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Gómez-García I, Ladehesa-Pineda ML, Diaz-Tocados JM, López-Medina C, Abalos-Aguilera MC, Ruiz-Vilches D, Paz-Lopez G, Gonzalez-Jimenez A, Ranea JAG, Escudero-Contreras A, Moreno-Indias I, Tinahones FJ, Collantes-Estévez E, Ruiz-Limón P. Bone metabolism and inflammatory biomarkers in radiographic and non-radiographic axial spondyloarthritis patients: a comprehensive evaluation. Front Endocrinol (Lausanne) 2024; 15:1227196. [PMID: 38449853 PMCID: PMC10915870 DOI: 10.3389/fendo.2024.1227196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Axial spondyloarthritis (axSpA) is a heterogeneous disease that can be represented by radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA). This study aimed to evaluate the relationship between the markers of inflammation and bone turnover in r-axSpA patients and nr-axSpA patients. Methods A cross-sectional study included 29 r-axSpA patients, 10 nr-axSpA patients, and 20 controls matched for age and sex. Plasma markers related to bone remodeling such as human procollagen type 1 N-terminal propeptide (P1NP), sclerostin, tartrate-resistant acid phosphatase 5b (TRACP5b), receptor activator of nuclear factor kappa B ligand (RANKL), and osteoprotegerin (OPG) were measured by an ELISA kit. A panel of 92 inflammatory molecules was analyzed by proximity extension assay. Results R-axSpA patients had decreased plasma levels of P1NP, a marker of bone formation, compared to controls. In addition, r-axSpA patients exhibited decreased plasma levels of sclerostin, an anti-anabolic bone hormone, which would not explain the co-existence of decreased plasma P1NP concentration; however, sclerostin levels could also be influenced by inflammatory processes. Plasma markers of osteoclast activity were similar in all groups. Regarding inflammation-related molecules, nr-axSpA patients showed increased levels of serum interleukin 13 (IL13) as compared with both r-axSpA patients and controls, which may participate in the prevention of inflammation. On the other hand, r-axSpA patients had higher levels of pro-inflammatory molecules compared to controls (i.e., IL6, Oncostatin M, and TNF receptor superfamily member 9). Correlation analysis showed that sclerostin was inversely associated with IL6 and Oncostatin M among others. Conclusion Altogether, different inflammatory profiles may play a role in the development of the skeletal features in axSpA patients particularly related to decreased bone formation. The relationship between sclerostin and inflammation and the protective actions of IL13 could be of relevance in the axSpA pathology, which is a topic for further investigation.
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Affiliation(s)
- Ignacio Gómez-García
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Maria L. Ladehesa-Pineda
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Juan M. Diaz-Tocados
- Vascular and Renal Translational Research Group, Biomedical Research Institute of Lleida, Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
| | - Clementina López-Medina
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Maria C. Abalos-Aguilera
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Desiree Ruiz-Vilches
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Guillermo Paz-Lopez
- Department of Molecular Biology and Biochemistry, Faculty of Science, University of Málaga, Málaga, Spain
| | - Andres Gonzalez-Jimenez
- Bioinformatic Platform, The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA-BIONANDPlatform), Malaga, Spain
| | - Juan A. G. Ranea
- Department of Molecular Biology and Biochemistry, Faculty of Science, University of Málaga, Málaga, Spain
- Bioinformatic Platform, The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA-BIONANDPlatform), Malaga, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Carlos III Health Institute, Madrid, Spain
- Spanish National Bioinformatics Institute (INB/ELIXIR-ES), Barcelona, Spain
| | - Alejandro Escudero-Contreras
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Isabel Moreno-Indias
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Malaga, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Malaga, Spain
- Center for Biomedical Network Research (CIBER) in Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - Francisco J. Tinahones
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Malaga, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Malaga, Spain
- Center for Biomedical Network Research (CIBER) in Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Eduardo Collantes-Estévez
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Patricia Ruiz-Limón
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Malaga, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Malaga, Spain
- Center for Biomedical Network Research (CIBER) in Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
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Fassio A, Atzeni F, Rossini M, D’Amico V, Cantatore F, Chimenti MS, Crotti C, Frediani B, Giusti A, Peluso G, Rovera G, Scolieri P, Raimondo V, Gatti D. Osteoimmunology of Spondyloarthritis. Int J Mol Sci 2023; 24:14924. [PMID: 37834372 PMCID: PMC10573470 DOI: 10.3390/ijms241914924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
The mechanisms underlying the development of bone damage in the context of spondyloarthritis (SpA) are not completely understood. To date, a considerable amount of evidence indicates that several developmental pathways are crucially involved in osteoimmunology. The present review explores the biological mechanisms underlying the relationship between inflammatory dysregulation, structural progression, and osteoporosis in this diverse family of conditions. We summarize the current knowledge of bone biology and balance and the foundations of bone regulation, including bone morphogenetic protein, the Wnt pathway, and Hedgehog signaling, as well as the role of cytokines in the development of bone damage in SpA. Other areas surveyed include the pathobiology of bone damage and systemic bone loss (osteoporosis) in SpA and the effects of pharmacological treatment on focal bone damage. Lastly, we present data relative to a survey of bone metabolic assessment in SpA from Italian bone specialist rheumatology centers. The results confirm that most of the attention to bone health is given to postmenopausal subjects and that the aspect of metabolic bone health may still be underrepresented. In our opinion, it may be the time for a call to action to increase the interest in and focus on the diagnosis and management of SpA.
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Affiliation(s)
- Angelo Fassio
- Dipartimento di Medicina, Università di Verona, 37124 Verona, Italy; (M.R.); (D.G.)
| | - Fabiola Atzeni
- Unità Operativa Complessa di Reumatologia Azienda Ospedaliero Universitaria Policlinico “G. Martino” di Messina, 35128 Messina, Italy; (F.A.); (V.D.)
| | - Maurizio Rossini
- Dipartimento di Medicina, Università di Verona, 37124 Verona, Italy; (M.R.); (D.G.)
| | - Valeria D’Amico
- Unità Operativa Complessa di Reumatologia Azienda Ospedaliero Universitaria Policlinico “G. Martino” di Messina, 35128 Messina, Italy; (F.A.); (V.D.)
| | - Francesco Cantatore
- Unità Operativa Complessa di Reumatologia Universitaria, Polic. “Riuniti” di Foggia, 71122 Foggia, Italy;
| | - Maria Sole Chimenti
- Dipartimento di Medicina dei Sistemi, Reumatologia, Allergologia e Immunologia Clinica Università di Roma Tor Vergata, 00133 Rome, Italy;
| | - Chiara Crotti
- UOC Osteoporosi e Malattie Metaboliche dell’Osso Dipartimento di Reumatologia e Scienze Mediche ASST-G. Pini-CTO, 20122 Milan, Italy;
| | - Bruno Frediani
- Department of Medical, Surgical and Neuroscience Sciences, Rheumatology University of Siena, 53100 Siena, Italy;
| | - Andrea Giusti
- SSD Malattie Reumatologiche e del Metabolismo Osseo, Dipartimento delle Specialità Mediche, ASL3, 16132 Genova, Italy;
| | - Giusy Peluso
- UOC di Reumatologia-Fondazione Policlinico Universitario Agostino Gemelli-IRCSS, 00168 Rome, Italy;
| | - Guido Rovera
- Ospedale S. Andrea, Divisione Reumatologia, 13100 Vercelli, Italy;
| | - Palma Scolieri
- Ambulatorio di Reumatologia Ospedale Nuovo Regina Margherita ASL ROMA1, 00153 Rome, Italy;
| | | | - Davide Gatti
- Dipartimento di Medicina, Università di Verona, 37124 Verona, Italy; (M.R.); (D.G.)
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Tian H, Li T, Wang Y, Lu H, Lin L, Wu X, Xu H. The correlations between C-reactive protein and MRI-detected inflammation in patients with axial spondyloarthritis: a systematic review and meta-analysis. Clin Rheumatol 2023; 42:2397-2407. [PMID: 37336841 PMCID: PMC10412674 DOI: 10.1007/s10067-023-06658-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 04/14/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA. MATERIALS AND METHODS A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models. RESULTS Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I2=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I2=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I2=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I2=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS. CONCLUSIONS In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.
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Affiliation(s)
- Haoran Tian
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Ting Li
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Yuanqiong Wang
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Hongjuan Lu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Li Lin
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Xin Wu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
- Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, 100084, China.
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China.
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Port H, Holm Nielsen S, Frederiksen P, Madsen SF, Bay-Jensen AC, Sørensen IJ, Jensen B, Loft AG, Madsen OR, Østergaard M, Pedersen SJ. Extracellular matrix turnover biomarkers reflect pharmacodynamic effects and treatment response of adalimumab in patients with axial spondyloarthritis-results from two randomized controlled trials. Arthritis Res Ther 2023; 25:157. [PMID: 37626399 PMCID: PMC10463764 DOI: 10.1186/s13075-023-03132-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To investigate if extracellular matrix (ECM) blood-based biomarkers reflect the pharmacodynamic effect and response to TNF-α inhibitor therapy (adalimumab, ADA), in patients with axial spondyloarthritis (axSpA). METHODS We investigated ECM biomarkers in two randomized, double-blind, placebo-controlled trials of axSpA patients (DANISH and ASIM, n = 52 and n = 49, respectively) receiving ADA 40 mg or placebo every other week for 12 and 6 weeks, respectively, and thereafter ADA to week 48. Serum concentrations of degraded type I (C1M), II (C2M, T2CM), III (C3M), IV (C4M), VI (C6M), type X (C10C) collagen; metabolite of C-reactive protein (CRPM), prolargin (PROM), citrullinated vimentin (VICM), calprotectin (CPa9-HNE); and formation of type II (PRO‑C2), III (PRO‑C3), and VI (PRO‑C6) turnover of type IV collagen (PRO-C4) were measured at baseline and weeks 6 or 12, 24, and 48. The pharmacodynamic effect and treatment response to ADA was evaluated by linear mixed models, and correlations between biomarkers and clinical scores were assessed by Spearman's correlation. RESULTS C1M, C3M, C4M, C6M, CRP, PRO-C4, and CPa9-HNE levels declined after 6 or 12 weeks in patients receiving ADA compared to placebo (all p < 0.05). Patients with AS Disease Activity Score C-reactive protein (ASDAS CRP) major improvement and/or clinically important improvement had significantly higher C1M, C3M, C4M, C6M, and PRO-C4 levels than patients with no/low improvement at baseline (all p < 0.05). Baseline levels of biomarkers showed weak to moderate correlations with ASDAS and structural damage scores. CONCLUSION ECM metabolites showed a pharmacodynamic effect and were associated with ASDAS response during TNF-α inhibitor treatment in patients with axSpA.
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Affiliation(s)
- Helena Port
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Nordic Bioscience A/S, Immunoscience, Herlev, Denmark.
| | - Signe Holm Nielsen
- Nordic Bioscience A/S, Immunoscience, Herlev, Denmark
- Biomedicine and Biotechnology, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | - Sofie Falkenløve Madsen
- Nordic Bioscience A/S, Immunoscience, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Inge Juul Sørensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
| | - Bente Jensen
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Ole Rintek Madsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Østergaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Juhl Pedersen
- Department of Rheumatology and Spine Diseases, Righospitalet, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
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Han Y, Zhou Y, Li H, Gong Z, Liu Z, Wang H, Wang B, Ye X, Liu Y. Identification of diagnostic mRNA biomarkers in whole blood for ankylosing spondylitis using WGCNA and machine learning feature selection. Front Immunol 2022; 13:956027. [PMID: 36172367 PMCID: PMC9510835 DOI: 10.3389/fimmu.2022.956027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022] Open
Abstract
Ankylosing spondylitis (AS) is a common inflammatory spondyloarthritis affecting the spine and sacroiliac joint that finally results in sclerosis of the axial skeleton. Aside from human leukocyte antigen B27, transcriptomic biomarkers in blood for AS diagnosis still remain unknown. Hence, this study aimed to investigate credible AS-specific mRNA biomarkers from the whole blood of AS patients by analyzing an mRNA expression profile (GSE73754) downloaded Gene Expression Omnibus, which includes AS and healthy control blood samples. Weighted gene co-expression network analysis was performed and revealed three mRNA modules associated with AS. By performing gene set enrichment analysis, the functional annotations of these modules revealed immune biological processes that occur in AS. Several feature mRNAs were identified by analyzing the hubs of the protein-protein interaction network, which was based on the intersection between differentially expressed mRNAs and mRNA modules. A machine learning-based feature selection method, SVM-RFE, was used to further screen out 13 key feature mRNAs. After verifying by qPCR, IL17RA, Sqstm1, Picalm, Eif4e, Srrt, Lrrfip1, Synj1 and Cxcr6 were found to be significant for AS diagnosis. Among them, Cxcr6, IL17RA and Lrrfip1 were correlated with severity of AS symptoms. In conclusion, our findings provide a framework for identifying the key mRNAs in whole blood of AS that is conducive for the development of novel diagnostic markers for AS.
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Affiliation(s)
- Yaguang Han
- Department of Orthopaedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yiqin Zhou
- Department of Orthopaedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haobo Li
- Department of Orthopaedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhenyu Gong
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ziye Liu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Huan Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Bo Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Bo Wang, ; Xiaojian Ye, ; Yi Liu,
| | - Xiaojian Ye
- Department of Orthopaedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Bo Wang, ; Xiaojian Ye, ; Yi Liu,
| | - Yi Liu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Department of Orthopaedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Bo Wang, ; Xiaojian Ye, ; Yi Liu,
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Multiparametric Large Field of View Rheumatology Imaging for Axial Spondyloarthropathy Detects Enthesitis in Setting of Inactive Sacroiliac Joint Disease and Impacts Clinical Diagnosis. J Comput Assist Tomogr 2022; 46:190-196. [PMID: 35297576 DOI: 10.1097/rct.0000000000001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To test the diagnostic efficacy of a multiparametric rheumatology lumbosacral magnetic resonance (MR) imaging protocol in detection and characterization of axial spondylarthritis (SpA) and compare it with serology and clinical findings. METHODS A consecutive series of multiparametric rheumatology lumbosacral MR imaging examinations performed on 3T MR scanner. Three-dimensional inversion recovery turbo spin echo, precontrast and postcontrast fat-suppressed T1-weighted images, as well as diffusion-weighted images were used to detect active erosions and enthesitis using established criteria. Pearson χ2 was used for categorical variables. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were measured for magnetic resonance imaging (MRI) and serology, based on the final diagnosis from rheumatologists. An alpha error below 0.05 was considered statistically significant. RESULTS The final study sample included 130 consecutive patients (80 women and 50 men; mean ± SD 44 ± 13 and 45 ± 14 years, respectively). Seventy-eight subjects were diagnosed with axial SpA and 52 with non-SpA arthropathy. In the non-SpA group, 27 patients were diagnosed with osteoarthritis, 6 had unremarkable imaging, whereas 19 were considered as clinically undetermined. There was positive correlation between positive MRI results and SpA diagnosis (P < 0.00001). No correlation existed between positive serology alone and SpA diagnosis (P = 0.0634). Although MRI and serology proved equally sensitive in detecting SpA, the specificity and overall accuracy of MRI were significantly higher. Inflammatory activity was detected in 45 (57.7%) cases, in the pelvic enthesis in 29 (37.2%) cases, in the lumbosacral spine in 16 (20.5%) cases, in the hip joints in 15 (19.2%) cases, and in the pubic symphysis in 5 (6.4%). Inactive sacral disease was seen in 7 of 35 enthesitis patients (20.0%), and in 2 SpA cases, there were no sacral lesions. CONCLUSIONS The results suggest that in patients with suspected SpA, MRI should not be limited to the sacroiliac joints, but also include enthesitis sites and other joints of the axial skeleton. The multiparametric rheumatology protocol increases the efficacy of MRI in detecting enthesitis and joint inflammatory disease, thereby offering additional information to the clinician and assisting in the early diagnosis/detecting disease activity.
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Shen J, Yang L, You K, Chen T, Su Z, Cui Z, Wang M, Zhang W, Liu B, Zhou K, Lu H. Indole-3-Acetic Acid Alters Intestinal Microbiota and Alleviates Ankylosing Spondylitis in Mice. Front Immunol 2022; 13:762580. [PMID: 35185872 PMCID: PMC8854167 DOI: 10.3389/fimmu.2022.762580] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
Ankylosing spondylitis (AS) is a systemic, chronic, and inflammatory autoimmune disease associated with the disorder of intestinal microbiota. Unfortunately, effective therapies for AS are lacking. Recent evidence has indicated that indole-3-acetic acid (IAA), an important microbial tryptophan metabolite, can modulate intestinal homeostasis and suppress inflammatory responses. However, reports have not examined the in vivo protective effects of IAA against AS. In this study, we investigated the protective effects and underlying mechanisms through which IAA acts against AS. We constructed a proteoglycan (PG)-induced AS mouse model and administered IAA (50 mg/kg body weight) by intraperitoneal injection daily for 4 weeks. The effects of IAA on AS mice were evaluated by examining disease severity, intestinal barrier function, aryl hydrocarbon receptor (AhR) pathway, T-helper 17 (Th17)/T regulatory (Treg) balance, and inflammatory cytokine levels. The intestinal microbiota compositions were profiled through whole-genome sequencing. We observed that IAA decreased the incidence and severity of AS in mice, inhibited the production of pro-inflammatory cytokines (tumor necrosis factor α [TNF-α], interleukin [IL]-6, IL-17A, and IL-23), promoted the production of the anti-inflammatory cytokine IL-10, and reduced the ratios of pro-/anti- inflammatory cytokines. IAA ameliorated pathological changes in the ileum and improved intestinal mucosal barrier function. IAA also activated the AhR pathway, upregulated the transcription factor forehead box protein P3 (FoxP3) and increased Treg cells, and downregulated the transcription factors retinoic acid receptor–related orphan receptor gamma t (RORγt) and signal transducer and activator of transcription 3 (STAT3) and decreased Th17 cells. Furthermore, IAA altered the composition of the intestinal microbiota composition by increasing Bacteroides and decreasing Proteobacteria and Firmicutes, in addition to increasing the abundances of Bifidobacterium pseudolongum and Mucispirillum schaedleri. In conclusion, IAA exerted several protective effects against PG-induced AS in mice, which was mediated by the restoration of balance among the intestinal microbial community, activating the AhR pathway, and inhibiting inflammation. IAA might represent a novel therapeutic approach for AS.
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Affiliation(s)
- Jun Shen
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Lianjun Yang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Ke You
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Tao Chen
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Zhihai Su
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Zhifei Cui
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Min Wang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Weicong Zhang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Bin Liu
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Kai Zhou
- Shenzhen Institute of Respiratory Diseases, Second Clinical Medical College (Shenzhen People’s Hospital), Jinan University, First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Hai Lu
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- *Correspondence: Hai Lu,
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Martínez-Feito A, Navarro-Compán V, Hernández-Breijo B, Olariaga-Mérida E, Peiteado D, Villalba A, Nuño L, Monjo I, Diego C, Pascual-Salcedo D, Nozal P, Balsa A, Plasencia-Rodríguez C. Early monitoring of infliximab serum trough levels predicts long-term therapy failure in patients with axial spondyloarthritis. Scand J Rheumatol 2021; 51:102-109. [PMID: 34182885 DOI: 10.1080/03009742.2021.1914430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To evaluate whether serum infliximab trough levels (ITL) during the early stages of treatment are predictive of long-term clinical failure in patients with axial spondyloarthritis (axSpA).Method: Longitudinal observational study involving 81 patients with axSpA monitored during infliximab therapy. Serum ITL were measured before starting infliximab treatment and at weeks 2 (W2), W6 and W12 of treatment. Disease activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS) at baseline, W24 and W52, and every 6 months thereafter until treatment discontinuation, regardless of the reason. Non-clinically important improvement was defined by ΔASDAS<1.1. The association between serum levels during the early stages and clinical outcomes (non-clinically important improvement at W52, drug survival and drop-out due to secondary inefficacy) was investigated through logistic regression models and Kaplan Meier curves. Receiver operating characteristic (ROC) curves were employed to determine the best cut-off for serum ITL.Results: Out of the 81 patients, 45 (56%) did not achieve clinical improvement at W52. These patients had lower serum ITL at W12 compared to those who improved: ITL [median (IQR)]: 4.1(0.9-8.3) µg/mL vs 7.1 (4.3-11.3) µg/mL, respectively;p = 0.007). ITL<6.7 µg/mL at W12 was significantly associated with: i) not achieving clinical improvement at W52 (OR: 2.3; 95%CI: 1.3-3.9); ii) shorter drug survival (5.0 years (95% CI 3.8-6.2) vs 7.0 years (95% CI 4.8-6.9; p = 0.04), and iii) higher drop-out rates due to secondary inefficacy (OR: 3.5; 95% CI: 1.2-10.2).Conclusion: Low serum ITL at W12 were associated with long-term clinical failure in patients with axSpA, due to secondary inefficacy.
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Affiliation(s)
- A Martínez-Feito
- Immunology Unit, La Paz University Hospital, Madrid, Spain.,Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain
| | - V Navarro-Compán
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain.,Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - B Hernández-Breijo
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain
| | - E Olariaga-Mérida
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain
| | - D Peiteado
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain.,Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - A Villalba
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain.,Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - L Nuño
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain.,Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - I Monjo
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain.,Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - C Diego
- Immunology Unit, La Paz University Hospital, Madrid, Spain
| | - D Pascual-Salcedo
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain
| | - P Nozal
- Immunology Unit, La Paz University Hospital, Madrid, Spain
| | - A Balsa
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain.,Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - C Plasencia-Rodríguez
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain.,Rheumatology Department, La Paz University Hospital, Madrid, Spain
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9
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Russell T, Bridgewood C, Rowe H, Altaie A, Jones E, McGonagle D. Cytokine "fine tuning" of enthesis tissue homeostasis as a pointer to spondyloarthritis pathogenesis with a focus on relevant TNF and IL-17 targeted therapies. Semin Immunopathol 2021; 43:193-206. [PMID: 33544244 PMCID: PMC7990848 DOI: 10.1007/s00281-021-00836-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
A curious feature of axial disease in ankylosing spondylitis (AS) and related non-radiographic axial spondyloarthropathy (nrAxSpA) is that spinal inflammation may ultimately be associated with excessive entheseal tissue repair with new bone formation. Other SpA associated target tissues including the gut and the skin have well established paradigms on how local tissue immune responses and proven disease relevant cytokines including TNF and the IL-23/17 axis contribute to tissue repair. Normal skeletal homeostasis including the highly mechanically stressed entheseal sites is subject to tissue microdamage, micro-inflammation and ultimately repair. Like the skin and gut, healthy enthesis has resident immune cells including ILCs, γδ T cells, conventional CD4+ and CD8+ T cells and myeloid lineage cells capable of cytokine induction involving prostaglandins, growth factors and cytokines including TNF and IL-17 that regulate these responses. We discuss how human genetic studies, animal models and translational human immunology around TNF and IL-17 suggest a largely redundant role for these pathways in physiological tissue repair and homeostasis. However, disease associated immune system overactivity of these cytokines with loss of tissue repair “fine tuning” is eventually associated with exuberant tissue repair responses in AS. Conversely, excessive biomechanical stress at spinal enthesis or peripheral enthesis with mechanically related or degenerative conditions is associated with a normal immune system attempts at cytokine fine tuning, but in this setting, it is commensurate to sustained abnormal biomechanical stressing. Unlike SpA, where restoration of aberrant and excessive cytokine “fine tuning” is efficacious, antagonism of these pathways in biomechanically related disease may be of limited or even no value.
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Affiliation(s)
- Tobias Russell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Charlie Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Hannah Rowe
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Ala Altaie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
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10
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Groen SS, Sinkeviciute D, Bay-Jensen AC, Thudium CS, Karsdal MA, Thomsen SF, Schett G, Nielsen SH. Exploring IL-17 in spondyloarthritis for development of novel treatments and biomarkers. Autoimmun Rev 2021; 20:102760. [PMID: 33485992 DOI: 10.1016/j.autrev.2021.102760] [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: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
Spondyloarthritis (SpA) is an umbrella term describing a family of chronic inflammatory rheumatic diseases. These diseases are characterised by inflammation of the axial skeleton, peripheral joints, and entheseal insertion sites throughout the body which can lead to structural joint damage including formation of axial syndesmophytes and peripheral osteophytes. Genetic evidence, preclinical and clinical studies indicate a clear role of interleukin (IL)- 23 and IL-17 as mediators in SpA pathogenesis. Targeting the IL-23/-17 pathways seems an efficient strategy for treatment of SpA patients, and despite the remaining challenges the pathway holds great promise for further advances and improved therapeutic opportunities. Much research is focusing on serological markers and imaging strategies to correctly diagnose patients in the early stages of SpA. Biomarkers may facilitate personalised medicine tailored to each patient's specific disease to optimise treatment efficacy and to monitor therapeutic response. This narrative review focuses on the IL-17 pathway in SpA-related diseases with emphasis on its role in pathogenesis, current approved IL-17 inhibitors, and the need for biomarkers reflecting core disease pathways for early diagnosis and measurement of disease activity, prognosis, and response to therapy.
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Affiliation(s)
- Solveig Skovlund Groen
- Immunoscience, Nordic Bioscience, Herlev, Denmark; Biomecial Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Dovile Sinkeviciute
- Immunoscience, Nordic Bioscience, Herlev, Denmark; Department of Clinical Sciences Lund, University of Lund, Lund, Sweden
| | | | | | | | - Simon Francis Thomsen
- Biomecial Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Signe Holm Nielsen
- Immunoscience, Nordic Bioscience, Herlev, Denmark; Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
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11
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Lorenzin M, Ometto F, Ortolan A, Felicetti M, Favero M, Doria A, Ramonda R. An update on serum biomarkers to assess axial spondyloarthritis and to guide treatment decision. Ther Adv Musculoskelet Dis 2020; 12:1759720X20934277. [PMID: 32636944 PMCID: PMC7315656 DOI: 10.1177/1759720x20934277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
Axial spondyloarthritis (axSpA) is a group of debilitating, chronic, rheumatic conditions characterized by inflammation and new bone formation, mainly involving the spine and the sacroiliac joints. The lack of biomarkers in axSpA is well known. Despite significant treatment advances in recent years thanks to the introduction of drugs with a new mode of action, such as new biologic and targeted synthetic disease-modifying antirheumatic drugs, no relevant improvement in the identification of disease biomarkers has been achieved. Common parameters, such as erythrocyte sedimentation rate and C-reactive protein, which are routinely used to measure systemic inflammation, are the sole markers available to date and are not adequate to assess disease activity in all patients. The aim of this study is to review the most promising serum biomarkers that may help treatment decision in axSpA via a proper assessment of disease activity and identification of negative prognostic factors.
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Affiliation(s)
- Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Padova, Italy
| | - Francesca Ometto
- 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
| | - Marta Favero
- Rheumatology Unit, Department of Medicine -DIMED, 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, Via Giustiniani 2, Padova, 35128, Italy
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12
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Ajrawat P, Touma Z, Sari I, Taheri C, Diaz Martinez JP, Haroon N. Effect of TNF-inhibitor therapy on spinal structural progression in ankylosing spondylitis patients: A systematic review and meta-analysis. Int J Rheum Dis 2020; 23:728-743. [PMID: 32419337 DOI: 10.1111/1756-185x.13829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/16/2020] [Accepted: 03/01/2020] [Indexed: 12/17/2022]
Abstract
To review the effect of tumor necrosis factor-alpha inhibitor (TNFi) therapies on radiographic progression in ankylosing spondylitis (AS) patients as evaluated by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Pubmed, MEDLINE, EMBASE, and the Cochrane Library databases were searched from inception to August 2019. All comparative and non-comparative studies that evaluated the clinical effectiveness of TNFi on radiographic progression as assessed by mSASSS change at a minimum follow-up of 1 year were included. The Newcastle-Ottawa Scale and Cochrane Collaboration Risk of Bias Tool were utilized to assess the methodological quality. Pooled analysis was performed for continuous and binomial variables where appropriate. Inter-rater reliability of mSASSS status and change scores were assessed with intra-class coefficients (ICC). Twenty-one studies were identified with a total of 4460 patients (mean age: 40.4 years [range 25.3-50 years]; 76% male; mean baseline mSASSS: 12.7 units [range 5.5-19.8 units]). All studies (3 randomized and 18 observational studies) were considered to have moderate-to-high methodological quality. The inter-rater reliability of mSASSS status and change scores from 14 of the 21 studies were excellent (ICC ranges, 0.91-0.99) and moderate-to-excellent (ICC ranges, 0.58-0.90), respectively. From the 21 studies, 11/21 (50%) demonstrated a delayed effect in mSASSS in AS patient administered TNFi. When stratifying these studies into those with ≤4 years of follow-up and >4 years follow-up, 3/11 (27%) and 8/10 (80%) studies respectively indicated a delayed effect of mSASSS with TNFi in AS patients. Pooling for meta-analysis from 3 studies (1159 patients) with study durations ranging 4-8 years, indicated that TNFi-treated patients had reduced odds of structural progression (odds ratio 0.81; 95% CI 0.68-0.96; P = .01; I2 = 0%). Mean rate of mSASSS change from 16 studies ranged from -0.15 to 7.3 mSASSS units for all AS patients. Meta-analysis indicated a numerical, but statistically non-significant, reduction in the rate of mSASSS change with TNFi treatment (7 studies [1438 patients]; mean difference, -0.24; 95% CI, -0.49-0.01; P = .06; I2 = 0%). This systematic review and meta-analysis indicated that >4 years of TNFi usage was associated with delayed structural progression by mSASSS. The narrative analysis of the data from 21 studies further confirmed that studies with >4 years of follow-up had delayed structural progression with TNFi use in AS patients. The systematic review also confirmed that mSASSS has good-to-excellent inter-rater reliability in AS.
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Affiliation(s)
- Prabjit Ajrawat
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, Toronto, ON, Canada
| | - Ismail Sari
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Cameron Taheri
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juan Pablo Diaz Martinez
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nigil Haroon
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Krembil Research Institute, Toronto, ON, Canada
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13
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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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14
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Li H, Shen C, Chen B, Du J, Peng B, Wang W, Chi F, Dong X, Huang Z, Yang C. Interleukin‑37 is increased in peripheral blood mononuclear cells of coronary heart disease patients and inhibits the inflammatory reaction. Mol Med Rep 2019; 21:151-160. [PMID: 31746393 PMCID: PMC6896322 DOI: 10.3892/mmr.2019.10805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/16/2019] [Indexed: 12/13/2022] Open
Abstract
It has been universally acknowledged that interleukin-37 (IL-37) has an immunosuppressive effect on various inflammatory disorders. However, whether IL-37 participates in the acute inflammation associated with coronary heart disease (CHD) has not yet been clarified. In the present study, the association between the serum levels of IL-37 and the clinical indexes of CHD were analysed. In addition, the anti-inflammatory effects of IL-37 on peripheral blood mononuclear cells (PBMCs) were studied in CHD patients. PBMCs from 46 healthy controls (HCs) and 92 CHD patients were cultured in vitro and stimulated using the recombinant IL-37 protein. The protein levels, as well as the mRNA expression of inflammatory cytokines (TNF-α, IL-1β, IL-6, and IL-17) were analysed by enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (RT-PCR). Spearman's correlation test was performed to examine the association between the serum level of IL-37 and the levels of pro-inflammatory cytokines, certain clinical indexes, and disease activity during CHD. Compared to the HCs, the CHD patients, especially those with acute myocardial infarction, exhibited higher levels of IL-37 in their PBMCs and sera. Serum levels of IL-37 were associated with the levels of IL-17, IL-6, and TNF-α, and clinical indexes such as the left ventricular ejection fraction (LVEF), amino-N-terminal pro-plasma brain natriuretic peptide (NT-proBNP) levels, and cardiac troponin T (cTnT) levels in CHD patients. Compared to the HC group, the production of inflammatory cytokines such as IL-17, IL-6, TNF-α, and IL-1β increased in the PBMCs of CHD patients and significantly decreased after the stimulation of the cells with recombinant IL-37. The IL-37 levels in CHD patients were high, and were correlated with the levels of CHD-related pro-inflammatory cytokines and disease activity. Notably, the expression of CHD-related pro-inflammatory cytokines in the PBMCs of CHD patients decreased following the stimulation of the cells with recombinant IL-37, indicating that IL-37 exerts anti-inflammatory effects during CHD.
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Affiliation(s)
- Huimin Li
- Department of Cardiac Surgery, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Chen Shen
- Department of Cardiac Surgery, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Bingni Chen
- Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, P.R. China
| | - Jing Du
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Bin Peng
- Department of Cardiac Surgery, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Wei Wang
- Department of Cardiac Surgery, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Fanwu Chi
- Department of Cardiac Surgery, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Xiaoqiang Dong
- Department of Cardiac Surgery, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Zhong Huang
- Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, P.R. China
| | - Chao Yang
- Department of Cardiac Surgery, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
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15
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Gulyás K, Horváth Á, Végh E, Pusztai A, Szentpétery Á, Pethö Z, Váncsa A, Bodnár N, Csomor P, Hamar A, Bodoki L, Bhattoa HP, Juhász B, Nagy Z, Hodosi K, Karosi T, FitzGerald O, Szücs G, Szekanecz Z, Szamosi S, Szántó S. Effects of 1-year anti-TNF-α therapies on bone mineral density and bone biomarkers in rheumatoid arthritis and ankylosing spondylitis. Clin Rheumatol 2019; 39:167-175. [DOI: 10.1007/s10067-019-04771-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023]
Abstract
Abstract
Objectives
Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with generalized and localized bone loss. We conducted a comprehensive study using imaging (dual-energy X-ray absorptiometry, DXA) and laboratory biomarkers in order to determine bone health and to study the effects of anti-tumor necrosis factor (TNF) biologics in RA and AS.
Patients and methods
Thirty-six RA and 17 AS patients undergoing 1-year etanercept (ETN) or certolizumab-pegol (CZP) therapy were studied. Bone density was assessed by DXA at baseline and after 12 months. Serum C-reactive protein (CRP), calcium, phosphate, parathyroid hormone (PTH), vitamin D3, osteocalcin, procollagen type I N-propeptide (P1NP), C-terminal telopeptide (βCTX), osteoprotegerin, sclerostin (SOST), Dickkopf-1 (DKK-1), soluble receptor activator nuclear kappa B ligand (sRANKL), and cathepsin K (cathK) levels were determined at baseline and after 6 and 12 months.
Results
TNF-α inhibition was clinically effective. Anti-TNF-α halted further bone loss over 1 year. In general, anti-TNF therapy significantly increased P1NP, SOST levels, and the P1NP/βCTX ratios, while decreased DKK-1 and CathK production at different time points in most patient subsets. In the full cohort and in RA, baseline and/or 12-month bone mineral density (BMD) at multiple sites exerted inverse relationships with CRP and βCTX, and positive correlation with SOST. In AS, L2-4 BMD after 1-year biologic therapy inversely correlated with baseline βCTX, while femoral neck BMD rather showed inverse correlations with CRP.
Conclusions
Anti-TNF therapy slowed down generalized bone loss, in association with clinical improvements, in both diseases. TNF blockade may enhance bone formation and suppress joint destruction. Anti-TNF therapy may act inversely on DKK-1 and SOST. Independent predictors of BMD were SOST and βCTX in RA, whilst CRP in AS.Key Points• One-year anti-TNF therapy halted generalized bone loss in association with clinical improvement in arthritides.• Anti-TNF therapy may inversely act on DKK-1 and SOST.• Independent predictors of BMD were SOST and βCTX in RA, while CRP in AS.
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16
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Braun J. Using combinations of biomarkers to understand inflammation and bone formation in axial spondyloarthritis – is anything better than CRP? Rheumatology (Oxford) 2019; 58:1517-1519. [DOI: 10.1093/rheumatology/kez125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
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17
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Lorenzin M, Ortolan A, Felicetti M, Favero M, Vio S, Zaninotto M, Polito P, Cosma C, Scapin V, Lacognata C, Ramonda R. Serological Biomarkers in Early Axial Spondyloarthritis During 24-Months Follow Up (Italian Arm of Space Study). Front Med (Lausanne) 2019; 6:177. [PMID: 31440510 PMCID: PMC6692922 DOI: 10.3389/fmed.2019.00177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/19/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives: The study aimed to evaluate biomarkers facilitating early axial-spondyloarthritis (axSpA) diagnosis and disease activity and imaging indices correlated. Materials and Methods: Seventy-five patients with low back pain (LBP) (≥3 months, ≤2 years, onset ≤45 years) participating in the Italian arm of the SpondyloArthritis-Caught-Early (SPACE) study underwent a physical examination, questionnaires, laboratory tests, spine, and sacroiliac joints (SIJ) X-rays and magnetic resonance imaging (MRI) at baseline and during a 24-months follow-up. Two expert rheumatologists formulated axSpA diagnosis and assessed fulfillment of Assessment of SpondyloArthritis International Society (ASAS) criteria. Disease activity and physical functioning were assessed using imaging, clinical, and serological indices. Spine and SIJ MRI and X-rays were scored independently by 2 readers following the Spondyloarthritis Research Consortium of Canada (SPARCC), mSASSS, and mNY-criteria. Patients were classified in accordance to ASAS criteria as: 21 patients classified according to axSpA imaging arm; 29 patients classified according to axSpA clinical ± imaging arm; 25 patients not fulfilling ASAS criteria. Results: At baseline biomarker levels were not significantly increased in any of the patient groups. Instead, a significant decrease of all functional and disease activity indices from baseline to 24 months was observed in all the three groups. In the same period, there were no significant variation in the serological markers values within each group. The correlations between IL-17 and IL-23 and clinical and functional indices were not significant. On the other hand, significant correlations were found between IL-22 and Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Patient Global Score (BASG1), Health Assessment Questionnaire (HAQ), Visual Analog Scale (VAS pain); MMP3 and mSASSS; MMP3 and hsCRP. Conclusions: Although not significantly higher in any of the cohorts, IL-22, MMP3, and hsCRP values correlated with some disease activity indices and with mSASSS. Further studies are warranted to confirm these preliminary findings.
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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
| | - Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Stefania Vio
- Radiology Unit, University of Padova, Padova, Italy
| | | | - Pamela Polito
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Chiara Cosma
- Medicine of Laboratory, University of Padova, Padova, Italy
| | - Vanna Scapin
- Radiology Unit, University of Padova, Padova, Italy
| | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
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Abstract
BACKGROUND Psoriasis, psoriatic arthritis, spondyloarthritis, rheumatoid arthritis, ulcerative colitis, and Crohn disease share similar underlying pathophysiological processes, providing the opportunity to treat the patients using similar biological therapies. Failure of biological treatments due to underexposure can be managed by therapeutic drug monitoring. Adjusting the treatment based on pharmacokinetic monitoring can be further improved by taking pharmacodynamic parameters such as clinical and molecular markers into account. METHODS Here, we critically evaluate the existing evidence, the hurdles to be taken, and the opportunities for a widespread implementation of pharmacodynamic monitoring. RESULTS Pharmacodynamic monitoring typically is the monitoring of biochemical markers. A pharmacodynamic marker preferably is specific for the pharmacological action of a drug, but most of the time nonspecific pharmacodynamic markers are used, such as C-reactive protein and the erythrocyte sedimentation rate. Clinical pharmacodynamic markers typically evaluate physical variables or symptoms. Although physician-reported outcomes have been studied for a longer time and often have been shown to correlate well with molecular pharmacodynamic markers and treatment outcomes, the introduction of mobile health or mHealth technologies caused a shift toward patient-reported outcomes, with the associated challenge to consistently reflect the inflammatory state, thereby preventing undertreatment or unnecessary overdosing of patients. CONCLUSIONS The primary goal of pharmacodynamic monitoring is to optimize the response, but it can also have an impact on safety, costs, patient adherence, etc. Ideally, the constant remote monitoring of patient-reported disease activity is expected to become the standard, facilitated by mHealth technologies.
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19
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Giacomelli R, Afeltra A, Alunno A, Bartoloni-Bocci E, Berardicurti O, Bombardieri M, Bortoluzzi A, Caporali R, Caso F, Cervera R, Chimenti MS, Cipriani P, Coloma E, Conti F, D'Angelo S, De Vita S, Di Bartolomeo S, Distler O, Doria A, Feist E, Fisher BA, Gerosa M, Gilio M, Guggino G, Liakouli V, Margiotta DPE, Meroni P, Moroncini G, Perosa F, Prete M, Priori R, Rebuffi C, Ruscitti P, Scarpa R, Shoenfeld Y, Todoerti M, Ursini F, Valesini G, Vettori S, Vitali C, Tzioufas AG. Guidelines for biomarkers in autoimmune rheumatic diseases - evidence based analysis. Autoimmun Rev 2019; 18:93-106. [PMID: 30408582 DOI: 10.1016/j.autrev.2018.08.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/11/2018] [Indexed: 12/21/2022]
Abstract
Autoimmune rheumatic diseases are characterised by an abnormal immune system response, complement activation, cytokines dysregulation and inflammation. In last years, despite many progresses in managing these patients, it has been shown that clinical remission is reached in less than 50% of patients and a personalised and tailored therapeutic approach is still lacking resulting in a significant gap between guidelines and real-world practice. In this context, the need for biomarkers facilitating early diagnosis and profiling those individuals at the highest risk for a poor outcome has become of crucial interest. A biomarker generally refers to a measured characteristic which may be used as an indicator of some biological state or condition. Three different types of medical biomarkers has been suggested: i. mechanistic markers; ii. clinical disease markers; iii. therapeutic markers. A combination of biomarkers from these different groups could be used for an ideal more accurate diagnosis and treatment. However, although a growing body of evidence is focused on improving biomarkers, a significant amount of this information is not integrated on standard clinical care. The overarching aim of this work was to clarify the meaning of specific biomarkers during autoimmune diseases; their possible role in confirming diagnosis, predicting outcome and suggesting specific treatments.
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Affiliation(s)
- Roberto Giacomelli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy.
| | - Antonella Afeltra
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Onorina Berardicurti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Alessandra Bortoluzzi
- Department of Medical Science, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Cona, Ferrara, Italy
| | - Roberto Caporali
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Maria Sole Chimenti
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Emmanuel Coloma
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Fabrizio Conti
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Salvatore D'Angelo
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, Azienda Ospedaliero Universitaria S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Salvatore Di Bartolomeo
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, DIMED, University of Padua, Padua, Italy
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology of the Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin A Fisher
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK; Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Maria Gerosa
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Michele Gilio
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Giuliana Guggino
- Dipartimento Biomedico di Medicina Interna e Specialistica, Rheumatology section, University of Palermo, Italy
| | - Vasiliki Liakouli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Domenico Paolo Emanuele Margiotta
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Pierluigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Gianluca Moroncini
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Chiara Rebuffi
- Grant Office and Scientific Documentation Center, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Yehuda Shoenfeld
- Zabludowitz Centre for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Monica Todoerti
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Ursini
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Serena Vettori
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Athanasios G Tzioufas
- Pathophysiology Department, General Hospital of Athens "Laiko", Medical School, National and Kapodistrian University of Athens, Greece
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Maksymowych WP. An update on biomarker discovery and use in axial spondyloarthritis. Expert Rev Mol Diagn 2017; 17:965-974. [DOI: 10.1080/14737159.2017.1381562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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21
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Brunner HI, Ruperto N, Tzaribachev N, Horneff G, Chasnyk VG, Panaviene V, Abud-Mendoza C, Reiff A, Alexeeva E, Rubio-Pérez N, Keltsev V, Kingsbury DJ, Del Rocio Maldonado Velázquez M, Nikishina I, Silverman ED, Joos R, Smolewska E, Bandeira M, Minden K, van Royen-Kerkhof A, Emminger W, Foeldvari I, Lauwerys BR, Sztajnbok F, Gilmer KE, Xu Z, Leu JH, Kim L, Lamberth SL, Loza MJ, Lovell DJ, Martini A. Subcutaneous golimumab for children with active polyarticular-course juvenile idiopathic arthritis: results of a multicentre, double-blind, randomised-withdrawal trial. Ann Rheum Dis 2017; 77:21-29. [PMID: 28507219 PMCID: PMC5754736 DOI: 10.1136/annrheumdis-2016-210456] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 03/03/2017] [Accepted: 03/12/2017] [Indexed: 11/30/2022]
Abstract
Objective This report aims to determine the safety, pharmacokinetics (PK) and efficacy of subcutaneous golimumab in active polyarticular-course juvenile idiopathic arthritis (polyJIA). Methods In this three-part randomised double-blinded placebo-controlled withdrawal trial, all patients received open-label golimumab (30 mg/m2 of body surface area; maximum: 50 mg/dose) every 4 weeks together with weekly methotrexate during Part 1 (weeks 0–16). Patients with at least 30% improvement per American College of Rheumatology Criteria for JIA (JIA ACR30) in Part 1 entered the double-blinded Part 2 (weeks 16–48) after 1:1 randomisation to continue golimumab or start placebo. In Part 3, golimumab was continued or could be restarted as in Part 1. The primary outcome was JIA flares in Part 2; secondary outcomes included JIA ACR50/70/90 responses, clinical remission, PK and safety. Results Among 173 patients with polyJIA enrolled, 89.0% (154/173) had a JIA ACR30 response and 79.2%/65.9%/36.4% demonstrated JIA ACR50/70/90 responses in Part 1. At week 48, the primary endpoint was not met as treatment groups had comparable JIA flare rates (golimumab vs placebo: 32/78=41% vs 36/76=47%; p=0.41), and rates of clinical remission were comparable (golimumab vs placebo: 10/78=12.8% vs 9/76=11.8%). Adverse event and serious adverse event rates were similar in the treatment groups during Part 2. Injection site reactions occurred with <1% of all injections. PK analysis confirmed adequate golimumab dosing for polyJIA. Conclusion Although the primary endpoint was not met, golimumab resulted in rapid, clinically meaningful, improvement in children with active polyJIA. Golimumab was well tolerated, and no unexpected safety events occurred. Clinical Trial Registration NCT01230827; Results.
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Affiliation(s)
- Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nicolino Ruperto
- Istituto Giannina Gaslini, Pediatria II - Rheumatologia, PRINTO, Genoa, Italy
| | | | - Gerd Horneff
- Department of Pediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Vyacheslav G Chasnyk
- Hospital Pediatry, State Pediatric Medical Academy, Saint Petersburg, Russian Federation
| | | | - Carlos Abud-Mendoza
- Regional Unit of Rheumatology and Osteoporosis, Central Hospital "Dr. Ignacio Morones Prieto" and Faculty of Medicine, Universidad Autónoma de San Luis Potosí, Mexico, San Luis Potosí, Mexico
| | - Andreas Reiff
- Department of Rheumatology, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Ekaterina Alexeeva
- Children's Health of RAMS and IM Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Nadina Rubio-Pérez
- Hospital Universitario, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | | | | | | | - Irina Nikishina
- Pediatric Department, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Earl D Silverman
- Department of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Rik Joos
- ZNA Jan Palfijn, Antwerpen, Belgium
| | | | | | - Kirsten Minden
- Department of Pediatric Rheumatology, Charité University Medicine, Berlin, Germany
| | - Annet van Royen-Kerkhof
- Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ivan Foeldvari
- Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Bernard R Lauwerys
- Pôle de pathologies rhumatismales systémiques et inflammatoires, Université catholique de Louvain, Institut de Recherche Clinique, Brussels, Belgium
| | - Flavio Sztajnbok
- Nucleo de Estudos da Saúde do Adolescente, Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil
| | - Keith E Gilmer
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Zhenhua Xu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Jocelyn H Leu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Lilianne Kim
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Sarah L Lamberth
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Matthew J Loza
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alberto Martini
- Istituto Giannina Gaslini, Pediatria II - Rheumatologia, PRINTO, Genoa, Italy
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Neve A, Maruotti N, Corrado A, Cantatore FP. Pathogenesis of ligaments ossification in spondyloarthritis: insights and doubts. Ann Med 2017; 49:196-205. [PMID: 27685190 DOI: 10.1080/07853890.2016.1243802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Despite intensive research in spondyloarthritis pathogenesis, some important questions still remain unanswered, particularly concerning enthesis new bone formation. Several evidences suggest that it prevalently occurs by endochondral ossification, however it remains to identify factors that can induce and influence its initiation and progression. Recent progress, achieved in animal models and in vitro and genetic association studies, has led us to hypothesize that several systemic factors (adipokines and gut hormones) and local factors (BMP and Wnt signaling) as well as angiogenesis and mechanical stress are involved. We critically review and summarize the available data and delineate the possible mechanisms involved in enthesis ossification, particularly at spinal ligament level. KEY MESSAGES Complete understanding of spondyloarthritis pathophysiology requires insights into inflammation, bone destruction and bone formation, which are all located in entheses and lead all together to ankylosis and functional disability. Several factors probably play a role in the pathogenesis of bone formation in entheses including not only cytokines but also several systemic factors such as adipokines and gut hormones, and local factors, such as BMP and Wnt signaling, as well as angiogenesis and mechanical stress. Data available about pathophysiology of new bone formation in spondyloarthritis are limited and often conflicting and future studies are needed to better delineate it and to develop new therapeutic approaches.
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Affiliation(s)
- Anna Neve
- a Rheumatology Clinic, Department of Medical and Surgical Sciences , University of Foggia Medical School , Foggia , Italy
| | - Nicola Maruotti
- a Rheumatology Clinic, Department of Medical and Surgical Sciences , University of Foggia Medical School , Foggia , Italy
| | - Addolorata Corrado
- a Rheumatology Clinic, Department of Medical and Surgical Sciences , University of Foggia Medical School , Foggia , Italy
| | - Francesco Paolo Cantatore
- a Rheumatology Clinic, Department of Medical and Surgical Sciences , University of Foggia Medical School , Foggia , Italy
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Uson J, Loza E, Möller I, Acebes C, Andreu JL, Batlle E, Bueno Á, Collado P, Fernández-Gallardo JM, González C, Jiménez Palop M, Lisbona MP, Macarrón P, Maymó J, Narváez JA, Navarro-Compán V, Sanz J, Rosario MP, Vicente E, Naredo E. Recommendations for the Use of Ultrasound and Magnetic Resonance in Patients With Spondyloarthritis, Including Psoriatic Arthritis, and Patients With Juvenile Idiopathic Arthritis. ACTA ACUST UNITED AC 2017; 14:27-35. [PMID: 28277255 DOI: 10.1016/j.reuma.2016.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging in patients with spondyloarthritis, including psoriatic arthritis, and juvenile idiopathic arthritis. METHODS Recommendations were generated following a nominal group technique. A panel of experts (15 rheumatologists and 3 radiologists) was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of participants voted≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. RESULTS A total of 12 recommendations were proposed for each disease. They include, along with explanations of the validity of US and magnetic resonance imaging regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. CONCLUSIONS These recommendations will help clinicians use US and magnetic resonance imaging in patients with spondyloarthritis and juvenile idiopathic arthritis.
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Affiliation(s)
- Jacqueline Uson
- Servicio de Reumatología, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | | | - Ingrid Möller
- Servicio de Reumatología, Instituto Poal de Reumatología, Barcelona, España
| | - Carlos Acebes
- Servicio de Reumatología, Hospital General de Villalba, Collado Villalba, Madrid, España
| | - Jose Luis Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Enrique Batlle
- Servicio de Reumatología, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España
| | - Ángel Bueno
- Servicio de Radiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Paz Collado
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | | - Carlos González
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Mercedes Jiménez Palop
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Pilar Macarrón
- Servicio de Reumatología, Hospital Universitario Clínico San Carlos, Madrid, España
| | - Joan Maymó
- Servicio de Reumatología, Hospital del Mar, Barcelona, España
| | - Jose Antonio Narváez
- Servicio de Radiodiagnóstico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Jesús Sanz
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Esther Vicente
- Servicio de Reumatología, Hospital Universitario de La Princesa, Madrid, España
| | - Esperanza Naredo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Turina MC, Yeremenko N, van Gaalen F, van Oosterhout M, Berg IJ, Ramonda R, Lebre CMC, Landewé R, Baeten D. Serum inflammatory biomarkers fail to identify early axial spondyloarthritis: results from the SpondyloArthritis Caught Early (SPACE) cohort. RMD Open 2017; 3:e000319. [PMID: 28123777 PMCID: PMC5237766 DOI: 10.1136/rmdopen-2016-000319] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/08/2016] [Accepted: 09/24/2016] [Indexed: 12/17/2022] Open
Abstract
Introduction Decreasing the diagnostic delay in axial spondyloarthritis (axSpA) remains a major challenge. Here, we assessed the value of serum inflammatory biomarkers to distinguish early axSpA from other pathologies in a large cohort of patients referred with early back pain. Methods Serum c reactive protein (CRP), erythrocyte sedimentation rate (ESR) and calprotectin were determined in the SPondyloArthritis Caught Early (SPACE) cohort (n=310), an early back pain inception cohort. Additionally, explorative serum biomarkers derived from the literature (interleukin-27 (IL-27), human β-defensin-2 (hBD-2) and lipcolin-2 (LCN-2)) were determined by ELISA in full-blown patients with ankylosing spondylitis (AS) (n=21) and healthy controls (n=20). Results Serum CRP and ESR levels were not elevated in early axSpA versus ‘control’ back pain patients. Serum calprotectin was elevated in early axSpA versus controls (p=0.01) but failed to identify early axSpA at the individual level (positive predictive value of 38.7%). As to explorative biomarkers, serum levels of IL-27 were not detectable, and hBD-2 and LCN-2 serum levels were not elevated in full-blown AS versus healthy controls (p=0.572, p=0.562, respectively). Therefore, these markers were not further determined in the SPACE cohort. Conclusions None of the candidate serum inflammatory markers were useful as diagnostic markers in the early phase of axSpA.
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Affiliation(s)
- Maureen C Turina
- Department of Clinical Immunology and Rheumatology , Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - Nataliya Yeremenko
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Immunology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Floris van Gaalen
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | | | - Inger J Berg
- Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - Ramona Ramonda
- Rheumatology Unit, Department of Medicine DIMED , University of Padova , Padova , Italy
| | - Cristina M C Lebre
- Department of Experimental Immunology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - Robert Landewé
- Department of Clinical Immunology and Rheumatology , Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - Dominique Baeten
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Immunology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Turina MC, Landewé R, Baeten D. Lessons to be learned from serum biomarkers in psoriasis and IBD – the potential role in SpA. Expert Rev Clin Immunol 2016; 13:333-344. [DOI: 10.1080/1744666x.2017.1244004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Maureen C. Turina
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Dominique Baeten
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Braun J, Baraliakos X, Hermann KGA, Xu S, Hsu B. Serum C-reactive Protein Levels Demonstrate Predictive Value for Radiographic and Magnetic Resonance Imaging Outcomes in Patients with Active Ankylosing Spondylitis Treated with Golimumab. J Rheumatol 2016; 43:1704-12. [PMID: 27422890 DOI: 10.3899/jrheum.160003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Serum C-reactive protein (CRP) associates with radiographic progression in patients with ankylosing spondylitis (AS) untreated with tumor necrosis factor (TNF) antagonists. We assessed correlations between serum CRP and radiographic progression/magnetic resonance imaging (MRI)-detected inflammation after 2 years of anti-TNF therapy. METHODS Patients with active AS receiving golimumab (GOL)/placebo through Week 16 (early escape) or Week 24 (crossover by design), followed by GOL through 4 years, had sera/images obtained through Week 208. Lateral spinal radiographs and spinal MRI were scored with the modified Stoke AS Spine Score (mSASSS) and the AS spine MRI activity (ASspiMRI-a) score, respectively. ANOVA assessed differences based on CRP levels and mSASSS progression. The relationships between CRP levels and mSASSS/ASspiMRI-a were assessed by Spearman correlation and logistic regression. RESULTS Of the randomized GO-RAISE patients, 299 (84.0%) had pre- and posttreatment spinal radiographs. Larger proportions of patients with Week 104 CRP ≥ 0.5 mg/dl (n = 47) versus < 0.5 mg/dl (n = 236, 40.4% vs 22.9%, p = 0.0121) had mSASSS changes ≥ 2 at Week 104. Across several visits, serum CRP demonstrated weak associations with mSASSS change (rs ≤ 0.21, p < 0.05, n = 262-293) and moderate associations with ASspiMRI-a change (rs = -0.33 to 0.54, p < 0.05, n = 65-89). Higher baseline CRP was associated with increased risk for syndesmophytes at Week 104/Week 208, and large, short-term decreases in CRP from baseline to Week 14/Week 24 also yielded increased syndesmophyte formation risk. CONCLUSION Elevated CRP after 2 years of anti-TNF treatment correlated with greater radiographic progression risk at 4 years. Elevated CRP at baseline or Week 14/Week 24 of anti-TNF treatment weakly predicted subsequent radiographic progression and modestly predicted residual spinal inflammation in patients with AS treated with anti-TNF. Findings are useful regarding new treatment options in patients treated with anti-TNF. ClinicalTrials.gov: NCT00265083.
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Affiliation(s)
- Jürgen Braun
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC.
| | - Xenofon Baraliakos
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC
| | - Kay-Geert A Hermann
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC
| | - Stephen Xu
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC
| | - Benjamin Hsu
- From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.J. Braun has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen Research and Development LLC. X. Baraliakos has received honoraria for talks, advisory boards, paid consultancies, and grants for studies from Janssen. K.G. Hermann has received honoraria for educational lectures from Janssen. S. Xu and B. Hsu are employees of Janssen.J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; K.G. Hermann, MD, PhD, Department of Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research and Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research and Development LLC
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Quaden DHF, De Winter LM, Somers V. Detection of novel diagnostic antibodies in ankylosing spondylitis: An overview. Autoimmun Rev 2016; 15:820-32. [PMID: 27288842 DOI: 10.1016/j.autrev.2016.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/05/2016] [Indexed: 12/17/2022]
Abstract
Ankylosing spondylitis (AS) is a debilitating, chronic, rheumatic disease characterized by inflammation and new bone formation resulting in fusion of the spine and sacroiliac joints. Since early treatment is impeded by a delayed diagnosis, it is highly important to find new biomarkers that improve early diagnosis and may also contribute to a better assessment of disease activity, prognosis and therapy response in AS. Because of the absence of rheumatoid factor, AS was long assumed to have a seronegative character and antibodies are thus not considered a hallmark of the disease. However, emerging evidence suggests plasma cells and autoantibodies to be involved in the disease course. In this review, the role of B cells and antibodies in AS is discussed. Furthermore, an overview is provided of antibodies identified in AS up till now, and their diagnostic potential. Many of these antibody responses were based on small study populations and further validation is lacking. Moreover, most were identified by a hypothesis-driven approach and thus limited to antibodies against targets that are already known to be involved in AS pathogenesis. Hence, we propose an unbiased approach to identify novel diagnostic antibodies. The already successfully applied techniques cDNA phage display and serological antigen selection will be used to identify antibodies against both known and new antigen targets in AS plasma. These newly identified antibodies will enhance early diagnosis of AS and provide more insight into the underlying disease pathology, resulting in a more effective treatment strategy and eventually an improved disease outcome.
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Affiliation(s)
- Dana H F Quaden
- Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Hasselt, Belgium
| | - Liesbeth M De Winter
- Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Hasselt, Belgium
| | - Veerle Somers
- Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Hasselt, Belgium.
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Prajzlerová K, Grobelná K, Pavelka K, Šenolt L, Filková M. An update on biomarkers in axial spondyloarthritis. Autoimmun Rev 2016; 15:501-9. [DOI: 10.1016/j.autrev.2016.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/28/2016] [Indexed: 12/17/2022]
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Braun J, Baraliakos X, Hermann KGA, Xu S, Hsu B. Serum Vascular Endothelial Growth Factor Levels Lack Predictive Value in Patients with Active Ankylosing Spondylitis Treated with Golimumab. J Rheumatol 2016; 43:901-6. [PMID: 26932345 DOI: 10.3899/jrheum.150897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To assess vascular endothelial growth factor (VEGF) correlations with new bone formation and bone marrow edema in patients with ankylosing spondylitis (AS) treated with golimumab (GOL). METHODS Following placebo control (through weeks 16 and 24), GO-RAISE (A Multicenter Randomized, Double-blind, Placebo-controlled Trial of Golimumab, a Fully Human Anti-TNF-α Monoclonal Antibody, Administered Subcutaneously, in Subjects with Active Ankylosing Spondylitis; ClinicalTrials.gov: NCT00265083) all patients received GOL; sera/images were available at weeks 0, 104, and 208. Lateral spinal radiographs and magnetic resonance imaging (MRI) were scored using the modified Stokes Ankylosing Spondylitis Spine Score (mSASSS) and the Ankylosing Spondylitis Spinal MRI activity score, respectively. RESULTS VEGF levels and the mSASSS did not significantly correlate. Logistic regression analyses showed no association between VEGF levels and an increased risk of syndesmophyte formation at weeks 104 and 208. Pretreatment/Week 14 VEGF did not predict MRI scores/changes at Week 104. CONCLUSION Serum VEGF did not predict radiographic progression/spinal inflammation in patients receiving antitumor necrosis factor.
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Affiliation(s)
- Jürgen Braun
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC.
| | - Xenofon Baraliakos
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC
| | - Kay-Geert A Hermann
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC
| | - Stephen Xu
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC
| | - Benjamin Hsu
- From Rheumatology, Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics, and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA.J. Braun, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; X. Baraliakos, MD, Department of Rheumatology, Rheumazentrum Ruhrgebiet, and Ruhr-University Bochum; K.G. Hermann, MD, PhD, Radiology, Charité Universitätsmedizin; S. Xu, MS, Biostatistics, Janssen Research & Development LLC; B. Hsu, MD, PhD, Immunology, Janssen Research & Development LLC
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Abstract
PURPOSE OF REVIEW To assess the literature for biomarker validation studies that address key unmet needs related to the evaluation and management of patients with axial spondyloarthritis (SpA). This review focused on biomarkers facilitating early diagnosis and reflecting disease activity, structural damage on radiography, and clinical response to major therapies. RECENT FINDINGS Early diagnosis may be facilitated by measurement of antibodies to the human leukocyte antigen class II-associated invariant chain peptide (anti-CD74) but sensitivity declines with increasing duration of disease. No disease activity biomarkers have demonstrated consistent superiority over standard C-reactive protein (CRP), and future validation should employ multivariate analysis aimed at demonstrating the added value of any associated biomarkers beyond available clinical parameters of disease activity and the use of magnetic resonance imaging inflammation as the primary endpoint. Several biomarkers reflecting inflammation (CRP and calprotectin), angiogenesis (vasoactive endothelial growth factor), and connective tissue turnover (C2 M, C3 M, and citrullinated metalloproteinase degraded fragment of vimentin ) have recently been shown to reflect radiographic progression in multivariate studies adjusted for baseline severity. Future studies should be prospective and demonstrate that predictive capacity adds to the information provided by known predictors such as CRP and baseline modified Stoke AS Spine Score. Calprotectin is a promising predictor of response to major therapies for axial SpA. SUMMARY Several promising biomarkers addressing major unmet clinical needs require further validation in prospective studies.
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Saban R. Angiogenic factors, bladder neuroplasticity and interstitial cystitis-new pathobiological insights. Transl Androl Urol 2016; 4:555-62. [PMID: 26816854 PMCID: PMC4708555 DOI: 10.3978/j.issn.2223-4683.2015.08.05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vascular endothelial growth factor (VEGF) is essential for normal embryonic development, and maintenance of adult vascular function. Originally described as a vascular permeability factor, VEGF alters tight cell junctions and contributes to maintenance of bladder permeability. VEGF and its receptors are not only expressed in bladder blood vessels but also in apical cells and intramural ganglia. VEGF receptors are fundamentally altered by inflammation and bladder diseases such as interstitial cystitis (IC). Experimental results indicate that VEGF exerts direct effects on bladder nerve density and function. Regardless of the etiology or initiating cause for IC, it is hypothesized that the urinary bladder responds to injury by increasing the production of VEGF that acts initially as a survival mechanism. However, VEGF also has the capacity to increase vascular permeability leading to glomerulations, edema, and inflammation. Moreover, due to elevated numbers of VEGF receptors in the urothelium, the increased levels of VEGF further increase bladder permeability and establish a vicioCus cycle of disease pathophysiology.
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Affiliation(s)
- Ricardo Saban
- 1 University Anhembi Morumbi, S.Paulo, SP 03164-000, Brazil ; 2 Department of Physiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Xu WD, Zhao Y, Liu Y. Insights into IL-37, the role in autoimmune diseases. Autoimmun Rev 2015; 14:1170-5. [DOI: 10.1016/j.autrev.2015.08.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/07/2015] [Indexed: 01/10/2023]
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Danve A, O'Dell J. The ongoing quest for biomarkers in Ankylosing Spondylitis. Int J Rheum Dis 2015; 18:826-34. [DOI: 10.1111/1756-185x.12779] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Abhijeet Danve
- Division of Rheumatology; University of Nebraska Medical Center; Omaha Nebraska USA
| | - James O'Dell
- Division of Rheumatology; University of Nebraska Medical Center; Omaha Nebraska USA
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Goldman AW, Burmeister Y, Cesnulevicius K, Herbert M, Kane M, Lescheid D, McCaffrey T, Schultz M, Seilheimer B, Smit A, St Laurent G, Berman B. Bioregulatory systems medicine: an innovative approach to integrating the science of molecular networks, inflammation, and systems biology with the patient's autoregulatory capacity? Front Physiol 2015; 6:225. [PMID: 26347656 PMCID: PMC4541032 DOI: 10.3389/fphys.2015.00225] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/27/2015] [Indexed: 12/25/2022] Open
Abstract
Bioregulatory systems medicine (BrSM) is a paradigm that aims to advance current medical practices. The basic scientific and clinical tenets of this approach embrace an interconnected picture of human health, supported largely by recent advances in systems biology and genomics, and focus on the implications of multi-scale interconnectivity for improving therapeutic approaches to disease. This article introduces the formal incorporation of these scientific and clinical elements into a cohesive theoretical model of the BrSM approach. The authors review this integrated body of knowledge and discuss how the emergent conceptual model offers the medical field a new avenue for extending the armamentarium of current treatment and healthcare, with the ultimate goal of improving population health.
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Affiliation(s)
- Alyssa W Goldman
- Concept Systems, Inc. Ithaca, NY, USA ; Department of Sociology, Cornell University Ithaca, NY, USA
| | | | | | - Martha Herbert
- Transcend Research Laboratory, Massachusetts General Hospital Boston, MA, USA
| | - Mary Kane
- Concept Systems, Inc. Ithaca, NY, USA
| | - David Lescheid
- International Academy of Bioregulatory Medicine Baden-Baden, Germany
| | - Timothy McCaffrey
- Division of Genomic Medicine, George Washington University Medical Center Washington, DC, USA
| | - Myron Schultz
- Biologische Heilmittel Heel GmbH Baden-Baden, Germany
| | | | - Alta Smit
- Biologische Heilmittel Heel GmbH Baden-Baden, Germany
| | | | - Brian Berman
- Center for Integrative Medicine, University of Maryland School of Medicine Baltimore, MD, USA
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Rios Rodriguez V, Poddubnyy D. Old and new treatment targets in axial spondyloarthritis. RMD Open 2015; 1:e000054. [PMID: 26557376 PMCID: PMC4632151 DOI: 10.1136/rmdopen-2015-000054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/31/2015] [Accepted: 04/05/2015] [Indexed: 01/13/2023] Open
Abstract
Two main treatment targets in axial spondyloarthritis (axSpA) could be currently defined: (1) reduction of inflammation resulting in control of signs and symptoms such as pain and stiffness and (2) prevention or retardation of structural damage progression in the spine resulting in preservation of functional status and improvement in the long-term outcome. A good control of signs and symptoms could be successfully achieved nowadays in the majority of patients treated with non-steroidal anti-inflammatory drugs (NSAIDs-the first-line therapy in axSpA) and with tumour necrosis factor (TNF) α blockers (the second-line therapy, if NSAIDs fail). Several pipeline drugs including interleukin (IL) 17 and IL-23 antagonists might be helpful in the immediate future in achievement of this treatment target in case of inefficacy of NSAIDs and TNFα blockers. Retardation of radiographical spinal progression in axSpA-disease modification-is currently a much more challenging task than a good symptom control. In this review, we discuss symptomatic and possible disease-modifying properties of current and forthcoming treatment options for axSpA.
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Affiliation(s)
- Valeria Rios Rodriguez
- Rheumatology, Medical Department I , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Denis Poddubnyy
- Rheumatology, Medical Department I , Charité Universitätsmedizin Berlin , Berlin , Germany
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Serum IL-6 and IL-23 Levels and Their Correlation with Angiogenic Cytokines and Disease Activity in Ankylosing Spondylitis, Psoriatic Arthritis, and SAPHO Syndrome. Mediators Inflamm 2015; 2015:785705. [PMID: 26339141 PMCID: PMC4539212 DOI: 10.1155/2015/785705] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/15/2015] [Accepted: 03/22/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To assess serum interleukin-6 (IL-6) and interleukin-23 (IL-23) and their correlation with angiogenic cytokines and disease activity in ankylosing spondylitis (AS), psoriatic arthritis (PsA), and SAPHO syndrome. PATIENTS AND METHODS We studied 152 spondyloarthritis (SpA) patients: 69 PsA, 61 AS, 22 SAPHO, and 29 controls. We recorded age, sex, disease duration, and treatment. We assessed BASDAI, VAS, and PASI scores. Serum IL-6, IL-23, VEGF, EGF, FGFb, and FGFa levels were determined using ELISA. We estimated ESR and CRP. RESULTS Serum IL-6 and IL-23 levels were higher in SpA than in control (P < 0.00001 and P = 0.0004, resp.). There was a positive correlation between serum IL-6 and CRP in AS (P = 0.000001), PsA (P = 0.000001), and SAPHO (P = 0.0003) patients. There was a positive correlation between serum IL-6 and ESR in AS (P = 0.000001), PsA (P = 0.002), and SAPHO (P = 0.02) patients. There was no correlation of serum IL-6 and IL-23 with VAS, BASDAI, and angiogenic cytokines in SpA. CONCLUSIONS Serum IL-6 but not serum IL-23 correlated with ESR and CRP in SpA. No correlation was found of serum IL-6 and IL-23 with VAS, BASDAI, and angiogenic cytokines.
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Bleil J, Maier R, Syrbe U, Sieper J, Appel H. In situ analysis of interleukin-6 expression at different sites of zygapophyseal joints from patients with ankylosing spondylitis in comparison to controls. Scand J Rheumatol 2015; 44:296-301. [PMID: 25928402 DOI: 10.3109/03009742.2014.1000371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Analysis of interleukin (IL)-6 serum levels in patients with ankylosing spondylitis (AS) has indicated that IL-6 might be a pro-inflammatory cytokine involved in AS. However, two placebo-controlled trials with monoclonal antibodies directed against the IL-6 receptor have failed to demonstrate the efficacy of the monoclonal humanized anti-human IL-6 receptor antibody over placebo for the treatment of symptoms of AS. In this study we conducted an in situ analysis of IL-6 expression at different sites of inflammation in zygapophyseal joints of patients with AS in comparison to osteoarthritis autopsy controls (CO). METHOD Our immunohistochemical analysis involved 14 patients with AS, 12 autopsy controls (CO), and 11 patients with osteoarthritis (OA). Immunohistochemistry was performed to detect IL-6+ cells at five different sites: within subchondral bone marrow, fibrous tissue replacing subchondral bone marrow, hyaline cartilage, and the subchondral bone plate, and at entheseal sites. RESULTS Apart from changes in subchondral bone marrow, no significant differences were observed at the sites analysed when comparing AS patients and controls. A significantly lower frequency of IL-6+ cells was evident in AS patients compared to controls (p = 0.0043). In addition, AS patients tended to have even lower percentages of IL-6+ cells than controls at subchondral bone plates and entheseal sites. A significantly lower number of IL-6 expressing cells was also seen within the fibrous tissue of AS compared to OA patients (p = 0.0237). CONCLUSIONS This in situ analysis confirms that IL-6 is not a key player in the pathogenesis of inflammatory processes in spondyloarthritides (SpA). The relevance of pro-inflammatory agents in axial SpA might be studied better in situ in bony specimens at the primary site of inflammation.
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Affiliation(s)
- J Bleil
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University Hospital, Campus Benjamin Franklin , Berlin , Germany
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Smith JA. Update on ankylosing spondylitis: current concepts in pathogenesis. Curr Allergy Asthma Rep 2015; 15:489. [PMID: 25447326 DOI: 10.1007/s11882-014-0489-6] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ankylosing spondylitis is an insidiously progressive and debilitating form of arthritis involving the axial skeleton. The long delay in diagnosis and insufficient response to currently available therapeutics both advocate for a greater understanding of disease pathogenesis. Genome-wide association studies of this highly genetic disease have implicated specific immune pathways, including the interleukin (IL)-17/IL-23 pathway, control of nuclear factor kappa B (NF-κB) activation, amino acid trimming for major histocompatibility complex (MHC) antigen presentation, and other genes controlling CD8 and CD4 T cell subsets. The relevance of these pathways has borne out in animal and human subject studies, in particular, the response to novel therapeutic agents. Genetics and the findings of autoantibodies in ankylosing spondylitis revisit the question of autoimmune vs. autoinflammatory etiology. As environmental partners to genetics, recent attention has focused on the roles of microbiota and biomechanical stress in initiating and perpetuating inflammation. Herein, we review these current developments in the investigation of ankylosing spondylitis pathogenesis.
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Affiliation(s)
- Judith A Smith
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, H4/472 CSC, Madison, WI, 53709-4108, USA,
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Mandl P, Navarro-Compán V, Terslev L, Aegerter P, van der Heijde D, D'Agostino MA, Baraliakos X, Pedersen SJ, Jurik AG, Naredo E, Schueller-Weidekamm C, Weber U, Wick MC, Bakker PAC, Filippucci E, Conaghan PG, Rudwaleit M, Schett G, Sieper J, Tarp S, Marzo-Ortega H, Østergaard M. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 2015; 74:1327-39. [DOI: 10.1136/annrheumdis-2014-206971] [Citation(s) in RCA: 300] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/07/2015] [Indexed: 12/26/2022]
Abstract
A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy. Experts applied research evidence obtained from systematic literature reviews using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendations (SOR) was assessed by taskforce members using a visual analogue scale. A total of 7550 references were identified in the search process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9–9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists and general practitioners.
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40
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Maneiro JR, Souto A, Salgado E, Mera A, Gomez-Reino JJ. Predictors of response to TNF antagonists in patients with ankylosing spondylitis and psoriatic arthritis: systematic review and meta-analysis. RMD Open 2015; 1:e000017. [PMID: 26509050 PMCID: PMC4612701 DOI: 10.1136/rmdopen-2014-000017] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/23/2014] [Indexed: 01/21/2023] Open
Abstract
Objective To identify predictors of response to tumor necrosis factor (TNF) antagonists in ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Methods Systematic review and meta-analysis of clinical trials and observational studies based on a systematic search. Meta-analyses of similar observations were performed using random effects computing summary OR. Heterogeneity was tested using I2, and risks of bias using funnel plots and the Egger test. Meta-regression was used to explore causes of heterogeneity. Results The electronic search captured 1340 references and 217 abstracts. 17 additional articles were identified after searching by hand. A total of 59 articles meet the purpose of the study and were reviewed. 37 articles (33 studies) included 6736 patients with AS and 23 articles (22 studies) included 4034 patients with PsA. 1 article included data on AS and PsA. Age (OR (95% CI) 0.91 (0.84 to 0.99), I2=84.1%), gender (1.57 (1.10 to 2.25), I2=0.0%), baseline BASDAI (1.31 (1.09 to 1.57), I2=0.0%), baseline BASFI (0.86 (0.79 to 0.93), I2=24.9%), baseline dichotomous C reactive protein (CRP) (2.14 (1.71 to 2.68), I2=22.3%) and human leucocyte antigen B27 (HLA-B27) (1.81 (1.35 to 2.42), I2=0.0%) predict BASDAI50 response in AS. No factor was identified as a source of heterogeneity. Only meta-analysis of baseline BASFI showed risk of publication bias (Egger test, p=0.004). Similar results were found for ASAS criteria response. No predictors of response were identified in PsA. Conclusions Young age, male sex, high baseline BASDAI, low baseline BASFI, high baseline CRP and HLA-B27 predict better response to TNF antagonists in AS but not in PsA.
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Affiliation(s)
- Jose Ramon Maneiro
- Rheumatology Unit , Complejo Hospitalario Universitario de Santiago de Compostela , Santiago , Spain
| | - Alejandro Souto
- Rheumatology Unit , Complejo Hospitalario Universitario de Santiago de Compostela , Santiago , Spain
| | - Eva Salgado
- Rheumatology Unit , Complejo Hospitalario Universitario de Santiago de Compostela , Santiago , Spain
| | - Antonio Mera
- Rheumatology Unit , Complejo Hospitalario Universitario de Santiago de Compostela , Santiago , Spain ; Department of Medicine , Medical School, Universidad de Santiago , Santiago , Spain
| | - Juan J Gomez-Reino
- Rheumatology Unit , Complejo Hospitalario Universitario de Santiago de Compostela , Santiago , Spain ; Department of Medicine , Medical School, Universidad de Santiago , Santiago , Spain
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Chen B, Huang K, Ye L, Li Y, Zhang J, Zhang J, Fan X, Liu X, Li L, Sun J, Du J, Huang Z. Interleukin-37 is increased in ankylosing spondylitis patients and associated with disease activity. J Transl Med 2015; 13:36. [PMID: 25627863 PMCID: PMC4323018 DOI: 10.1186/s12967-015-0394-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 01/13/2015] [Indexed: 12/17/2022] Open
Abstract
Background Interleukin-37 (IL-37) has been known to play an immunosuppressive role in various inflammatory disorders, but whether it participates in the regulation of pathogenesis of ankylosing spondylitis (AS) has not been investigated. Here, we examined the serum levels of IL-37 and its clinical association in AS, and explored the anti-inflammatory effects of IL-37 on peripheral blood mononuclear cells (PBMCs) from AS patients. Methods The mRNA levels of IL-37, TNF-α, IL-6, IL-17, and IL-23 in PBMCs and their serum concentrations from 46 AS patients were examined by real-time polymerase chain reaction (RT-PCR) and enzyme-linked immunoassay (ELISA), respectively. The correlations between serum IL-37 levels with disease activity, laboratory values and pro-inflammatory cytokines in AS were analyzed by Spearman correlation test. PBMCs from 46 AS patients were stimulated with recombinant IL-37 protein, expressions of TNF-α, IL-6, IL-17 and IL-23 were determined by RT-PCR and ELISA. Results Compared to healthy controls (HC), AS patients and active AS patients showed higher levels of IL-37 in PBMCs and serum respectively. Strikingly, serum IL-37 levels were higher in AS patients with osteoporosis than those without. Serum levels of IL-37 were correlated with laboratory values as well as TNF-α, IL-6 and IL-17, but not IL-23 in patients with AS. The productions of pro-inflammatory cytokines such as TNF-α, IL-6, IL-17, IL-23 in PBMCs from AS patients were obviously attenuated after recombinant IL-37 stimulation, but not in the HC. Conclusion The higher levels of IL-37 were found in AS patients, which were correlated with disease activity and AS related pro-inflammatory cytokines. More importantly, IL-37 inhibits the expressions of the pro-inflammatory cytokines from PBMCs in AS patients, indicating the potential anti-inflammatory role of IL-37 in AS. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0394-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bingni Chen
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
| | - Kunzhao Huang
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
| | - Liang Ye
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
| | - Yanqun Li
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
| | - Jiawei Zhang
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
| | - Jinshun Zhang
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
| | - Xinmin Fan
- Department of pathology, Shenzhen University School of Medicine, Shenzhen, 518060, China.
| | - Xiaokai Liu
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
| | - Li Li
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
| | - Jinxia Sun
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
| | - Jing Du
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China.
| | - Zhong Huang
- Biological therapy institute, Shenzhen University School of Medicine, Shenzhen, 518060, Guangdong, China. .,Department of Pathogen biology and immunology, Shenzhen University School of Medicine, Shenzhen, 518060, China. .,Shenzhen City Shenzhen University Immunodiagnostic Technology Platforms, Shenzhen, 518060, China.
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González-Álvaro I, Martínez-Fernández C, Dorantes-Calderón B, García-Vicuña R, Hernández-Cruz B, Herrero-Ambrosio A, Ibarra-Barrueta O, Martín-Mola E, Monte-Boquet E, Morell-Baladrón A, Sanmartí R, Sanz-Sanz J, de Toro-Santos FJ, Vela P, Román Ivorra JA, Poveda-Andrés JL, Muñoz-Fernández S. Spanish Rheumatology Society and Hospital Pharmacy Society Consensus on recommendations for biologics optimization in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Rheumatology (Oxford) 2014; 54:1200-9. [PMID: 25526976 PMCID: PMC4473767 DOI: 10.1093/rheumatology/keu461] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to establish guidelines for the optimization of biologic therapies for health professionals involved in the management of patients with RA, AS and PsA. METHODS Recommendations were established via consensus by a panel of experts in rheumatology and hospital pharmacy, based on analysis of available scientific evidence obtained from four systematic reviews and on the clinical experience of panellists. The Delphi method was used to evaluate these recommendations, both between panellists and among a wider group of rheumatologists. RESULTS Previous concepts concerning better management of RA, AS and PsA were reviewed and, more specifically, guidelines for the optimization of biologic therapies used to treat these diseases were formulated. Recommendations were made with the aim of establishing a plan for when and how to taper biologic treatment in patients with these diseases. CONCLUSION The recommendations established herein aim not only to provide advice on how to improve the risk:benefit ratio and efficiency of such treatments, but also to reduce variability in daily clinical practice in the use of biologic therapies for rheumatic diseases.
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Affiliation(s)
- Isidoro González-Álvaro
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Carmen Martínez-Fernández
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Benito Dorantes-Calderón
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Rosario García-Vicuña
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Blanca Hernández-Cruz
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Alicia Herrero-Ambrosio
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Olatz Ibarra-Barrueta
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Emilio Martín-Mola
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Emilio Monte-Boquet
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Alberto Morell-Baladrón
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Raimon Sanmartí
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Jesús Sanz-Sanz
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Francisco Javier de Toro-Santos
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Paloma Vela
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - José Andrés Román Ivorra
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - José Luis Poveda-Andrés
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
| | - Santiago Muñoz-Fernández
- Rheumatology Service, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, Madrid, Research Unit, Spanish Rheumatology Society, Madrid, Hospital Pharmacy Clinical Management Unit, Hospital de Valme, Seville, Rheumatology Clinical Management Unit, Hospital Universitario Virgen Macarena, Seville, Hospital Pharmacy Service, Hospital Universitario La Paz, IdiPaz, Madrid, Hospital Pharmacy Service, Hospital de Galdakano-Usansolo, Vizcaya, Rheumatology Service, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Hospital Pharmacy Service, Hospital Universitari i Politécnic La Fe, Valencia, Hospital Pharmacy Service, Hospital Universitario de La Princesa, Madrid, Rheumatology Service, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelona, Rheumatology Service, Hospital Puerta de Hierro, Madrid, Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), Sergas. Universidade da Coruña, A Coruña, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Rheumatology Service, Hospital Universitari i Politécnic La Fe, Valencia andRheumatology Service, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
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Tošovský M, Bradna P, Andrýs C, Andrýsová K, Čermáková E, Soukup T. THE VEGF AND BMP-2 LEVELS IN PATIENTS WITH ANKYLOSING SPONDYLITIS AND THE RELATIONSHIP TO TREATMENT WITH TUMOUR NECROSIS FACTOR ALPHA INHIBITORS. ACTA MEDICA (HRADEC KRÁLOVÉ) 2014; 57:56-61. [DOI: 10.14712/18059694.2014.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by the development of osteoproductive changes in the spine which could possibly result in ankylosis. Treatment with tumour necrosis factor alpha (TNFα) inhibitors has proved to be an important step forward in the treatment of this disease, but for the time being it is not clear whether it favourably influences radiographic progression of the disease. Vascular endothelial growth factor most probably plays a role in the development of osteoproductive changes and recently its predictive influence on radiographic progression has been demonstrated. Bone morphogenic protein 2 (BMP-2) participates in the regulation of bone proliferation and its increased serum level has been demonstrated in patients with advanced AS and correlated with the degree of radiographic changes. Aim: The study aims to evaluate the VEGF and BMP-2 levels in patients with ankylosing spondylitis and how these levels relate to the concurrent treatment with TNFα inhibitors. Methods: Sera were evaluated from patients at the Rheumatologic Clinic of the Hradec Králové Faculty Hospital who fulfilled the modified New York Criteria for AS (n = 55). In these patients, the parameters of the activity of the disease (BASDAI = Bath Ankylosing Spondylitis Disease Activity Index, CRP = C-reactive protein) and the concurrent therapy (TNFα inhibitors, n = 21, vs. non-anti TNFα, n = 34) were recorded. The levels of VEGF and BMP-2 were analyzed using the ELISA method. Results: In patients treated with TNFα inhibitors, a significantly lower VEGF level was found when compared to untreated patients (140.3 (109.4; 262.2) vs. 261 (172.4; 396.6) pg/ml; p = 0.02). No difference was found between BMP-2 levels in both groups (treated vs. untreated patients) (254.8 (2301; 267.3) vs. 261.1 (248.6; 273.5) pg/ml; p = 0.24). A correlation analysis did not reveal any relationship between VEG F and BMP-2 (r = 0.057; p = 0.68). Serum levels of VEGF correlated with serum levels of CRP (r = 0.56; p = 0.00001) and the BASDAI value (r = 0.33; p = 0.015). Conclusion: Significantly lower VEGF levels were found in patients treated with TNFα inhibitors versus the untreated patients. These findings are in harmony with some hitherto published analyses and may give evidence of a favourable effect of TNFα inhibitors on radiographic progression. Neither influence on the BMP-2 level by treatment with TNFα inhibitors nor correlation with VEGF levels was demonstrated.
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Kiltz U, Sieper J, Kellner H, Krause D, Rudwaleit M, Chenot JF, Stallmach A, Jaresch S, Braun J. [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 8.4 Pharmaceutical therapy, 8.5 Evaluation of therapy success of pharmaceutical measures]. Z Rheumatol 2014; 73 Suppl 2:78-96. [PMID: 25181978 DOI: 10.1007/s00393-014-1443-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland,
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Sharma SK, Ahmad S, Sharma SK. Serum IL-6 level as a marker of disease activity in ankylosing spondylitis patients with pure axial involvement. INDIAN JOURNAL OF RHEUMATOLOGY 2014. [DOI: 10.1016/j.injr.2014.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Turina MC, Yeremenko N, Paramarta JE, De Rycke L, Baeten D. Calprotectin (S100A8/9) as serum biomarker for clinical response in proof-of-concept trials in axial and peripheral spondyloarthritis. Arthritis Res Ther 2014; 16:413. [PMID: 25135077 PMCID: PMC4293104 DOI: 10.1186/s13075-014-0413-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 07/25/2014] [Indexed: 02/07/2023] Open
Abstract
Introduction Biomarkers complementing clinical evaluations may help to reduce the length and size of proof-of-concept (PoC) trials aimed to obtain quick “go/no go” decisions in the clinical development of new treatments. We aimed to identify and validate serum biomarkers with a high sensitivity to change upon effective treatment in spondyloarthritis (SpA) PoC trials. Methods The candidate biomarkers high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), pentraxin-3 (PTX-3), alpha-2-macroglobulin (alpha-2-MG), matrix metalloproteinase-3 (MMP-3), calprotectin, and vascular endothelial growth factor (VEGF) were determined by enzyme-linked immunosorbent assay (ELISA) in healthy controls (n = 20) and SpA patients before and after 2 weeks of infliximab (n = 18) or placebo (n = 19) treatment in cohort 1. Clinical outcome was evaluated at week 12. Results were validated in ankylosing spondylitis (AS) with infliximab (cohort 2, n = 21) and peripheral SpA with etanercept (cohort 3, n = 20). Results Serum levels of calprotectin, hs-CRP, PTX-3, VEGF (all P < 0.001) and MMP-3 (P = 0.062), but not IL-6 and alpha-2-MG, were increased in SpA versus healthy controls. Treatment with infliximab, but not placebo, significantly decreased calprotectin (P < 0.001) and hs-CRP (P < 0.001) levels, with a similar trend for MMP-3 (P = 0.063). The standardized response mean (SRM), which reflects the ability to detect changes over time, was high for calprotectin (−1.26), good for hs-CRP (−0.96) and moderate for MMP-3 (−0.52). Calprotectin and hs-CRP, but not MMP-3, were good biomarkers for treatment response in axial and peripheral SpA as evaluated and confirmed in cohort 2 and 3 respectively. Conclusions Calprotectin and hs-CRP are good serum biomarkers with high sensitivity to change upon effective treatment at the group level in small-scale, short term PoC trials in SpA.
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The effects of infliximab or adalimumab on vascular endothelial growth factor and angiopoietin 1 angiogenic factor levels in inflammatory bowel disease: serial observations in 37 patients. Inflamm Bowel Dis 2014; 20:695-702. [PMID: 24562175 DOI: 10.1097/mib.0000000000000004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Infliximab and adalimumab effectiveness might be related with changes in angiogenic factors. The aim of the study was to compare the concentrations of angiogenic proteins in patients with inflammatory bowel disease (IBD) and healthy controls and to analyze changes in the levels during infliximab and adalimumab treatment. METHODS A prospective case-control study was conducted in 37 patients with IBD starting treatment with infliximab (16 with Crohn's disease and 6 with ulcerative colitis) or adalimumab (15 with Crohn's disease) and 40 control subjects. Four samples were taken from IBD patients, one before each of the first 3 doses of infliximab/adalimumab and one at week 14. Serum levels of vascular endothelial growth factor (VEGF), placental growth factor, angiopoietin 1 (Ang1), angiopoietin 2, and Tie2 were measured using enzyme-linked immunosorbent assay. RESULTS Patients with IBD had higher VEGF levels than control subjects (511.5 ± 255.6 versus 395.5 ± 256.4; P = 0.05). Patients who achieved remission at the third dose of anti-TNF-alpha had lower VEGF levels at baseline (453.5 ± 250.7 versus 667.5 ± 153.9 pg/mL) and before the second (409.7 ± 217 versus 681.3 ± 350.6 pg/mL) and third (400.5 ± 222.8 versus 630.4 ± 243.1 pg/mL) doses compared with those with no remission (P < 0.05). Ang1 levels decreased before each treatment dose in patients who achieved remission (P < 0.05). High baseline VEGF levels predicted for a poor response to anti-TNF-alpha therapy (area under the receiver operating characteristics curve = 0.8), whereas high Ang1 levels were associated with disease remission (area under the receiver operating characteristics curve = 0.7). Concentrations of angiogenic proteins did not correlate with clinical activity scores. CONCLUSIONS Circulating VEGF and Ang1 levels decrease after anti-TNF-alpha therapy and may predict response to treatment. Whether these changes are a direct effect of anti-TNF-alpha therapy or a sign of disease improvement remains to be elucidated.
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D'Agostino MA, Boers M, Kirwan J, van der Heijde D, Østergaard M, Schett G, Landewé RB, Maksymowych WP, Naredo E, Dougados M, Iagnocco A, Bingham CO, Brooks PM, Beaton DE, Gandjbakhch F, Gossec L, Guillemin F, Hewlett SE, Kloppenburg M, March L, Mease PJ, Moller I, Simon LS, Singh JA, Strand V, Wakefield RJ, Wells GA, Tugwell P, Conaghan PG. Updating the OMERACT filter: implications for imaging and soluble biomarkers. J Rheumatol 2014; 41:1016-24. [PMID: 24584916 DOI: 10.3899/jrheum.131313] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Filter provides a framework for the validation of outcome measures for use in rheumatology clinical research. However, imaging and biochemical measures may face additional validation challenges because of their technical nature. The Imaging and Soluble Biomarker Session at OMERACT 11 aimed to provide a guide for the iterative development of an imaging or biochemical measurement instrument so it can be used in therapeutic assessment. METHODS A hierarchical structure was proposed, reflecting 3 dimensions needed for validating an imaging or biochemical measurement instrument: outcome domain(s), study setting, and performance of the instrument. Movement along the axes in any dimension reflects increasing validation. For a given test instrument, the 3-axis structure assesses the extent to which the instrument is a validated measure for the chosen domain, whether it assesses a patient-centered or disease-centered variable, and whether its technical performance is adequate in the context of its application. Some currently used imaging and soluble biomarkers for rheumatoid arthritis, spondyloarthritis, and knee osteoarthritis were then evaluated using the original OMERACT Filter and the newly proposed structure. Breakout groups critically reviewed the extent to which the candidate biomarkers complied with the proposed stepwise approach, as a way of examining the utility of the proposed 3-dimensional structure. RESULTS Although there was a broad acceptance of the value of the proposed structure in general, some areas for improvement were suggested including clarification of criteria for achieving a certain level of validation and how to deal with extension of the structure to areas beyond clinical trials. CONCLUSION General support was obtained for a proposed tri-axis structure to assess validation of imaging and soluble biomarkers; nevertheless, additional work is required to better evaluate its place within the OMERACT Filter 2.0.
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Affiliation(s)
- Maria-Antonietta D'Agostino
- From Versailles-Saint Quentin En Yvelines University, Department of Rheumatology, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; Departments of Epidemiology and Biostatistics, and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; University of Bristol, Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Copenhagen, Denmark; Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam and Atrium Medical Center, Amsterdam, The Netherlands; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Paris-Descartes University, Medicine Faculty, APHP, Cochin Hospital, Rheumatology B, Paris, France; Rheumatology Unit, Sapienza Università di Roma, Rome, Italy; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA; University of Melbourne, Medicine, Dentistry and Health Sciences, Melbourne, Australia; St. Michael's Hospital, Mobility Program Clinical Research Unit; Institute for Work and Health; University of Toronto, Department of Health Policy, Management and Evaluation, Department of Rehabilitation Science and Department of Occupational Science and Occupational Therapy, Toronto, Ontario, Canada; Pierre et Marie Curie University (UPMC) - Paris, GRC-UPMC 08 (EEMOIS); AP-HP Pitié Salpêtrière Hospital, Department of Rheumatology, Paris; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy and Inserm CIC-EC, CHU de Nancy, Nancy, France; Department of Nursing, University of the West of England, Bris
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Sieper J, Braun J, Kay J, Badalamenti S, Radin AR, Jiao L, Fiore S, Momtahen T, Yancopoulos GD, Stahl N, Inman RD. Sarilumab for the treatment of ankylosing spondylitis: results of a Phase II, randomised, double-blind, placebo-controlled study (ALIGN). Ann Rheum Dis 2014; 74:1051-7. [PMID: 24550171 PMCID: PMC4431338 DOI: 10.1136/annrheumdis-2013-204963] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/24/2014] [Indexed: 11/22/2022]
Abstract
Objectives The ALIGN study (NCT01061723) evaluated the efficacy and safety of sarilumab, the first fully human monoclonal antibody against interleukin-6 receptor-α (IL-6Rα), in patients with ankylosing spondylitis (AS). Methods Patients with active AS despite conventional treatment were randomised to placebo, or one of five subcutaneous dose regimens of sarilumab (100, 150 or 200 mg every other week, or 100 or 150 mg every week), for 12 weeks. The primary efficacy end point was the percentage of patients achieving the Axial SpondyloArthritis international Society (ASAS) 20 response criteria at week 12. Secondary endpoints included ASAS40 response, ASAS partial remission, AS Disease Activity Score, high-sensitivity C-reactive protein (hs-CRP) value, and safety. Results Baseline demographic and disease characteristics of the 301 patients enrolled were similar across treatment groups. At week 12, there was no statistically significant difference in ASAS20 response rate between placebo (ASAS20 = 24.0%) and any sarilumab dose group. A significantly greater reduction in hs-CRP value was achieved with the higher sarilumab doses versus placebo. No other statistically significant differences were evident for secondary efficacy endpoints. The most common treatment-emergent adverse events reported for sarilumab included infections (non-serious), neutropenia, and increase in alanine aminotransferase. No cases of tuberculosis, opportunistic, or fungal infections, or bowel perforations were reported. Seven patients experienced a treatment-emergent serious adverse event (all in sarilumab treatment groups). No deaths occurred. Conclusions The ALIGN study shows that IL-6Rα blockade with sarilumab was not an effective treatment for AS. Sarilumab was generally well tolerated with a manageable safety profile.
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Affiliation(s)
- Joachim Sieper
- Med. Department 1, Rheumatology, Charité University Medicine Berlin, Berlin, Germany
| | | | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Allen R Radin
- Translational Medicine, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Lixia Jiao
- Research and Development, Sanofi, Bridgewater, New Jersey, USA
| | - Stefano Fiore
- Research and Development, Sanofi, Bridgewater, New Jersey, USA
| | - Tanya Momtahen
- Research and Development, Sanofi, Bridgewater, New Jersey, USA
| | - George D Yancopoulos
- Translational Medicine, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Neil Stahl
- Translational Medicine, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Robert D Inman
- Division of Rheumatology, Toronto Hospital Western Division, Toronto, Canada
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Abstract
PURPOSE OF REVIEW To review the recent literature on the prevalence of osteoporosis, risk of vertebral fractures, and the recent advances in the treatment of osteoporosis in patients with ankylosing spondylitis (AS). RECENT FINDINGS Newer data suggest that the prevalence of osteoporosis is 25% and vertebral fractures is 10% in patients with AS. New advances in the field of osteoimmunology help explain the trabecular bone loss and generalized osteoporosis linked to increased expression of receptor activator of nuclear factor kappa B ligand (RANK-L) due to pro-inflammatory cytokines, and the simultaneous new bone formation (e.g. syndesmophytes) in areas of previous inflammation through suppressed Dickkopf-related protein 1 levels and increased WNT (wingless) signaling. SUMMARY Osteoporosis is a common problem for patients with AS. We recommend screening within 10 years of diagnosis. Suspecting and promptly recognizing vertebral fractures in patients with AS could prevent serious neurological complications. Although bisphosphonates and tumor necrosis factor-α inhibitors look promising, further prospective trials on the treatment of osteoporosis in AS are needed.
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