric Baumann
- Unity of Methodology, Data Management and Statistic, University Hospital of Nancy, Nancy, France
| | - Isabelle Chary-Valckenaere
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France.,Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Hepatology, Inserm NGERE, University Hospital of Nancy, Lorraine University, Nancy, France.,Inserm U1256 NGERE, Lorraine University, Vandoeuvre-Les-Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, IMoPA, University Hospital of Nancy, Lorraine University, Nancy, France.,Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
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39
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Understanding the paradigm of non-radiographic axial spondyloarthritis. Clin Rheumatol 2020; 40:501-512. [PMID: 32996069 DOI: 10.1007/s10067-020-05423-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/17/2022]
Abstract
The concept of axial spondyloarthritis (axSpA) encompasses both non-radiographic (nr-axSpA) and traditional radiographic axSpA (r-axSpA) forms. The former was conceived following the establishment of the ASAS classification criteria for axSpA, which for the first time included the use of magnetic resonance imaging of the sacroiliac joints. This facilitated the classification of patients with axSpA who did not present substantial structural damage. This conception of nr-axSpA revolutionized the classical understanding of axSpA opening new doors for research and broadening the scope of treatment to the entire spectrum of axSpA. In this sense, epidemiologic patterns of the disease were viewed anew, and early diagnosis became a primary objective in the management of the disease. However, despite these advances, this new axSpA subtype led to some concerns within the scientific community. These issues have been addressed by several studies that set out to clarify the concept of nr-axSpA. In this review, we summarize the findings of the most relevant studies including nr-axSpA and then discuss recent advances in understanding disease clinical patterns, burden of disease, and treatment effects. Current scientific research has shown subtle differences between nr-axSpA and r-axSpA. In the near future, these advances will allow for better management of individual patients across the axSpA spectrum.
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40
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Weber U, Jurik AG, Zejden A, Larsen E, Jørgensen SH, Rufibach K, Schioldan C, Schmidt-Olsen S. MRI of the sacroiliac joints in athletes: recognition of non-specific bone marrow oedema by semi-axial added to standard semi-coronal scans. Rheumatology (Oxford) 2020; 59:1381-1390. [PMID: 31600395 DOI: 10.1093/rheumatology/kez458] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/02/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Assessment of combined semi-axial and semi-coronal SI joint MRI in two cohorts of young athletes to explore frequency and topography of non-specific bone marrow oedema (BMO), its association with four constitutional SI joint features, and potential restriction of false-positive assignments of Assessment of SpondyloArthritis International Society-defined sacroiliitis on standard semi-coronal scans alone. METHODS Combined semi-axial and semi-coronal SI joint MRI scans of 20 recreational runners before/after running and 22 elite ice-hockey players were evaluated by three blinded readers for BMO and its association with four constitutional SI joint features: vascular partial volume effect, deep iliac ligament insertion, fluid-filled bone cyst and lumbosacral transitional anomaly. Scans of TNF-treated spondyloarthritis patients served to mask readers. We analysed distribution and topography of BMO and SI joint features across eight anatomical SI joint regions (upper/lower ilium/sacrum, subdivided in anterior/posterior slices) descriptively, as concordantly recorded by ⩾2/3 readers on both MRI planes. BMO confirmed on both scans was compared with previous evaluation of semi-coronal MRI alone, which met the Assessment of SpondyloArthritis International Society definition for active sacroiliitis. RESULTS Perpendicular semi-axial and semi-coronal MRI scans confirmed BMO in the SI joint of every fourth young athlete, preferentially in the anterior upper sacrum. BMO associated with four constitutional SI joint features was observed in 20-36% of athletes, clustering in the posterior lower ilium. The proportion of Assessment of SpondyloArthritis International Society-positive sacroiliitis recorded on the semi-coronal plane alone decreased by 33-56% upon amending semi-axial scans. CONCLUSION Semi-axial combined with standard semi-coronal scans in MRI protocols for sacroiliitis facilitated recognition of non-specific BMO, which clustered in posterior lower ilium/anterior upper sacrum.
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Affiliation(s)
- Ulrich Weber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg.,Hospital of Southern Jutland, University Hospital of the Region of Southern Denmark, Aabenraa.,Department of Regional Health Research, University of Southern Denmark, Odense
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus.,Department of Clinical Medicine, Health, Aarhus University, Aarhus
| | - Anna Zejden
- Department of Radiology, Aarhus University Hospital, Aarhus
| | | | - Steen Hylgaard Jørgensen
- Department of Clinical Medicine, Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Kaspar Rufibach
- Rufibach rePROstat EF, Biostatistical Consulting and Training, Meiringen.,Division of Biostatistics, F. Hoffmann-La Roche, Basel, Switzerland
| | | | - Søren Schmidt-Olsen
- Department of Rheumatology and Sports Medicine, North Denmark Regional Hospital, Hjørring, Denmark
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41
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Sundaram TG, Muhammed H, Aggarwal A, Gupta L. A prospective study of novel disease activity indices for ankylosing spondylitis. Rheumatol Int 2020; 40:1843-1849. [PMID: 32757024 DOI: 10.1007/s00296-020-04662-w] [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] [Received: 05/02/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
There is an ongoing quest for robust disease activity measures in Ankylosing spondylitis (AS). Thus, we prospectively validated two new disease activity indices, Simplified AS Disease Activity Score (SASDAS) and modified Juvenile Spondyloarthritis Disease Activity Score (JSpADA). Patients with AS were assessed for BASDAI, ASDAS and other outcome measures at baseline and 3 months. Comparisons were drawn between those with juvenile onset, early disease and peripheral involvement, with the rest. Fisher's r to Z transformation was used to compare correlations. Receiver-operating characteristic (ROC) curves were used to calculate cutoffs for inactive, low, high and very high disease activity. Of the 107 patients (mean age-29 years) of 6-years long disease, 38.3% had a juvenile onset. SASDAS and modified JSpADA exhibited excellent correlation with BASDAI and ASDAS (all p < 0.001) and were higher in active vs. inactive disease. Treatment responders had a greater fall in SASDAS and modified JSpADA as compared to non-responders. The novel scores were higher in those with peripheral disease. Only SASDAS could discriminate early from late disease. Based on the previously proposed cutoffs, optimal scores for inactive, moderate, high and very high disease activity were deduced. SASDAS-CRP showed better internal consistency than SASDAS-ESR and correlated better with ASDAS-CRP in late disease (Z = 3.04; p = 002) and those with adult onset disease (Z = 2.18; p = 0.03). SASDAS and Modified JSpADA perform as well as standard complex scores and have potential for simpler daily use. From our analyses, SASDAS with CRP performs better than SASDAS-ESR, pending further validation.
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Affiliation(s)
- T G Sundaram
- Departments of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Hafis Muhammed
- Departments of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Amita Aggarwal
- Departments of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Latika Gupta
- Departments of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
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Verhoeven F, Sondag M, Chouk M, Prati C, Wendling D. Ultrasonographic Involvement of the anterior chest wall in Spondyloarthritis: Factors associated with 5-years structural progression. A prospective study in 58 patients. Joint Bone Spine 2020; 87:321-325. [DOI: 10.1016/j.jbspin.2020.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/26/2020] [Indexed: 12/09/2022]
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43
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Abstract
The term axial spondyloarthritis (axSpA) encompasses a heterogeneous group of diseases that have variable presentations, extra-articular manifestations and clinical outcomes, and that will respond differently to treatments. The prototypical type of axSpA, ankylosing spondylitis, is thought to be caused by interaction between the genetically primed host immune system and gut microbiota. Currently used biomarkers such as HLA-B27 status, C-reactive protein and erythrocyte sedimentation rate have, at best, moderate diagnostic and predictive value. Improved biomarkers are needed for axSpA to assist with early diagnosis and to better predict treatment responses and long-term outcomes. Advances in a range of 'omics' technologies and statistical approaches, including genomics approaches (such as polygenic risk scores), microbiome profiling and, potentially, transcriptomic, proteomic and metabolomic profiling, are making it possible for more informative biomarker sets to be developed for use in such clinical applications. Future developments in this field will probably involve combinations of biomarkers that require novel statistical approaches to analyse and to produce easy to interpret metrics for clinical application. Large publicly available datasets from well-characterized case-cohort studies that use extensive biological sampling, particularly focusing on early disease and responses to medications, are required to establish successful biomarker discovery and validation programmes.
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Giani T, Bernardini A, Basile M, Di Maurizo M, Perrone A, Renzo S, Filistrucchi V, Cimaz R, Lionetti P. Usefulness of magnetic resonance enterography in detecting signs of sacroiliitis in young patients with inflammatory bowel disease. Pediatr Rheumatol Online J 2020; 18:42. [PMID: 32493352 PMCID: PMC7268528 DOI: 10.1186/s12969-020-00433-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Arthritis is often an underestimated extraintestinal manifestation in pediatric inflammatory bowel disease (IBD), including sacroiliitis, whose early signs are well detectable at magnetic resonance imaging (MRI). Magnetic resonance enterography (MRE) is an accurate imaging modality for pediatric IBD assessment. We studied the possibility to detect signs of sacroiliac inflammation in a group of children with IBD who underwent MRE for gastrointestinal disease evaluation. METHODS We retrospectively reviewed MRE scans performed in pediatric patients with IBD. We looked for signs of sacroiliitis taking the ASAS (Assessment of SpondyloArthritis international Society) criteria as a model. Presence of bone marrow edema (using T2W sequences with fat suppression), diffusion restriction in Diffusion Weighted Imaging (DWI) or Diffusion Weighted Imaging with Background Suppression (DWIBS), and dynamic contrast enhancement were evaluated. Each SI joint was divided into 4 quadrants: upper iliac, lower iliac, upper sacral, and lower sacral. Two blinded observers with experience in pediatric and skeletal imaging independently evaluated the images. Cases upon which there was a disagreement were evaluated by the two reviewing radiologists and a third radiologist with similar experience together. RESULTS We enrolled 34 patients (24 males and 10 females, with mean age at scanning 14.3 years, median 15.3 years; 2 affected by ulcerative colitis, 32 by Crohn's disease) for a total of 59 examinations performed at the time of their first diagnosis or at symptom exacerbations. No patient complained of musculoskeletal symptoms, neither had pathological findings at articular examination. At the time of MRE 25 patients were under treatment for their IBD. Five patients had radiological signs of SI inflammation at MRE, albeit of mild degree. All patients with SI joint edema also had a restricted diffusion in DWIBS or DWI and almost everyone had contrast media uptake. CONCLUSIONS Sacroiliitis is one of the extraintestinal manifestation associated with IBD; it is often asymptomatic and clinically underdetected, with an unrelated progression with respect to the underlying IBD. MRE offers the possibility to study SI joints in young patients with IBD who undergo MRE for the investigation of their intestinal condition. Furthermore, we observed that gadolinium enhancement does not improve diagnostic specificity in sacroiliiitis detection.
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Affiliation(s)
- Teresa Giani
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy ,grid.9024.f0000 0004 1757 4641Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Azzurra Bernardini
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Massimo Basile
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Marco Di Maurizo
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Anna Perrone
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Sara Renzo
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Viola Filistrucchi
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health and Research Center for Adult and Rheumatic Diseases, University of Milan, Milan, Italy.
| | - Paolo Lionetti
- grid.413181.e0000 0004 1757 8562Anna Meyer Children’s Hospital, Florence, Italy ,grid.8404.80000 0004 1757 2304Neurofarba Department, University of Florence, Florence, Italy
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Dougados M. Treat to target in axial spondyloarthritis: From its concept to its implementation. J Autoimmun 2020; 110:102398. [DOI: 10.1016/j.jaut.2019.102398] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/23/2022]
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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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Abstract
Axial involvement in psoriatic arthritis is a well-recognized manifestation with a prevalence between 12.5% and 78%. This huge heterogeneity is due to the different criteria used by authors to define psoriatic arthritis with axial involvement combining clinical features with radiographic evidence of disease. Specific genetic and clinical attributes of axial psoriatic arthritis might differentiate it from axial spondyloarthritis with concurrent skin psoriasis. Few studies address the specific management. The purpose of this review is to acknowledge the current understanding of axial involvement in psoriatic arthritis and highlight the need for a definition to facilitate research and clinical recognition.
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Resende GG, Meirelles EDS, Marques CDL, Chiereghin A, Lyrio AM, Ximenes AC, Saad CG, Gonçalves CR, Kohem CL, Schainberg CG, Campanholo CB, Bueno Filho JSDS, Pieruccetti LB, Keiserman MW, Yazbek MA, Palominos PE, Goncalves RSG, Lage RDC, Assad RL, Bonfiglioli R, Anti SMA, Carneiro S, Oliveira TL, Azevedo VF, Bianchi WA, Bernardo WM, Pinheiro MDM, Sampaio-Barros PD. The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis - 2019. Adv Rheumatol 2020; 60:19. [PMID: 32171329 DOI: 10.1186/s42358-020-0116-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022] Open
Abstract
Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013.A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed.These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.
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Affiliation(s)
- Gustavo Gomes Resende
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso, 175 / 2° Andar. Santa Efigênia. CEP 30.150-260, Belo Horizonte, MG, Brazil.
| | | | | | | | - Andre Marun Lyrio
- Pontifície Universidade Católica (PUC) de Campinas, Campinas, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ricardo da Cruz Lage
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso, 175 / 2° Andar. Santa Efigênia. CEP 30.150-260, Belo Horizonte, MG, Brazil
| | | | | | | | - Sueli Carneiro
- Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
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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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Huang JX, Chung HY, Chui ETF, Lee KH, Chan SCW, Tsang HHL, Ng AHY. Intensity of spinal inflammation is associated with radiological structural damage in patients with active axial spondyloarthritis. Rheumatol Adv Pract 2020; 4:rkz049. [PMID: 32016167 PMCID: PMC6991179 DOI: 10.1093/rap/rkz049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/26/2019] [Indexed: 12/17/2022] Open
Abstract
Objective The aim was to investigate the relationship between the intensity of spinal inflammation using the apparent diffusion coefficient (ADC) and radiographic progression in axial SpA. Methods This is a cross-sectional study of participants with axial SpA and back pain. Clinical, biochemical and radiological parameters were collected. The ankylosing spondylitis disease activity score (ASDAS)-CRP was determined. Radiographic progression was represented by the modified Stoke ankylosing spondylitis spine score (mSASSS). MRI with short tau inversion recovery (STIR) and diffusion-weighted imaging sequences were performed simultaneously. Inflammatory lesions on STIR were used for the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI indexes and as references in outlining regions of interest in ADC maps to produce mean (ADCmean) and maximal (ADCmax) ADC values. Univariate and multivariate linear regression analyses were used to determine independent associations between ADC and radiographic progression. Results The 84 participants with identifiable lesions on spinal ADC maps recruited were characterized by a mean (s.d.) age of 45.01 (13.68) years, long disease duration [13.40 (11.01) years] and moderate clinical disease activity [ASDAS-CRP 2.07 (0.83)]. Multivariate regression analysis using ADCmean as the independent variable showed that age (regression coefficient [B] = 0.34; P = 0.01), male sex (B = 0.25; P = 0.04) and ADCmean (B = 0.30; P = 0.01) were positively associated with mSASSS. Multivariate regression analysis using ADCmax as the independent variable showed a tendency for ADCmax to be associated with mSASSS (B = 0.21; P = 0.07). Conclusion The intensity of spinal inflammation as determined by ADC is associated with radiographic progression in participants with active axial SpA.
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Affiliation(s)
- Jin Xian Huang
- Division of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, China
| | - Eva Tze Fung Chui
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, China
| | - Kam Ho Lee
- Department of Radiology, Queen Mary Hospital, Hong Kong, China
| | - Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, China
| | - Helen Hoi Lun Tsang
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, China
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