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Ruyssen-Witrand A, Caillet-Portillo D, Najm A, Fogel O, Baillet A, Claudepierre P, Conort O, Dernis E, Fayet F, Gossec L, Goupille P, Hudry C, Letarouilly JG, Lukas C, Marotte H, Molto A, Pouplin S, Senbel E, Sordet C, Tournadre A, Truchetet ME, Wendling D, Dougados M. Standardized reporting for systematic global evaluation of axial spondyloarthritis: An evidence-based and consensus-driven initiative. Joint Bone Spine 2024; 91:105733. [PMID: 38604594 DOI: 10.1016/j.jbspin.2024.105733] [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: 01/03/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION National and international scientific societies advocate for a regular, systematic, and standardized global evaluation of axial spondyloarthritis (axSpA) patients. However, there are no recommendations specifying the content of this global evaluation. This initiative aimed to propose a standardized reporting framework, using evidence-based and consensus approaches, to collect data on all domains of axSpA. METHODS A literature review and consensus process involved a steering committee and an expert panel of 37 rheumatologists and health professionals. The first steering committee took place in March 2022 and identified the main domains for inclusion in the standardized report. A hierarchical literature review was conducted to identify items within these domains and tools for assessment. The items and tools for assessment were discussed and consensus was reached through a vote session during an expert meeting that took place in March 2023. RESULTS The steering committee identified four main domains to include in the standardized reporting framework: disease assessment, comorbidities, lifestyle, and quality of life. Items and tools for assessment were adopted after the expert meeting. Additionally, recommendations regarding digital tools (websites, apps, social media) were provided. CONCLUSION This initiative led to a consensus, based on evidence and expertise, on a reporting framework for use during periodic systematic global evaluations of axSpa in daily practice.
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Affiliation(s)
- Adeline Ruyssen-Witrand
- Rheumatology Centre, Toulouse University Hospital, Centre d'Investigation Clinique de Toulouse (CIC1436), Inserm, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", University of Toulouse 3, Toulouse, France.
| | - Damien Caillet-Portillo
- Rheumatology Centre, Toulouse University Hospital, University of Toulouse 3, Toulouse, France
| | - Aurélie Najm
- Institute of Infection and Immunity, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Olivier Fogel
- Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Athan Baillet
- Université Grenoble-Alpes, TIMC, CNRS UMR5525, Grenoble, France
| | - Pascal Claudepierre
- AP-HP, Service de Rhumatologie, Hôpital Henri-Mondor, Université Paris Est Créteil, EA 7379, EpiDermE, Paris, France
| | - Orenella Conort
- Department Clinical Pharmacy, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Dernis
- Department of Rheumatology and Clinical Immunology, General hospital Le Mans, Le Mans, France
| | - Françoise Fayet
- Rheumatology Centre, Clermont University Hospital, Clermont-Ferrand, France
| | - Laure Gossec
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, AP-HP, Pitié-Salpêtrière Hospital, Rheumatology Department, Paris, France
| | - Philippe Goupille
- Université de Tours, EA 6295, Department of Rheumatology, University Hospital of Tours, Tours, France
| | | | | | - Cédric Lukas
- Department of Rheumatology, University Hospital of Montpellier, Inserm UA11 (IDESP), University of Montpellier, Montpellier, France
| | - Hubert Marotte
- Université Jean-Monnet Saint-Étienne, CHU de Saint-Étienne, Service de Rhumatologie, Mines Saint-Étienne, Inserm, SAINBIOSE U1059, 42023 Saint-Étienne, France
| | - Anna Molto
- ECAMO team (Inserm U1153), Center of Research in Epidemiology and Statistics (CRESS), Université Paris-Cité, Paris, France
| | - Sophie Pouplin
- Rheumatology Centre, Rouen University Hospital, Rouen, France
| | - Eric Senbel
- Centre de Rhumatologie de l'Eldorado, Marseille, France
| | - Christelle Sordet
- Rheumatology Center, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Anne Tournadre
- Rheumatology Centre, Clermont University Hospital, UNH INRAe University Clermont Auvergne, Clermont-Ferrand, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, Hôpital Pellegrin, Bordeaux, France; Bordeaux University, CNRS, ImmunoConcept, UMR 5164, 33000 Bordeaux, France
| | - Daniel Wendling
- Rheumatology Centre, CHU de Besançon, University Hospital, EA4266, Université de Franche-Comté, Besançon, France
| | - Maxime Dougados
- University of Paris-Cité, Department of Rheumatology, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, Inserm (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
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2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. Joint Bone Spine 2022; 89:105344. [PMID: 35038574 DOI: 10.1016/j.jbspin.2022.105344] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Update the French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. METHODS Following standardized procedures, a systematic literature review was done by four supervised rheumatology residents based on questions defined by a task force of 16 attending rheumatologists. The findings were reviewed during three working meetings that culminated in each recommendation receiving a grade and the level of agreement among experts being determined. RESULTS Five general principles and 15 recommendations were developed. They take into account pharmacological and non-pharmacological measures along with treatment methods based on the dominant phenotype present (axial, articular, enthesitis/dactylitis) and the extra-articular manifestations (psoriasis, inflammatory bowel disease, uveitis). NSAIDs are the first-line pharmacological treatment in the various presentations. Conventional synthetic disease modifying antirheumatic drugs (csDMARDs) are not indicated in the axial and isolated entheseal forms. If the response to conventional treatment is not adequate, targeted therapies (biologics, synthetics) should be considered; the indications depend on the clinical phenotype and presence of extra-articular manifestations. CONCLUSION This update incorporates recent data (published since the prior update in 2018) and the predominant clinical phenotype concept. It aims to help physicians with the everyday management of patients affected by spondyloarthritis, including psoriatic arthritis.
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Portier E, Dougados M, Moltó A. Disease activity outcome measures are only available in half of the electronic medical files of patients with axial spondyloarthritis followed in an outpatient clinic: the results of an audit of a tertiary-care rheumatology department. Rheumatol Int 2021; 42:825-829. [PMID: 34821969 DOI: 10.1007/s00296-021-05055-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/13/2021] [Indexed: 12/29/2022]
Abstract
Current recommendations for management of patients with axial spondyloarthritis (axSpA) include regular collection of validated disease activity outcomes. This study aimed at evaluating the proportion of patients for whom validated outcome measures were available on their electronic medical reports (EMR), and the factors associated with the presence of such information on the EMR. We performed a cross-sectional monocentric observational study, including patients with an axSpA diagnosis who attended an outpatient visit between February, 2018 and February, 2019. Patients (demographics, disease characteristics, treatment) and physician characteristics (age, gender) and the disease activity outcome measures (BASDAI, CRP and ASDAS, and the items allowing to calculate them) were retrieved from the EMR. The proportion of patients in which disease activity outcome measures were available in the EMR was calculated, and the association between the presence of such outcomes and patients and physician's characteristics was evaluated. 320 EMR of axSpA patients seen in the outpatient clinic were examined. Among them, 131 (41%) and 123 (38.4%) had a BASDAI + CRP and an ASDAS reported, respectively, but at least one was available in 178 (55.6%) of the EMR. The most frequently reported disease activity items were duration of morning stiffness (n = 230, 72%) and CRP (n = 224, 70%). Only previous participation on a systematic holistic review was independently associated with a reported disease activity outcome. Thus, implementation of recommendations with regard to regularly collecting disease activity outcome measures is not optimal. The participation in educational programs including self-assessment educational programs might be a key to improve such implementation.
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Affiliation(s)
- Elodie Portier
- Rheumatology Department, Cochin Hospital, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.
| | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,INSERM U-1153, CRESS, University of Paris, Paris, France
| | - Anna Moltó
- Rheumatology Department, Cochin Hospital, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,INSERM U-1153, CRESS, University of Paris, Paris, France
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Wendling D, Claudepierre P, Goupille P, Pham T, Prati C. Tight control and treat-to-target in axial spondyloarthritis. Where are we? Joint Bone Spine 2021; 89:105263. [PMID: 34506936 DOI: 10.1016/j.jbspin.2021.105263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/31/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Daniel Wendling
- Department of rheumatology, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4266, EPILAB, université de Franche-Comté, Besançon, France.
| | - Pascal Claudepierre
- EpiDermE, université Paris Est Créteil, 94010 Créteil, France; Service de rhumatologie, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Philippe Goupille
- Department of rheumatology, CHRU de Tours, Tours, France; EA 7501, GICC, université de Tours, Tours, France
| | - Thao Pham
- Department of rheumatology, Aix Marseille université, CHU Sainte-Marguerite, AP-HM, Marseille, France
| | - Clément Prati
- Department of rheumatology, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4267, PEPITE, université de Franche-Comté, FHU INCREASE, Besançon, France
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Wendling D, Prati C, Lequerré T, Miceli C, Dougados M, Molto A, Guillot X. Uveitis occurrence in early inflammatory back pain. Five years data from the prospective French nationwide DESIR cohort. Joint Bone Spine 2020; 88:105100. [PMID: 33166730 DOI: 10.1016/j.jbspin.2020.105100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Uveitis is a frequent extra rheumatological manifestation in axial Spondyloarthritis (SpA). The aim of study was to evaluate the prevalence and incidence of uveitis over the first five years of a prospective nationwide cohort of patients with high suspicion of early axial SpA, and to evaluate its associated factors. METHODS DESIR is a prospective observational cohort of patients with recent onset inflammatory back pain (more than 3 months, less than 3 years), suggestive of axial SpA, All available factors in the database were compared between patients with and without uveitis at 5 years, by uni and then multivariate analysis. Baseline factors associated with new cases of uveitis occurrence over the 5 years were also analyzed. SIGNIFICANCE P less than 0.05. RESULTS After 5 years, 91 patients (out of 480 with complete follow-up) had at least one uveitis episode, giving an estimated prevalence of 18.9% [95% CI: 15.4-22.4]. In multivariate analysis, uveitis was significantly associated with dactylitis, and elevated ESR. New incident uveitis occurred in 31 cases over 5 years, giving an estimated incidence rate of 1.29 [0.84-1.74]/100 patient-years. Incidence of new uveitis was associated in multivariate analysis with baseline factors: diagnosis of SpA, sacro iliac MRI inflammatory SPARCC score, dactylitis, syndesmophyte score. No significant association was found with HLA-B27, DMARDs, BASDAI, ASDAS, BASFI. CONCLUSION Five-years data of the DESIR cohort allowed an estimation of incidence rate of uveitis of 1.3/100p-y; over five years, uveitis was associated with dactylitis, biologic and sacro iliac MRI inflammation.
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Affiliation(s)
- Daniel Wendling
- Service de Rhumatologie, CHRU de Besançon, Besançon, France; EA 4266, Université de Franche-Comté, Besançon, France.
| | - Clément Prati
- Service de Rhumatologie, CHRU de Besançon, Besançon, France; EA4267, Université de Franche-Comté, Besançon, France
| | - Thierry Lequerré
- Service de Rhumatologie, Normandie Univ, UNIROUEN, Inserm U 1234, CIC-CRB 1404, 76031 Rouen, France; CHU de Rouen, Service de Rhumatologie, 76031 Rouen, France
| | | | | | - Anna Molto
- Rhumatologie, Hôpital Cochin, Paris, France
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