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Slouma M, Kharrat L, Tezegdenti A, Dhahri R, Ghazouani E, Gharsallah I. Pro-inflammatory cytokines in spondyloarthritis: a case-control study. Expert Rev Clin Immunol 2024; 20:655-663. [PMID: 38205504 DOI: 10.1080/1744666x.2024.2304080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
OBJECTIVES We aimed to determine the discriminative values of pro-inflammatory cytokines to distinguish spondyloarthritis patients from healthy subjects and to assess the association between these cytokines and spondyloarthritis characteristics. METHODS We conducted a case-control study, including 144 subjects matched for age and sex: 72 spondyloarthritis patients(G1) and 72 controls (G2). The disease activity was assessed using ASDAS-CRP and BASDAI. Structural damage was assessed using BASRI. The levels of interleukin (IL) IL-1, IL-6, IL-8, IL-17, IL-23, and tumor necrosis factor α(TNFα) were measured. RESULTS Each group included 57 men. The mean age was 44.84 ± 13.42 years. Except for IL-8, all cytokine levels were significantly higher in patients compared to controls (IL-1: p = 0.05, IL-6: p = 0.021, TNFα: p = 0.039, IL-17 and IL-23: p < 0.001). Cutoff values of IL-17 and IL-23 distinguishing patients in G1 from those in G2 were 17.6 and 7.96 pg/mL, respectively. TNFα level correlated to BASDAI (p = 0.029) and BASRI (p = 0.002). Multivariate analysis showed that structural damage was associated with the male gender (p = 0.017), longer disease duration (p = 0.038), and high disease activity (p = 0.044). Disease activity was associated with longer disease duration (p = 0.012) and increased IL-6 levels (p = 0.05). CONCLUSION Our study showed that IL-17 was the ablest to distinguish between spondyloarthritis patients and controls, suggesting that IL-17 may be helpful for the diagnosis of spondyloarthritis.
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Affiliation(s)
- Maroua Slouma
- Department of Rheumatology, Military Hospital, Tunis, Tunisia
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
- Faculté des sciences de Tunis, Mycology, pathologies, and biomarkers laboratory, Tunis, Tunisia
| | - Lobna Kharrat
- Department of Rheumatology, Military Hospital, Tunis, Tunisia
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Aymen Tezegdenti
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
- Department of Immunology, Military Hospital, Tunis, Tunisia
| | - Rim Dhahri
- Department of Rheumatology, Military Hospital, Tunis, Tunisia
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Ezzeddine Ghazouani
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
- Department of Immunology, Military Hospital, Tunis, Tunisia
| | - Imen Gharsallah
- Department of Rheumatology, Military Hospital, Tunis, Tunisia
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
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Golstein MA. Diagnostic errors in rheumatology and medico-legal consequences. Med Leg J 2024:258172241235016. [PMID: 38757615 DOI: 10.1177/00258172241235016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Medical errors and adverse effects of treatment are inherent to medical practice. Like any other medical specialty, rheumatology is not exempt. Although the problem is imprecisely quantified, according to some authors it affects up to 10% of hospitalised patients. Describing and qualifying misdiagnoses in rheumatology will help us to understand and reduce these. Further, misdiagnosis generates unjustified costs and medico-legal consequences with errors in initial diagnosis the basis for medico-legal disputes involving assessment of work incapacity.
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Rudwaleit M, Deodhar A, Bauer L, Gensler L, Hoepken B, Kumke T, Auteri SE, Kim M, Maksymowych W. Long-term clinical outcomes of certolizumab pegol treatment in non-radiographic axial spondyloarthritis stratified by baseline MRI and CRP status. RMD Open 2024; 10:e003884. [PMID: 38724259 PMCID: PMC11086426 DOI: 10.1136/rmdopen-2023-003884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/03/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE There is a paucity of data on long-term clinical responses in patients with non-radiographic axial spondyloarthritis (nr-axSpA) based on their baseline objective signs of inflammation such as MRI or C-reactive protein (CRP) levels. This study reports clinical outcomes up to 3 years of the C-axSpAnd trial, including safety follow-up extension (SFE) from Weeks 52 to 156, stratified by patients' baseline MRI and CRP status. METHODS C-axSpAnd (NCT02552212) was a phase 3, multicentre study that evaluated certolizumab pegol (CZP) in patients with active nr-axSpA who had active sacroiliitis on MRI and/or elevated CRP. In this post hoc analysis, efficacy outcomes are reported to Week 156 of C-axSpAnd for patients stratified according to their MRI and CRP status at Week 0 (MRI+/CRP-, MRI-/CRP+ and MRI+/CRP+). RESULTS Across all outcome measures, including major improvement in Ankylosing Spondylitis Disease Activity Score (ASDAS-MI) and Assessment of SpondyloArthritis international Society criteria ≥40% response (ASAS40), outcomes were generally sustained in SFE patients from Week 52 to Week 156. MRI+/CRP+ patients showed numerically higher or comparable responses relative to MRI-/CRP+ and MRI+/CRP- patients at Weeks 52 and 156; however, all three subgroups demonstrated substantial improvements from Week 0 (in CZP-randomised patients, ASDAS-MI at Week 156 [observed case]: MRI+/CRP+: 73.1%, MRI-/CRP+: 52.2%, MRI+/CRP-: 30.4%; ASAS40: MRI+/CRP+: 76.9%, MRI-/CRP+: 62.5%, MRI+/CRP-: 65.2%). CONCLUSIONS In patients with nr-axSpA and objective signs of inflammation, long-term clinical outcomes achieved after 1 year were generally sustained at 3 years across MRI+/CRP+, MRI-/CRP+ and MRI+/CRP- subgroups.
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Affiliation(s)
| | - Atul Deodhar
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Lianne Gensler
- University of California, San Francisco, California, USA
| | | | | | | | | | - Walter Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Londono J, Pacheco-Tena C, Santos AM, Cardiel MH, Rodríguez-Salas G, Rueda I, Arias-Correal S, Mesa C, Marta Juliana M, Santacruz JC, Rueda JC, Vargas-Alarcón G, Burgos-Vargas R. Differences between radiographic and non-radiographic axial spondyloarthritis patients in a Mexican cohort. Sci Rep 2024; 14:10342. [PMID: 38710901 DOI: 10.1038/s41598-024-61001-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024] Open
Abstract
To compare the demographic, clinical, and laboratory characteristics, disease onset, and clinical features of radiographic axial Spondyloarthritis (r-axSpA) and non-radiographic axial Spondyloarthritis (nr-axSpA) patients. All patients who attended outpatient spondylarthritis (SpA) clinics at Hospital General de Mexico and the Instituto Nacional de la Nutrición from 1998 to 2005 and met the rheumatologist diagnostic criteria for SpA were selected. Then the SpA patients were classified by European Spondyloarthropathy Study Group criteria (ESSG). We selected SpA patients with axial presentation as axial SpA (axSpA), and they were classified as r-axSpA if they met modified New York (mNY) criteria for sacroiliitis and as nr-axSpA if they did not meet mNY criteria; to compared clinical, demographic, and laboratory test between the subgroups. It included 148 SpA patients; 55 (37.2%) patients had r-axSpA, and 70 (47.3%) had nr-axSpA. The nr-axSpA patients had a lower proportion of males (58.6% vs 78.2%, P < 0.05), lower HLA-B27 frequency (54.3%. vs. 92.7%, P < 0.05), were older at disease onset (21 vs 16 years; P < 0.01) and had a higher frequency of infections at disease onset (9.1% vs 32.9, P < 0.05) than r-axSpA. BASFI (2.9 vs 4.8; P < 0.0001), Dougados functional index (7 vs. 14; P < 0.05), and BASDAI (4.1 vs. 5.2; P < 0.001) were lower in patients with nr-axSpA than r-axSpA, respectively. The factors that most influenced the presentation of r-axSpA were history of uveitis (OR 14, 95% CI 2.3-85), HLA-B27 (OR 7.97, 95% CI, 2.96-122), male sex (OR 6.16, 95% CI, 1.47-25.7), axial enthesopathy count (OR 1.17 95% CI, 1.03-1.33). This study provides insight into the differences between nr-axSpA and r-axSpA in Mexico. Patients with r-axSpA were mainly male, with a younger presentation age, a higher prevalence of HLA-B27, more history of uveitis, fewer episodes of dactylitis, more axial enthesopathy, and higher disease activity than nr-axSpA.
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Affiliation(s)
- John Londono
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia.
| | - Cesar Pacheco-Tena
- PABIOM Laboratory, Faculty of Medicine and Biomedical Sciences, Autonomous University of Chihuahua, 31125, Chihuahua, Mexico
| | - Ana Maria Santos
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Mario Humberto Cardiel
- Hospital General "Dr. Miguel Silva", Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, McMaster University, Universidad Michoacana de San Nicolas de Hidalgo Instituto de Física y Matemáticas, Morelia, Mexico
| | - Gustavo Rodríguez-Salas
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Igor Rueda
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
- Aspirante a Doctorado en Biociencias, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - Sofía Arias-Correal
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Cristian Mesa
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Mantilla Marta Juliana
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Juan Camilo Santacruz
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Juan Camilo Rueda
- Department of Rheumatology and Immunology-Spondyloarthritis Study Group (GESPA), Universidad de La Sabana-Hospital Militar Central, Bogotá, Colombia
| | - Gilberto Vargas-Alarcón
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Rubén Burgos-Vargas
- Rheumatology Department, Hospital General de México Eduardo Liceaga, Mexico City, Mexico
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Abacar K, Kaymaz-Tahra S, Bayındır Ö, İnce B, Kutu ME, Yazıcı A, Ediboğlu ED, Demirci-Yıldırım T, Ademoğlu Z, Omma A, Yaşar-Bilge NŞ, Kimyon G, Kaşifoğlu T, Emmungil H, Önen F, Akar S, Cefle A, Alpay-Kanıtez N, Çelik S, İnanç M, Aksu K, Keser G, Direskeneli H, Alibaz-Öner F. Frequency and the effects of spondyloarthritis-spectrum disorders on the clinical course and management of Takayasu arteritis: an observational retrospective study. Clin Rheumatol 2024; 43:1571-1578. [PMID: 38563865 DOI: 10.1007/s10067-024-06939-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Extravascular findings of Takayasu arteritis (TAK) often share features with the spondyloarthritis (SpA) spectrum of disorders. However, the characteristics of this overlap and its effect on the vascular manifestations of TAK are not fully known. Therefore, we aimed to investigate the frequency of SpA-related features in TAK patients. MATERIAL AND METHODS In this observational retrospective study, 350 patients with TAK classified according to ACR 1990 criteria, from 12 tertiary rheumatology clinics, were included and evaluated for the presence of axSpA, IBD, or psoriasis. Demographic, clinical features, angiographic involvement patterns, disease activity, and treatments of TAK patients with or without SpA were analyzed. RESULTS Mean age was 45.5 ± 13.6 years and mean follow-up period was 76.1 ± 65.9 months. Among 350 patients, 31 (8.8%) had at least one additional disease from the SpA spectrum, 8 had IBD, 8 had psoriasis, and 20 had features of axSpA. In the TAK-SpA group, TAK had significantly earlier disease onset, compared to TAK-without-SpA (p = 0.041). SpA-related symptoms generally preceded TAK symptoms. Biological treatments, mostly for active vasculitis, were higher in the TAK-SpA group (70.9%) compared to TAK-without-SpA (27.9%) (p < 0.001). Vascular involvements were similar in both. CONCLUSION Our study confirmed that diseases in the SpA spectrum are not rare in TAK. Vascular symptoms appeared earlier in such patients, and more aggressive therapy with biological agents was required in the TAK-SpA group, suggesting an association between TAK and SpA spectrum. Key Points • The pathogenesis of Takayasu arteritis is mediated by an MHC class I alelle (HLA-B*52), similar to spondyloarthritis-disorders. • Extravascular findings of Takayasu arteritis are in the spectrum of spondyloarthritis disease. • This frequent coexistence between Takayasu arteritis and spondyloarthritic disorders suggests a relationship rather than a coincidence.
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Affiliation(s)
- Kerem Abacar
- Internal Medicine, Rheumatology, Marmara University, Istanbul, Turkey.
| | - Sema Kaymaz-Tahra
- Internal Medicine, Rheumatology, Sancaktepe Prof. Dr. İlhan Varank Hospital, Istanbul, Turkey
| | - Özün Bayındır
- Internal Medicine, Rheumatology, Ege University, Izmir, Turkey
| | - Burak İnce
- Istanbul Faculty of Medicine, Internal Medicine, Rheumatology, Istanbul University, Istanbul, Turkey
| | - Muhammet Emin Kutu
- Internal Medicine, Rheumatology, Bakırköy Sadi Konuk Hospital, Istanbul, Turkey
| | - Ayten Yazıcı
- Internal Medicine, Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Elif Durak Ediboğlu
- Internal Medicine, Rheumatology, İzmir Katip Çelebi University, Izmir, Turkey
| | | | - Zeliha Ademoğlu
- Internal Medicine, Rheumatology, Trakya University, Edirne, Turkey
| | - Ahmet Omma
- Internal Medicine, Rheumatology, Ankara Sehir Hospital, Ankara, Turkey
| | | | - Gezmiş Kimyon
- Internal Medicine, Rheumatology, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Timuçin Kaşifoğlu
- Internal Medicine, Rheumatology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Hakan Emmungil
- Internal Medicine, Rheumatology, Trakya University, Edirne, Turkey
| | - Fatoş Önen
- Internal Medicine, Rheumatology, Dokuz Eylül University, Izmir, Turkey
| | - Servet Akar
- Internal Medicine, Rheumatology, İzmir Katip Çelebi University, Izmir, Turkey
| | - Ayşe Cefle
- Internal Medicine, Rheumatology, Kocaeli University, Kocaeli, Turkey
| | | | - Selda Çelik
- Internal Medicine, Rheumatology, Bakırköy Sadi Konuk Hospital, Istanbul, Turkey
| | - Murat İnanç
- Istanbul Faculty of Medicine, Internal Medicine, Rheumatology, Istanbul University, Istanbul, Turkey
| | - Kenan Aksu
- Internal Medicine, Rheumatology, Ege University, Izmir, Turkey
| | - Gökhan Keser
- Internal Medicine, Rheumatology, Ege University, Izmir, Turkey
| | - Haner Direskeneli
- Internal Medicine, Rheumatology, Marmara University, Istanbul, Turkey
| | - Fatma Alibaz-Öner
- Internal Medicine, Rheumatology, Marmara University, Istanbul, Turkey
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Séauve M, Auréal M, Laplane S, Lega JC, Cabrera N, Coury F. Risk of infections in psoriatic arthritis or axial spondyloarthritis patients treated with targeted therapies: A meta-analysis of randomized controlled trials. Joint Bone Spine 2024; 91:105673. [PMID: 38042364 DOI: 10.1016/j.jbspin.2023.105673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE To evaluate the risk of global infections in patients with psoriatic arthritis (PsA) and axial spondyloarthritis encompassing ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) treated with targeted therapies. METHODS Medline and Cochrane databases were systematically searched up to March 2021 for randomized controlled trials (RCTs) performed in patients with PsA or axial spondyloarthritis treated with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Global infections (any infections reported, including bacterial, viral and fungal infections, except serious infections) were the primary outcome. Secondary outcomes included serious infections defined as life-threatening infections or any infection requiring intravenous antibiotics or hospitalization. The relative risk of infections was determined by meta-analysis of RCTs. RESULTS A total of 60 RCTs were included (20,418 patients), encompassing 17 b/tsDMARDs, compared with placebo, conventional synthetic drugs (csDMARDs) or non-steroidal anti-inflammatory drugs (NSAIDs). An increased risk of any infection for patients exposed to these drugs was found (RR 1.15, 95% CI [1.06-1.25]), mainly with high doses and longer duration of treatment. Most infections were respiratory tract or ear, nose, and throat (ENT) infections. Subgroup analyses showed a statistically significant increased risk of infections for axial spondyloarthritis patients (RR 1.32, 95% CI [1.14-1.52]), but not for PsA patients (RR 1.05, 95% CI [0.97-1.14]). Infection risk was highest with TNF inhibitors (RR 1.23, 95% CI [1.11-1.37]) and IL-17 inhibitors (RR 1.30, 95% CI [1.07-1.59]). No increased risk of serious infections was shown. CONCLUSION In contrast to serious infections, the risk of global infections is moderately increased with b/tsDMARDs in spondyloarthritis, and is associated in particular with use of TNF and IL-17 inhibitors.
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Affiliation(s)
- Milène Séauve
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Mélanie Auréal
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Soline Laplane
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Jean-Christophe Lega
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Internal and Vascular Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France; University of Lyon, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, 69100 Lyon, France; Lyon Immunopathology Federation, Lyon, France
| | - Natalia Cabrera
- University of Lyon, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, 69100 Lyon, France
| | - Fabienne Coury
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Lyon Immunopathology Federation, Lyon, France; University of Lyon, Inserm UMR 1033, 69100 Lyon, France.
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Kaushik P, Bastible S, Bannon M, Drew Williams C. Pembrolizumab-Induced Axial Spondyloarthritis. Ann Pharmacother 2024; 58:555-556. [PMID: 37365767 DOI: 10.1177/10600280231181400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
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Gheysens O, de Ponfilly MP, Nocturne G, Seror R, Besson FL, Jamar F. [ 18F]FDG-PET/CT in Polymyalgia Rheumatica: An Update and Future Aspects. Semin Nucl Med 2024; 54:371-378. [PMID: 38030423 DOI: 10.1053/j.semnuclmed.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Abstract
Polymyalgia rheumatica (PMR) is an inflammatory disorder usually diagnosed in patients older than 50 years of age. It is characterized by sudden onset pain and prolonged morning stiffness in the scapular and/or pelvic girdle, sometimes debilitating and accompanied by constitutional symptoms such as weight loss. In approximately 20% of the cases, it is linked to giant cell arteritis (GCAV) representing a disease continuum. The diagnosis is mainly clinical and noninvasive imaging such as ultrasound of joints may be helpful. In atypical PMR cases, whole body imaging using [18F]FDG-PET/CT may be useful. First, to confirm or rule out the diagnosis of PMR, secondly, to assess the coexistence of a GCA, and thirdly to establish the differential diagnosis with other types of arthritides encountered in this age group, such as elderly-onset rheumatoid arthritis, spondyloarthropathies, crystal-induced arthropathies or the rare remittent seronegative symmetrical synovitis with pitting edema. Relatively typical patterns of [18F]FDG-PET/CT are well known, based on the clinical distribution of the disease (eg, scapular and pelvic girdle, interspinous bursae, sterno-costoclavicular joints, entheses), especially the hypermetabolism at the interspinous lumbar bursae that has shown the best post-test likelihood ratio in a meta-analysis. This article focuses on the differential diagnosis and on the visual and semi-quantitative tools that can be used to guide to the correct diagnosis of PMR as an add-on to the clinical picture. Further, we briefly discuss the options that can improve molecular imaging in the future for inflammatory rheumatisms in elderly.
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Affiliation(s)
- Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Marie Péan de Ponfilly
- Department of Rheumatology, Hôpital Bicêtre Assistance Publique -Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Gaetane Nocturne
- Department of Rheumatology, Hôpital Bicêtre Assistance Publique -Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Raphaële Seror
- Department of Rheumatology, Université Paris-Saclay, INSERM U1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Florent L Besson
- Department of Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaire Paris-Saclay, AP-HP, DMU SMART IMAGING, CHU Bicêtre Le Kremlin-Bicêtre, France; Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, Paris, France; Université Paris-Saclay, Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Centre National de la Recherche Scientifique (CNRS), Inserm, BioMaps, Le Kremlin-Bicêtre, France
| | - François Jamar
- Department of Nuclear Medicine, Cliniques Universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium.
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Ivanova M, Zimba O, Dimitrov I, Angelov AK, Georgiev T. Axial Spondyloarthritis: an overview of the disease. Rheumatol Int 2024:10.1007/s00296-024-05601-9. [PMID: 38689098 DOI: 10.1007/s00296-024-05601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
Axial Spondyloarthritis (axSpA) is a chronic, inflammatory, immune-mediated rheumatic disease that comprises two subsets, non-radiographic and radiographic axSpA, and belongs to a heterogeneous group of spondyloarthritides (SpA). Over the years, the concept of SpA has evolved significantly, as reflected in the existing classification criteria. Considerable progress has been made in understanding the genetic and immunological basis of axSpA, in studying the processes of chronic inflammation and pathological new bone formation, which are pathognomonic for the disease. As a result, new medication therapies were developed, which bring more effective ways for disease control. This review presents a brief overview of the literature related to these aspects of disease after summarising the available information on the topic that we considered relevant. Specifically, it delves into recent research illuminating the primary pathological processes of enthesitis and associated osteitis in the context of inflammation in axSpA. The exploration extends to discussion of inflammatory pathways, with a particular focus on Th1/Th17-mediated immunity and molecular signaling pathways of syndesmophyte formation. Additionally, the review sheds light on the pivotal role of cytokine dysregulation, highlighting the significance of the IL-23/17 axis and TNF-α in this intricate network of immune responses which is decisive for therapeutic approaches in the disease.
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Affiliation(s)
- Mariana Ivanova
- Medical Faculty, Medical University-Sofia, Sofia, Bulgaria.
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", 13, Urvich St., Sofia, 1612, Bulgaria.
| | - Olena Zimba
- Department of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Kraków, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Ivan Dimitrov
- Clinic of Orthopedics and Traumatology, University Hospital "Prof. Dr. St. Kirkovich", Stara Zagora, Bulgaria
- Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | | | - Tsvetoslav Georgiev
- First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, Varna, Bulgaria
- Rheumatology Clinic, St. Marina University Hospital-Varna, Varna, Bulgaria
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Helliwell PS. 50 years of spondyloarthritis: a look back and a look ahead. Curr Opin Rheumatol 2024:00002281-990000000-00115. [PMID: 38656252 DOI: 10.1097/bor.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW It is now 50 years since the concept of spondyloarthritis was introduced by Moll, Wright and co-authors from Leeds, UK. This review will review the original concept and mark significant milestones over the last 50 years while looking ahead to developments in the future. RECENT FINDINGS While the diseases included under this rubric in the original description may have changed the core conditions remain and are still characterized by axial inflammation as a common feature. Imaging, animal models, genetics and immunology have contributed to our knowledge of the pathogenesis and classification of these diseases and have led to the development of more effective treatments. SUMMARY Future developments, facilitated by large research consortia, will help build on our current knowledge and will help clarify disease heterogeneity and provide insights into new therapeutic pathways.
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Affiliation(s)
- Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
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Strugariu G, Pomîrleanu C, Russu M, Popescu A, Petrariu LA, Ancuta E, Chirieac R, Temelie-Olinici D, Ancuța C. Long-Term Outcomes of Patients with Biologically Treated Psoriatic Arthritis and Atopic Dermatitis-A Single-Center Experience. J Pers Med 2024; 14:427. [PMID: 38673054 PMCID: PMC11051139 DOI: 10.3390/jpm14040427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Although the association between psoriasis and atopic dermatitis (AD) is reported in the literature, scarce data are known about the efficacy of biologic therapy (including TNF and IL-17 inhibitors) in patients with psoriatic arthritis (PsA) and concomitant AD. (2) Objective: We aimed to explore AD in patients with PsA undergoing biologics for their active disease, focusing on prevalence and clinical and potential therapeutic implications. (3) Material and methods: We performed a retrospective analysis of 64 patients with PsA receiving various biological agents, followed-up in an academic outpatient rheumatology department up to 10 years. (4) Results: Atopic diseases were reported in about one third of cases, with a higher incidence of AD (10 cases; 52.6%) vs. atopic rhinitis (6 cases; 31.6%) and allergic asthma (3 cases; 15.8%). Three morphological patterns of AD were recognized including chronic prurigo (3 cases), a chronic lichen simplex (1 case), and eczemas (6 cases). All PsA with concomitant AD displayed a late onset of skin atopy (in their adult life) and demonstrated a specific profile (younger), from urban settings, equally distributed among genders, and requiring switching to a higher number of biologics to achieve disease control. (5) Conclusion: PsA and AD may coexist, requiring special attention when selecting the optimal biologic agent.
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Affiliation(s)
- Georgiana Strugariu
- Department of Rheumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (G.S.); (M.R.); (A.P.); (C.A.)
- Rheumatoloy 2 Department, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania;
| | - Cristina Pomîrleanu
- Department of Rheumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (G.S.); (M.R.); (A.P.); (C.A.)
- Rheumatoloy 2 Department, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania;
| | - Mara Russu
- Department of Rheumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (G.S.); (M.R.); (A.P.); (C.A.)
- Rheumatoloy 2 Department, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania;
| | - Alexandra Popescu
- Department of Rheumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (G.S.); (M.R.); (A.P.); (C.A.)
| | - Luiza Andreea Petrariu
- Rheumatoloy 2 Department, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania;
| | - Eugen Ancuta
- Research Department, Elena Doamna Clinical Hospital, 700398 Iasi, Romania
| | | | - Doinița Temelie-Olinici
- Department of Morpho-Functional Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Codrina Ancuța
- Department of Rheumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (G.S.); (M.R.); (A.P.); (C.A.)
- Rheumatoloy 2 Department, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania;
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12
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Huber MK, Valim V, Serrano ÉV, Mendonça JA, Lourenço RB, Espírito Santo TMR, Nordal H, de Fátima Bissoli M, de Oliveira Gavi MBR. Prevalence of spondyloarthritis in inflammatory bowel disease according ASAS and ultrassonography and its correlation with plasma calprotectin. Adv Rheumatol 2024; 64:27. [PMID: 38622711 DOI: 10.1186/s42358-023-00348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/24/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Enteropathic spondyloarthritis is underdiagnosed and inflammatory biomarkers and ultrasonography (US) could be useful for screening inflammatory bowel disease (IBD) patients. The objective of this study was to evaluate the prevalence of spondyloarthritis (SpA) in IBD patients, according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and the correlation of results of US of entheses and joints with plasma calprotectin levels. METHODS This was an observational cross-sectional study. Patients from the IBD outpatient clinic of a reference center were evaluated according to ASAS criteria classification, results of US of entheses and joints, and inflammatory biomarker measurements (erythrocyte sedimentation rates, C-reactive protein levels, fecal and plasma calprotectin levels). A p value lower than 0.05 was considered significant. RESULTS A total of 30.5% of the studied sample (n = 118) of patients with IBD presented at least one inflammatory musculoskeletal manifestation. The overall prevalence of enteropathic SpA was 13.55%, with 10.16% axial SpA and 4.23% peripheral SpA according to the ASAS criteria. A total of 42.1% of patients had an MASEI score greater than 18, 35.2% had synovitis, and 14.7% had tenosynovitis on US, increasing the frequency of diagnosis of enteropathic SpA to 22.8%. Plasma calprotectin levels were similar to those in healthy controls, and correlated only with the fecal calprotectin level (p 0.041). CONCLUSIONS A total of 13.5% of patients met the criteria in accordance with the ASAS criteria for enteropathic SpA, which increased to 22.8% with the addition of US. The prevalence of enthesitis, synovitis and tenosynovitis by US of symptomatic joints and entheses were 42%, 35% and 14.7% respectively. Plasma calprotectin was correlated with fecal calprotectin but not with inflammatory biomarkers or US or ASAS criteria.
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Affiliation(s)
- Míriam Küster Huber
- Program in Public Health of Health Science Center of Federal University of Espírito Santo (PPGSC-UFES), Vitoria, Espírito Santo, Brazil
| | - Valeria Valim
- Program in Public Health of Health Science Center of Federal University of Espírito Santo (PPGSC-UFES), Vitoria, Espírito Santo, Brazil.
- Medicine Department of Federal University of Espírito Santo (UFES), University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil.
| | - Érica Vieira Serrano
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
| | | | - Rafael Burgomeister Lourenço
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
| | | | - Hilde Nordal
- Haukeland Hospital, University of Bergen, Bergen, Norway
| | - Maria de Fátima Bissoli
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
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Bragazzi MC, Pianigiani F, Venere R, Ridola L. Dysbiosis in Inflammatory Bowel Disease and Spondyloarthritis: Still a Long Way to Go? J Clin Med 2024; 13:2237. [PMID: 38673510 PMCID: PMC11050776 DOI: 10.3390/jcm13082237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
The association between Inflammatory Bowel Disease (IBD) and Spondyloarthritis (SpA) has been known for years, as has the concept that IBD is associated with an altered intestinal bacterial composition, a condition known as "dysbiosis". Recently, a state of intestinal dysbiosis has also been found in SpA. Dysbiosis in the field of IBD has been well characterized so far, as well as in SpA. The aim of this review is to summarize what is known to date and to emphasize the similarities between the microbiota conditions in these two diseases: particularly, an altered distribution in the gut of Enterobacteriaceae, Streptococcus, Haemophilus, Clostridium, Akkermansia, Ruminococcus, Faecalibacterium Prausnitzii, Bacteroides Vulgatus, Dialister Invisus, and Bifidubacterium Adolescentis is common to both IBD and SpA. At the same time, little is known about intestinal dysbiosis in IBD-related SpA. Only a single recent study has found an increase in Escherichia and Shigella abundances and a decrease in Firmicutes, Ruminococcaceae, and Faecalibacterium abundances in an IBD-related SpA group. Based on what has been discovered so far about the altered distribution of bacteria that unite both pathologies, it is appropriate to carry out further studies aiming to improve the understanding of IBD-related SpA for the purpose of developing new therapeutic strategies.
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Affiliation(s)
| | | | | | - Lorenzo Ridola
- Department of Medical-Surgical Sciences and Biotechnology, Sapienza University of Rome, Polo Pontino, 04100 Rome, Italy; (M.C.B.); (F.P.); (R.V.)
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14
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Enrique CP, María SA, Gustavo RS, Igor R, Magali CM, Diana PO, Sofia AC, Juliana MM, Camilo SJ, Camilo RJ, Mesa C, Marlon P, Sebastián SCJ, Luis F GC, Cesar PT, Humberto CM, Pedro SM, John L. Assessment of enthesopathy in conventional pelvis radiography: Another tool for spondyloarthritis diagnosis beyond sacroiliitis. Semin Arthritis Rheum 2024; 67:152435. [PMID: 38642418 DOI: 10.1016/j.semarthrit.2024.152435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION/OBJECTIVES Enthesitis is a cardinal feature of spondylarthritis (SpA), and the pelvis is a common site of enthesitis. This study aimed to establish the association between pelvic enthesis involvement on pelvic X-ray and SpA diagnosis through a radiographic enthesis index (REI) and to assess the reliability and accuracy of this REI. MATERIALS AND METHODS The participants were SpA patients and a control group composed of patients with chronic lumbar pain without SpA. Three blinded observers assessed each pelvic radiography three times. Three zones were used: Zone I (ZI), the iliopubic ramus; Zone II (ZII), the pubic symphysis, and Zone III (ZIII), the ischiopubic ramus. A grading system was created from 0 to 3 [Grade 0, normal; Grade 1, minimal changes (subcortical bone demineralization and/or periosteal wishkering, seen as radiolucency and trabeculation of the cortical bone upon tendon insertion); Grade 2, destructive changes (Grade 1 findings and erosions at the enthesis site); and Grade 3, findings of Grade 2 plus >2 mm whiskering out of the cortical bone) for the REI. The sum of the results of the three zones was called the total REI. For statistical analysis, we used the weighted kappa statistic adjusted for prevalence and bias using Gwet's agreement coefficient. RESULTS We enrolled 161 patients, 111 of them with SpA (39.6 % with axial SpA and 47.7 % with peripheral SpA) and 50 without SpA. In the SpA group, 36.7 % and 25.7 % had REI Grades 2 and 3 in ZIII, respectively, while only 6 % of the controls had these grades. For ZI, the frequency of Grades 1 to 3 was 42.3 % in the SpA group (8.1 %, 14.4 %, and 19.8 %, respectively), compared to only 2 % in the controls. ZII was unaffected in most of the patients with SpA (82.9 %) and in the controls (98 %). In the control group, Grade 0 was the most common REI grade in all three zones. The agreement was almost perfect for each zone and between the independent readers. The ROC-curve analysis showed that the highest performance areas were the total REI, ZIII, and ZI. Most (75 %) of the SpA patients without sacroiliitis on X-ray were REI-positive. The sensitivity of the REI for SpA diagnosis was 82 %, while the sensitivity of sacroiliitis on X-ray was 38.7 %. CONCLUSIONS The assessment of pelvic enthesis using the REI on pelvic radiography may be useful for SpA diagnosis. Total REI, ZIII, and ZI had the highest accuracy and almost perfect reliability. The REI is especially helpful in patients without sacroiliitis on imaging.
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Affiliation(s)
| | - Santos Ana María
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Rodríguez-Salas Gustavo
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Rueda Igor
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia; Bioscience programme, faculty of Medicine and Engineering, Universidad de La Sabana, Chía, Colombia
| | | | - Padilla-Ortiz Diana
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia
| | - Arias-Correal Sofia
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Mantilla Marta Juliana
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Santacruz Juan Camilo
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Rueda Juan Camilo
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia; Bioscience programme, faculty of Medicine and Engineering, Universidad de La Sabana, Chía, Colombia
| | - Cristian Mesa
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Porras Marlon
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia
| | | | - Giraldo-Cadavid Luis F
- Universidad de La Sabana - Interventional Pulmonology, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Pacheco-Tena Cesar
- PABIOM Laboratory, Faculty of Medicine and Biomedical Sciences, Autonomous University of Chihuahua, 31125 Chihuahua, Mexico
| | - Cardiel Mario Humberto
- Hospital General "Dr. Miguel Silva", Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, McMaster University, Universidad Michoacana de San Nicolas de Hidalgo Instituto de Física y Matemáticas
| | | | - Londono John
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia.
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15
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Gente K, Feisst M, Marx D, Klika KD, Christopoulos P, Graf J, Will J, Luft T, Hassel JC, Müller-Tidow C, Carvalho RA, Lorenz HM, Souto-Carneiro MM. Altered serum metabolome as an indicator of paraneoplasia or concomitant cancer in patients with rheumatic disease. Ann Rheum Dis 2024:ard-2023-224839. [PMID: 38561219 DOI: 10.1136/ard-2023-224839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES A timely diagnosis is imperative for curing cancer. However, in patients with rheumatic musculoskeletal diseases (RMDs) or paraneoplastic syndromes, misleading symptoms frequently delay cancer diagnosis. As metabolic remodelling characterises both cancer and RMD, we analysed if a metabolic signature can indicate paraneoplasia (PN) or reveal concomitant cancer in patients with RMD. METHODS Metabolic alterations in the sera of rheumatoid arthritis (RA) patients with (n=56) or without (n=52) a history of invasive cancer were quantified by nuclear magnetic resonance analysis. Metabolites indicative of cancer were determined by multivariable regression analyses. Two independent RA and spondyloarthritis (SpA) cohorts with or without a history of invasive cancer were used for blinded validation. Samples from patients with active cancer or cancer treatment, pulmonary and lymphoid type cancers, paraneoplastic syndromes, non-invasive (NI) precancerous lesions and non-melanoma skin cancer and systemic lupus erythematosus and samples prior to the development of malignancy were used to test the model performance. RESULTS Based on the concentrations of acetate, creatine, glycine, formate and the lipid ratio L1/L6, a diagnostic model yielded a high sensitivity and specificity for cancer diagnosis with AUC=0.995 in the model cohort, AUC=0.940 in the blinded RA validation cohort and AUC=0.928 in the mixed RA/SpA cohort. It was equally capable of identifying cancer in patients with PN. The model was insensitive to common demographic or clinical confounders or the presence of NI malignancy like non-melanoma skin cancer. CONCLUSIONS This new set of metabolic markers reliably predicts the presence of cancer in arthritis or PN patients with high sensitivity and specificity and has the potential to facilitate a rapid and correct diagnosis of malignancy.
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Affiliation(s)
- Karolina Gente
- Medical Clinic 5. Hematology, Oncology, Rheumatology, Heidelberg University, Heildelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry (IMBI), Heidelberg University, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Dorothea Marx
- Medical Clinic 5. Hematology, Oncology, Rheumatology, Heidelberg University, Heildelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Karel D Klika
- Molecular and Structural Biology, German Cancer Research Centre, Heidelberg, Baden-Württemberg, Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology and National Center for Tumor Diseases (NCT), Heidelberg University, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Jürgen Graf
- Institute of Organic Chemistry, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Julia Will
- Medical Clinic 5. Hematology, Oncology, Rheumatology, Heidelberg University, Heildelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Thomas Luft
- Medical Clinic 5. Hematology, Oncology, Rheumatology, Heidelberg University, Heildelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Jessica C Hassel
- Department of Dermatology and National Center for Tumor Diseases (NCT), Heidelberg University, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Carsten Müller-Tidow
- Medical Clinic 5. Hematology, Oncology, Rheumatology, Heidelberg University, Heildelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Rui A Carvalho
- Department of Life Sciences, Faculty of Sciences and Technology, University of Coimbra, Coimbra, Portugal
| | - Hanns-Martin Lorenz
- Medical Clinic 5. Hematology, Oncology, Rheumatology, Heidelberg University, Heildelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - M Margarida Souto-Carneiro
- Medical Clinic 5. Hematology, Oncology, Rheumatology, Heidelberg University, Heildelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
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16
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Priego-Pérez C, Puche-Larrubia MÁ, Ladehesa-Pineda L, Calvo-Guitérrez J, Ortega-Castro R, Escudero-Contreras A, Barbarroja N, Collantes-Estévez E, López-Medina C. Different Therapeutic Response to Anti-TNF Drugs in Patients with Axial Spondyloarthritis Depending on Their Clinical Profile: An Unsupervised Cluster Analysis. J Clin Med 2024; 13:1855. [PMID: 38610620 PMCID: PMC11012734 DOI: 10.3390/jcm13071855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The objectives were as follows: (a) to identify, among patients with axial spondyloarthritis (axSpA), "clusters" of patients based on the presence of peripheral and extra-musculoskeletal manifestations (EMMs) and (b) to compare the effectiveness of the first anti-TNF drugs across the different clusters after 6 months of follow-up. Methods: An observational and retrospective study of 90 axSpA patients naïve to bDMARDs was conducted. An unsupervised cluster analysis using the "k-means" technique was performed using variables of peripheral and EMMs. Baseline clinical and sociodemographic characteristics were evaluated, and the response to anti-TNF treatment (considering responders as those with an improvement ≥1.1 for the Ankylosing Spondylitis Disease Activity Score (ASDAS) or ≥2.0 for the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) was compared across the clusters after 6 months of follow-up. Results: Two clusters were identified: cluster 1 (n = 14), with a higher prevalence of peripheral manifestations, inflammatory bowel disease (IBD), and HLA-B27-positive status, and a lower prevalence of uveitis in comparison with cluster 2 (n = 76). Patients from cluster 1 experienced a more pronounced absolute improvement in ASDAS and BASDAI indices after 6 months. The percentage of responders after 6 months of follow-up was superior in cluster 1 compared to cluster 2 (85.7% vs. 48.7%, p = 0.011). Conclusion: This study suggests the existence of two clinical profiles in axSpA patients according to the peripheral and EMMs, with higher rates of anti-TNF effectiveness after 6 months in those with a greater presence of peripheral features.
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Affiliation(s)
- Carmen Priego-Pérez
- Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain; (C.P.-P.); (L.L.-P.); (J.C.-G.); (R.O.-C.); (A.E.-C.); (N.B.); (E.C.-E.); (C.L.-M.)
| | - María Ángeles Puche-Larrubia
- Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain; (C.P.-P.); (L.L.-P.); (J.C.-G.); (R.O.-C.); (A.E.-C.); (N.B.); (E.C.-E.); (C.L.-M.)
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Consolidated Group 05, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Lourdes Ladehesa-Pineda
- Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain; (C.P.-P.); (L.L.-P.); (J.C.-G.); (R.O.-C.); (A.E.-C.); (N.B.); (E.C.-E.); (C.L.-M.)
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Consolidated Group 05, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Jerusalem Calvo-Guitérrez
- Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain; (C.P.-P.); (L.L.-P.); (J.C.-G.); (R.O.-C.); (A.E.-C.); (N.B.); (E.C.-E.); (C.L.-M.)
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Consolidated Group 05, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Rafaela Ortega-Castro
- Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain; (C.P.-P.); (L.L.-P.); (J.C.-G.); (R.O.-C.); (A.E.-C.); (N.B.); (E.C.-E.); (C.L.-M.)
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Consolidated Group 05, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Alejandro Escudero-Contreras
- Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain; (C.P.-P.); (L.L.-P.); (J.C.-G.); (R.O.-C.); (A.E.-C.); (N.B.); (E.C.-E.); (C.L.-M.)
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Consolidated Group 05, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Nuria Barbarroja
- Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain; (C.P.-P.); (L.L.-P.); (J.C.-G.); (R.O.-C.); (A.E.-C.); (N.B.); (E.C.-E.); (C.L.-M.)
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Consolidated Group 05, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Eduardo Collantes-Estévez
- Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain; (C.P.-P.); (L.L.-P.); (J.C.-G.); (R.O.-C.); (A.E.-C.); (N.B.); (E.C.-E.); (C.L.-M.)
- Consolidated Group 05, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Clementina López-Medina
- Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain; (C.P.-P.); (L.L.-P.); (J.C.-G.); (R.O.-C.); (A.E.-C.); (N.B.); (E.C.-E.); (C.L.-M.)
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Consolidated Group 05, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
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Macaluso FS, Caprioli F, Benedan L, Bezzio C, Caporali R, Cauli A, Chimenti MS, Ciccia F, D'Angelo S, Fantini MC, Festa S, Iannone F, Lubrano E, Mariani P, Papi C, Provenzano G, Pugliese D, Rispo A, Saibeni S, Salvarani C, Variola A, Zenga M, Armuzzi A, Orlando A, Gerli R. The management of patients with inflammatory bowel disease-associated spondyloarthritis: Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) and Italian Society of Rheumatology (SIR) recommendations based on a pseudo-Delphi consensus. Autoimmun Rev 2024:103533. [PMID: 38521214 DOI: 10.1016/j.autrev.2024.103533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
Spondyloarthritis (SpA) is the most frequent extraintestinal manifestation in patients with inflammatory bowel diseases (IBD). When IBD and spondyloarthritis coexist, musculoskeletal and intestinal disease features should be considered when planning a therapeutic strategy. Treatment options for IBD and SpA have expanded enormously over the last few years, but randomized controlled trials with specific endpoints focused on SpA are not available in the IBD setting. To address this important clinical topic, the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) and the Italian Society of Rheumatology (SIR) jointly planned to draw updated therapeutic recommendations for IBD-associated SpA using a pseudo-Delphi method. This document presents the official recommendations of IG-IBD and SIR on the management of IBD-associated SpA in the form of 34 statements and 4 therapeutic algorithms. It is intended to be a reference guide for gastroenterologists and rheumatologists dealing with IBD-associated SpA.
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Affiliation(s)
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Laura Benedan
- Bicocca-Applied Statistics Center, Department of Economics, Management and Statistics, University of Milano-Bicocca, Milano, Italy
| | - Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Roberto Caporali
- Rheumatology Unit, Department of Clinical and Community Sciences, University of Milan, ASST Gaetano Pini-CTO, Milan, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medicine and Public Health, AOU and University of Cagliari, Cagliari, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Francesco Ciccia
- Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Naples, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
| | - Massimo Claudio Fantini
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | | | | | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy
| | - Paolo Mariani
- Bicocca-Applied Statistics Center, Department of Economics, Management and Statistics, University of Milano-Bicocca, Milano, Italy
| | | | | | - Daniela Pugliese
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; IBD Unit, CEMAD, Digestive Diseases Center, Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Simone Saibeni
- IBD Center, Gastroenterology Unit, Rho Hospital ASST Rhodense, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia, Italy
| | | | - Mariangela Zenga
- Bicocca-Applied Statistics Center, Department of Economics, Management and Statistics, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Roberto Gerli
- Rheumatology Unit, Department of Medicine & Surgery, University of Perugia, Italy
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Farina N, Tomelleri A, Boffini N, Cariddi A, Calvisi S, Baldissera E, Matucci-Cerinic M, Dagna L. Secukinumab is not associated with cancer recurrence or progression in patients with spondyloarthritis and history of neoplastic disease. Rheumatol Int 2024:10.1007/s00296-024-05571-y. [PMID: 38506924 DOI: 10.1007/s00296-024-05571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
Secukinumab is a monoclonal antibody directed against interleukin-17 approved for the treatment of psoriasis and spondyloarthritis. The favorable oncological profile of secukinumab in patients with a history of malignancy has been shown in patients with psoriasis. However, systematic data to this regard have not been published yet for patients with spondyloarthritis. The objective of the present study was to evaluate the oncological safety of secukinumab in patients affected by this group of diseases. We performed a retrospective study in which we identified from our cohort patients with spondyloarthritis treated with secukinumab and with a history of malignancy. These patients' baseline demographic, treatment, rheumatological, and oncological data were collected. The neoplastic outcome (i.e., cancer recurrence or progression) after secukinumab start was then analyzed. Our study included 22 patients with spondyloarthritis. The most frequently reported oncological diagnosis was breast cancer (9 [41%] patients). Secukinumab was started after a median of 24 months following cancer diagnosis. At this time point, all but three patients were in oncological remission. No case of cancer relapse or progression was recorded over a median follow-up of 30 months. In the largest cohort reported to date to this regard, secukinumab was not associated with oncological recurrence or progression in patients with spondyloarthritis with a history of malignancy. Secukinumab may, therefore, represent a safe option in this clinical scenario.
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Affiliation(s)
- Nicola Farina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Boffini
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Stefania Calvisi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Elena Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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19
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Jin XY, Li DD, Quan W, Chao Y, Zhang B. Leaky gut, circulating immune complexes, arthralgia, and arthritis in IBD: coincidence or inevitability? Front Immunol 2024; 15:1347901. [PMID: 38571963 PMCID: PMC10987687 DOI: 10.3389/fimmu.2024.1347901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
Most host-microbiota interactions occur within the intestinal barrier, which is essential for separating the intestinal epithelium from toxins, microorganisms, and antigens in the gut lumen. Gut inflammation allows pathogenic bacteria to enter the blood stream, forming immune complexes which may deposit on organs. Despite increased circulating immune complexes (CICs) in patients with inflammatory bowel disease (IBD) and discussions among IBD experts regarding their potential pathogenic role in extra-intestinal manifestations, this phenomenon is overlooked because definitive evidence demonstrating CIC-induced extra-intestinal manifestations in IBD animal models is lacking. However, clinical observations of elevated CICs in newly diagnosed, untreated patients with IBD have reignited research into their potential pathogenic implications. Musculoskeletal symptoms are the most prevalent extra-intestinal IBD manifestations. CICs are pivotal in various arthritis forms, including reactive, rheumatoid, and Lyme arthritis and systemic lupus erythematosus. Research indicates that intestinal barrier restoration during the pre-phase of arthritis could inhibit arthritis development. In the absence of animal models supporting extra-intestinal IBD manifestations, this paper aims to comprehensively explore the relationship between CICs and arthritis onset via a multifaceted analysis to offer a fresh perspective for further investigation and provide novel insights into the interplay between CICs and arthritis development in IBD.
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Affiliation(s)
- Xi-ya Jin
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dan-dan Li
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wei Quan
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yang Chao
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Bin Zhang
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
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20
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Lima SF, Pires S, Rupert A, Oguntunmibi S, Jin WB, Marderstein A, Funez-dePagnier G, Maldarelli G, Viladomiu M, Putzel G, Yang W, Tran N, Xiang G, Grier A, Guo CJ, Lukin D, Mandl LA, Scherl EJ, Longman RS. The gut microbiome regulates the clinical efficacy of sulfasalazine therapy for IBD-associated spondyloarthritis. Cell Rep Med 2024; 5:101431. [PMID: 38378002 PMCID: PMC10982976 DOI: 10.1016/j.xcrm.2024.101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/28/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024]
Abstract
Sulfasalazine is a prodrug known to be effective for the treatment of inflammatory bowel disease (IBD)-associated peripheral spondyloarthritis (pSpA), but the mechanistic role for the gut microbiome in regulating its clinical efficacy is not well understood. Here, treatment of 22 IBD-pSpA subjects with sulfasalazine identifies clinical responders with a gut microbiome enriched in Faecalibacterium prausnitzii and the capacity for butyrate production. Sulfapyridine promotes butyrate production and transcription of the butyrate synthesis gene but in F. prausnitzii in vitro, which is suppressed by excess folate. Sulfasalazine therapy enhances fecal butyrate production and limits colitis in wild-type and gnotobiotic mice colonized with responder, but not non-responder, microbiomes. F. prausnitzii is sufficient to restore sulfasalazine protection from colitis in gnotobiotic mice colonized with non-responder microbiomes. These findings reveal a mechanistic link between the efficacy of sulfasalazine therapy and the gut microbiome with the potential to guide diagnostic and therapeutic approaches for IBD-pSpA.
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Affiliation(s)
- Svetlana F Lima
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Silvia Pires
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Amanda Rupert
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Seun Oguntunmibi
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Wen-Bing Jin
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Andrew Marderstein
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Gabriela Funez-dePagnier
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Grace Maldarelli
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Monica Viladomiu
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Gregory Putzel
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Wei Yang
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Nancy Tran
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Grace Xiang
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Alex Grier
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Chun-Jun Guo
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Dana Lukin
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery and Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Ellen J Scherl
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Randy S Longman
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
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Ben Tekaya A, Ben Said H, Yousfi I, Ben Dhia S, Bouden S, Rouached L, Mahmoud I, Tekaya R, Saidane O, Abdelmoula L. Burden of disease, pain catastrophizing, and central sensitization in relation to work-related issues in young spondyloarthritis patients. Reumatologia 2024; 62:35-42. [PMID: 38558896 PMCID: PMC10979370 DOI: 10.5114/reum/185390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Spondyloarthritis (SpA) is a common rheumatic inflammatory disease and can impact patients' work productivity. We aimed to evaluate the impact of pain catastrophizing and central sensitization on work outcomes in young SpA patients and determine the predictive factors of work productivity loss. Material and methods We performed a cross-sectional study over 6 months. We included patients aged between 18 and 50 years old, diagnosed with axial or peripheral SpA. Pain catastrophizing and central sensitization were assessed using the Pain Catastrophizing Scale (PCS) and Central Sensitization Inventory (CSI) questionnaire, respectively. Impact of SpA on work productivity and activity impairment during and outside of work was measured with the Work Productivity and Activity Impairment Questionnaire (WPAI: Spondyloarthritis). Results A total of 72 patients were enrolled, with a median age of 39 years (28.3-46), 65.3% men, and 54.4% working patients. Median scores of activity impairment outside of work, and work productivity loss were 50% (40-70), and 50% (40-60), respectively. Median absenteeism and presenteeism scores were 0% (IQR 0-7), and 100% (IQR 86.5-100), respectively. Regarding work-related outcomes: activity impairment was positively correlated with CSI and PCS; presenteeism was significantly associated with male sex (p = 0.009); and work productivity loss was positively associated with anxiety, depression, and poor quality of life. Multivariate regression analysis identified predictive factors of work productivity loss: male sex, poor quality of life, and prolonged morning stiffness. Conclusions Assessment of the impact of pain catastrophizing and central sensitization on work-related outcomes in patients with SpA is important to understand the burden of illness and to identify early those in need of interventions in clinical practice.
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Affiliation(s)
- Aicha Ben Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hanene Ben Said
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
- Occupational Pathology and Fitness for Work Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Imene Yousfi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
- Occupational Pathology and Fitness for Work Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Siwar Ben Dhia
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Selma Bouden
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Leila Rouached
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Ines Mahmoud
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Rawdha Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Olfa Saidane
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Leila Abdelmoula
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Braun J, Rudwaleit M, Sieper J. [The role of HLA-B27 in the pathogenesis and diagnosis of axial spondyloarthritis : 50 years after discovery of the strong genetic association]. Z Rheumatol 2024; 83:125-133. [PMID: 38112753 DOI: 10.1007/s00393-023-01460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The association of the human lymphocyte antigen B27 (HLA-B27) with ankylosing spondylitis (AS), also now called axial spondylarthritis (axSpA), was first described 50 years ago. OBJECTIVE This article gives an overview of the available knowledge on the topic. MATERIAL AND METHODS This is a narrative review based on the experience of the authors. RESULTS The HLA-B27 is a member of the HLA class I family of genes of the major histocompatibility complex (MHC). The prevalence of HLA-B27 in the central European population is approximately 8 %, i.e., the vast majority of carriers of HLA-B27+ remain healthy. The frequency of HLA-B27 shows a decline from north to south. The HLA-B27 explains only 30 % of the genetic burden of axSpA. The prevalence of the disease correlates with the frequency of HLA-B27 in the population, i.e., there are geographic differences. Approximately 60-90 % of patients with axSpA worldwide are HLA-B27+. Some 200 subtypes of HLA-B27 can be differentiated using the polymerase chain reaction (PCR). In Thailand and Sardinia two subtypes were found that are not associated with axSpA. The physiological function of HLA class I molecules is the defence of the organism against microbes. Microbial peptides are presented to the immune system, which can be specifically attacked by CD8+ T‑cells. Genetic polymorphisms of the enzyme endoplasmic reticulum aminopeptidase 1 (ERAP1), which breaks down peptides in the endoplasmic reticulum, are associated only with HLA-B27+ diseases. DISCUSSION The pathogenesis of axSpA is unclear but a major hypothesis is that of the arthritogenic peptides. In this it is assumed that potentially pathogenic foreign or autologous peptides can be presented by HLA-B27. If nothing else, HLA-B27 plays an important role in the diagnosis, classification and determination of the severity of axSpA.
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Affiliation(s)
- Jürgen Braun
- Rheumatologisches Versorgungszentrum Steglitz, Berlin, Deutschland.
- Ruhr Universität Bochum, Bochum, Deutschland.
- , Berlin, Deutschland.
| | - Martin Rudwaleit
- Klinikum Bielefeld, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld, Deutschland
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Sen R, Caplan L, Danila MI. Cardiovascular disease in spondyloarthritis: a narrative review of risk factors and the effect of treatments. Curr Opin Rheumatol 2024; 36:95-107. [PMID: 38126207 DOI: 10.1097/bor.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the recent evidence available regarding the epidemiology of cardiovascular disease in spondyloarthritis (SpA), including the effect of disease modifying drugs on cardiovascular risk. RECENT FINDINGS People with SpA suffer from an increased risk of cardiovascular disease compared to the general population. This elevated risk is explained by the high prevalence of traditional cardiovascular risk factors and inflammation from disease activity leading to endothelial dysfunction and accelerated atherosclerosis. Consequently, the American College of Cardiology/American Heart Association and the European League Against Rheumatism recommend enhanced cardiovascular risk screening in SpA patients. There is evidence from observational studies that methotrexate and tumor necrosis factor inhibitors reduce the risk of cardiovascular events in SpA. Unlike what is observed in the general population, the use of nonsteroidal anti-inflammatory drugs does not appear to increase cardiovascular disease risk in SpA. SUMMARY Cardiovascular diseases are increasingly recognized in patients suffering from SpA, especially axial SpA and psoriatic arthritis. Cardiovascular diseases can cause significant morbidity, mortality, and add to the overall disease burden. Disease modifying drugs may mitigate some of the cardiovascular risk; however, a multidisciplinary team is needed to monitor patients and improve cardiovascular health status.
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Affiliation(s)
- Rouhin Sen
- The University of Alabama Birmingham, Division of Clinical Immunology and Rheumatology
- Birmingham Veterans Affairs Medical Center (VAMC), Birmingham, Alabama
| | - Liron Caplan
- Rocky Mountain Regional VAMC
- University of Colorado, Division of Rheumatology, Aurora, Colorado, USA
| | - Maria I Danila
- The University of Alabama Birmingham, Division of Clinical Immunology and Rheumatology
- Birmingham Veterans Affairs Medical Center (VAMC), Birmingham, Alabama
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Jung YH, Suh JS, Choi JY. The association between refractory plantar fasciitis and insertional Achilles tendinopathy and peripheral spondyloarthritis: a report of human leukocyte antigen B-27 investigation and treatment outcome. Int Orthop 2024; 48:711-718. [PMID: 37897545 DOI: 10.1007/s00264-023-06019-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE This study aimed to determine the presence of peripheral spondyloarthritis and investigate the clinical characteristics of patients with concurrent peripheral spondyloarthritis in those presenting with refractory plantar fasciitis and Achilles tendinopathy by conducting human leukocyte antigen B-27 (HLA-B27) testing. METHODS This retrospective study aimed to investigate patients who complained of persistent pain and significant limitations in daily activities due to their respective foot pain, despite receiving conservative treatment for over one year under the diagnosis of plantar fasciitis or insertional Achilles tendinopathy. The study included 63 patients who underwent HLA-B27 testing. The patients were classified into two groups based on the presence or absence of HLA-B27 positivity. The Mann-Whitney U test assessed significant relationships between continuous variables, and the chi-square test was used to compare categorical variables. RESULTS Among the 63 included patients, HLA-B27 positivity was confirmed in 11 patients (17.5%), which was significantly associated with a lower average age (22.8 years versus 31.7 years, P = 0.01) and a substantially lower proportion of females compared to HLA-B27-negative patients (9.1% vs. 25.0%, P = 0.001). Ten of the 11 patients initiated treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) combined with oral steroids as the first-line medication after being diagnosed as HLA-B27 positive. Six patients experienced pain relief with the first-line medication (60%). Four patients who did not achieve pain control with the first-line medication received tumour necrosis factor-alpha inhibitors as the second-line medication. Two patients experienced pain relief, while two experienced reduced but persistent pain. CONCLUSIONS Among the patients with "refractory" plantar fasciitis and insertional Achilles tendinopathy, 17.5% were diagnosed with peripheral spondyloarthritis. Patients diagnosed with peripheral spondyloarthritis had a higher proportion of men and relatively younger mean age compared to those without the diagnosis. Approximately 70% of these patients achieved symptom improvement in foot and ankle joints by taking conventional synthetic DMARDs, TNF-α inhibitors, or both appropriate for spondyloarthritis.
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Affiliation(s)
- Young Ho Jung
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jun Young Choi
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea.
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Alizadeh M, Wong U, Siaton BC, Patil SA, George L, Raufman JP, Scott WH, von Rosenvinge EC, Ravel J, Cross RK. ExpLOring the role of the intestinal MiCrobiome in InflammATory bowel disease-AssocIated SpONdylarthritis (LOCATION-IBD). Heliyon 2024; 10:e26571. [PMID: 38420375 PMCID: PMC10900801 DOI: 10.1016/j.heliyon.2024.e26571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/12/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
Background Inflammatory Bowel Disease (IBD)-associated arthritis is a frequent and potentially debilitating complication of IBD, that can affect those with or without active intestinal disease, and is often difficult to treat. The microbiome is known to play a role in IBD development and has been shown to be associated with inflammatory arthritis without concomitant IBD, but its role in IBD-associated arthritis is still unexplored. Further, disease localization is associated with development of IBD-associated arthritis, and stool compositional profiles are predictive of disease localization, yet mucosal location-specific microbiomes have not been well characterized. To address this gap in understanding, we designed a study (LOCATION-IBD) to characterize the mucosa-associated intestinal microbiome and metabolome in IBD-associated arthritis. Methods Adults with an established diagnosis of IBD undergoing clinical colonoscopy between May of 2021 and February of 2023 were invited to participate in this study; those interested in participation who met inclusion criteria were enrolled. Prior to enrollment, participants were stratified into those with or without IBD-associated arthritis. All participants were interviewed and had clinical and demographic data collected, and 97.8% completed clinical colonoscopy with biopsy collection. Results and conclusion A total of 182 participants, 53 with confirmed IBD-associated arthritis, were enrolled in this study, resulting in 1151 biopsies obtained for microbiome and metabolome analysis (median 6, mean 6.3 per participant). Clinical and demographic data obtained from the study population will be analyzed with microbiome and metabolome data obtained from biopsies, with the goal of better understanding the mechanisms underpinning the host-microbiome relationship associated the development of IBD-associated arthritis.
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Affiliation(s)
- Madeline Alizadeh
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Uni Wong
- Department of Veterans Affairs, Washington DC Veterans Health Administration, Washington DC, USA
| | - Bernadette C Siaton
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Seema A Patil
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Lauren George
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Jean-Pierre Raufman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - William H Scott
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Erik C von Rosenvinge
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Martini V, Silvestri Y, Ciurea A, Möller B, Danelon G, Flamigni F, Jarrossay D, Kwee I, Foglierini M, Rinaldi A, Cecchinato V, Uguccioni M. Patients with ankylosing spondylitis present a distinct CD8 T cell subset with osteogenic and cytotoxic potential. RMD Open 2024; 10:e003926. [PMID: 38395454 PMCID: PMC10895246 DOI: 10.1136/rmdopen-2023-003926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease affecting mainly the axial skeleton. Peripheral involvement (arthritis, enthesitis and dactylitis) and extra-musculoskeletal manifestations, including uveitis, psoriasis and bowel inflammation, occur in a relevant proportion of patients. AS is responsible for chronic and severe back pain caused by local inflammation that can lead to osteoproliferation and ultimately spinal fusion. The association of AS with the human leucocyte antigen-B27 gene, together with elevated levels of chemokines, CCL17 and CCL22, in the sera of patients with AS, led us to study the role of CCR4+ T cells in the disease pathogenesis. METHODS CD8+CCR4+ T cells isolated from the blood of patients with AS (n=76) or healthy donors were analysed by multiparameter flow cytometry, and gene expression was evaluated by RNA sequencing. Patients with AS were stratified according to the therapeutic regimen and current disease score. RESULTS CD8+CCR4+ T cells display a distinct effector phenotype and upregulate the inflammatory chemokine receptors CCR1, CCR5, CX3CR1 and L-selectin CD62L, indicating an altered migration ability. CD8+CCR4+ T cells expressing CX3CR1 present an enhanced cytotoxic profile, expressing both perforin and granzyme B. RNA-sequencing pathway analysis revealed that CD8+CCR4+ T cells from patients with active disease significantly upregulate genes promoting osteogenesis, a core process in AS pathogenesis. CONCLUSIONS Our results shed light on a new molecular mechanism by which T cells may selectively migrate to inflammatory loci, promote new bone formation and contribute to the pathological ossification process observed in AS.
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Affiliation(s)
- Veronica Martini
- Institute for Research in Biomedicine, Universitá della Svizzera italiana, Bellinzona, Switzerland
| | - Ylenia Silvestri
- Institute for Research in Biomedicine, Universitá della Svizzera italiana, Bellinzona, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Burkhard Möller
- Department of Rheumatology and Immunology, Inselspital-University Hospital Bern, University of Bern, Bern, Switzerland
| | - Gabriela Danelon
- Institute for Research in Biomedicine, Universitá della Svizzera italiana, Bellinzona, Switzerland
| | - Flavio Flamigni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - David Jarrossay
- Institute for Research in Biomedicine, Universitá della Svizzera italiana, Bellinzona, Switzerland
| | - Ivo Kwee
- Institute for Research in Biomedicine, Universitá della Svizzera italiana, Bellinzona, Switzerland
| | - Mathilde Foglierini
- Institute for Research in Biomedicine, Universitá della Svizzera italiana, Bellinzona, Switzerland
| | - Andrea Rinaldi
- Institute of Oncology Research, Universitá della Svizzera italiana, Bellinzona, Switzerland
| | - Valentina Cecchinato
- Institute for Research in Biomedicine, Universitá della Svizzera italiana, Bellinzona, Switzerland
| | - Mariagrazia Uguccioni
- Institute for Research in Biomedicine, Universitá della Svizzera italiana, Bellinzona, Switzerland
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Conigliaro P, D’Antonio A, Wlderk A, Sabuzi F, Ferraioli M, Sichi L, Da Ros V, Biancone L, Bergamini A, Sole Chimenti M. Clinical and imaging findings in enteropathic spondyloarthritis with special emphasize in diagnostic delay: a cross-sectional study. Ther Adv Chronic Dis 2024; 15:20406223241229843. [PMID: 38380226 PMCID: PMC10878219 DOI: 10.1177/20406223241229843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/10/2024] [Indexed: 02/22/2024] Open
Abstract
Background Enteropathic spondyloarthritides (eSpAs) are chronic inflammatory joint diseases associated with inflammatory bowel disease (IBD). Limited data are available on the prevalence since arthritis in IBD patients may be underestimated because medications may hide disease activity with a possible diagnostic delay. Objectives We aimed to evaluate diagnostic delay in eSpA and explore associated demographic, clinical, and radiographic characteristics. Design Single-centre cross-sectional study conducted on consecutive out-patients referred to the combined Gi-Rhe clinic (November 2018-October 2019). Methods We analysed eSpA patients for diagnostic delay, disease activity, inflammatory markers, conventional radiography (CR) and magnetic resonance images (MRI) of sacroiliac joints/spine. Results A total of 190 eSpA patients [118 peripheral SpA, 72 axial (Ax) SpA including 44 non-radiographic (nr)-axSpA] were enrolled. axSpA patients had a higher prevalence of men sex, HLA-B27 positivity, uveitis and pancolitis compared with peripheral eSpA. Median diagnostic delay in eSpA was 48 months (IQR 6-77) with no difference between axial and peripheral patients. Radiographic-axial SpA (r-axSpA) patients displayed a higher diagnostic delay compared with nr-axSpA (median/IQR 36/17-129 versus 31/10-57 months, p = 0.03) and were older, with longer disease duration, low education status and high rate of employment than patients with nr-axSpA. r-axSpA patients with sclerosis, syndesmophytes and bridge at CR had higher diagnostic delay than those without lesions. Men showed higher prevalence of spine damage lesions than women as sclerosis, squaring, syndesmophytes and bridges. Longer disease duration was detected in patients with radiographic damage as bridge and sacroiliitis grade 3. On MRI, sacroiliac bone oedema was associated with reduced diagnostic delay, whereas bone erosions were associated with higher diagnostic delay compared with that in patients without these lesions. Patients with psoriasis displayed a higher diagnostic delay compared to those without skin involvement. Conclusion Diagnostic delay was higher in r-axSpA compared with nr-axSpA despite the same treatment. Demographic, clinical features and radiological lesions were associated with diagnostic delay.
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Affiliation(s)
- Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Via Montpellier 1, Rome 00133, Italy
| | - Arianna D’Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Wlderk
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Federico Sabuzi
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Mario Ferraioli
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Sichi
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Valerio Da Ros
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Livia Biancone
- Gastroenterology Unit, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Bergamini
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
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Mease PJ, Blachley T, Malatestinic WN, Harrold LR, Dube B, Lisse JR, Bolce RJ, Hunter TM. Effectiveness of bDMARDs in ankylosing spondylitis patients by biologic use: experience from the CorEvitas PsA/SpA Registry. Curr Med Res Opin 2024; 40:315-323. [PMID: 38050693 DOI: 10.1080/03007995.2023.2291160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To describe bDMARD initiators by biologic experience among ankylosing spondylitis (AS) patients and change in disease activity and patient-reported outcomes (PROs) in real-world US patients. METHODS We included patients ≥18 years with AS based on physician diagnosis enrolled between 3/2013 and 11/2019 in the CorEvitas Psoriatic Arthritis (PSA)/Spondyloarthritis Registry (NCT02530268). Patients concurrently diagnosed with PSA were excluded. Baseline (bDMARD initiation) demographics, comorbidities, disease characteristics, treatment, and PROs were collected. Response rates and changes in disease activity and PROs between baseline and 6- and 12- month follow-up visits were calculated. RESULTS Of the 489 AS patients in the PsA/SpA Registry, 254 AS (52.0%) patients initiated a bDMARD at enrollment or during follow-up (total initiations: AS = 313). Of the 313 AS initiations, 179 (57.2%) had a 6-month follow-up, 122 (39.0%) had a 12-month follow-up, and 94 (30.0%) had a 6- and 12-month follow-up visit. For those AS initiators with a 6-month follow-up, the mean age was 49.1 years, 44.4% were female, and 70.4%, 47.5%, 96.1%, and 46.9% had never used cDMARDs, TNFis, non-TNFis, and bDMARDs, respectively. Of these 179 AS initiators, 20.1% and 14.0% achieved ASAS20/40, respectively. Further, only 34% achieved low disease activity (ASDAS <2.1). When stratified by biologic-naivete and biologic-experience, the ASAS 20/40 achievement rates were 26.2% and 14.7%, and 21.4% and 7.4%, respectively, for this cohort. CONCLUSION Although AS patients initiate bDMARDs, many do not achieve optimal treatment responses. Future research is needed to investigate the aspects associated with inadequate improvement and treatment response to bDMARDs.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
| | | | | | - Leslie R Harrold
- CorEvitas, LLC, Waltham, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
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Chao YJ, Hung JH, Lin CP, Kuo HK, Chen SN, Hwang YS, Li KJ, Lin CJ, Hwang DK, Sheu SJ. Diagnosis, Treatment, and Prevention of Noninfectious Acute Anterior Uveitis with or without Human Leukocyte Antigen B27 in Adults - Expert Consensus in Taiwan. Ocul Immunol Inflamm 2024; 32:226-233. [PMID: 36701640 DOI: 10.1080/09273948.2023.2165113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/31/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anterior uveitis is the most common anatomical type of uveitis. Patients with noninfectious anterior uveitis may develop various ocular complications and eventually visual impairment. Appropriately differentiating the etiologies can help clinicians to predict the outcome, arrange clinical follow-up, and decide the treatment or prevention strategy. Adequate treatment and effective prevention strategies can reduce the frequency of recurrence and the risk of developing complications. Human leukocyte antigen (HLA)-B27 is the most common positive finding in patients with noninfectious AAU in many countries including Taiwan. PURPOSE To report a consensus from experienced uveitis specialists and rheumatologists was made in Taiwan. METHODS A panel of nine ophthalmologists from nine different referral centers with expertise in the management of uveitis and an experienced rheumatologist was held on January 16, 2022. A comprehensive literature review was performed. Differential diagnoses for etiologies, general treatments, and prevention strategies were discussed. Each statement in the consensus was made only if more than 70% of the experts agreed. RESULTS A flow chart and seven statements regarding the differential diagnoses for etiologies, treatments and preventions, and co-management with rheumatologists were included in the consensus. CONCLUSIONS This article discusses the general diagnosis, treatment, and prevention of noninfectious acute anterior uveitis, with or without HLA-B27, in adults for general ophthalmologists to improve overall outcomes of these patients.
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Affiliation(s)
- Yu-Jang Chao
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jia-Horung Hung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan, ROC
| | - San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
- Department of Medication, China Medical University, Taichung, Taiwan, ROC
| | - Yih-Shiou Hwang
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan, ROC
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
- Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen Branch, Xiamen, China
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Ko-Jen Li
- Division of Rheumatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
- Department of Optometry, Asia University, Taichung, Taiwan, ROC
| | - De-Kuang Hwang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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30
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Pineda-Sic RA, Vega-Morales D, Santoyo-Fexas L, Garza-Elizondo MA, Mendiola-Jiménez A, González Marquez KI, Carrillo-Haro B. Are the cut-offs of the rheumatoid factor and anti-cyclic citrullinated peptide antibody different to distinguish rheumatoid arthritis from their primary differential diagnoses? Int J Immunogenet 2024; 51:1-9. [PMID: 37933209 DOI: 10.1111/iji.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP) are commonly used for diagnosis of rheumatoid arthritis (RA), although other rheumatic diseases with arthritis can test positive. This study aimed to determine the cutoff values for RF and anti-CCP with the best diagnostic performance in a sample of patients with RA, compared with other rheumatic diseases. METHODS This was a descriptive, prospective study. EUROINMMUN enzyme-linked immunosorbent assays for RF isotypes immunoglobulin (Ig) A (IgA), IgG and IgM and third-generation assay IgG for anti-CCP were used in serum samples of patients with RA, other rheumatic diseases and healthy subjects. The cutoff with the best diagnostic performance was determined by the Youden Index and receiver operating characteristic analysis Results: Three hundred and thirty-two serum samples were analysed. The cutoffs proposed in our population were for RF in RA patients versus other rheumatic diseases, and healthy subjects IgM 135 IU/mL, for each disease, compared with RA, were psoriatic arthritis (Psa) IgA 47.2 IU/mL, clinically suspicious arthralgia (CSA) IgA 39.5 IU/mL, primary Sjögren's syndrome (pSS) IgM 180.6 IU/mL, systemic lupus erythematosus (SLE) IgA 42.6 IU/mL, primary fibromyalgia (pFM) IgM 68.6 IU/mL, osteoarthritis (OA) IgM 48 IU/mL, gout IgM 117 IU/mL and healthy IgM 16.3 IU/mL. For anti-CCP, in RA patients versus other rheumatic diseases, and healthy subjects 6.95 IU/mL, for each disease, compared with RA, were Psa 6.8 IU/mL, CSA 9.95 IU/mL, pSS 20.7 IU/mL, SLE 6 IU /mL, pFM 11.8 IU/mL, OA 11.9 IU/mL, gout 5 IU/mL and healthy 5 IU/mL. CONCLUSION Irrespective of the manufacturer's suggested cutoff, the RA versus differential diagnosis cutoffs must be considered.
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Affiliation(s)
| | - David Vega-Morales
- Rheumatology Department, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | | | | | | | - Berenice Carrillo-Haro
- School of Medicine and Health Sciences, Instituto Tecnologico y de Estudios Superiores de Monterrey, Monterrey, Mexico
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31
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Caillet Portillo D, Puéchal X, Masson M, Kostine M, Michaut A, Ramon A, Wendling D, Costedoat-Chalumeau N, Richette P, Marotte H, Vix-Portet J, Dubost JJ, Ottaviani S, Mouterde G, Grasland A, Frazier A, Germain V, Coury F, Tournadre A, Soubrier M, Cavalie L, Brevet P, Zabraniecki L, Jamard B, Couture G, Arnaud L, Richez C, Degboé Y, Ruyssen-Witrand A, Constantin A. Diagnosis and treatment of Tropheryma whipplei infection in patients with inflammatory rheumatic disease: Data from the French Tw-IRD registry. J Infect 2024; 88:132-138. [PMID: 38141787 DOI: 10.1016/j.jinf.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/23/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES Tropheryma whipplei infection can manifest as inflammatory joint symptoms, which can lead to misdiagnosis of inflammatory rheumatic disease and the use of disease-modifying antirheumatic drugs. We investigated the impact of diagnosis and treatment of Tropheryma whipplei infection in patients with inflammatory rheumatic disease. METHODS We initiated a registry including patients with disease-modifying antirheumatic drugs-treated inflammatory rheumatic disease who were subsequently diagnosed with Tropheryma whipplei infection. We collected clinical, biological, treatment data of the inflammatory rheumatic disease, of Tropheryma whipplei infection, and impact of antibiotics on the evolution of inflammatory rheumatic disease. RESULTS Among 73 inflammatory rheumatic disease patients, disease-modifying antirheumatic drugs initiation triggered extra-articular manifestations in 27% and resulted in stabilisation (51%), worsening (34%), or improvement (15%) of inflammatory rheumatic disease. At the diagnosis of Tropheryma whipplei infection, all patients had rheumatological symptoms (mean age 58 years, median inflammatory rheumatic disease duration 79 months), 84% had extra-rheumatological manifestations, 93% had elevated C-reactive protein, and 86% had hypoalbuminemia. Treatment of Tropheryma whipplei infection consisted mainly of doxycycline plus hydroxychloroquine, leading to remission of Tropheryma whipplei infection in 79% of cases. Antibiotic treatment of Tropheryma whipplei infection was associated with remission of inflammatory rheumatic disease in 93% of cases and enabled disease-modifying antirheumatic drugs and glucocorticoid discontinuation in most cases. CONCLUSIONS Tropheryma whipplei infection should be considered in inflammatory rheumatic disease patients with extra-articular manifestations, elevated C-reactive protein, and/or hypoalbuminemia before disease-modifying antirheumatic drugs initiation or in inflammatory rheumatic disease patients with an inadequate response to one or more disease-modifying antirheumatic drugs. Positive results of screening and diagnostic tests for Tropheryma whipplei infection involve antibiotic treatment, which is associated with complete recovery of Tropheryma whipplei infection and rapid remission of inflammatory rheumatic disease, allowing disease-modifying antirheumatic drugs and glucocorticoid discontinuation.
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Affiliation(s)
- Damien Caillet Portillo
- Pierre-Paul Riquet University Hospital, Toulouse & Toulouse III University - Paul Sabatier, Rheumatology, Toulouse, France.
| | - Xavier Puéchal
- National Referral Centre for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre, Paris, France; Université Paris Cité, Paris, France
| | - Maëva Masson
- Pierre-Paul Riquet University Hospital, Toulouse & Toulouse III University - Paul Sabatier, Rheumatology, Toulouse, France
| | - Marie Kostine
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases RESO, Bordeaux University Hospital, Bordeaux, France
| | - Alexia Michaut
- Hospital Centre, Loire Vendée Ocean, Rheumatology, La Roche-sur-Yon, France
| | - André Ramon
- Le Bocage Hospital, University Hospital of Dijon, Rheumatology, Dijon, France
| | - Daniel Wendling
- CHU de Besançon, Service de Rhumatologie, Université de Franche-Comté, Besançon, France
| | - Nathalie Costedoat-Chalumeau
- National Referral Centre for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre, Paris, France; Université Paris Cité, Paris, France
| | - Pascal Richette
- Hôpital Lariboisière Hospital, AP-HP, Paris, Rheumatology, Paris, France
| | - Hubert Marotte
- Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Service de Rhumatologie, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, F-42023 Saint-Etienne, France
| | | | - Jean-Jacques Dubost
- CHU Clermont-Ferrand, Université Clermont Auvergne, INRAe, Department of Rheumatology, Clermont Ferrand, France
| | | | - Gaël Mouterde
- Rheumatology Department, CHU Montpellier & IDESP, Montpellier University, Montpellier, France
| | - Anne Grasland
- Louis-Mourier Hospital, AP-HP, Université Paris Cité, Rheumatology, Colombes, France
| | - Aline Frazier
- Hôpital Lariboisière Hospital, AP-HP, Paris, Rheumatology, Paris, France
| | | | - Fabienne Coury
- University of Lyon, University Lyon 1, Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon Immunopathology Federation (LIFe), INSERM UMR 1033, Lyon, France
| | - Anne Tournadre
- CHU Clermont-Ferrand, Université Clermont Auvergne, INRAe, Department of Rheumatology, Clermont Ferrand, France
| | - Martin Soubrier
- CHU Clermont-Ferrand, Université Clermont Auvergne, INRAe, Department of Rheumatology, Clermont Ferrand, France
| | - Laurent Cavalie
- Bacteriology and Hygiene Laboratory, Federal Institute of Biology (IFB), Purpan Hospital, Toulouse & IRSD, INSERM, INRAE, ENVT Toulouse III University - Paul Sabatier, Toulouse, France
| | - Pauline Brevet
- Department of Rheumatology and CIC-CRB 1404, Inserm 1234, Rouen University, Rouen, France
| | - Laurent Zabraniecki
- Pierre-Paul Riquet University Hospital, Toulouse & Toulouse III University - Paul Sabatier, Rheumatology, Toulouse, France
| | - Bénédicte Jamard
- Pierre-Paul Riquet University Hospital, Toulouse & Toulouse III University - Paul Sabatier, Rheumatology, Toulouse, France
| | - Guillaume Couture
- Pierre-Paul Riquet University Hospital, Toulouse & Toulouse III University - Paul Sabatier, Rheumatology, Toulouse, France
| | - Laurent Arnaud
- Hautepierre Hospital, University Hospital of Strasbourg, Rheumatology, Strasbourg, France
| | - Christophe Richez
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases RESO, Bordeaux University Hospital, Bordeaux, France
| | - Yannick Degboé
- Pierre-Paul Riquet University Hospital, Toulouse & Toulouse III University - Paul Sabatier, Rheumatology, Toulouse, France
| | - Adeline Ruyssen-Witrand
- Pierre-Paul Riquet University Hospital, Toulouse & Toulouse III University - Paul Sabatier, Rheumatology, Toulouse, France; Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS "Pharmacologie En Population Cohortes et Biobanques", Toulouse, France
| | - Arnaud Constantin
- Pierre-Paul Riquet University Hospital, Toulouse & Toulouse III University - Paul Sabatier, Rheumatology, Toulouse, France.
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Fong W, Woon TH, Kwan YH, Braun J, van der Heijde D, Boonen A, Kiltz U. Comparison of the ASAS Health Index in patients classified as radiographic axial spondyloarthritis (axSpA) or non-radiographic axSpA in the ASAS Health Index international validation study. RMD Open 2024; 10:e003794. [PMID: 38296803 PMCID: PMC10831435 DOI: 10.1136/rmdopen-2023-003794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVES To determine if there were differences in the Assessment of SpondyloArthritis international Society Health Index (ASAS HI) scores between patients classified as radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axSpA (nr-axSpA), and to identify factors associated with higher ASAS HI scores in both disease phenotypes. METHODS This study was an ancillary analysis of the ASAS HI international validation project performed in 23 countries. Patients were included if they were ≥18 years of age and diagnosed with axSpA. Univariable and multivariable analysis were performed to determine if ASAS HI scores differed between the axSpA phenotypes, and to identify other variables associated with ASAS HI scores. We also tested for potential interactions between the axSpA phenotype and significant variables identified through the multivariable regression. RESULTS A total of 976 patients were included, with 703 having r-axSpA and 273 nr-axSpA. Patients with r-axSpA reported higher (worse) ASAS HI scores compared with those with nr-axSpA (6.8 (4.4) vs 6.0 (4.0), p=0.02), but the axSpA phenotype was not associated with ASAS HI scores in the multivariable regression (β: -0.19, 95% CI: -0.56 to 0.19). Female gender, having worse physical function (Bath Ankylosing Spondylitis Functional Index), disease activity (Ankylosing Spondylitis Disease Activity Score) and anxiety and depressive symptoms (Hospital Anxiety and Depression Scale) were associated with higher ASAS HI scores. No interactions were found to be significant. CONCLUSION Overall health and functioning are similarly affected in patients with r-axSpA and nr-axSpA. Female patients, having worse physical function, disease activity, anxiety and depressive symptoms were independently associated with higher ASAS HI scores.
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Affiliation(s)
- Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ting Hui Woon
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Yu Heng Kwan
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | | | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and the Caphri Research Institute Maastricht University, Maastricht, The Netherlands
| | - Uta Kiltz
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
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Fatica M, Monosi B, Conigliaro P, D'Antonio A, Essofi S, Cuccagna E, Bergamini A, Biancone L, Monteleone G, Triggianese P, Calabrese E, Chimenti MS. Impact of biological therapy in reducing the risk of arthritis development in inflammatory bowel diseases. RMD Open 2024; 10:e003820. [PMID: 38296800 PMCID: PMC10831466 DOI: 10.1136/rmdopen-2023-003820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE Evaluate spondyloarthritis (SpA) incidence in inflammatory bowel diseases (IBD) between patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) and conventional DMARDs (cDMARDs) and define risk factors associated with SpA development. METHODS Retrospective cohort study was conducted on patients with Crohn's disease (CD) or ulcerative colitis (UC) and divided into two cohorts: cDMARDs or bDMARDs/targeted synthetic (ts) DMARDs treated patients. Rheumatological assessment was performed in patients presenting musculoskeletal symptoms. Multivariate analysis and Kaplan-Meier curves were used to evaluate the adjusted SpA risk development. RESULTS 507 patients were included in the study. 176 patients with CD received bDMARDs, 112 cDMARDs and 106 new SpA diagnosies were formulated. Females (OR 1.7 (95% CI 1.1 to 3), adjusted p=0.04), non-stricturing/non-penetrating phenotype (OR 2 (95% CI 1.1 to 3.4), adjusted p=0.01), psoriasis (OR 2.1 (95% CI 1 to 4.6), adjusted p=0.04) and non-infectious uveitis (OR 6.8 (95% CI 1.4 to 33.4), adjusted p=0.01) were associated with increased SpA risk development, while bDMARDs usage was protective (OR 0.4 (95% CI 0.2 to 0.8), adjusted p=0.01), statistically higher than cDMARDs throughout the entire follow-up (effect size 0.47). 98 patients with UC received b-tsDMARDs, 121 cDMARDs and 56 new SpA diagnoses were formulated. Females (OR 2.1 (95% CI 1 to 4.3), adjusted p=0.02) and psoriasis (OR 2.7 (95% CI 1 to 6.8), adjusted p=0.03) were associated with increased SpA risk development, while bDMARDs were protective for SpA development for up to 12 months of treatment compared with cDMARDs (p=0.03). CONCLUSIONS bDMARDs treatment had an impact in reducing SpA development and clinical associated risk factors to transition from IBD to IBD-SpA emerged.
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Affiliation(s)
- Mauro Fatica
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Benedetta Monosi
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Conigliaro
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Arianna D'Antonio
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sara Essofi
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Cuccagna
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Bergamini
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Livia Biancone
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Monteleone
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Triggianese
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emma Calabrese
- Gastrointestinal Unit, Departement of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Gordon H, Burisch J, Ellul P, Karmiris K, Katsanos K, Allocca M, Bamias G, Barreiro-de Acosta M, Braithwaite T, Greuter T, Harwood C, Juillerat P, Lobaton T, Müller-Ladner U, Noor N, Pellino G, Savarino E, Schramm C, Soriano A, Michael Stein J, Uzzan M, van Rheenen PF, Vavricka SR, Vecchi M, Zuily S, Kucharzik T. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis 2024; 18:1-37. [PMID: 37351850 DOI: 10.1093/ecco-jcc/jjad108] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Hannah Gordon
- Department of Gastroenterology, Barts Health NHS Trust, London, Centre for Immunobiology, Blizard Institute, Faculty of Medicine, Barts & The London Medical School, Queen Mary University of London, UK
| | - Johan Burisch
- Gastrounit, medical division, Hvidovre Hospital, University of Copenhagen, Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Giorgos Bamias
- GI Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Manuel Barreiro-de Acosta
- University Hospital Santiago De Compostela CHUS, Department of Gastroenterology - IBD Unit, Santiago De Compostela, Spain
| | - Tasanee Braithwaite
- School of Immunology and Microbiology, King's College London, The Medical Eye Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Thomas Greuter
- Division of Gastroenterology and Hepatology, GZO - Zurich Regional Health Center, Wetzikon, Division of Gastroenterology and Hepatology, University Hospital Lausanne - CHUV, Lausanne, Switzerland; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Pascal Juillerat
- Gastroenterology, Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland; Crohn and Colitis Center, Gastro-entérologie Beaulieu SA, Lausanne, Switzerland
| | - Triana Lobaton
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent; Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
| | - Nurulamin Noor
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gianluca Pellino
- Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Christoph Schramm
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Soriano
- Gastroenterology Division and IBD Center, Internal Medicine Department, Azienda Unità Sanitaria Locale - IRCCS, 42122 Reggio Emilia, Italy
| | - Jürgen Michael Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
| | - Mathieu Uzzan
- Department of Gastroenterology, Hôpital Henri Mondor, APHP, Créteil, France
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - Maurizio Vecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stephane Zuily
- Vascular Medicine Division and French Referral Center for Rare Auto-Immune Diseases, Université de Lorraine, INSERM, DCAC and CHRU-Nancy, Nancy, France
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Münster, Lüneburg, Germany
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Cure O, Kizilkaya B, Ciftel S, Mercantepe F. The Effect of Anti-Tumor Necrosis Factor Therapy on The Plasma Atherogenic Index in Rheumatic Diseases. Metab Syndr Relat Disord 2024. [PMID: 38252497 DOI: 10.1089/met.2023.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Background: The risk of atherosclerosis is increased in individuals with rheumatological disease. The objective of this study is to examine the heightened susceptibility to atherosclerosis in persons afflicted with rheumatological disorders. This study aimed to assess the impact of anti-tumor necrosis factor (anti-TNF) medication on the plasma atherogenic index (PAI) in persons diagnosed with rheumatological disease. Methods: This study used a retrospective cross-sectional design to investigate a cohort of 136 patients with rheumatological disease who were undergoing anti-TNF therapy (Group 1), as well as a comparison group of 117 patients getting conventional therapy (Group 2). Measurements of PAI were conducted at the initial baseline and again at the sixth month of treatment. Results: Initially, there was no statistically significant disparity observed in PAI values between the two cohorts. After a period of 6 months, a notable reduction in PAI was identified in the group receiving anti-TNF medication (P = 0.01), while no significant alteration was detected in the group receiving conventional treatment. Conclusion: It provides findings showing that anti-TNF therapy can reduce the PAI in individuals with rheumatological disease. This may indicate a potential cardiovascular protective effect of anti-TNF therapy.
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Affiliation(s)
- Osman Cure
- Department of Rheumatology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Bayram Kizilkaya
- Department of Internal Medicine, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Serpil Ciftel
- Department of Endocrinology and Metabolism, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Filiz Mercantepe
- Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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Schindler M, Puchner S, Reinhard J, Leiss F, Windhager R, Lass R. Recurrence-Free Survival after Synovectomy and Subsequent Radiosynoviorthesis in Patients with Synovitis of the Knee-A Retrospective Data Analysis. J Clin Med 2024; 13:601. [PMID: 38276107 PMCID: PMC10816869 DOI: 10.3390/jcm13020601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Persistent knee synovitis leads to joint discomfort, incapacitating inflammation, and functional limitations. The conventional approach has involved surgical procedures to eliminate the actively inflamed synovial membrane. This study aims to investigate the recurrence-free survival and functional outcome after synovectomy and subsequent radiosynoviorthesis (RSO) in patients with knee synovitis. METHODS Thirty-seven knees diagnosed with pigmented villonodular synovitis (PVNS), rheumatoid arthritis (RA), and peripheral spondyloarthritis underwent synovectomy and subsequent RSO between May 2005 and October 2016. The mean age was 34.9 ± 15.1 years, and the mean follow-up period was 84 ± 36.4 months. Clinical outcomes were assessed using the Oxford Knee Score and the presence of swelling and pain at the last follow-up. Recurrence-free survival denotes the duration from synovectomy to surgical re-synovectomy. RESULTS In general, twelve knees underwent re-synovectomy after a mean follow-up of 34.8 ± 24.9 months. The recurrence-free survival was 83.8% at two years, 71.3% at five years, and 61.7% at ten years. The subgroup analysis revealed recurrence-free survival at two years in 63.6% of patients with PVNS, 86.7% of those with RA, and 100% of individuals with peripheral spondyloarthritis. CONCLUSIONS This study demonstrates that combined therapy for synovitis is an effective approach, significantly improving clinical outcomes.
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Affiliation(s)
- Melanie Schindler
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (R.W.); (R.L.)
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany
| | - Stephan Puchner
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (R.W.); (R.L.)
| | - Jan Reinhard
- Department of Orthopedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany; (J.R.); (F.L.)
| | - Franziska Leiss
- Department of Orthopedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany; (J.R.); (F.L.)
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (R.W.); (R.L.)
| | - Richard Lass
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (R.W.); (R.L.)
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Werkl P, Rademacher J, Pleyer U. HLA-B27-positive anterior uveitis : Clinical aspects, diagnostics, interdisciplinary management, and treatment. Ophthalmologie 2024; 121:12-22. [PMID: 38085287 DOI: 10.1007/s00347-023-01960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/03/2024]
Abstract
Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation. Other characteristics are reduced intraocular pressure and a high tendency to relapse, which can also involve the partner eye. Patients with HLA-B27 positive AAU share a high risk for other genetically associated diseases, especially spondylarthritis, chronic inflammatory bowel diseases and psoriasis. As up to 40% of those affected have a systemic disease that has not yet been diagnosed, the ophthalmologist is of major importance for early detection.
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Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz-LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Judith Rademacher
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Universitäts-Augenklinik, Charité, Campus Virchow Klinikum-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, 13355, Berlin, Germany.
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Martins FR, Bernardes M, Sequeira G, Costa L, Carvalho PD. Neutrophile to lymphocyte and platelet to lymphocyte ratios predict clinical response to bDMARD in naïve spondylarthritis patients. ARP Rheumatol 2024; 3:18-28. [PMID: 38368549 DOI: 10.63032/utgy3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Objective: We aim to study association between neutrophile to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios and disease activity, and their value to predict bDMARD response. Methods: A set of spondylarthritis (SpA) patients under bDMARD registered in the Reuma.pt registry was studied. Sociodemographic, clinical and laboratorial variables were assessed on bDMARD initiation, 6, 12, 18 and 24 months (M) thereafter. Univariable and multivariable generalized estimation equations models assessed associations with disease activity. The NLR and PLR predictive value was assessed using univariable and multivariable logistic regression models. Results: A total of 170 patients were included. Most were male (54.7%), with a predominantly axial phenotype (84.7%). Significant associations were observed between NLR [B=1.55, 95% confidence interval (CI) = (1.38; 1.74)] and PLR [(B=1.16, 95% CI = (1.09; 1.24)] with ASDAS-CRP (p < 0.001). Both baseline ratios predicted ∆ ASDAS-CRP ≥ 1.1 at 6 months [OR = 2.20, 95% CI = (1.21, 4.00) for NLR; OR = 1.02, 95% CI = (1.01, 1.04) for PLR, p < 0.01)]. PLR was a significant predictor of ∆ ASDAS-CRP ≥ 1.1 in all timepoints [OR (12 M) = 1.02, 95% CI = (1.00, 1.03), p < 0.05; OR (18M) = 1.02, 95% CI = (1.01, 1.03), p < 0.001; OR (24M) = 1.01, 95% CI = (1.01, 1.02), p < 0.01]. Conclusion: NLR and PLR were associated with disease activity during the follow up of these patients. They seem to be significant predictors of therapeutic response to bDMARD in naïve SpA patients.
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Ferjani HL, Boudriga O, Nessib DB, Kaffel D, Maatallah K, Hamdi W. Probability of the 10-year Risk of Hip and Major Osteoporotic Fracture in Non-radiographic Axial Spondyloarthritis. Curr Rheumatol Rev 2024; 20:82-87. [PMID: 37539931 DOI: 10.2174/1573397119666230804122659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/17/2023] [Accepted: 06/13/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Fracture risk in non-radiographic spondyloarthritis is underestimated. A reliable tool such as the Fracture Risk Assessment tool (FRAX) may assess this risk probability. This study aimed to assess the fracture risk by the FRAX score in patients with nr-axSpA and to determine factors associated with high fracture risk. METHODS We conducted a retrospective study of nr-axSpA patients meeting the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for spondyloarthritis. All patients had Bone Mineral Density (BMD) by dual-energy X-ray absorptiometry (DEXA). The 10- year probability of major osteoporotic fracture (MOF) and hip fracture (HF) was calculated using the Fracture Risk Assessment Tool (FRAX). RESULTS Among 40 patients with nr-axSpA, 27 were women (67.5%). Their mean age was 43.7 ± 12.1 years. The mean disease duration was 3.15 ± 2.7 years. Eighteen patients (45%) had osteopenia, and 12 patients (30%) had osteoporosis. The median HF FRAX was 0% [0-1.2]. The median MOF FRAX was 0.5% [0.3-1.8]. MOF FRAX was positively correlated with age (p = 0.002), disease onset age (p = 0.006), disease duration (p = 0.024), and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) (p < 0.0001), and negatively correlated with daily calcium intake (p < 0.0001). HF FRAX was positively correlated with mSASSS (p < 0.0001) and negatively correlated with daily calcium intake (p = 0.005). CONCLUSION Our study confirmed the frequency of bone loss during nr-axSpA and showed that osteoporotic risk fracture was related not only to traditional risk factors for osteoporosis but also to disease-related factors.
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Affiliation(s)
- Hanene Lassoued Ferjani
- Department of Rheumatology, Kassab Orthopedics Institute, Tunis El Manar University, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Ons Boudriga
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
| | - Dorra Ben Nessib
- Department of Rheumatology, Kassab Orthopedics Institute, Tunis El Manar University, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Dhia Kaffel
- Department of Rheumatology, Kassab Orthopedics Institute, Tunis El Manar University, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Kaouther Maatallah
- Department of Rheumatology, Kassab Orthopedics Institute, Tunis El Manar University, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Wafa Hamdi
- Department of Rheumatology, Kassab Orthopedics Institute, Tunis El Manar University, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
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Hughes CD, Ryan SE, Steel KJA, van den Beukel MD, Trouw LA, van Schie KAJ, Toes REM, Menon B, Kirkham BW, Taams LS. Type 17-specific immune pathways are active in early spondyloarthritis. RMD Open 2023; 9:e003328. [PMID: 38123480 DOI: 10.1136/rmdopen-2023-003328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/04/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Undifferentiated, early inflammatory arthritis (EIA) can differentiate into seropositive or seronegative rheumatoid arthritis (RA), peripheral spondyloarthritis (SpA) or remain as seronegative undifferentiated inflammatory arthritis (UIA). Little is known about immune pathways active in the early stages of SpA and seronegative UIA, in contrast to detailed knowledge of seropositive RA. The aim of this study was to examine if specific immune pathways were active in synovial CD4+ and CD8+ T cells in EIA. METHODS Synovial fluid (SF) samples from 30 patients with EIA were analysed for expression of IL-17A, IFNγ and TNFα in CD8+ or CD4+ T cells. Final clinical diagnoses were made at least 12 months after sample collection, by two independent clinicians blind to the study data. RESULTS Flow cytometry analysis of all EIA samples indicated considerable variation in synovial IL-17A+CD8+ T cells (Tc17) cell frequencies between patients. The group with a final diagnosis of SpA (psoriatic arthritis or peripheral SpA, n=14) showed a significant enrichment in the percentage of synovial Tc17 cells compared with the group later diagnosed with seronegative UIA (n=10). The small number of patients later diagnosed with seropositive RA (n=6) patients had few Tc17 cells, similar to our previous findings in established disease. In contrast, RA SF contained a significantly higher percentage of CD8+IFNγ+ T cells compared with SpA or seronegative UIA. CONCLUSION These results suggest that adaptive T cell cytokine pathways differ not only between RA and SpA but also seronegative UIA early in the disease process, with a particular activation of Tc17 pathways in early SpA.
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Affiliation(s)
- Catherine D Hughes
- Centre for Inflammation Biology & Cancer Immunology, King's College London, London, UK
| | - Sarah E Ryan
- Centre for Inflammation Biology & Cancer Immunology, King's College London, London, UK
| | - Kathryn J A Steel
- Centre for Inflammation Biology & Cancer Immunology, King's College London, London, UK
| | | | - L A Trouw
- Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Karin A J van Schie
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - René E M Toes
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Bina Menon
- Department of Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Bruce W Kirkham
- Department of Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Leonie S Taams
- Centre for Inflammation Biology & Cancer Immunology, King's College London, London, UK
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Gioia C, Picchianti Diamanti A, Perricone R, Chimenti MS, Afeltra A, Navarini L, Migliore A, Massafra U, Bruzzese V, Scolieri P, Meschini C, Paroli M, Caccavale R, Scapato P, Scrivo R, Conti F, Laganà B, Di Franco M. Anti-tumor necrosis factor α: originators versus biosimilars, comparison in clinical response assessment in a multicenter cohort of patients with inflammatory arthropathies. Reumatismo 2023; 75. [PMID: 38115772 DOI: 10.4081/reumatismo.2023.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/25/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To compare etanercept and adalimumab biosimilars (SB4 and ABP501) and respective bioriginators in terms of safety and efficacy in a real-life contest. METHODS We consequently enrolled patients affected by rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, treated with SB4, and ABP501, or with corresponding originators, belonging to the main biological prescribing centers in the Lazio region (Italy), from 2017 to 2020. Data were collected at recruitment and after 4, 8, 12, and 24 months of therapy. RESULTS The multicenter cohort was composed by 455 patients treated with biosimilars [SB4/ABP501 276/179; female/male 307/146; biologic disease-modifying anti-rheumatic drug (b-DMARD) naïve 56%, median age/ interquartile range 55/46-65 years] and 436 treated with originators (etanercept/adalimumab 186/259, female/ male 279/157, b-DMARD naïve 67,2%, median age/interquartile range 53/43-62 years). No differences were found about safety, but the biosimilar group presented more discontinuations due to inefficacy (p<0.001). Female gender, being a smoker, and being b-DMARD naïve were predictive factors of reduced drug survival (p=0.05, p=0.046, p=0.001 respectively). The retention rate at 24 months was 81.1% for bioriginators and 76.5% for biosimilars (median retention time of 20.7 and 18.9 months, respectively) (p=0.002). Patients with remission/low disease activity achievement at 4 months showed a cumulative survival of 90% to biosimilar therapy until 24 months (p=0.001); early adverse reactions instead represented a cause of subsequent drug discontinuation (p=0.001). CONCLUSIONS Real-life data demonstrated a similar safety profile between biosimilars and originators, but a reduced biosimilar retention rate at 24 months. Biosimilars could be considered a valid, safe, and less expensive alternative to originators, allowing access to treatments for a wider patient population.
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Affiliation(s)
- C Gioia
- Division of Rheumatology, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University, Rome.
| | - A Picchianti Diamanti
- Rheumatology, Clinical and Molecular Medicine, Sapienza University, Sant'Andrea University Hospital, Rome.
| | - R Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Tor Vergata University, Rome.
| | - M S Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Tor Vergata University, Rome.
| | - A Afeltra
- Allergology, Clinical Immunology and Rheumatology, Bio-Medical Campus, University of Rome.
| | - L Navarini
- Allergology, Clinical Immunology and Rheumatology, Bio-Medical Campus, University of Rome.
| | - A Migliore
- San Pietro Fatebenefratelli Hospital, Rome.
| | - U Massafra
- San Pietro Fatebenefratelli Hospital, Rome.
| | - V Bruzzese
- Department of Internal Medicine, Rheumatology and Gastroenterology, Nuovo Regina Margherita Hospital, Rome.
| | - P Scolieri
- Department of Internal Medicine, Rheumatology and Gastroenterology, Nuovo Regina Margherita Hospital, Rome.
| | - C Meschini
- General Medicine, Belcolle Hospital, Viterbo.
| | - M Paroli
- Department of Medical-Surgical Sciences and Biotechnology, Polo Pontino, Sapienza University, Latina.
| | - R Caccavale
- Department of Medical-Surgical Sciences and Biotechnology, Polo Pontino, Sapienza University, Latina.
| | - P Scapato
- Rheumatology, Department of Medicine, S. Camillo de Lellis Hospital, Rieti.
| | - R Scrivo
- Division of Rheumatology, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University, Rome.
| | - F Conti
- Division of Rheumatology, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University, Rome.
| | - B Laganà
- Rheumatology, Clinical and Molecular Medicine, Sapienza University, Sant'Andrea University Hospital, Rome.
| | - M Di Franco
- Division of Rheumatology, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University, Rome.
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Lee KH, Lee RW, Lee KH, Park W, Kwon SR, Lim MJ. The Development and Validation of an AI Diagnostic Model for Sacroiliitis: A Deep-Learning Approach. Diagnostics (Basel) 2023; 13:3643. [PMID: 38132228 PMCID: PMC10743277 DOI: 10.3390/diagnostics13243643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Sacroiliitis refers to the inflammatory condition of the sacroiliac joints, frequently causing lower back pain. It is often associated with systemic conditions. However, its signs on radiographic images can be subtle, which may result in it being overlooked or underdiagnosed. This study aims to utilize artificial intelligence (AI) to create a diagnostic tool for more accurate sacroiliitis detection in radiological images, with the goal of optimizing treatment plans and improving patient outcomes. MATERIALS AND METHOD The study included 492 patients who visited our hospital. Right sacroiliac joint films were independently evaluated by two musculoskeletal radiologists using the Modified New York criteria (Normal, Grades 1-4). A consensus reading resolved disagreements. The images were preprocessed with Z-score standardization and histogram equalization. The DenseNet121 algorithm, a convolutional neural network with 201 layers, was used for learning and classification. All steps were performed on the DEEP:PHI platform. RESULT The AI model exhibited high accuracy across different grades: 94.53% (Grade 1), 95.83% (Grade 2), 98.44% (Grade 3), 96.88% (Grade 4), and 96.09% (Normal cases). Sensitivity peaked at Grade 3 and Normal cases (100%), while Grade 4 achieved perfect specificity (100%). PPVs ranged from 82.61% (Grade 1) to 100% (Grade 4), and NPVs peaked at 100% for Grade 3 and Normal cases. The F1 scores ranged from 64.41% (Grade 1) to 95.38% (Grade 3). CONCLUSIONS The AI diagnostic model showcased a robust performance in detecting and grading sacroiliitis, reflecting its potential to enhance diagnostic accuracy in clinical settings. By facilitating earlier and more accurate diagnoses, this model could substantially impact treatment strategies and patient outcomes.
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Affiliation(s)
- Kyu-Hong Lee
- Department of Radiology, College of Medicine, Inha University, Incheon 22212, Republic of Korea; (K.-H.L.)
| | - Ro-Woon Lee
- Department of Radiology, College of Medicine, Inha University, Incheon 22212, Republic of Korea; (K.-H.L.)
| | - Kyung-Hee Lee
- Department of Radiology, College of Medicine, Inha University, Incheon 22212, Republic of Korea; (K.-H.L.)
| | - Won Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon 22212, Republic of Korea; (W.P.)
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon 22212, Republic of Korea; (W.P.)
| | - Mie-Jin Lim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon 22212, Republic of Korea; (W.P.)
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Altenberger R, Rauchegger T, Haas G, Teuchner B, Schirmer M. Eye Disease in Patients with Rheumatic Diseases: A Retrospective Observational Cohort Study. J Clin Med 2023; 12:7510. [PMID: 38137579 PMCID: PMC10744173 DOI: 10.3390/jcm12247510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Data on eye diseases in rheumatic patients are limited. The aim of this study was to retrospectively assess the prevalence of ophthalmologic diseases in patients at a rheumatology outpatient clinic who also visited the ophthalmologic clinic. For this retrospective observational cohort study, a chart review was performed according to the STROBE guidelines. In this cohort, an ophthalmologic diagnosis was made in 26.9% of the 1529 rheumatic outpatients, whereas from a rheumatologic perspective, inflammatory non-infectious diagnoses dominated, at 71.7%. From an ophthalmologic perspective, diagnoses without inflammatory pathophysiologic backgrounds dominated, at 54.9%. Inflammatory non-infectious ophthalmologic disease was diagnosed in 24.2% of patients with rheumatoid arthritis and 29.3% of patients with peripheral spondyloarthritis. Not a single rheumatoid arthritis patient was diagnosed with anterior uveitis; however, 16.5% of spondyloarthritis patients were diagnosed with anterior uveitis (p < 0.001). The prevalence of uveitis was 16.3% in axial and 20.1% in peripheral spondyloarthritis. In conclusion, an interdisciplinary rheumatologic-ophthalmologic setting appears justified to further improve the management of patients with rheumatic diseases.
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Affiliation(s)
- Ralf Altenberger
- Clinic II, Department of Internal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Teresa Rauchegger
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, 6020 Innsbruck, Austria; (T.R.); (G.H.)
| | - Gertrud Haas
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, 6020 Innsbruck, Austria; (T.R.); (G.H.)
| | - Barbara Teuchner
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, 6020 Innsbruck, Austria; (T.R.); (G.H.)
| | - Michael Schirmer
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, 6020 Innsbruck, Austria; (T.R.); (G.H.)
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Deshpande G, Sonawale A, Mulkalwar A, Jain H, Goyal A. Short-Term Efficacy and Adverse Effects of Sulfasalazine in the Management of Axial Spondyloarthropathy. Cureus 2023; 15:e49978. [PMID: 38179353 PMCID: PMC10766130 DOI: 10.7759/cureus.49978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is an inflammatory spondyloarthropathy that involves the sacroiliac joints and the axial skeleton. Sulfasalazine's efficacy in treating the axial symptoms of AS has been a subject of controversy. METHODS This prospective observational study recruited AS patients and categorized them into two groups: the first group had AS for less than or equal to four years and the second group had AS for more than four years. Erythrocytic sedimentation rate (ESR) and C-reactive protein (CRP) levels were recorded at baseline and at six-month follow-up. Disease severity was assessed using the ankylosing spondylitis disease activity score (ASDAS), Bath ankylosing spondylitis disease activity index (BASDAI) score, and Bath ankylosing spondylitis functional index (BASFI) score. RESULTS A total of 33 patients diagnosed with AS were recruited in this study, mostly males (88%) and within 21-30 years of age. ESR and CRP values were measured at baseline and at six months post-treatment with sulfasalazine. Mean ESR and mean CRP values showed a statistically significant reduction of 43.5% (p=0.001) and 58.45% (p=0.0012) respectively, at the 6-month follow-up. Four patients (12.12%) reported gastrointestinal intolerance. The mean reduction in the ASDAS score was 24% (p=0.002), the BASDAI score was 40.08% (p=0.001), and the BASFI score was 39.54% (p=0.01). Additionally, the duration of symptoms did not appear to influence with efficacy of sulfasalazine. DISCUSSION Sulfasalazine is a safe alternative therapy for patients with AS who cannot afford biologics, due to its reasonable short-term efficacy, good tolerability, cost-effective nature, and low incidence of adverse effects.
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Affiliation(s)
- Gauravi Deshpande
- Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Archana Sonawale
- Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Alhad Mulkalwar
- Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Hritvik Jain
- Internal Medicine, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, IND
| | - Aman Goyal
- Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
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Bekaryssova D, Mruthyunjaya Vijaya P, Ahmed S, Sondur S, Zimba O. Revisiting articular syndrome in the peri-pandemic COVID-19 era. Rheumatol Int 2023; 43:2157-2166. [PMID: 37747562 DOI: 10.1007/s00296-023-05459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
Articular syndrome is often the presentation of a person's various rheumatic or related diseases. It includes both arthralgia and arthritis, with objective signs of joint inflammation defining the latter. This syndromic approach to joint pain enables a scientific method for early diagnosis of common rheumatic conditions without compromising the recognition of uncommon conditions. This review explores common rheumatic conditions associated with articular syndrome, including osteoarthritis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE). It supports the early differentiation of uncommon but emerging entities such as reactive arthritis (ReA). The aim of the review is to comprehensively overview various forms of articular syndrome to update rheumatologists' and allied health specialists' knowledge. Epidemiology, clinical presentations, diagnostic approaches, and therapeutic strategies are discussed in the context of articular syndrome. The challenges emerging in the peri-pandemic COVID-19 era are highlighted. The improved understanding of the spectrum of clinical conditions and disease states presenting with articular syndrome may facilitate early diagnosis, optimal management, and enhanced patient outcomes within the realm of rheumatology.
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Affiliation(s)
- Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.
| | - Prakashini Mruthyunjaya Vijaya
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Suhas Sondur
- Department of Orthopedics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Kraków, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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Pastor M, Lukas C, Ramos-Pascual S, Saffarini M, Wantz W, Cyteval C. Sacroiliac joint MRI for diagnosis of ax-SpA: algorithm to improve the specificity of the current ASAS MRI criteria. Eur Radiol 2023; 33:8645-8655. [PMID: 37498385 DOI: 10.1007/s00330-023-09969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/31/2023] [Accepted: 05/26/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To compare sacroiliac joint (SIJ) lesions on MRI in women with versus without axial spondyloarthritis (ax-SpA) and establish an algorithm to determine whether such lesions are due to ax-SpA. METHODS This retrospective comparative study assessed bone marrow edema (BME), sclerosis, erosions, osteophytes, and ankylosis at the SIJ in two groups of women, one with and another without ax-SpA. Sensitivity and specificity were calculated for combinations/characteristics of lesions, using rheumatologists' assessment with assessment of spondyloarthritis international society (ASAS) criteria as the gold standard for diagnosis of ax-SpA. RESULTS Compared to women without ax-SpA, women with ax-SpA had more BME (61% vs 17%, p < 0.001), sclerosis (40% vs 22%, p < 0.001), erosions (35% vs 5%, p < 0.001), and ankylosis (2% vs 0%, p = 0.007), but less osteophytes (5% vs 33%, p < 0.001). The ASAS MRI criteria yielded 59% sensitivity and 88% specificity, while a new algorithm achieved 56% sensitivity and 95% specificity using the following criteria: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. CONCLUSIONS We recommend the following pragmatic algorithm for MRI diagnosis of ax-SpA in women: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. The false positive rate when using the new algorithm (3.3%) is less than half than when using the ASAS MRI criteria (7.7%); thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA. CLINICAL RELEVANCE STATEMENT The developed algorithm has a false-positive rate that is less than half than when using the ASAS MRI criteria (3.3% vs 7.7%), thus its application in clinical practice could reduce overdiagnosis and prevent overtreatment of axial spondyloarthritis. KEY POINTS • Compared to women without axial spondyloarthritis (ax-SpA), women with ax-SpA had a significantly higher prevalence of bone marrow edema (BME), sclerosis, erosions, and ankylosis, but a significantly lower prevalence of osteophytes. • A new algorithm for positive ax-SpA based on sacroiliac joint MRI was developed: no osteophytes at the sacroiliac joint (SIJ) and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. • We recommend this new algorithm for diagnosis of ax-SpA in women, as it has a significantly better specificity than the assessment of spondyloarthritis international society (ASAS) MRI criteria and less than half the false positive rate; thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.
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Affiliation(s)
- Maxime Pastor
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, 34295, Montpellier, France
| | - Cedric Lukas
- Department of Rheumatology, Montpellier University Hospital, 34295, Montpellier, France
| | | | - Mo Saffarini
- ReSurg SA, 22 Rue Saint-Jean, 1260, Nyon, Switzerland
| | - William Wantz
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, 34295, Montpellier, France
| | - Catherine Cyteval
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, 34295, Montpellier, France
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Mariani FM, Alunno A, Di Ruscio E, Altieri P, Ferri C, Carubbi F. Human Leukocyte Antigen B*27-Negative Spondyloarthritis: Clinical, Serological, and Radiological Features of a Single-Center Cohort. Diagnostics (Basel) 2023; 13:3550. [PMID: 38066792 PMCID: PMC10706745 DOI: 10.3390/diagnostics13233550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 04/05/2024] Open
Abstract
The strong genetic association between HLA-B*27 and spondyloarthritis (SpA) accounts for about 90% of the susceptibility to axial SpA (axSpA), and the presence of HLA-B*27 is helpful in classifying patients according to the Assessment of SpondyloArthritis International Society (ASAS) classification criteria. However, over the years, other HLA-B alleles have been associated with an increased risk of developing SpA; on this basis, the aim of our study was to describe the demographic, clinical, and radiological characteristics of a cohort of SpA patients who were negative for HLA-B*27. We identified 85 patients with a clinical diagnosis of SpA displaying HLA-B alleles other than HLA-B*27; HLA-B*51 emerged as the most prevalent allele (N = 33, 39%), regardless of the fulfilment of either the axial or the peripheral ASAS criteria. The second most prevalent allele in the full cohort (N = 16, 19%) and in the patients fulfilling either the axial or the peripheral criteria was HLA-B*35. The third most prevalent allele in the full cohort was HLA-B*18 (N = 12, 15%), which was also the second most prevalent allele in the patients fulfilling neither of the two sets of criteria. Overall, the clinical picture was similar across the subgroups fulfilling the different sets of ASAS criteria; however, the patients not fulfilling any ASAS criteria had a higher likelihood of having arthritis compared to the patients fulfilling the axial criteria, whereas the Bath Ankylosing Spondylitis Functional Index was significantly higher in those patients fulfilling the axial criteria compared to those who did not fulfill any criteria. Our results indicate that other HLA alleles, beyond HLA-B*27, could be useful in facilitating SpA diagnosis, particularly in patients with a clinical picture which is consistent with SpA but does not fulfill the ASAS classification criteria.
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Affiliation(s)
| | | | | | | | - Claudio Ferri
- Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L’Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy (A.A.); (P.A.); (F.C.)
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Jacquot R, Jamilloux Y, Bert A, Gerfaud-Valentin M, Richard-Colmant G, Kodjikian L, Sève P. Etiological Diagnosis of Uveitis: Contribution of the of the Extra-Ophthalmological Clinical Examination. Ocul Immunol Inflamm 2023:1-12. [PMID: 37948510 DOI: 10.1080/09273948.2023.2276304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Determining uveitis etiology is a challenge. It is based primarily on demographic data and the characteristics of eye examination. It is not clear to what extent extraocular physical signs contribute to elucidating the etiology. This study aimed to establish the contribution of the clinical extra-ophthalmological features for the assessment of the underlying etiology of uveitis. METHODS We retrospectively reviewed 1307 patients with uveitis referred to our tertiary center between 2003 and 2021. Uveitis was classified according to the Standardization of Uveitis Nomenclature. Clinical features were collected at diagnosis by internists before the etiological diagnosis was made. The main outcome description was the contribution of clinical features. RESULTS Clinical extra-ophthalmological features contributed to the assessment of the underlying etiology of uveitis in 363 (27.8%) patients. The joint and the skin examinations were the most useful for etiological investigations, respectively in 12.3% and 11.8% of patients. Five etiologies of uveitis accounted for 80% of the cases: sarcoidosis, HLA-B27-related uveitis, Behçet's disease, multiple sclerosis, and Vogt-Koyanagi-Harada disease. Clinical extra-ophthalmological features were particularly important in the etiological diagnosis of acute bilateral anterior uveitis and panuveitis. CONCLUSION This study suggests that clinical extra-ophthalmological features are essential for the etiological diagnosis of uveitis in more than a quarter of patients. It demonstrates once again the value of collaboration between ophthalmologists and other specialists experienced in performing extra-ophthalmological clinical examinations, particularly in patients with acute bilateral anterior uveitis and panuveitis.
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Affiliation(s)
- Robin Jacquot
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
- Immunopathology Department, Lyon Immunopathology FEderation (LIFE), Lyon, France
| | - Arthur Bert
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Gaëlle Richard-Colmant
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, University Claude Bernard Lyon 1, Villeurbanne, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
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Fagni F, Bettiol A, Silvestri E, Fedi R, Palermo A, Urban ML, Mazzotta R, Malandrino D, Bello F, Mattioli I, Simon D, Di Scala G, Schett G, Prisco D, Emmi G. Prevalence and clinical associations of ultrasound-confirmed enthesitis in systemic lupus erythematosus. Rheumatology (Oxford) 2023; 62:3619-3626. [PMID: 36929914 DOI: 10.1093/rheumatology/kead123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To assess the prevalence of US-confirmed enthesitis in a cohort of patients with SLE and to analyse the clinical associations to enthesitis during the course of SLE. METHODS In a retrospective analysis of the SLE cohort of the Lupus Unit of the Careggi University Hospital, US examinations of SLE patients presenting with tender and/or swollen joints were retrieved to assess the presence of enthesitis. Patients with US-proven enthesitis were compared with SLE controls with tender and/or swollen joints who showed no US evidence of enthesitis. Clinical and laboratory features were compared at disease onset and during follow-up. RESULTS A total of 400 patients fulfilling EULAR/ACR classification criteria for SLE were assessed. Of these, 106 underwent articular US examination. Evidence of enthesitis was found in 31/106 (29.2%) patients. Seventy-one patients without US-enthesitis were included as controls; four were excluded due to lack of follow-up data. Laboratory and clinical features were comparable between cases and controls at disease onset. Throughout a median follow-up of 10.0 (interquartile range [IQR] 8.3-23.3) years for cases and 12.4 (IQR 7.2-13.3) years for controls, patients with enthesitis were less likely to develop renal involvement (22.6% vs 46.5%, P = 0.028) and failed B cell depletion more frequently (75.0% vs 0%). CONCLUSION In SLE patients with clinically active joints, US-proven enthesitis is a fairly common finding. Enthesitis in SLE could be the hallmark of a distinct disease phenotype with less renal involvement, more arthritis and low response to anti-CD 20 therapy, potentially requiring a tailored treatment.
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Affiliation(s)
- Filippo Fagni
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - Roberto Fedi
- Internal Medicine Unit IV, Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Adalgisa Palermo
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - Ruggero Mazzotta
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - Danilo Malandrino
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Gerardo Di Scala
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, and Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy
- Centre for Inflammatory Diseases, Monash University, Department of Medicine, Monash Medical Centre, Melbourne, Australia
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50
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Li JX, Wu X, Lee YH, Xu H. West meets East in genetics of ankylosing spondylitis. Int J Rheum Dis 2023; 26:2122-2126. [PMID: 37910030 DOI: 10.1111/1756-185x.14846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Jing-Xing Li
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Xin Wu
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yung-Heng Lee
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan
- Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Huji Xu
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, China
- Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
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