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Baraliakos X, Østergaard M, Poddubnyy D, van der Heijde D, Deodhar A, Machado PM, Navarro-Compán V, Hermann KGA, Kishimoto M, Lee EY, Gensler LS, Kiltz U, Eigenmann MF, Pertel P, Readie A, Richards HB, Porter B, Braun J. Effect of Secukinumab Versus Adalimumab Biosimilar on Radiographic Progression in Patients With Radiographic Axial Spondyloarthritis: Results From a Head-to-Head Randomized Phase IIIb Study. Arthritis Rheumatol 2024. [PMID: 38556921 DOI: 10.1002/art.42852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Spinal radiographic progression is an important outcome in radiographic axial spondyloarthritis (SpA). The objective of the phase IIIb SURPASS study was to compare spinal radiographic progression in patients with radiographic axial SpA treated with secukinumab (interleukin-17A inhibitor) versus adalimumab biosimilar (Sandoz adalimumab [SDZ-ADL]; tumor necrosis factor inhibitor). METHODS Biologic-naive patients with active radiographic axial SpA, at high risk of radiographic progression (high-sensitivity C-reactive protein [hsCRP] ≥5 mg/L and/or ≥1 syndesmophyte[s] on spinal radiographs), were randomized (1:1:1) to secukinumab (150/300 mg) or SDZ-ADL (40 mg). The proportion of patients with no radiographic progression (change from baseline [CFB] in modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS] ≤0.5) on secukinumab versus SDZ-ADL at week 104 (primary endpoint), mean CFB-mSASSS, proportion of patients with ≥1 syndesmophyte(s) at baseline with no new syndesmophyte(s), and safety were evaluated. RESULTS Overall, 859 patients (78.5% male, mSASSS 16.6, Bath Ankylosing Spondylitis Disease Activity Index 7.1, hsCRP 20.4 mg/L, and 73.0% with ≥1 syndesmophyte[s]) received secukinumab 150 mg (n = 287), secukinumab 300 mg (n = 286), or SDZ-ADL (n = 286). At week 104, the proportion of patients with no radiographic progression was 66.1%, 66.9%, and 65.6% (P = not significant, both secukinumab doses) and mean CFB-mSASSS was 0.54, 0.55, and 0.72 in secukinumab 150 mg, secukinumab 300 mg, and SDZ-ADL arms, respectively. Overall, 56.9%, 53.8%, and 53.3% of patients on secukinumab 150 mg, secukinumab 300 mg, and SDZ-ADL, respectively, with ≥1 syndesmophyte(s) at baseline did not develop new syndesmophyte(s) by week 104. There were no unexpected safety findings. CONCLUSION Spinal radiographic progression over two years was low with no significant difference between secukinumab and SDZ-ADL arms. The safety of both treatments was consistent with previous reports.
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Affiliation(s)
| | - Mikkel Østergaard
- Rigshospitalet, Glostrup, Denmark, and University of Copenhagen, Copenhagen, Denmark
| | - Denis Poddubnyy
- Charité Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany
| | | | | | | | | | | | | | - Eun Young Lee
- Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | - Aimee Readie
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | | | - Brian Porter
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Juergen Braun
- Rheuma Praxis Berlin, Berlin, Germany, and Ruhr-Universität Bochum, Bochum, Germany
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Selmi C, Chimenti MS, Novelli L, Parikh BK, Morello F, de Vlam K, Ciccia F. Pain in axial spondyloarthritis: role of the JAK/STAT pathway. Front Immunol 2024; 15:1341981. [PMID: 38464510 PMCID: PMC10921361 DOI: 10.3389/fimmu.2024.1341981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that is characterized by new bone formation in the axial musculoskeletal system, with X-ray discriminating between radiographic and non-radiographic forms. Current therapeutic options include non-steroidal anti-inflammatory drugs in addition to biological disease-modifying anti-rheumatic drugs that specifically target tumor necrosis factor-alpha (TNFα) or interleukin (IL)-17. Pain is the most critical symptom for axSpA patients, significantly contributing to the burden of disease and impacting daily life. While the inflammatory process exerts a major role in determining pain in the early phases of the disease, the symptom may also result from mechanical and neuromuscular causes that require complex, multi-faceted pharmacologic and non-pharmacologic treatment, especially in the later phases. In clinical practice, pain often persists and does not respond further despite the absence of inflammatory disease activity. Cytokines involved in axSpA pathogenesis interact directly/indirectly with the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signaling cascade, a fundamental component in the origin and development of spondyloarthropathies. The JAK/STAT pathway also plays an important role in nociception, and new-generation JAK inhibitors have demonstrated rapid pain relief. We provide a comprehensive review of the different pain types observed in axSpA and the potential role of JAK/STAT signaling in this context, with specific focus on data from preclinical studies and data from clinical trials with JAK inhibitors.
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Affiliation(s)
- Carlo Selmi
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | | | - Bhumik K. Parikh
- Global Medical Affairs, AbbVie, Inc., Mettawa, IL, United States
| | | | - Kurt de Vlam
- Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Center (SBE), Department of Development and Regeneration, KULeuven, Leuven, Belgium
| | - Francesco Ciccia
- Department of Precision Medicine Napoli, Università degli Studi della Campania “Luigi Vanvitelli”, Caserta, Italy
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Werkl P, Rademacher J, Pleyer U. HLA-B27-positive anterior uveitis : Clinical aspects, diagnostics, interdisciplinary management, and treatment. DIE OPHTHALMOLOGIE 2024; 121:12-22. [PMID: 38085287 DOI: 10.1007/s00347-023-01960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/03/2024]
Abstract
Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation. Other characteristics are reduced intraocular pressure and a high tendency to relapse, which can also involve the partner eye. Patients with HLA-B27 positive AAU share a high risk for other genetically associated diseases, especially spondylarthritis, chronic inflammatory bowel diseases and psoriasis. As up to 40% of those affected have a systemic disease that has not yet been diagnosed, the ophthalmologist is of major importance for early detection.
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Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz-LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Judith Rademacher
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Universitäts-Augenklinik, Charité, Campus Virchow Klinikum-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, 13355, Berlin, Germany.
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4
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Wendel M, Klemm P, Schulz N. [44-year-old patient with back pain]. Dtsch Med Wochenschr 2024; 149:13-14. [PMID: 38158201 DOI: 10.1055/a-2195-3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Michael Wendel
- Justus-Liebig-Universität Gießen, Campus Kerckhoff, Abteilung für Rheumatologie, klinische Immunologie, Osteologie und physikalische Medizin
| | - Philipp Klemm
- Justus-Liebig-Universität Gießen, Campus Kerckhoff, Abteilung für Rheumatologie, klinische Immunologie, Osteologie und physikalische Medizin
| | - Nils Schulz
- Justus-Liebig-Universität Gießen, Campus Kerckhoff, Abteilung für Rheumatologie, klinische Immunologie, Osteologie und physikalische Medizin
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Stisen ZR, Skougaard M, Christensen KR, Ainsworth MA, Hansen RL, Thomsen SF, Mogensen M, Dreyer L, Kristensen LE, Jørgensen TS. Exploring disease-related and treatment-related issues and concerns experienced by adults with spondyloarthritis, inflammatory bowel disease and psoriasis to identify unmet needs: a qualitative clinical concept mapping study. BMJ Open 2023; 13:e071586. [PMID: 38081674 PMCID: PMC10729280 DOI: 10.1136/bmjopen-2023-071586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/28/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Exploring patients' perspectives for significant factors of relevance in living with a chronic disease is important to discover unmet needs and challenges. The primary objective of this study was to explore disease-related and treatment-related issues and concerns experienced by adults with spondyloarthropathies (SpA) and associated diseases. As a secondary objective, we wanted to explore whether these factors were generic or disease dependent. DESIGN We used group concept mapping (GCM), a validated qualitative method, to identify disease-related and treatment-related issues and concerns. Participants generated statements in the GCM workshops and organised them into clusters to develop concepts. Furthermore, participants rated each statement for importance from 1: 'not important at all' to 5: 'of great importance'. SETTING Participants were recruited during routine care at the outpatient clinic at the hospitals in the period from May 2018 to July 2022. PARTICIPANTS Eligible participants were adults ≥18 years and diagnosed with axial spondyloarthritis (AxSpA), psoriatic arthritis (PsA), psoriasis (PsO) or inflammatory bowel disease -split into Crohn's disease (CD) and ulcerative colitis (UC). RESULTS 52 patients participated in the 11 workshops divided into groups according to their diagnosis. They created a total of 1275 statements that generated 10 AxSpA concepts, 7 PsA concepts, 7 PsO concepts, 10 CD concepts and 11 UC concepts. The highest rated concepts within each disease group were: AxSpA, 'lack of understanding/to be heard and seen by healthcare professionals' (mean rating 4.0); PsA, 'medication (effects and side effects)' (mean rating 3.8); PsO, 'social and psychological problems, the shame' (mean rating 4.0); CD, 'positive attitudes' (mean rating 4.3) and UC; 'take responsibility and control over your life' (mean rating 4.0). CONCLUSION People with SpA and associated diseases largely agree on which concepts describe their disease-related and treatment-related issues and concerns with a few of them being more disease-specific.
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Affiliation(s)
- Zara R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Marie Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mark Andrew Ainsworth
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Rebekka Lund Hansen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette Mogensen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Tanja Schjødt Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
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Mao S, Xiao K, Zhou W, Xu H, Zhang S. The Impact of Hot Spring Hydrotherapy on Pain Perception and Dysfunction Severity in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis. J Pain Res 2023; 16:3925-3944. [PMID: 38026467 PMCID: PMC10658949 DOI: 10.2147/jpr.s438744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Chronic Low Back Pain (CLBP) is a prevalent global health issue, leading to prolonged discomfort and functional limitations. Hot spring hydrotherapy, which utilizes mineral-rich, warm spring water, offers a unique physical therapy that holds promise in alleviating CLBP symptoms. Objective This meta-analysis aims to assess the effectiveness of hot spring hydrotherapy in improving CLBP symptoms, encompassing pain intensity, functional disability, quality of life, and medication usage. Methods A systematic review and meta-analysis were conducted by searching relevant literature in multiple databases. Included studies compared hot spring hydrotherapy with control interventions or other treatments. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated for pain intensity, functional disability, medication usage, and quality of life. Results A total of 16 studies met the inclusion criteria, involving 1656 participants with chronic low back pain across various countries. The meta-analysis demonstrated that hot spring hydrotherapy was effective in reducing pain intensity (SMD = -0.901, 95% CI [-1.777, -0.025], P < 0.05) and improving functional disability (SMD = -3.236, 95% CI [-4.898, -1.575], P < 0.0001) in CLBP patients. Hot spring hydrotherapy also resulted in a significant reduction in medication usage (P < 0.05). Subgroup analysis showed that the effects of hot spring hydrotherapy were more pronounced in patients aged 60 and above, while no significant differences were observed in patients below 60 years of age, single hot Spring Hydrotherapy help improve patients' quality of life. Conclusion Hot spring hydrotherapy is an effective intervention for improving CLBP symptoms, including pain intensity, functional disability, and medication usage. It is particularly beneficial for CLBP patients aged 60 and above. These findings support the integration of hot spring hydrotherapy into the treatment approach for CLBP, although further research is needed to determine its efficacy in younger patients and to explore the underlying mechanisms of its therapeutic effects. Prospero Id CRD42023430860.
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Affiliation(s)
- Sujie Mao
- Discipline Construction Office, Nanjing Sport Institute, NanJing, Jiangsu, People’s Republic of China
| | - Kaiwen Xiao
- Discipline Construction Office, Nanjing Sport Institute, NanJing, Jiangsu, People’s Republic of China
| | - Wensheng Zhou
- Department of Physical Education, Jiangsu Second Normal University, Nanjing, JiangSu, People’s Republic of China
| | - Hong Xu
- Department of Physical Education, Nanjing Xiao-Zhuang University, Nanjing, JiangSu, People’s Republic of China
| | - Shikun Zhang
- Department of Police Physical Education, Jiangsu Police Institute, Nanjing, JiangSu, People’s Republic of China
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Drosos AA, Venetsanopoulou AI, Voulgari PV. Axial Spondyloarthritis: Evolving concepts regarding the disease's diagnosis and treatment. Eur J Intern Med 2023; 117:21-27. [PMID: 37414646 DOI: 10.1016/j.ejim.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
Spondyloarthritis (SpA) is a chronic inflammatory disease that affects the axial skeleton (axSpA) and/or the peripheral joints (p-SpA) and entheses. The natural history of SpA in the decades of the 80 and 90 s involved a progressive disease with pain, spinal stiffness, ankylosis of the axial skeleton, structural damage of peripheral joints, and a poor prognosis. In the last 20 years, enormous advances in understanding and managing SpA have occurred. With the introduction of the ASAS classification criteria and MRI, early disease recognition is now possible. The ASAS criteria widened the spectrum of SpA to include all the disease phenotypes, such as radiographic (r-axSpA), non-radiographic (nr-axSpA), and p-SpA and extraskeletal manifestations. Nowadays, the treatment of SpA is based on a shared decision between patients and rheumatologists and includes non-pharmacological and pharmacological therapies. Moreover, the discovery of TNFα, IL-17, which play a pivotal role in disease pathophysiology, has revolutionized disease management. Thus, new targeted therapies and many biological agents are now available and used in SpA patients. TNFα inhibitors (TNFi), IL-17, and JAK inhibitors were proven to be efficacious, with an acceptable toxicity profile. Overall, their efficacy and safety are comparable with some differences. Sustained clinical disease remission, low disease activity, improvement of patient's quality of life, and prevention of progression of structural damage, are the results of the above interventions. The concept of SpA has changed in the last 20 years. The disease burden can be ameliorated by early and accurate diagnosis and targeting therapies.
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Affiliation(s)
- Alexandros A Drosos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece.
| | - Aliki I Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece
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Rondags A, van Marle L, Horváth B, Wink FR, Arends S, Spoorenberg A. Psoriasis seems often underdiagnosed in patient with axial spondyloarthritis. Arthritis Res Ther 2023; 25:145. [PMID: 37559146 PMCID: PMC10410990 DOI: 10.1186/s13075-023-03119-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is known to be associated with several extra-skeletal manifestations (ESM), including the inflammatory skin disease psoriasis. It is important to recognize and diagnose psoriasis timely in axSpA in order to provide optimal treatment and outcome for both axSpA and psoriasis. METHODS In this observational study, all patients from the Dutch Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort included before June 2016 were sent a questionnaire with self-screening psoriasis questions including prototypical color pictures. RESULTS Of the 592 questionnaires sent, 448 (75.7%) were eligible for analysis. Of these 448 respondents, 58 (13%) had a positive self-screening for psoriasis symptoms, currently or in the past. In 28 (48%) of 58 patients, psoriasis diagnosis could be verified by medical records, resulting in a psoriasis prevalence rate of 6.3%. In comparison with patients with a confirmed psoriasis diagnosis, patients reporting psoriasis symptoms without a verified diagnosis mentioned more mild than moderate-severe psoriasis symptoms (25% vs. 3%, p = 0.02), and their psoriasis lesions were less often located on the torso area (3% vs. 18%, p = 0.04), the intergluteal cleft (0% vs. 25%, p = 0.02), and legs (7% vs. 43%, p < 0.01). Of the 31 axSpA patients who reported currently active psoriasis, 74% had only mild psoriasis symptoms. CONCLUSIONS Especially mild psoriasis seems often underdiagnosed in patients with axSpA using a patient questionnaire with prototypical pictures of psoriasis lesions. This questionnaire could be beneficial in tracing patients with undiagnosed psoriasis in daily clinical practice. As a next step, further validation of this questionnaire is needed.
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Affiliation(s)
- Angelique Rondags
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Laura van Marle
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Freke R Wink
- Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Suzanne Arends
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Anneke Spoorenberg
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Kristensen LE, Navarro-Compán V, Magrey M, Bushmakin AG, Cappelleri JC, Yndestad A, Dina O, Taylor PC. Pain and Inflammation as Mediators of Tofacitinib Treatment Effect on Fatigue in Patients with Ankylosing Spondylitis: A Mediation Analysis. Rheumatol Ther 2023; 10:1073-1087. [PMID: 37351781 PMCID: PMC10326212 DOI: 10.1007/s40744-023-00570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Tofacitinib is an oral Janus kinase inhibitor for treatment of ankylosing spondylitis (AS). Using mediation modelling, we describe interrelationships between fatigue, pain, morning stiffness, C-reactive protein (CRP) and tofacitinib treatment in patients with AS. METHODS Data from phase 2 (NCT01786668)/phase 3 (NCT03502616) studies of patients receiving tofacitinib 5 mg twice daily (BID) or placebo were used. Initial models included treatment as the independent binary variable (tofacitinib 5 mg BID versus placebo); fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F; model A] or Bath AS Disease Activity Index [BASDAI] Q1 [model B]) as the dependent variable; and pain (total back pain/nocturnal spinal pain [model A] or pain measured by BASDAI Q2/3 [model B]), morning stiffness (BASDAI Q5/6) and CRP as mediator variables. RESULTS Pooled data from 370/371 patients were included in models A/B. Initial models demonstrated that tofacitinib treatment affects fatigue mainly indirectly via pain and morning stiffness. As a result, initial models were respecified to exclude direct treatment effect and the indirect effect via CRP. For respecified model A, 44.0% of the indirect effect of tofacitinib treatment on fatigue was mediated via back pain/morning stiffness, 40.0% via morning stiffness alone and 16.0% via back pain alone (all P < 0.05). For respecified model B, 80.8% of the indirect effect of tofacitinib treatment on fatigue was mediated via pain/morning stiffness and 19.2% via pain alone (both P < 0.05). CONCLUSIONS In tofacitinib-treated patients with AS, improvements in fatigue were collectively mediated through combined treatment effects on morning stiffness and pain.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Marina Magrey
- Division of Rheumatology, Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | - Oluwaseyi Dina
- Pfizer Inc, 235 East 42nd Street, New York, NY, 10017, USA.
| | - Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Magrey M, Walsh JA, Flierl S, Howard RA, Calheiros RC, Wei D, Khan MA. The International Map of Axial Spondyloarthritis Survey: A US Patient Perspective on Diagnosis and Burden of Disease. ACR Open Rheumatol 2023; 5:264-276. [PMID: 37095710 PMCID: PMC10184009 DOI: 10.1002/acr2.11543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that causes inflammation in the axial skeleton, resulting in structural damage and disability. We aimed to understand the effect of axSpA on work activity, day-to-day function, mental health, relationships, and quality of life and to examine barriers to early diagnosis. METHODS A 30-minute quantitative US version of the International Map of Axial Spondyloarthritis survey was administered online to US patients aged 18 years and older with a diagnosis of axSpA who were under the care of a health care provider from July 22 to November 10, 2021. This analysis describes demographics, clinical characteristics, journey to axSpA diagnosis, and disease burden. RESULTS We surveyed 228 US patients with axSpA. Patients had a mean diagnostic delay of 8.8 years, with a greater delay in women versus men (11.2 vs. 5.2 years), and 64.5% reported being misdiagnosed before receiving an axSpA diagnosis. Most patients (78.9%) had active disease (Bath Ankylosing Spondylitis Disease Activity Index score ≥4), reported psychological distress (57.0%; General Health Questionnaire 12 score ≥3), and experienced a high degree of impairment (81.6%; Assessment of Spondyloarthritis International Society Health Index score ≥6). Overall, 47% of patients had a medium or high limitation in activities of daily living, and 46% were not employed at survey completion. CONCLUSION The majority of US patients with axSpA had active disease, reported psychological distress, and reported impaired function. US patients experienced a substantial delay in time to diagnosis of axSpA that was twice as long in women versus men.
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Affiliation(s)
- Marina Magrey
- Case Western Reserve University School of Medicine and University Hospitals, Cleveland, Ohio
| | - Jessica A Walsh
- University of Utah School of Medicine and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah
| | | | | | | | - David Wei
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Muhammad A Khan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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11
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Werkl P, Rademacher J, Pleyer U. [HLA-B27 positive anterior uveitis : Clinical aspects, diagnostics, interdisciplinary management and treatment]. DIE OPHTHALMOLOGIE 2023; 120:108-122. [PMID: 36633629 DOI: 10.1007/s00347-022-01793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 01/13/2023]
Abstract
Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation. Other characteristics are reduced intraocular pressure and a high tendency to relapse, which can also involve the partner eye. Patients with HLA-B27 positive AAU share a high risk for other genetically associated diseases, especially spondylarthritis, chronic inflammatory bowel diseases and psoriasis. As up to 40% of those affected have a systemic disease that has not yet been diagnosed, the ophthalmologist is of major importance for early detection.
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Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz - LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - Judith Rademacher
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Deutschland.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Uwe Pleyer
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. .,Universitäts-Augenklinik, Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, Berlin, Deutschland.
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12
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Semenetz ZJ, Al-Jaberi L, Brescia AC, Saul D, Holton RS. An Atypical Case of Scurvy in an Adolescent With Sacroiliitis. Clin Pediatr (Phila) 2022; 61:826-829. [PMID: 35746876 DOI: 10.1177/00099228221106426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Zachary J Semenetz
- Nemours Children's Hospital, Wilmington, DE, USA
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - David Saul
- Nemours Children's Hospital, Wilmington, DE, USA
- Thomas Jefferson University, Philadelphia, PA, USA
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13
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Lyu X, Chen J, Gao X, Yang J. Emerging story of gut dysbiosis in spondyloarthropathy: From gastrointestinal inflammation to spondyloarthritis. Front Cell Infect Microbiol 2022; 12:973563. [PMID: 36072223 PMCID: PMC9441705 DOI: 10.3389/fcimb.2022.973563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
As a set of inflammatory disorders, spondyloarthritis (SpA) exhibits distinct pathophysiological, clinical, radiological, and genetic characteristics. Due to the extra-articular features of this disorder, early recognition is crucial to limiting disability and improving outcomes. Gut dysbiosis has been linked to SpA development as evidence grows. A pathogenic SpA process is likely to occur when a mucosal immune system interacts with abnormal local microbiota, with subsequent joint involvement. It is largely unknown, however, how microbiota alterations predate the onset of SpA within the “gut-joint axis”. New microbiome therapies, such as probiotics, are used as an adjuvant therapy in the treatment of SpA, suggesting that the modulation of intestinal microbiota and/or intestinal barrier function may contribute to the prevention of SpA. In this review, we highlight the mechanisms of SpA by which the gut microbiota impacts gut inflammation and triggers the activation of immune responses. Additionally, we analyze the regulatory role of therapeutic SpA medication in the gut microbiota and the potential application of probiotics as adjunctive therapy for SpA.
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Affiliation(s)
- Xing Lyu
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jieli Chen
- Discipline Construction Office, Tianjin Medical University, Tianjin, China
| | - Xingjie Gao
- Department of Biochemistry and Molecular Biology, Department of Immunology, Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), Key Laboratory of Cellular and Molecular Immunology in Tianjin, Excellent Talent Project, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Science, Tianjin Medical University, Tianjin, China
| | - Jie Yang
- Department of Biochemistry and Molecular Biology, Department of Immunology, Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), Key Laboratory of Cellular and Molecular Immunology in Tianjin, Excellent Talent Project, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Science, Tianjin Medical University, Tianjin, China
- *Correspondence: Jie Yang,
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14
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Magrey M, Schwartzman S, de Peyrecave N, Sloan VS, Stark JL. Nonradiographic axial spondyloarthritis: expanding the spectrum of an old disease: A narrative review. Medicine (Baltimore) 2022; 101:e29063. [PMID: 35475794 PMCID: PMC9276084 DOI: 10.1097/md.0000000000029063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/24/2022] [Indexed: 01/04/2023] Open
Abstract
Nonradiographic axial spondyloarthritis (nr-axSpA) represents a distinct phenotype within the spectrum of axial spondyloarthritis (axSpA), which is characterized by a range of clinical manifestations. Despite a high disease burden that is comparable to ankylosing spondylitis (also known as radiographic axSpA), there is an unmet need to recognize and effectively manage patients with active nr-axSpA.A targeted literature search was conducted in OVID (MEDLINE and Embase databases) to identify articles on nr-axSpA, including its definition, demographics, epidemiology, burden, diagnosis, clinical presentation, and treatment guidelines.The lack of adequate epidemiological data and incomplete understanding of nr-axSpA among rheumatologists and nonrheumatologists contributes to delayed referrals and diagnosis. This delay results in a substantial burden on patients, physically and psychologically, and the healthcare system. Targeted therapies, such as biologics, including inhibitors of tumor necrosis factor or interleukin-17A, have been approved and utilized for the management of nr-axSpA, and other novel therapeutics with different mechanisms of action are in development. Raising awareness among US internists regarding the prevalence of nr-axSpA, disease burden, clinical presentation, diagnostic tools, and available treatments is important for improved disease management.Future clinical investigations focusing on the development of markers that aid early diagnosis and predict treatment response may also improve the management of nr-axSpA. This review provides an overview of nr-axSpA with the aim of raising awareness of the disease among US internists, with an overarching goal to contribute toward the improved recognition and timely referral of these patients to rheumatologists for diagnosis and management.
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Affiliation(s)
- Marina Magrey
- Case Western Reserve University School of Medicine at MetroHealth Medical Center, Department of Medicine, Division of Rheumatology, Cleveland, OH
- University Hospitals Cleveland Medical Center School of Medicine, Division of Rheumatology, Cleveland, OH
| | | | | | - Victor S. Sloan
- Sheng Consulting LLC, Flemington, NJ
- Rutgers Robert Wood Johnson Medical School, Division of Rheumatology and Connective Tissue Research, New Brunswick, NJ
- The Peace Corps, Washington, DC
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15
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Gavigan K, Nowell WB, Hunter T, Curtis JR, Malatestinic WN, Bolce RJ, Lisse JR, Walsh J. Employment, Work Productivity, and Biologic Treatments in Self-Reported Axial Spondyloarthritis: a Cross-Sectional Study in a Female Predominant Population from the ArthritisPower Registry. Rheumatol Ther 2022; 9:663-677. [PMID: 35191010 PMCID: PMC8964841 DOI: 10.1007/s40744-022-00428-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The aim of this study was to characterize employment, work productivity, and biologic disease-modifying anti-rheumatic drug (bDMARD) treatment in a predominantly female population of axial spondyloarthritis (axSpA) patients in a real-world setting. METHODS This was a cross-sectional study of axSpA participants within the ArthritisPower registry. Outcomes were assessed with surveys (Work Productivity and Activity Impairment [WPAI], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], and Patient-Reported Outcomes Measurement Information System instruments) and compared between subgroups (employed vs. not employed; taking vs. not taking a bDMARD). RESULTS Among the 195 participants, 117 (60.0%) were employed and 78 (40.0%) were not employed entirely or partially due to axSpA. The mean age of the participants was 47.6 years and 86.7% were female. Current bDMARD use was reported by 57.4% of those surveyed (59.8% employed vs. 53.9% not employed; p = 0.408). Compared to not employed participants, employed participants had more favorable disease activity (BASDAI 6.0 vs. 7.6; p < 0.001) and overall health (self-rated health 2.5 vs. 1.8; p < 0.001). Employed participants, compared to not employed participants, were diagnosed at an earlier age (36.0 vs. 42.5 years, respectively) and experienced a shorter time between symptom onset and diagnosis (9.5 vs. 13.6 years, respectively). Employed participants reported missing on average 6.5 days of work and experienced a 52.7% impairment on work productivity due to axSpA over a 3-month period. Absenteeism and presenteeism were statistically similar between participants taking a bDMARD versus those not taking a bDMARD. CONCLUSIONS Although bDMARD treatment rates were similar between employed and not employed participants, disease activity and overall health were better in employed than non-employed participants. Employed participants experienced substantial work productivity impairment due to axSpA.
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Affiliation(s)
- Kelly Gavigan
- Global Healthy Living Foundation, 515 N Midland Ave, Upper Nyack, NY, 10960, USA.
| | - W Benjamin Nowell
- Global Healthy Living Foundation, 515 N Midland Ave, Upper Nyack, NY, 10960, USA
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16
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Interobserver Reliability of Magnetic Resonance Imaging of Sacroiliac Joints in Axial Spondyloarthritis. Life (Basel) 2022; 12:life12040470. [PMID: 35454961 PMCID: PMC9032207 DOI: 10.3390/life12040470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction: Axial spondyloarthritis (axSpA) is characterized by damage to the axial skeleton and entheses, and is often associated with extra-articular manifestations, in the presence of the human leukocyte antigen (HLA) B27. The aim of our study is to assess the performance of rheumatologists in interpreting the inflammatory and structural damage to sacroiliac joints, in comparison to radiologists. Material and Methods: The present study included a total of 34 patients diagnosed with axSpA, according to the Assessment of SpondyloArthritis International Society (ASAS) criteria for axSpA, examined from January 2021 to November 2021 in the Departments of Rheumatology and Radiology and Medical Imaging of the University of Medicine and Pharmacy of Craiova. All patients underwent physical examination, laboratory tests, and magnetic resonance imaging (MRI) of the sacroiliac joints. The images were interpreted by a senior radiologist (SR), a junior radiologist (JR), a senior rheumatologist (SRh), and a junior rheumatologist (JRh), who were blinded to the clinical and paraclinical data. Results: The overall κ was 0.7 for the JR (substantial agreement), 0.707 for the SRh (substantial agreement), and 0.601 for the JRh (moderate agreement), in comparison with the SR. Regarding the overall inflammatory changes, the SRh and JR were proven to have substantial agreement (κ = 0.708 and 0.742, respectively) with the SR, while the JRh was proven to have moderate agreement (κ = 0.607). The structural damage observed by the JR showed substantial agreement (κ = 0.676) with the SR, while the SRh and JRh had substantial and moderate agreement (κ = 0.705 and 0.596, respectively) with the SR. Conclusions: Our study showed substantial agreement between the senior radiologist, senior rheumatologist, and junior radiologist, and moderate agreement with the junior rheumatologist.
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17
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Yong JH, Hong JP, Lee YH, Huang CC, Huang SW, Lin HW. Association and Risk of Axial Spondyloarthritis of Scoliosis Patients: A Database Study. Spine (Phila Pa 1976) 2022; 47:438-443. [PMID: 34610609 DOI: 10.1097/brs.0000000000004248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective longitudinal cohort study. OBJECTIVE To investigate the incidence and risk of axial spondyloarthritis (axSpA) in patients with scoliosis in Taiwan. SUMMARY OF BACKGROUND DATA Scoliosis and axSpA causes back pain which reduces quality of life in many patients. Both scoliosis and axSpA had attracted numerous research attention, but the association between the two was hardly known. METHODS In this retrospective study, the data of 25,566 patients were obtained from Taiwan's National Health Insurance Research Database. We identified patients diagnosed with scoliosis and included them in the study cohort. We included age- and sex-matched patients without scoliosis in the control cohort. The total follow-up period was 7 years. Cox proportional hazards models were used to analyze the retrieved data. Hazard ratios (HRs) and adjusted HRs were calculated. RESULTS The study and control cohorts included 4261 and 21,305 patients, respectively. The incidences of axSpA were 141 and 46 per 100,000 person-years in the study and control cohorts, respectively. The crude HRs and adjusted HRs for patients with scoliosis were 2.98 (95% confidence interval, 1.87-4.73; P < 0.001) and 2.78 (95% confidence interval, 1.74-4.43; P < 0.001), respectively. The prevalence of comorbidities such as chronic obstructive pulmonary disease, osteoporosis, depression, autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosus), and thyroid disease was significantly higher in the study cohort. CONCLUSION Our findings indicate an association between scoliosis and axSpA. Additional studies should be performed to explain this phenomenon.Level of Evidence: 3.
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Affiliation(s)
- Jocelyn Huan Yong
- Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jia-Pei Hong
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hao Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Chang Huang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan
- ICF Research Center, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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18
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Shridharmurthy D, Khan S, Lapane KL, Yi E, Kay J, Liu SH. Development of a screening tool to identify patients with axial spondyloarthritis: a cognitive interview study. Clin Rheumatol 2022; 41:1391-1402. [DOI: 10.1007/s10067-022-06072-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 12/19/2022]
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19
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Al Rayes H, Alazmi M, Alderaan K, Alghamdi M, Alghanim N, Alhazmi A, Alkhadhrawi N, Almohideb M, Alzahrani Z, Bedaiwi M, Halabi H, Attar S. Expert recommendations on early diagnosis and referral of axial spondyloarthritis in the Kingdom of Saudi Arabia. Clin Rheumatol 2022; 41:991-1002. [PMID: 34997382 DOI: 10.1007/s10067-021-06019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/11/2021] [Accepted: 12/04/2021] [Indexed: 01/13/2023]
Abstract
Axial spondyloarthritis is a chronic inflammatory disorder that primarily involves the axial skeleton (sacroiliac joints and spine), causing stiffness, severe pain and fatigue. In some patients, definitive structural damage of sacroiliac joints is visible on imaging and is known as radiographic axial spondyloarthritis. Some patients do not have a clear radiographic damage of the sacroiliac joints, and this subtype is known as non-radiographic axial spondyloarthritis. Early diagnosis is important for reducing the risk of irreversible structural damage and disability. Management of axial spondyloarthritis is challenging in Saudi Arabia because of inadequate disease knowledge and the unavailability of local guidelines. Therefore, this expert consensus is intended to provide recommendations, including the referral pathway, the definition of remission and the treat-to-target approach, to all healthcare professionals for the management of patients with axial spondyloarthritis. A Delphi technique of consensus was developed by involving an expert panel of 10 rheumatologists, 1 dermatologist and 1 general physician. The experts offered consensus-based recommendations based on a review of available scientific evidence and clinical experience for the referral, screening and management of patients with axial spondyloarthritis.
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Affiliation(s)
- Hanan Al Rayes
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, 21577, Saudi Arabia.
| | - Mansour Alazmi
- Department of Rheumatology, Prince Mohammed Medical City, Al Jouf, Saudi Arabia
| | - Khaled Alderaan
- Department of Rheumatology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mushabab Alghamdi
- Department of Rheumatology, University of Bisha, Bisha, Saudi Arabia
| | - Nayef Alghanim
- Department of Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alhazmi
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Nadeer Alkhadhrawi
- Department of Family Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammad Almohideb
- Department of Dermatology, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Zeyad Alzahrani
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohamed Bedaiwi
- Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Suzan Attar
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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20
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Schwartzman S, Ruderman EM. A Road Map of the Axial Spondyloarthritis Continuum. Mayo Clin Proc 2022; 97:134-145. [PMID: 34801248 DOI: 10.1016/j.mayocp.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/17/2022]
Abstract
Axial spondyloarthritis (axSpA) is a chronic, immune-mediated inflammatory disease characterized by inflammatory low back pain, inflammation in peripheral joints and entheses, and other extra-articular or systemic manifestations. Although our understanding of the natural history of axSpA has been limited by incomplete knowledge of disease pathogenesis, axSpA is increasingly understood as a spectrum of axial, peripheral, and extra-articular inflammatory conditions that includes nonradiographic axSpA and radiographic axSpA, also known as ankylosing spondylitis. In this narrative review, we present a road map of this axSpA continuum, highlighting genetic risk factors for the development of axSpA, triggers of disease, and reasons for and implications of diagnostic delay. We present a detailed overview of the spectrum of axSpA clinical manifestations and highlight factors known to influence the risk of disease progression. Finally, we provide some expert commentary on the practical use of this road map to assist health care providers in the identification of axSpA in clinical practice.
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Affiliation(s)
| | - Eric M Ruderman
- Northwestern University Feinberg School of Medicine, Chicago, IL
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21
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Sharma M, Jain N, Wang D, Ugiliweneza B, Boakye M, Drazin D. Impact of age on mortality and complications in patients with Ankylosing Spondylitis spine fractures. J Clin Neurosci 2021; 95:188-197. [PMID: 34929644 DOI: 10.1016/j.jocn.2021.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/11/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this retrospective cohort study was to study the impact of age on in-hospital complications and mortality following surgery for Ankylosing Spondylitis (AS) associated spine fractures. METHODS We extracted data from the Nationwide Inpatient Sample (NIS) database (1998-2018) using ICD-9/10 codes. Patients with a primary diagnosis of AS associated spine fractures who underwent fusion surgery were included. Complications and in-hospital mortality were analyzed. RESULTS A total cohort of 8526 patients was identified. Overall, the median age of the cohort was 69 years. AS associated fractures were equally distributed among cervical and thoracolumbar regions. Overall, complications were noted in 48% of patients and pulmonary complications were the most common (32%) followed by renal (13%) and infection (12%). Complications were seen in 57.3% of patients ≥ 70 years of age compared to 38.4% of patients < 70 years of age (p < .0001). Also, 9.9 % of patients ≥ 70 years of age had in-hospital mortality compared to 3.1 % of patients < 70 years of age (p < .0001). Based on surgical approaches, elderly patients (≥70 years) who underwent anterior, posterior, and anterior + posterior approaches had 19.8%, 7.4% and 16.4% in-hospital mortality compared to 5.3%, 2.2% and 7.4% respectively for patients < 70 years. CONCLUSIONS Elderly patients (≥70 years of age) were 3.2 times more likely to have in-hospital mortality and higher complications compared to younger patients (57% vs. 38%). Cervical compared to thoracolumbar fractures and anterior compared to posterior surgical approaches were associated with higher complications and in-hospital mortality.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA
| | - Nikhil Jain
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA; Kentucky Spinal Cord Injury Research Center, School of Medicine, University of Louisville, Louisville, KY, USA; Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA; Kentucky Spinal Cord Injury Research Center, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Doniel Drazin
- Pacific Northwest University of Health Sciences, Yakima, WA, USA.
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22
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Deodhar A, Kruzikas D, Zhou L, Biljan A, Saffore CD. Geographic Variations in Diagnosis and Treatment of Ankylosing Spondylitis in the United States: A Real-World Study. Rheumatol Ther 2021; 9:447-463. [PMID: 34927217 PMCID: PMC8964895 DOI: 10.1007/s40744-021-00406-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Diagnosis difficulties are common for ankylosing spondylitis (AS) patients, leading to inadequate and inconsistent treatment. We evaluated the national and geographic variability in disease diagnosis and treatment in the United States. Methods This retrospective, cross-sectional analysis utilized the IBM® MarketScan® Administrative Claims Database from 2014 to 2019. AS patients ≥ 18 years of age with continuous medical and pharmacy enrollment during the calendar year and complete geographic information during the study period were included. Patient cohorts assessed were D1 (≥ 1 AS diagnoses within each calendar year of assessment between 2014 and 2019), D2 (≥ 2 non-rheumatologist AS diagnoses), and D3 (≥ 2 rheumatologist AS diagnoses). For D2 and D3, diagnoses were ≥ 6 months apart, but within 18 months. Annual AS diagnostic prevalence and treatment rates were determined from 2014 to 2019 nationally and per state in 2019. Treatments assessed were disease-modifying antirheumatic drugs (DMARDs), opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and methotrexate. Results Nationally, AS diagnostic prevalence increased from 2014 to 2019, with 2019 rates of 9.6 (D1), 5.1 (D2), and 3.5 (D3) per 10,000 persons. Diagnostic prevalence varied between states, which was not explained by age, sex, racial distribution, or rheumatologists per capita. Nationally, a greater percentage of D3 patients vs. D1 and D2 patients received biologic/targeted synthetic DMARDs (bDMARD/tsDMARDs) and conventional synthetic DMARD. Opioid use ranged from 37 to 40% in 2019 and decreased from 2014 for all cohorts. Corticosteroid and methotrexate use decreased slightly, while NSAID and bDMARD/tsDMARD use generally increased from 2014 to 2019. Conclusions AS diagnostic prevalence is increasing nationally, though it remains low among some states. bDMARD/tsDMARDs use was more common among patients treated by rheumatologists. Opioid and corticosteroid use is decreasing, though national rates remain high with significant state variability. Further education is needed, particularly in states with low prevalence and inadequate treatment, to improve diagnosis and treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00406-9.
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Affiliation(s)
- Atul Deodhar
- Department of Medicine, Rheumatology Clinics, Oregon Health and Science University, Portland, OR, USA.
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Ungprasert P, Chaikijurajai T, Wijarnpreecha K, Kröner PT. Clinical characteristics and resource utilization of 19,130 hospitalizations of patients with ankylosing spondylitis in United States: National Inpatient Sample 2018. Joint Bone Spine 2021; 89:105313. [PMID: 34861402 DOI: 10.1016/j.jbspin.2021.105313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Thanat Chaikijurajai
- Internal Medicine Residency Program, University of Minnesota Medical School, Minneapolis, MN, USA; Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Paul T Kröner
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
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24
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Maguire S, Wilson F, Gallagher P, O'Shea F. The toll of unemployment in axial spondyloarthropathy: high prevalence and negative impact on outcomes captured in a national registry. Scand J Rheumatol 2021; 51:300-303. [PMID: 34788188 DOI: 10.1080/03009742.2021.1992861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Axial spondyloarthropathy (axSpA) is an inflammatory arthritis of the axial skeleton. Persistent disease activity can result in significant disability and affect the ability to maintain employment. This study aimed to determine the prevalence of unemployment in axSpA and the impact on patient outcomes. METHOD Data from the Ankylosing Spondylitis Registry of Ireland (ASRI) were cleaned, and information on employment, demographics, and disease characteristics was extracted. Patients were analysed on the basis of employment and categorized as employed or unemployed. RESULTS Of the 759 participants included in the analysis, 23.5% (178) were unemployed, higher than national averages of 6.2-13.1% during the study period. Unemployed participants reported significantly worse Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; 5.1 vs 3.6), Metrology Index (BASMI; 4.8 vs 3.4), Functional Index (BASFI; 5.2 vs 3.0), Health Assessment Questionnaire (HAQ; 0.82 vs 0.40), and Ankylosing Spondylitis Quality of Life (ASQoL; 9.4 vs 5.4) scores compared to employed (all p < 0.01). Male gender (odds ratio, 95% confidence interval: 2.65, 1.46-4.83), worse BASMI (1.16, 1.02-1.33), and worse HAQ scores (2.18, 1.13-4.19) were significantly associated with unemployment. CONCLUSION The prevalence of unemployment in axSpA patients is higher than in the general population, and is associated with worse quality of life, poorer levels of function, and higher levels of disease activity. Predictors of unemployment in axSpA were male gender, worse spinal mobility, and poorer level of function. Recognition of patients at risk of unemployment will improve opportunities for intervention and maintain participation in the workforce.
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Affiliation(s)
- S Maguire
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - F Wilson
- Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - P Gallagher
- Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland
| | - F O'Shea
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
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Reiff DD, Stoll ML, Cron RQ. Precision medicine in juvenile idiopathic arthritis-has the time arrived? THE LANCET. RHEUMATOLOGY 2021; 3:e808-e817. [PMID: 38297525 DOI: 10.1016/s2665-9913(21)00252-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022]
Abstract
The introduction of disease-modifying anti-rheumatic drug therapies for treating children and adolescents with chronic arthritis (ie, juvenile idiopathic arthritis [JIA]) has revolutionised care and outcomes. The biologic revolution continues to expand, with ever-changing immunological targets coming to market after basic research and clinical trials. The first class of biologics that was beneficial for children with JIA was tumour necrosis factor (TNF) inhibitors. If used early and aggressively, TNF inhibitors are capable of inducing disease remission for most of the seven subtypes of JIA, with the exception of systemic JIA (which more frequently responds to interleukin [IL]-1 or IL-6 inhibition). Nevertheless, there are still subsets of patients with JIA with disease that is difficult to treat or who develop extra-articular features that require a different therapeutic approach. Although finding an effective biological therapy for individual children with JIA can be trial and error, ongoing research and clinical trials are providing insight into a more personalised approach to care. In addition, redefining the JIA classification, in part based on shared similarities with various adult arthritides, could allow for extrapolation of knowledge from studies in adults with chronic arthritis.
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Affiliation(s)
- Daniel D Reiff
- Department of Pediatrics, Division of Rheumatology, University of Alabama, Birmingham, AL, USA
| | - Matthew L Stoll
- Department of Pediatrics, Division of Rheumatology, University of Alabama, Birmingham, AL, USA
| | - Randy Q Cron
- Department of Pediatrics, Division of Rheumatology, University of Alabama, Birmingham, AL, USA.
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Passalent L, Sundararajan K, Perruccio AV, Hawke C, Coyte PC, Bombardier C, Bloom JA, Haroon N, Inman RD, Rampersaud YR. Bridging the Gap between Symptom Onset and Diagnosis in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2021; 74:997-1005. [PMID: 34268914 DOI: 10.1002/acr.24751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate a stratified screening process for early identification of axial spondyloarthritis (axSpA) considering: 1) wait times from primary care to rheumatology screen; 2) incremental precision and accuracy from primary care to rheumatology screen; and 3) diagnostic delay. METHODS Adults with low back pain (LBP) attending primary care LBP clinics prospectively underwent a primary standardized clinical screen. Patients with LBP >3 months and onset age <50 years were referred for a comprehensive secondary screen by a physiotherapist with advanced rheumatology training. At secondary screening, patients with inflammatory features were deemed to have a low, medium, or high risk of axSpA vs. no risk. Precision and accuracy of this screening strata were measured against a rheumatologist with axSpA expertise. RESULTS In all, 405 patients underwent primary and secondary screening. Mean age was 36.9 years (±9.9); 55% were female. HLA-B27 was present in 14.4%. Median wait time from primary to secondary screen was 15 days. AxSpA risk assignment by rheumatologist was: 64.9% (none or low risk axSpA) and 35.1% (medium or high risk axSpA). The best combination of sensitivity (68%), specificity (90%), positive (80%) and negative (84%) predictive values was evident with the secondary screen. 15.6% of patients received a final diagnosis of axSpA. Median LBP duration from onset to diagnosis was: 2 years (non-radiographic axSpA) and 7 years (ankylosing spondylitis). CONCLUSION A stratified interprofessional screening process can facilitate rapid diagnosis of persistent LBP, with high precision and accuracy, in patients with axSpA.
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Affiliation(s)
- Laura Passalent
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kala Sundararajan
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network Toronto, Toronto, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Evaluation Unit, University Health Network, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Christopher Hawke
- Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jeff A Bloom
- Family and Community Medicine, University Health Network, Toronto, Canada
| | - Nigil Haroon
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robert D Inman
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Departments of Medicine and Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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