1
|
Chmielińska M, Felis-Giemza A, Olesińska M, Paradowska-Gorycka A, Szukiewicz D. The failure of biological treatment in axial spondyloarthritis is linked to the factors related to increased intestinal permeability and dysbiosis: prospective observational cohort study. Rheumatol Int 2024:10.1007/s00296-024-05614-4. [PMID: 38743252 DOI: 10.1007/s00296-024-05614-4] [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: 12/17/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND A significant number of patients with axial spondyloarthritis (axSpA) do not respond to biological therapy. Therefore, we decided to investigate the specificity of this group of patients and, in particular, whether haptoglobin (Hp), its polymorphism and zonulin, in addition to other clinical features, are predictors of poor response to biological treatment. METHODS 48 patients with axSpA who were unsuccessfully treated with standard drugs were converted to biological treatment, and from this time on, a 12-week follow-up was started to assess the failure of biological treatment (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) decrease < 2 points). Predictors of treatment failure were identified using logistic regression analysis. RESULTS 21% of subjects had biological treatment failure. Patients who had a higher zonulin level, a history of frequent infections, were older, had inflammatory bowel disease (IBD), had a lower Hp level at the time of inclusion in biological therapy showed an increased risk of treatment failure. CONCLUSIONS The results of the study support the hypothesis that the effectiveness of biological treatment of axSpA is limited by changed microbiota and intestinal epithelial barrier dysfunction, as an increased risk of biological treatment failure was observed in patients who were older, had higher zonulin level, IBD and repeated courses of antibiotics due to frequent infections. Therefore, starting biological treatment should be followed by reducing intestinal permeability and regulating the disturbed gut microbiome.
Collapse
Affiliation(s)
- Magdalena Chmielińska
- Department of Biophysics, Physiology and Pathophysiology, Faculty of Health Sciences, Medical University of Warsaw, 02-004, Warsaw, Poland.
- Department of Outpatient Clinics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland.
| | - Anna Felis-Giemza
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Marzena Olesińska
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Agnieszka Paradowska-Gorycka
- Department of Molecular Biology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Dariusz Szukiewicz
- Department of Biophysics, Physiology and Pathophysiology, Faculty of Health Sciences, Medical University of Warsaw, 02-004, Warsaw, Poland
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Marques ML, Ramiro S, van Lunteren M, Stal RA, Landewé RB, van de Sande M, Fagerli KM, Berg IJ, van Oosterhout M, Exarchou S, Ramonda R, van der Heijde D, van Gaalen FA. Can rheumatologists unequivocally diagnose axial spondyloarthritis in patients with chronic back pain of less than 2 years duration? Primary outcome of the 2-year SPondyloArthritis Caught Early (SPACE) cohort. Ann Rheum Dis 2024; 83:589-598. [PMID: 38233104 DOI: 10.1136/ard-2023-224959] [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: 09/04/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To investigate the prevalence of axial spondyloarthritis (axSpA) in patients with chronic back pain (CBP) of less than 2 years (2y) duration referred to the rheumatologist, the development of diagnosis over time, and patient characteristics of those developing definite (d-)axSpA over 2y. METHODS We analysed the 2y data from SPondyloArthritis Caught Early, a European cohort of patients (<45 years) with CBP (≥3 months, ≤2y) of unknown origin. The diagnostic workup comprised evaluation of clinical SpA features, acute phase reactants, HLA-B27, radiographs and MRI (sacroiliac joints and spine), with repeated assessments. At each visit (baseline, 3 months, 1y and 2y), rheumatologists reported a diagnosis of axSpA or non-axSpA with level of confidence (LoC; 0-not confident at all to 10-very confident). MAIN OUTCOME axSpA diagnosis with LoC≥7 (d-axSpA) at 2y. RESULTS In 552 patients with CBP, d-axSpA was diagnosed in 175 (32%) at baseline and 165 (30%) at 2y. Baseline diagnosis remained rather stable: at 2y, baseline d-axSpA was revised in 5% of patients, while 8% 'gained' d-axSpA. Diagnostic uncertainty persisted in 30%. HLA-B27+ and baseline sacroiliitis imaging discriminated best 2y-d-axSpA versus 2y-d-non-axSpA patients. Good response to non-steroidal anti-inflammatory drugs and MRI-sacroiliitis most frequently developed over follow-up in patients with a new d-axSpA diagnosis. Of the patients who developed MRI-sacroiliitis, 7/8 were HLA-B27+ and 5/8 male. CONCLUSION A diagnosis of d-axSpA can be reliably made in nearly one-third of patients with CBP referred to the rheumatologist, but diagnostic uncertainty may persist in 5%-30% after 2y. Repeated assessments yield is modest, but repeating MRI may be worthwhile in male HLA-B27+ patients.
Collapse
Affiliation(s)
- Mary Lucy Marques
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, Netherlands
| | - Miranda van Lunteren
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Rosalinde Anne Stal
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Robert Bm Landewé
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, Netherlands
- Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marleen van de Sande
- Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Karen Minde Fagerli
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Inger Jorid Berg
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Sofia Exarchou
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Lund, Sweden
| | - Roberta Ramonda
- Rheumatology Unit, Padua University Hospital, Padova, Veneto, Italy
| | | | - Floris A van Gaalen
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| |
Collapse
|
4
|
Proft F, Torgutalp M, Muche B, Rios Rodriguez V, Listing J, Protopopov M, Rademacher J, Haibel H, Spiller L, Weber AK, Verba M, Brandt-Juergens J, Kiltz U, Sieburg M, Jacki S, Sieper J, Poddubnyy D. Comparison of the effect of treatment with NSAIDs added to anti-TNF therapy versus anti-TNF therapy alone on the progression of structural damage in the spine over 2 years in patients with radiographic axial spondyloarthritis from the randomised-controlled CONSUL trial. Ann Rheum Dis 2024; 83:599-607. [PMID: 38228361 DOI: 10.1136/ard-2023-224699] [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: 07/10/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES The study aimed to evaluate the effect of adding a non-steroidal anti-inflammatory drug (NSAID), celecoxib (CEL), to a tumour necrosis factor inhibitor (TNFi), golimumab (GOL), compared with TNFi monotherapy on radiographic spinal progression in patients with radiographic axial spondyloarthritis (r-axSpA) over 2 years. METHODS R-axSpA patients, having risk factors for radiographic progression (high disease activity plus C reactive protein >5 mg/L and/or ≥1 syndesmophyte(s)), underwent a 12-week run-in phase with GOL 50 mg every 4 weeks. In the core phase (96 weeks), only patients with a good clinical response at week 12 were randomised (1:1) to GOL+CEL 200 mg two times per day (combination therapy) or GOL monotherapy. The primary endpoint was radiographic progression assessed by modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change at week 108 in the intent-to-treat population. RESULTS A total of 128 patients were enrolled in the run-in phase; and 109 patients were randomised at week 12 to monotherapy (n=55) or combination therapy (n=54). At week 108, 97 (52 vs 45) patients completed the study. The change in mSASSS at week 108 was 1.7 (95% CI 0.8 to 2.6) in the monotherapy vs 1.1 (95% CI 0.4 to 1.8) in the combination therapy groups (p=0.79). New syndesmophytes occurred in 25% of patients in the monotherapy vs 11% of patients in the combination therapy groups (p=0.12). During the study, no significant differences in adverse events and serious adverse events were observed between the groups. CONCLUSIONS Combination therapy with GOL+CEL did not demonstrate statistically significant superiority over GOL monotherapy in retarding radiographic spinal progression over 2 years in r-axSpA.
Collapse
Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Burkhard Muche
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
- Department of Rheumatology CCM, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
- BIH, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Laura Spiller
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Anne-Katrin Weber
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Maryna Verba
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | | | - Swen Jacki
- Rheumatologische Schwerpunktpraxis, Tübingen, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| |
Collapse
|
5
|
Navarro-Compán V, Ramiro S, Deodhar A, Mease PJ, Rudwaleit M, de la Loge C, Fleurinck C, Taieb V, Mørup MF, Massow U, Kay J, Magrey M. Association of clinical response criteria and disease activity levels with axial spondyloarthritis core domains: results from two phase 3 randomised studies, BE MOBILE 1 and 2. RMD Open 2024; 10:e004040. [PMID: 38599650 PMCID: PMC11015249 DOI: 10.1136/rmdopen-2023-004040] [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: 01/02/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE To assess how achievement of increasingly stringent clinical response criteria and disease activity states at week 52 translate into changes in core domains in patients with non-radiographic (nr-) and radiographic (r-) axial spondyloarthritis (axSpA). METHODS Patients in BE MOBILE 1 and 2 achieving different levels of response or disease activity (Assessment of SpondyloArthritis International Society (ASAS) and Ankylosing Spondylitis Disease Activity Score (ASDAS) response criteria, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50)) at week 52 were pooled, regardless of treatment arm. Associations between achievement of these endpoints and change from baseline (CfB) in patient-reported outcomes (PROs) measuring core axSpA domains, including pain, fatigue, physical function, overall functioning and health, and work and employment, were assessed. RESULTS Achievement of increasingly stringent clinical efficacy endpoints at week 52 was generally associated with sequentially greater improvements from baseline in all PROs. Patients with nr-axSpA achieving ASAS40 demonstrated greater improvements (CfB) than patients who did not achieve ASAS40 but did achieve ASAS20, in total spinal pain (-5.3 vs -2.8, respectively), Functional Assessment of Chronic Illness-Fatigue subscale (12.7 vs 6.7), Bath Ankylosing Spondylitis Function Index (-3.9 vs -1.8), European Quality of Life 5-Dimension 3-Level Version (0.30 vs 0.16), Work Productivity and Activity Impairment-axSpA presenteeism (-35.4 vs -15.9), overall work impairment (-36.5 vs -12.9), activity impairment (-39.0 vs -21.0) and sleep (9.0 vs 3.9). Results were similar for ASDAS and BASDAI50. Similar amplitudes of improvement were observed between patients with nr-axSpA and r-axSpA. CONCLUSIONS Patients treated with bimekizumab across the full axSpA disease spectrum, who achieved increasingly stringent clinical response criteria and lower disease activity at week 52, reported larger improvements in core axSpA domains.
Collapse
Affiliation(s)
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Philip J Mease
- School of Medicine, Swedish Medical Center and University, Seattle, Washington, USA
| | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | | | | | | | | | | | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marina Magrey
- Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
6
|
Hernández-Cruz B, Otero-Varela L, Freire-González M, Busquets-Pérez N, García González AJ, Moreno-Ramos M, Blanco-Madrigal JM, Manrique-Arija S, Perez-Pampin E, Ruiz-Montesino D, Sánchez-Alonso F, Sanchez-Piedra C, Castrejón I. Janus kinase inhibitors and tumour necrosis factor inhibitors show a favourable safety profile and similar persistence in rheumatoid arthritis, psoriatic arthritis and spondyloarthritis: real-world data from the BIOBADASER registry. Ann Rheum Dis 2024:ard-2023-225271. [PMID: 38594056 DOI: 10.1136/ard-2023-225271] [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: 11/13/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To compare the safety of Janus kinase inhibitors (JAKi) with that of tumour necrosis factor inhibitors (TNFi) and determine drug persistence among patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). METHODS We analysed data from patients included in BIOBADASER 3.0 and treated with JAKi or TNFi from 2015 to 2023 and estimated the incidence rate ratio (IRR) of adverse events and persistence. RESULTS A total of 6826 patients were included. Of these, 52% had RA, 25% psoriatic arthritis and 23% axial SpA. Treatment was with TNFi in 86%. The mean duration of treatment was 2.2±2.0 years with TNFi versus 1.8±1.5 with JAKi. JAKis were prescribed in older patients with longer term disease, greater comorbidity and later treatment lines and more frequently as monotherapy. The IRR of all infections and gastrointestinal events was higher among patients with RA treated with JAKi. Drug persistence at 1, 2 and 3 years was 69%, 55% and 45% for TNFi and 68%, 54% and 45% for JAKi. Multivariate regression models showed a lower probability of discontinuation for JAKi (HR=0.85; 95% CI 0.78-0.92) and concomitant conventional synthetic disease-modifying antirheumatic drugs (HR=0.90; 95% CI 0.84-0.96). The risk of discontinuation increased with glucocorticoids, comorbidities, greater disease activity and later treatment lines. CONCLUSIONS Infections, herpes zoster and gastrointestinal adverse events in patients with RA tended to be more frequent with JAKi. However, prognosis was poor in patients receiving JAKi. Persistence was similar for TNFi and JAKi, although factors associated with discontinuation differed by diagnostic group.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Hospital Regional Universitario de Málaga, UGC de Reumatología, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Eva Perez-Pampin
- Department of Rheumatology, Hospital Clinico Universitario Santiago de Compostela, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Isabel Castrejón
- Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigacion Sanitaria Gregorio Marañón, Madrid, Spain
| |
Collapse
|
7
|
Kim JW, Yoon JS, Park S, Kim H, Lee JS, Choe JY. Risk of cardiovascular disease with high-dose versus low-dose use of non-steroidal anti-inflammatory drugs in ankylosing spondylitis. Ann Rheum Dis 2024:ard-2023-225406. [PMID: 38594057 DOI: 10.1136/ard-2023-225406] [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: 12/11/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To investigate the risk of cardiovascular disease (CVD) associated with increasing dose of a non-steroidal anti-inflammatory drug (NSAID) in patients with ankylosing spondylitis (AS). METHODS Using the Korean National Health Insurance database, patients newly diagnosed with AS without prior CVD between 2010 and 2018 were included in this nationwide cohort study. The primary outcome was CVD, a composite outcome of ischaemic heart disease, stroke or congestive heart failure. Exposure to NSAIDs was evaluated using a time-varying approach. The dose of NSAIDs was considered in each exposure period. Cox proportional hazard regression was used to investigate the risk of CVD associated with NSAID use. RESULTS Of the 19 775 patients (mean age, 36 years; 75% were male), 19 706 received NSAID treatment. During follow-up period of 98 290 person-years, 1663 cases of CVD occurred including 1157 cases of ischaemic heart disease, 301 cases of stroke and 613 cases of congestive heart failure. Increasing dose of NSAIDs was associated with incident CVD after adjusting for confounders (adjusted HR (aHR) 1.10; 95% CI 1.08 to 1.13). Specifically, increasing dose of NSAIDs was associated with incident ischaemic heart disease (aHR 1.08; 95% CI 1.05 to 1.11), stroke (aHR 1.09; 95% CI 1.04 to 1.15) and congestive heart failure (aHR 1.12; 95% CI 1.08 to 1.16). The association between NSAID dose and higher CVD risk was consistent in different subgroups. CONCLUSION In a real-world AS cohort, higher dose of NSAID treatment was associated with a higher risk of CVD, including ischaemic heart disease, stroke and congestive heart failure.
Collapse
Affiliation(s)
- Ji-Won Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea (the Republic of)
| | - Jun Sik Yoon
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (the Republic of)
| | - Sojeong Park
- Data Science Team, Hanmi Pharm Co Ltd, Seoul, Korea (the Republic of)
| | - Hasung Kim
- Data Science Team, Hanmi Pharm Co Ltd, Seoul, Korea (the Republic of)
| | - Ji Sung Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea (the Republic of)
| |
Collapse
|
8
|
Braun J, Märker-Hermann E, Rudwaleit M, Sieper J. HLA-B27 and the role of specific T cell receptors in the pathogenesis of spondyloarthritis. Ann Rheum Dis 2024:ard-2024-225661. [PMID: 38575323 DOI: 10.1136/ard-2024-225661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Jürgen Braun
- Ruhr University Bochum, Bochum, Germany
- Rheumatologisches Versorgungszentrum Steglitz (RVZ), Charité, Berlin, Germany
| | - Elisabeth Märker-Hermann
- Horst-Schmidt-Kliniken, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Wiesbaden, Germany
| | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Rosenhöhe, Universität Bielefeld, Bielefeld, NRW, Germany
| | - Joachim Sieper
- Medical Department I, Rheumatology, Department of Gastroenterology & Infectiology, Charité- University Medical Center,Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Willesen ST, Hadsbjerg AE, Møller JM, Vladimirova N, Vora BMK, Seven S, Pedersen SJ, Østergaard M. MRI-based synthetic CT: a new method for structural damage assessment in the spine in patients with axial spondyloarthritis - a comparison with low-dose CT and radiography. Ann Rheum Dis 2024:ard-2023-225444. [PMID: 38490729 DOI: 10.1136/ard-2023-225444] [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: 12/20/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To investigate the ability of MRI-based synthetic CT (sCT), low-dose CT (ldCT) and radiography to detect spinal new bone formation (NBF) in patients with axial spondyloarthritis (axSpA). METHODS Radiography of lumbar and cervical spine, ldCT and sCT of the entire spine were performed in 17 patients with axSpA. sCT was reconstructed using the BoneMRI application (V.1.6, MRIGuidance BV, Utrecht, NL), a quantitative three-dimensional MRI-technique based on a dual-echo gradient sequence and a machine learning processing pipeline that can generate CT-like MR images. Images were anonymised and scored by four readers blinded to other imaging/clinical information, applying the Canada-Denmark NBF assessment system. RESULTS Mean scores of NBF lesions for the four readers were 188/209/37 for ldCT/sCT/radiography. Most NBF findings were at anterior vertebral corners with means 163 on ldCT, 166 on sCT and 35 on radiography. With ldCT of the entire spine as reference standard, the sensitivity to detect NBF was 0.67/0.13 for sCT/radiography; both with specificities >0.95. For levels that were assessable on radiography (C2-T1 and T12-S1), the sensitivity was 0.61/0.48 for sCT/radiography, specificities >0.90. For facet joints, the sensitivity was 0.46/0.03 for sCT/radiography, specificities >0.94. The mean inter-reader agreements (kappa) for all locations were 0.68/0.58/0.56 for ldCT/sCT/radiography, best for anterior corners. CONCLUSION With ldCT as reference standard, MRI-based sCT of the spine showed very high specificity and a sensitivity much higher than radiography, despite limited reader training. sCT could become highly valuable for detecting/monitoring structural spine damage in axSpA, not the least in clinical trials.
Collapse
Affiliation(s)
- Simone Tromborg Willesen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Anna Ef Hadsbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | - Nora Vladimirova
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Bimal M K Vora
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Sengül Seven
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| |
Collapse
|
11
|
Sigmo GD, Hauge S, Hufthammer KO, Wallenius M, Salvesen KÅ, Daltveit AKN, Bakland G, Fevang BTS. Male patients with inflammatory joint diseases are less likely than controls to be childless: results from a Norwegian population-based cohort study of 10 865 patients. Ann Rheum Dis 2024; 83:457-463. [PMID: 38262688 PMCID: PMC10958328 DOI: 10.1136/ard-2023-224998] [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: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To investigate the number of children per man and the proportion of childless men as a proxy of fertility in a national cohort of men with inflammatory joint diseases (IJDs), compared with matched controls from the general population. METHODS This is a nationwide, population-based retrospective cohort study. Male patients with IJDs (n = 10 865) in the Norwegian Arthritis Registry were individually matched 1:5 on birth year and county of residence with men without IJDs obtained from the National Population Register (n = 54 325). Birth data were obtained from the Medical Birth Registry of Norway. We compared the mean number of children per man and the proportion of childless men and analysed the impact of age and year of diagnosis. RESULTS The mean number of children per man in the patient group was 1.80 versus 1.69 in the comparison group (p <0.001), and 21% of the patients in the patient group were childless versus 27% in the comparison group (p <0.001). The finding of less childlessness and higher number of children per man remained consistent across age at diagnosis, except for those diagnosed at age 0-19 years. The difference in childlessness was most pronounced for men diagnosed after year 2000, especially when diagnosed at 30-39 years of age (22% vs 32%, p<0.001). CONCLUSION In this large cohort study we found that patients with IJD have a higher number of children and are less likely to be childless compared with controls. Factors associated with developing or having an IJD might influence fertility and this requires further investigation.
Collapse
Affiliation(s)
- Gudrun David Sigmo
- Department of Rheumatology, Stavanger University Hospital, Stavanger, Norway
| | - Solveig Hauge
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Marianne Wallenius
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Department of Obstetrics and Gynecology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Kjersti Nesje Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Medical Birth Registry, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
- Department of Rheumatology, University of Tromsø, Tromsø, Norway
| | - Bjorg-Tilde Svanes Fevang
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
12
|
Jourdain H, Hoisnard L, Sbidian E, Zureik M. Persistence and safety of anti-TNF biosimilars versus originators in immune-mediated inflammatory diseases: an observational study on the French National Health Data System. RMD Open 2024; 10:e003531. [PMID: 38453213 PMCID: PMC10921511 DOI: 10.1136/rmdopen-2023-003531] [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: 07/24/2023] [Accepted: 01/20/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES Biosimilar-originator equivalence has been demonstrated in phase 3 trials in a few indications of infliximab, etanercept and adalimumab. The objective of our study was to compare the persistence and safety of biosimilars versus originators in all the licensed indications of these molecules. METHODS We used data from the French National Health Data System (SNDS), covering 99% of the French population, to identify infliximab, etanercept and adalimumab initiators from biosimilar launch (January 2015, May 2016 and October 2018, respectively) to 30 June 2021. Patients were then followed for 1 year. Treatment persistence (duration without treatment discontinuation or modification) and safety (including severe infections, all-cause hospitalisation and death) were compared between originator and biosimilar users by Cox regressions weighting the populations on the inverse probability of treatment. Analyses were performed by molecule, by disease and by biosimilar product. RESULTS From January 2015 to June 2021, 86 776 patients were included in the study: 22 670, 24 442 and 39 664 patients had initiated infliximab, etanercept and adalimumab, respectively; 49 752 (53%) were biosimilar initiators. We did not find any risk of discontinuation (HRs were below or around 1, here all pathologies and products together: infliximab 0.88 (0.80-0.97), etanercept 0.85 (0.81-0.90) and adalimumab 0.96 (0.91-1.00)) or safety event (infection: infliximab 0.97 (0.78-1.21), etanercept 1.04 (0.81-1.33) and adalimumab 0.98 (0.83-1.16); hospitalisation: infliximab 1.08 (0.96-1.23), etanercept 0.99 (0.87-1.11) and adalimumab 0.91 (0.83-0.99)) associated with biosimilar versus originator use. CONCLUSIONS Our study shows reassuring results regarding the persistence and safety of biosimilar tumour necrosis factor-alpha inhibitors compared with originators in all licensed indications.
Collapse
Affiliation(s)
- Hugo Jourdain
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
| | - Léa Hoisnard
- Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
- Centre d'Investigation Clinique 1430, INSERM, Créteil, France
- EpiDermE Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris Est Créteil University UPEC, Créteil, France
| | - Emilie Sbidian
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
- Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
- Centre d'Investigation Clinique 1430, INSERM, Créteil, France
- EpiDermE Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris Est Créteil University UPEC, Créteil, France
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
| | - Mahmoud Zureik
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
- Anti-Infective Evasion and Pharmacoepidemiology, CESP, University Paris-Saclay - UVSQ, Montigny le Bretonneux, France
| |
Collapse
|
13
|
Di Matteo A, Smerilli G, Di Donato S, Liu AR, Becciolini A, Camarda F, Cazenave T, Cipolletta E, Corradini D, de Agustín JJ, Destro Castaniti GM, Di Donato E, Di Geso L, Duran E, Farisogullari B, Fornaro M, Francioso F, Giorgis P, Granel A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Karadag O, Li L, Marin J, Martire MV, Michelena X, Moscioni E, Muntean L, Piga M, Rosemffet M, Rovisco J, Sahin D, Salaffi F, Saraiva L, Scioscia C, Tamas MM, Tanimura S, Venetsanopoulou A, Ventura-Rios L, Villota O, Villota-Eraso C, Voulgari PV, Vukatana G, Zacariaz Hereter J, Marzo-Ortega H, Grassi W, Filippucci E. Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study. Ann Rheum Dis 2024:ard-2023-225443. [PMID: 38443140 DOI: 10.1136/ard-2023-225443] [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: 03/07/2024]
Abstract
OBJECTIVES To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population. METHODS In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas). RESULTS In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses. CONCLUSIONS This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.
Collapse
Affiliation(s)
- Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Stefano Di Donato
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - An Ran Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Federica Camarda
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Tomas Cazenave
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | | | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Provincial Hospital Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - Emine Duran
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bayram Farisogullari
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Marco Fornaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Rheumatology Unit, University of Bari, Bari, Italy
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Pamela Giorgis
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Amelia Granel
- Rheumatology, Hospital San Roque de Gonnet, La Plata, Buenos Aires, Argentina
| | | | - Rudolf Horvath
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Praha, Czech Republic
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Praha, Czech Republic
| | - Diogo Jesus
- Rheumatology Department, Leiria Hospital Centre, Pousos, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
| | - Omer Karadag
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ling Li
- Department of Rheumatology and Immunology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Josefina Marin
- Rheumatology Unit, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Xabier Michelena
- Rheumatology Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Erica Moscioni
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Laura Muntean
- Department of Rheumatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Matteo Piga
- Rheumatology Unit, University of Cagliari, Cagliari, Italy
| | - Marcos Rosemffet
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Didem Sahin
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Liliana Saraiva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Crescenzio Scioscia
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Rheumatology Unit, University of Bari, Bari, Italy
| | - Maria-Magdalena Tamas
- Department of Rheumatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Department of Rheumatology, The Hokkaido Medical Center, Sapporo, Japan
| | - Aliki Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Lucio Ventura-Rios
- Division of Rheumatology, National Institute of Rehabilitation Luis Guillermo Ibarra, Ciudad de Mexico, Mexico
| | - Orlando Villota
- Division of Rheumatology, Fundación Hospital San Pedro, San Juan de Pasto, Colombia
- Department of Rheumatology, Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Catalina Villota-Eraso
- Department of Rheumatology, Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Gentiana Vukatana
- Rheumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Bologna, Italy
| | - Johana Zacariaz Hereter
- Rheumatology Unit, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
14
|
Dougados M, Lardy-Cléaud A, Desfleurs E, Claudepierre P, Goupille P, Ryussen-Witrand A, Saraux A, Tournadre A, Wendling D, Lukas C. Impact of the time of initiation and line of biologic therapy on the retention rate of secukinumab in axial spondyloarthritis (axSpA): data from the French multicentre retrospective FORSYA study. RMD Open 2024; 10:e003942. [PMID: 38428974 PMCID: PMC10910420 DOI: 10.1136/rmdopen-2023-003942] [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: 11/24/2023] [Accepted: 02/05/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE To compare the 1-year retention rate of secukinumab in axial spondyloarthritis (axSpA) and its predisposing factors with regard to its time of initiation (eg, right after or remotely from its launch). METHODS Study design: Retrospective multicentre French study of patients with axSpA. Study periods: Two cohorts were evaluated regarding the time of initiation of secukinumab: cohort 1 (C1)-between 16 August 2016 and 31 August 2018-and cohort 2 (C2)-between 1 September 2018 and 13 November 2020. STATISTICAL ANALYSIS The 1-year retention rate of secukinumab was estimated using the Kaplan-Meier method, and the log-rank test was used to compare the retention curves of the two cohorts. Preselected factors (eg, disease characterristics, line and time of secukinumab initiation) of secukinumab retention at 1 year were analysed by univariate and multivariate Cox model regression. RESULTS In total, 906 patients in C1 and 758 in C2 from 50 centres were included in the analysis. The 1-year retention rate was better in C2 (64% (61%-68%)) vs C1 (59% (55%-62%)) (HR=1.19 (1.02-1.39); p=0.0297). In the multivariate analysis, the line of biologic therapy was the single predictive factor of the 1-year retention rate of secukinumab picked up in both cohorts, with a better retention rate when prescribed as first-line biologic therapy. CONCLUSION The better secukinumab retention rate remotely from its launch is explained by its use at an earlier stage of the disease, suggesting a change in the behaviour of prescribing physicians. Our results emphasise the relevance of iterative evaluations of routine care treatments.
Collapse
Affiliation(s)
- Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes Faculté de Médecine, Paris, France
| | | | | | - Pascal Claudepierre
- Rheumatology, Hôpital Henri Mondor, Créteil, France
- EA EpidermE, Université Paris Est Créteil, Créteil, France
| | | | - Adeline Ryussen-Witrand
- Rheumatology, CHU Purpan, Toulouse, France
- UMR1027, INSERM/UPS Toulouse III, Toulouse, France
| | - Alain Saraux
- Université de Bretagne Occidentale (Univ Brest), Brest, France
| | - Anne Tournadre
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Cédric Lukas
- Rheumatology, University Hospital Lapeyronie, Montpellier, France
- EA2415, Montpellier University, Montpellier, France
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Chen Y, Liu H, Yu Q, Qu X, Sun T. Entry point of machine learning in axial spondyloarthritis. RMD Open 2024; 10:e003832. [PMID: 38360037 PMCID: PMC10875480 DOI: 10.1136/rmdopen-2023-003832] [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: 10/20/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Axial spondyloarthritis (axSpA) is a globally prevalent and challenging autoimmune disease. Characterised by insidious onset and slow progression, the absence of specific clinical manifestations and biomarkers often leads to misdiagnosis, thereby complicating early detection and diagnosis of axSpA. Furthermore, the high heterogeneity of axSpA, its complex pathogenesis and the lack of specific drugs means that traditional classification standards and treatment guidelines struggle to meet the demands of personalised treatment. Recently, machine learning (ML) has seen rapid advancements in the medical field. By integrating large-scale data with diverse algorithms and using multidimensional data, such as patient medical records, laboratory examinations, radiological data, drug usage and molecular biology information, ML can be modelled based on real-world clinical issues. This enables the diagnosis, stratification, therapeutic efficacy prediction and prognostic evaluation of axSpA, positioning it as an emerging research topic. This study explored the application and progression of ML in the diagnosis and therapy of axSpA from five perspectives: early diagnosis, stratification, disease monitoring, drug efficacy evaluation and comorbidity prediction. This study aimed to provide a novel direction for exploring rational diagnostic and therapeutic strategies for axSpA.
Collapse
Affiliation(s)
- Yuening Chen
- Department of Rheumatology, China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing, China
| | - Hongxiao Liu
- Department of Rheumatology, China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing, China
| | - Qing Yu
- Department of Rheumatology, China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing, China
| | - Xinning Qu
- Department of Rheumatology, China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing, China
| | - Tiantian Sun
- Department of Rheumatology, China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing, China
| |
Collapse
|
17
|
Maksymowych W, Hadsbjerg AEFEF, Østergaard M, Micheroli R, Pedersen SJ, Ciurea A, Vladimirova N, Nissen MS, Bubova K, Wichuk S, de Hooge M, Mathew AJ, Pintaric K, Gregová M, Snoj Z, Wetterslev M, Gorican K, Möller B, Eshed I, Paschke J, Lambert RG. Validation of SPARCC MRI-RETIC e-tools for increasing scoring proficiency of MRI sacroiliac joint lesions in axial spondyloarthritis. RMD Open 2024; 10:e003923. [PMID: 38351052 PMCID: PMC10868186 DOI: 10.1136/rmdopen-2023-003923] [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: 11/19/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The Spondyloarthritis Research Consortium of Canada (SPARCC) developers have created web-based calibration modules for the SPARCC MRI sacroiliac joint (SIJ) scoring methods. We aimed to test the impact of applying these e-modules on the feasibility and reliability of these methods. METHODS The SPARCC-SIJ RETIC e-modules contain cases with baseline and follow-up scans and an online scoring interface. Visual real-time feedback regarding concordance/discordance of scoring with expert readers is provided by a colour-coding scheme. Reliability is assessed in real time by intraclass correlation coefficient (ICC), cases being scored until ICC targets are attained. Participating readers (n=17) from the EuroSpA Imaging project were randomised to one of two reader calibration strategies that each comprised three stages. Baseline and follow-up scans from 25 cases were scored after each stage was completed. Reliability was compared with a SPARCC developer, and the System Usability Scale (SUS) assessed feasibility. RESULTS The reliability of readers for scoring bone marrow oedema was high after the first stage of calibration, and only minor improvement was noted following the use of the inflammation module. Greater enhancement of reader reliability was evident after the use of the structural module and was most consistently evident for the scoring of erosion (ICC status/change: stage 1 (0.42/0.20) to stage 3 (0.50/0.38)) and backfill (ICC status/change: stage 1 (0.51/0.19) to stage 3 (0.69/0.41)). The feasibility of both e-modules was evident by high SUS scores. CONCLUSION The SPARCC-SIJ RETIC e-modules are feasible, effective knowledge transfer tools, and their use is recommended before using the SPARCC methods for clinical research and tria.
Collapse
Affiliation(s)
- Walter Maksymowych
- Medicine, University of Alberta, Edmonton, Alberta, Canada
- CARE ARTHRITIS Limited, Edmonton, Alberta, Canada
| | - Anna Enevold Fløistrup E F Hadsbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Susanne Juhl Pedersen
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Nora Vladimirova
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Kristyna Bubova
- First Faculty of Medicine, Rheumatology, Charles University, Prague, Czech Republic
| | - Stephanie Wichuk
- Rheumatology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Manouk de Hooge
- Ghent University Hospital, Ghent, Oost-Vlaanderen, Belgium
- Leiden University, Leiden, Netherlands
| | - Ashish J Mathew
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Clinical Immunology and Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
| | | | - Monika Gregová
- First Faculty of Medicine, Rheumatology, Charles University, Prague, Czech Republic
| | - Ziga Snoj
- Radiology, UKC Ljubljana, Ljubljana, Slovenia
| | - Marie Wetterslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karel Gorican
- Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Burkhard Möller
- Rheumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Robert Gw Lambert
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
18
|
Nordén KR, Semb AG, Dagfinrud H, Hisdal J, Sexton J, Fongen C, Bakke E, Ødegård S, Skandsen J, Blanck T, Metsios GS, Tveter AT. Effect of high-intensity interval training in physiotherapy primary care for patients with inflammatory arthritis: the ExeHeart randomised controlled trial. RMD Open 2024; 10:e003440. [PMID: 38242550 PMCID: PMC10806524 DOI: 10.1136/rmdopen-2023-003440] [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: 06/27/2023] [Accepted: 12/25/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES To assess the effect of high-intensity interval training (HIIT) delivered in physiotherapy primary care on the primary outcome of cardiorespiratory fitness (CRF) in patients with inflammatory arthritis (IA). Additionally, to explore the effects of HIIT on secondary outcomes, including cardiovascular disease (CVD) risk factors and disease activity. METHODS Single-blinded randomised controlled trial with 60 patients randomly assigned to either a control group receiving usual care or an exercise group receiving usual care and 12 weeks of individualised HIIT at 90%-95% peak heart rate. Outcomes were assessed at baseline, 3 months and 6 months post baseline and included CRF measured as peak oxygen uptake (VO2peak), classic CVD risk factors, disease activity, anthropometry and patient-reported physical activity, pain, fatigue, disease impact and exercise beliefs and self-efficacy. RESULTS Intention-to-treat analysis demonstrated a significant between-group difference in VO2peak at 3 months (2.5 mL/kg/min, 95% CI 0.9 to 4.0) and 6 months (2.6 mL/kg/min, 95% CI 0.8 to 4.3) in favour of the exercise group. A beneficial change in self-reported physical activity in favour of the exercise group was observed at 3 and 6 months. The HIIT intervention was well-tolerated with minimal adverse events and no apparent impact on disease activity. Differences in secondary outcomes related to CVD risk factors, disease impact, pain, fatigue and exercise beliefs and self-efficacy were generally small and non-significant. CONCLUSION After 12 weeks of supervised HIIT delivered in physiotherapy primary care, patients with IA demonstrated a favourable improvement in CRF, with sustained effects at 6-month follow-up. TRIAL REGISTRATION NUMBER NCT04922840.
Collapse
Affiliation(s)
- Kristine Røren Nordén
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Hanne Dagfinrud
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Camilla Fongen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Emilie Bakke
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Sigrid Ødegård
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Diakonhjemmet Hospital, Oslo, Norway
| | - Jon Skandsen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Thalita Blanck
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - George S Metsios
- Department of Nutrition and Dietetics, University of Thessaly, Volos, Greece
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Health Sciences, Institute of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Akershus, Norway
| |
Collapse
|
19
|
Tanaka H, Okada Y, Nakayamada S, Miyazaki Y, Sonehara K, Namba S, Honda S, Shirai Y, Yamamoto K, Kubo S, Ikari K, Harigai M, Sonomoto K, Tanaka Y. Extracting immunological and clinical heterogeneity across autoimmune rheumatic diseases by cohort-wide immunophenotyping. Ann Rheum Dis 2024; 83:242-252. [PMID: 37903543 PMCID: PMC10850648 DOI: 10.1136/ard-2023-224537] [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: 06/09/2023] [Accepted: 09/13/2023] [Indexed: 11/01/2023]
Abstract
OBJECTIVE Extracting immunological and clinical heterogeneity across autoimmune rheumatic diseases (AIRDs) is essential towards personalised medicine. METHODS We conducted large-scale and cohort-wide immunophenotyping of 46 peripheral immune cells using Human Immunology Protocol of comprehensive 8-colour flow cytometric analysis. Dataset consisted of >1000 Japanese patients of 11 AIRDs with deep clinical information registered at the FLOW study, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). In-depth clinical and immunological characterisation was conducted for the identified RA patient clusters, including associations of inborn human genetics represented by Polygenic Risk Score (PRS). RESULTS Multimodal clustering of immunophenotypes deciphered underlying disease-cell type network in immune cell, disease and patient cluster resolutions. This provided immune cell type specificity shared or distinct across AIRDs, such as close immunological network between mixed connective tissue disease and SLE. Individual patient-level clustering dissected patients with AIRD into several clusters with different immunological features. Of these, RA-like or SLE-like clusters were exclusively dominant, showing immunological differentiation between RA and SLE across AIRDs. In-depth clinical analysis of RA revealed that such patient clusters differentially defined clinical heterogeneity in disease activity and treatment responses, such as treatment resistance in patients with RA with SLE-like immunophenotypes. PRS based on RA case-control and within-case stratified genome-wide association studies were associated with clinical and immunological characteristics. This pointed immune cell type implicated in disease biology such as dendritic cells for RA-interstitial lung disease. CONCLUSION Cohort-wide and cross-disease immunophenotyping elucidate clinically heterogeneous patient subtypes existing within single disease in immune cell type-specific manner.
Collapse
Affiliation(s)
- Hiroaki Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
- Department of Statistical Genetics, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe), Osaka University, Suita, Japan
| | - Shingo Nakayamada
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Yusuke Miyazaki
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Kyuto Sonehara
- Department of Statistical Genetics, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Shinichi Namba
- Department of Statistical Genetics, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Suguru Honda
- Department of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yuya Shirai
- Department of Statistical Genetics, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenichi Yamamoto
- Department of Statistical Genetics, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- Laboratory of Children's health and Genetics, Division of Health Science, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoshi Kubo
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Katsunori Ikari
- Department of Orthopedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Koshiro Sonomoto
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| |
Collapse
|
20
|
Rosenzweig HL, Vance EE, Asare-Konadu K, Koney KV, Lee EJ, Deodhar AA, Sen R, Caplan L, Napier RJ. Card9/neutrophil signalling axis promotes IL-17A-mediated ankylosing spondylitis. Ann Rheum Dis 2024; 83:214-222. [PMID: 37813481 PMCID: PMC10850635 DOI: 10.1136/ard-2022-223146] [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: 07/25/2022] [Accepted: 09/05/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Polymorphisms in the antifungal signalling molecule CARD9 are associated with ankylosing spondylitis (AS). Here, we investigated the cellular mechanism by which CARD9 controls pathogenic Th17 responses and the onset of disease in both experimental murine AS and patients. METHODS Experiments in SKG, Card9-/-SKG, neutrophil-deplete SKG mice along with in vitro murine, neutrophil and CD4+ T cell cocultures examined Card9 function in neutrophil activation, Th17 induction and arthritis in experimental AS. In AS patients the neutrophil: Bath Ankylosing Spondylitis Functional Index relationship was analysed. In vitro studies with autologous neutrophil: T cell cocultures examined endogenous CARD9 versus the AS-associated variant (rs4075515) of CARD9 in T cellular production of IL-17A. RESULTS Card9 functioned downstream of Dectin-1 and was essential for induction of Th17 cells, arthritis and spondylitis in SKG mice. Card9 expression within T cells was dispensable for arthritis onset in SKG mice. Rather, Card9 expression controlled neutrophil function; and neutrophils in turn, were responsible for triggering Th17 expansion and disease in SKG mice. Mechanistically, cocultures of zymosan prestimulated neutrophils and SKG T cells revealed a direct cellular function for Card9 within neutrophils in the potentiation of IL-17 production by CD4+ T cells on TCR-ligation. The clinical relevance of the neutrophil-Card9-coupled mechanism in Th17-mediated disease is supported by a similar observation in AS patients. Neutrophils from HLA-B27+ AS patients expanded autologous Th17 cells in vitro, and the AS-associated CARD9S12N variant increased IL-17A. CONCLUSIONS These data reveal a novel neutrophil-intrinsic role for Card9 in arthritogenic Th17 responses and AS pathogenesis. These data provide valuable utility in our future understanding of CARD9-specific mechanisms in spondyloarthritis .
Collapse
Affiliation(s)
- Holly L Rosenzweig
- Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, Oregon, USA
- Portland VA Medical Center, Portland, Oregon, USA
| | - Emily E Vance
- Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, Oregon, USA
- Portland VA Medical Center, Portland, Oregon, USA
| | - Kofi Asare-Konadu
- Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Ellen J Lee
- Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, Oregon, USA
- Portland VA Medical Center, Portland, Oregon, USA
| | - Atul A Deodhar
- Div Arthritis/Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Rouhin Sen
- University of Colorado, Denver, Colorado, USA
- VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Liron Caplan
- VA Eastern Colorado Health Care System, Aurora, Colorado, USA
- Rheumatology Division, University of Colorado, Denver, Colorado, USA
| | - Ruth J Napier
- Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, Oregon, USA
- Portland VA Medical Center, Portland, Oregon, USA
- Div Arthritis/Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
21
|
Port H, Christiansen F, Nielsen SH, Frederiksen P, Bay-Jensen AC, Karsdal MA, Seven S, Sørensen IJ, Loft AG, Madsen OR, Ostergaard M, Pedersen SJ. Identification of patient endotypes and adalimumab treatment responders in axial spondyloarthritis using blood-derived extracellular matrix biomarkers. RMD Open 2024; 10:e003769. [PMID: 38199849 PMCID: PMC10806480 DOI: 10.1136/rmdopen-2023-003769] [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: 09/28/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE To explore the potential of a panel of ECM remodelling markers as endotyping tools for axial spondyloarthritis (axSpA) by separating patients into subtypes and investigate how they differ among each other in disease activity scores and response to treatment with adalimumab. METHODS In three axSpA studies, a panel of 14 blood-based ECM biomarkers related to formation of collagen (PRO-C2, PRO-C3, PRO-C6), degradation of collagen by metalloproteinases (C1M, C2M, T2CM, C3M, C4M, C6M, C10C), matrix metalloproteinase (MMP)-degraded prolargin (PROM), MMP-degraded and citrullinated vimentin (VICM), basement membrane turnover (PRO-C4) and neutrophil activity (CPa9-HNE) were assessed to enable patient clustering (endotyping). MASH (n=41) was a cross-sectional study, while Adalimumab in Axial Spondyloarthritis study (ASIM,n=45) and Danish Multicenter Study of Adalimumab in Spondyloarthritis (DANISH, n=49) were randomised, double-blind placebo-controlled trials of adalimumab versus placebo every other week for 6 or 12 weeks, respectively, followed by active treatment. Biomarker data were log-transformed, standardised by mean centering and scaled by the SD prior to principal component analysis and K-means clustering. RESULTS Based on all three studies, we identified two orthogonal dimensions reflecting: (1) inflammation and neutrophil activity (driven by C1M and CPa9-HNE) and (2) collagen turnover (driven by PRO-C2). Three endotypes were identified: high inflammation endotype (Endotype1), low inflammation endotype (Endotype 2) and high collagen turnover endotype (Endotype3). Endotype1 showed higher disease activity (Ankylosing Spondylitis Disease Activity Score (ASDAS)) at baseline compared with Endotype2 and Endotype3 and higher percentage of patients responding to adalimumab based on ASDAS clinical improvement at week 24. Endotype3 showed higher percentage of patients with 50% improvement in Bath Ankylosing Spondylitis Disease Activity Index response at week 24 compared with Endotype2. CONCLUSION These endotypes differ in their tissue remodelling profile and may in the future have utility for patient stratification and treatment tailoring.
Collapse
Affiliation(s)
- Helena Port
- Department of Clinical Medicine, Copenhagen University Hospital, Kobenhavn, Denmark
- Nordic Bioscience, Herlev, Denmark
| | | | | | | | | | | | - Sengul Seven
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Gentofte and Frederiksberg, Denmark
| | - Inge Juul Sørensen
- Department of Clinical Medicine, Copenhagen University Hospital, Kobenhavn, Denmark
- Department of Rheumatology and Spine diseases, Righospitalet, Copenhagen, Denmark
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Rintek Madsen
- Department of Clinical Medicine, Copenhagen University Hospital, Kobenhavn, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Gentofte and Frederiksberg, Denmark
- Department of Rheumatology and Spine diseases, Righospitalet, Copenhagen, Denmark
| | - Mikkel Ostergaard
- Department of Clinical Medicine, Copenhagen University Hospital, Kobenhavn, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Gentofte and Frederiksberg, Denmark
- Department of Rheumatology and Spine diseases, Righospitalet, Copenhagen, Denmark
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Gentofte and Frederiksberg, Denmark
- Department of Rheumatology and Spine diseases, Righospitalet, Copenhagen, Denmark
| |
Collapse
|
22
|
Marques ML, Ramiro S, van der Heijde D, Reijnierse M, Diekhoff T, Hermann KGA, van Gaalen FA, de Hooge M. Atlas for the CT Syndesmophyte Score (CTSS) in patients with axial spondyloarthritis. RMD Open 2024; 10:e003702. [PMID: 38199850 PMCID: PMC10806465 DOI: 10.1136/rmdopen-2023-003702] [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: 09/08/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The Computed Tomography Syndesmophyte Score (CTSS) was developed as a reliable and sensitive tool to assess syndesmophytes in low-dose CT images of the entire spine in patients with axial spondyloarthritis (axSpA). The original paper provided sparce examples of the CTSS grades. OBJECTIVES Provide an atlas tailored to assist readers in understanding and employing the CTSS method. METHODS In this paper, illustrations of the different grades and views of the CTSS are presented. CTSS is used to measure bone formation in the spine of patients with axial spondyloarthritis (axSpA), in the form of syndesmophytes. In both the sagittal and coronal planes, syndesmophytes can be graded from 0 to 3 over 23 vertebral units starting at C2 and ending at S1. The CTSS ranges from 0 (absence of axSpA-related syndesmophytes) to 552 (total ankylosis of the spine). RESULTS The current atlas contains low-dose CT images of the spine without lesions (for reference) and all grades of syndesmophytes in different planes used in the CTSS. Examples are arranged per spinal segment (cervical, thoracic and lumbar). CONCLUSIONS These images can be used to assist any reader in the assessment of syndesmophytes on (low-dose) CT in patients with axSpA.
Collapse
Affiliation(s)
- Mary Lucy Marques
- Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
- Department of Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Désirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Manouk de Hooge
- Department of Rheumatology, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium
| |
Collapse
|
23
|
Kiefer D, Schneider L, Braun J, Kiltz U, Kolle N, Andreica I, Tsiami S, Buehring B, Sewerin P, Herbold S, Baraliakos X. Clinically relevant differences in spinal mobility related to daytime performance in patients with axial spondyloarthritis. RMD Open 2024; 10:e003733. [PMID: 38191214 PMCID: PMC10806495 DOI: 10.1136/rmdopen-2023-003733] [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: 09/18/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE Patients with axial spondyloarthritis (axSpA) suffer from clinical symptoms like morning stiffness and back pain. Mobility of patients with axSpA is often impaired. The aim of this study is to compare the performance of patients with axSpA regarding mobility measures including performance-based tests and objective electronic assessments with the Epionics SPINE device (ES) at different times of the day compared with healthy controls (HC). METHODS Observational trial, consecutive inpatients with axSpA (n=100) and 20 HCs were examined in the morning (V1: before 10:00 am) and in the afternoon (V2: after 02:00 pm) by the Bath Ankylosing Spondylitis Metrology Index (BASMI), the AS physical performance index (ASPI), the Short Physical Performance Battery (SPPB) and ES measurements, including range of motion (RoM) and range of kinematics (RoK). RESULTS The assessments of patients with axSpA performed in the morning clearly differed from those in the afternoon, especially regarding performance-based tests. Significant improvements were seen for BASMI (4.0±3.8 to 3.8±1.9; p<0.001), ASPI (36.2±18.3 to 28.8±11.9 s; p<0.001), SPPB (10.1±1.5 to 10.7±1.4 points; p<0.001) and for ES measures of speed (RoK; p<0.018) but not for RoM, except for lateral flexion (13.3±7.4 to 14.7±8.2°; p=0.002). This time of assessment-related variability was not observed in HC. CONCLUSION The spinal mobility of patients with axSpA was worse in the morning but significantly improved in the afternoon. This was captured best by performance-based measures and was not seen in HC. The diurnal variation of mobility has implications for clinical studies, suggesting that the time of assessments needs to be standardised.
Collapse
Affiliation(s)
- David Kiefer
- Rheumatologie, Ruhr-Universitat Bochum, Bochum, Germany
- Rheumatologie, Rheumazentrum Ruhrgebiet, Herne, NRW, Germany
| | - Lucia Schneider
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Jürgen Braun
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Uta Kiltz
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
- Rheumazentrum Ruhrgebiet, Herne, Nordrhein-Westfalen, Germany
| | - Niklas Kolle
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Ioana Andreica
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
- Rheumazentrum Ruhrgebiet, Herne, Nordrhein-Westfalen, Germany
| | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet, Herne, Nordrhein-Westfalen, Germany
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | | | - Philipp Sewerin
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Susanne Herbold
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | | |
Collapse
|
24
|
Redeker I, Landewé R, van der Heijde D, Ramiro S, Boonen A, Dougados M, Braun J, Kiltz U. Impact of disease outcomes on the Assessment of SpondyloArthritis International Society Health Index (ASAS HI): a Bayesian network analysis of the DESIR cohort. RMD Open 2023; 9:e003587. [PMID: 38123481 DOI: 10.1136/rmdopen-2023-003587] [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: 08/06/2023] [Accepted: 10/18/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE The objective of this study is to build a structural model visualising and quantifying the interrelationships of different disease outcomes with the Assessment of SpondyloArthritis International Society Health Index (ASAS HI) in patients with axial spondyloarthritis (axSpA). METHODS Cross-sectional data collected at month 72 of the Devenir des Spondylarthropathies Indifferénciées Récentes cohort was analysed. Combining prior knowledge and observed data, probabilistic Bayesian network modelling was used to study how the interplay of different disease outcomes affects the ASAS HI, which measures disease-specific overall functioning and health. Disease outcomes comprised, among others, the Ankylosing Spondylitis (AS) Disease Activity Score (ASDAS) and the Bath AS Functional Index (BASFI). RESULTS Data of 384 patients were analysed. The obtained structure suggests that ASAS HI is determined by both patient-reported physical function (BASFI) and disease activity (ASDAS). The parameters of the structural model show that an increase of ASDAS or BASFI by 1 unit corresponds to an increase of ASAS HI by 0.70 or 1.25 units, respectively. Moreover, the model suggests that disease activity has an indirect impact on ASAS HI via BASFI. No relationship between spinal mobility or structural damage and ASAS HI was found. CONCLUSIONS This is the first structural model developed to better understand the construct and the interplay between clinically relevant outcomes related to ASAS HI in axSpA patients. It shows that disease activity and physical function have a strong impact on ASAS HI, confirming it to be a valid construct of overall functioning and health in axSpA patients.
Collapse
Affiliation(s)
- Imke Redeker
- Ruhr-Universität Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Robert Landewé
- Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Sofia Ramiro
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and the Caphri Research Institute Maastricht University, Maastricht, The Netherlands
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes Faculté de Médecine, Paris, France
| | | | - Uta Kiltz
- Ruhr-Universität Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| |
Collapse
|
25
|
Ciurea A, Götschi A, Bräm R, Bürki K, Exer P, Andor M, Nissen MJ, Möller B, Hügle T, Rubbert-Roth A, Kyburz D, Distler O, Scherer A, Micheroli R. Early axial spondyloarthritis according to the ASAS consensus definition: characterisation of patients and effectiveness of a first TNF inhibitor in a large observational registry. RMD Open 2023; 9:e003455. [PMID: 38053462 DOI: 10.1136/rmdopen-2023-003455] [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: 07/01/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To characterise the population fulfilling the Assessment of SpondyloArthritis international Society (ASAS) consensus definition of early axial spondyloarthritis (axSpA) and to determine the effectiveness of a first tumour necrosis factor inhibitor (TNFi) in early versus established axSpA in a large observational registry. METHODS A total of 3064 patients with axSpA in the Swiss Clinical Quality Management registry with data on duration of axial symptoms were included (≤2 years=early axSpA, N=658; >2 years=established axSpA, N=2406). Drug retention was analysed in patients starting a first TNFi in early axSpA (N=250) versus established axSpA (N=874) with multiple-adjusted Cox proportional hazards models. Adjusted logistic regression analyses were used to determine the achievement of the ASAS criteria for 40% improvement (ASAS40) at 1 year. RESULTS Sex distribution, disease activity, impairments of function and health-related quality of life were comparable between patients with early and established axSpA. Patients with established disease were older, had more prevalent axial radiographical damage and had a higher impairment of mobility. A comparable TNFi retention was found in early versus established disease after adjustment for age, sex, human leucocyte antigen-B27 status, education, body mass index, smoking, elevated C reactive protein and sacroiliac inflammation on MRI (HR 1.05, 95% CI 0.78 to 1.42). The adjusted ASAS40 response was similar in the two groups (OR 1.09, 95% CI 0.67 to 1.78). Results were confirmed in the population fulfilling the ASAS classification criteria. CONCLUSION Considering the recent ASAS definition of early axSpA, TNFi effectiveness seems comparable in early versus established disease.
Collapse
Affiliation(s)
- Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrea Götschi
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - René Bräm
- Swiss Ankylosing Spondylitis Association, Zurich, Switzerland
| | - Kristina Bürki
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Pascale Exer
- Gemeinschaftspraxis Rheuma-Basel, Basel, Switzerland
| | - Michael Andor
- Rheumatologie im Zürcher Oberland, Uster, Switzerland
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Burkhard Möller
- Department of Rheumatology and Immunology, Inselspital, Bern, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, University of Lausanne, Lausanne, Switzerland
| | - Andrea Rubbert-Roth
- Department of Rheumatology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Oliver Distler
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Almut Scherer
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
26
|
Li Z, Khan MK, van der Linden SM, Winkens B, Villiger PM, Baumberger H, van Zandwijk H, Khan MA, Brown MA. HLA-B27, axial spondyloarthritis and survival. Ann Rheum Dis 2023; 82:1558-1567. [PMID: 37679034 DOI: 10.1136/ard-2023-224434] [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: 05/13/2023] [Accepted: 08/10/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Ankylosing spondylitis (AS), and carriage of HLA-B27 gene in otherwise healthy individuals, are reportedly associated with increased mortality. We evaluated this hypothesis, using data from both a 35-year AS follow-up study and UK Biobank data. METHODS In 1985, 363 members of the Swiss AS Patient Society and 806 relatives were screened clinically and then radiographically for AS/axial spondyloarthritis (axSpA). Life expectancy was analysed in 377 axSpA patients having available pelvic radiographs and HLA-B27 status, comparing with matched Swiss population data. Survival in relation to HLA-B27 status in the general population was studied in UK Biobank European-ancestry participants (n=407 480, n=30 419 deaths). RESULTS AS patients have increased standardised mortality rate (SMR) compared with the general population (1.37, 95% CI 1.11 to 1.62). This increase was significant for HLA-B27-positive AS (SMR 1.38, 95% CI 1.11 to 1.65). Shortened life expectancy was observed among both HLA-B27-positive AS women (SMR 1.77, 95% CI 1.09 to 2.70) and men (SMR 1.31, 95% CI 1.02 to 1.59). Patients with non-radiographic axSpA (nr-axSpA) had significantly lower SMR: 0.44 (95% CI 0.23 to 0.77), compared with the general population. In the UK Biobank European-ancestry population cohort, HLA-B27 carriage was not significantly associated with any change in mortality (HR 1, 95% CI 0.97 to 1.1, p=0.349, adjusted by sex), in either males (HR 1, 95% CI 0.98 to 1.1, p=0.281) or females (HR 0.96, 95% CI 0.9 to 1, p=0.232), and no increase in vascular disease mortality was observed. DISCUSSION AS patients, but not nr-axSpA patients, have a significantly shortened life expectancy. Increased mortality is particularly significant among women with HLA-B27-positive AS. HLA-B27 carriage in the European-ancestry general population does not influence survival, or the risk of death due to vascular disease.
Collapse
Affiliation(s)
- Zhixiu Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Queensland University of Technology, Woolloongabba, Queensland, Australia
| | | | - Sjef M van der Linden
- University of Bern, Bern, Switzerland
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), University of Maastricht, Maastricht, The Netherlands
| | - Peter M Villiger
- University of Bern, Bern, Switzerland
- Department of Rheumatology and Clinical Immunology, Medical Center Monbijou, Bern, Switzerland
| | - Heinz Baumberger
- Former President of Swiss Ankylosing Spondylitis Patient Society, Flims, Switzerland
| | | | - Muhammad Asim Khan
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew A Brown
- Genomics England Ltd, London, UK
- Department of Medical and Molecular Genetics, King's College London, London, UK
| |
Collapse
|
27
|
Rudwaleit M, Mørup MF, Humphries B, Zannat NE, Willems D, Taieb V, Boonen A. Work productivity in patients with axial spondyloarthritis initiating biological or targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review and meta-analysis. RMD Open 2023; 9:e003468. [PMID: 38035757 PMCID: PMC10689353 DOI: 10.1136/rmdopen-2023-003468] [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: 07/04/2023] [Accepted: 09/04/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) can limit work participation. Our objective was to characterise productivity in patients with axSpA, including changes after 12-16 weeks of treatment with biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). METHODS A systematic literature review identified studies published from 1 January 2010 to 21 October 2021 reporting work productivity using the Work Productivity and Activity Impairment (WPAI) questionnaire in patients with axSpA initiating b/tsDMARDs. Baseline and Week 12-16 overall work productivity, absenteeism, presenteeism and activity impairment scores were used in a random-effects meta-analysis to calculate absolute mean change from baseline for each WPAI-domain. RESULTS Eleven studies in patients with axSpA who received either placebo (n=727) or treatment with adalimumab, bimekizumab, etanercept, ixekizumab, secukinumab or tofacitinib (n=994) were included. In working patients initiating a b/tsDMARD, mean baseline overall work productivity impairment, absenteeism and presenteeism scores were 52.1% (N=7 studies), 11.0% and 48.8% (N=6 studies), respectively. At Week 12-16, the pooled mean change from baseline in overall work impairment for b/tsDMARDs or placebo was -21.6% and -12.3%. When results were extrapolated to 1 year, the potential annual reductions in cost of paid and unpaid productivity loss per patient ranged from €11 962.88 to €14 293.54. CONCLUSIONS Over 50% of employed patients with active axSpA experienced work impairment, primarily due to presenteeism. Overall work productivity improved at Weeks 12-16 to a greater extent for patients who received b/tsDMARDs than placebo. Work productivity loss was associated with a substantial cost burden, which was reduced with improvements in impairment.
Collapse
Affiliation(s)
- Martin Rudwaleit
- Department of Internal Medicine and Rheumatology, University of Bielefeld, Klinikum Bielefeld, Bielefeld, Germany
| | | | - Brittany Humphries
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Vanessa Taieb
- Statistical Sciences & Innovation, UCB Pharma, Colombes, France
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| |
Collapse
|
28
|
Moon SJ, Lee S, Hwang J, Lee J, Kang S, Cha HS. Performances of machine learning algorithms in discriminating sacroiliitis features on MRI: a systematic review. RMD Open 2023; 9:e003783. [PMID: 37996126 PMCID: PMC10668284 DOI: 10.1136/rmdopen-2023-003783] [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: 10/03/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES Summarise the evidence of the performance of the machine learning algorithm in discriminating sacroiliitis features on MRI and compare it with the accuracy of human physicians. METHODS MEDLINE, EMBASE, CIHNAL, Web of Science, IEEE, American College of Rheumatology and European Alliance of Associations for Rheumatology abstract archives were searched for studies published between 2008 and 4 June 2023. Two authors independently screened and extracted the variables, and the results are presented using tables and forest plots. RESULTS Ten studies were selected from 2381. Over half of the studies used deep learning models, using Assessment of Spondyloarthritis International Society sacroiliitis criteria as the ground truth, and manually extracted the regions of interest. All studies reported the area under the curve as a performance index, ranging from 0.76 to 0.99. Sensitivity and specificity were the second-most commonly reported indices, with sensitivity ranging from 0.56 to 1.00 and specificity ranging from 0.67 to 1.00; these results are comparable to a radiologist's sensitivity of 0.67-1.00 and specificity of 0.78-1.00 in the same cohort. More than half of the studies showed a high risk of bias in the analysis domain of quality appraisal owing to the small sample size or overfitting issues. CONCLUSION The performance of machine learning algorithms in discriminating sacroiliitis features on MRI varied owing to the high heterogeneity between studies and the small sample sizes, overfitting, and under-reporting issues of individual studies. Further well-designed and transparent studies are required.
Collapse
Affiliation(s)
- Sun Jae Moon
- Department of Medicine, Santa Marie 24 Clinic, Seongnam-si, Korea (the Republic of)
| | - Seulkee Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Jinseub Hwang
- Department of Data Science, Daegu University, Gyeongsan-si, Korea (the Republic of)
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Seonyoung Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| |
Collapse
|
29
|
Charles-Schoeman C, Choy E, McInnes IB, Mysler E, Nash P, Yamaoka K, Lippe R, Khan N, Shmagel AK, Palac H, Suboticki J, Curtis JR. MACE and VTE across upadacitinib clinical trial programmes in rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. RMD Open 2023; 9:e003392. [PMID: 37945286 PMCID: PMC10649869 DOI: 10.1136/rmdopen-2023-003392] [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: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES To provide an integrated analysis of major adverse cardiovascular events (MACEs) and events of venous thromboembolism (VTE) and associated risk factors across rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) phase 2b/3 upadacitinib clinical programmes. METHODS Data were analysed and summarised from clinical trials of RA, PsA and AS treated with upadacitinib 15 mg once daily (QD) and 30 mg QD (as of 30 June 2021). Data from adalimumab (RA and PsA) and methotrexate (RA) arms were included as comparators. Adjudicated MACEs and VTE events were presented as exposure-adjusted rates per 100 patient-years (E/100 PY). Univariable Cox proportional hazard regression analyses assessed potential associations of risk factors for MACE and VTE. RESULTS In total, 4298 patients received upadacitinib 15 mg (RA n=3209, PsA n=907 and AS n=182) and 2125 patients received upadacitinib 30 mg (RA n=1204 and PsA n=921). In patients with RA and PsA, rates of MACE (0.3-0.6 E/100 PY) and VTE (0.2-0.4 E/100 PY) were similar across upadacitinib doses; in patients with AS, no MACEs and one VTE event occurred. Most patients experiencing MACEs or VTE events had two or more baseline cardiovascular risk factors. Across RA and PsA groups, rates of MACEs and VTE events were similar. CONCLUSIONS Rates of MACEs and VTE events with upadacitinib were consistent with previously reported data for patients receiving conventional synthetic and biologic disease-modifying anti-rheumatic drugs and comparable with active comparators adalimumab and methotrexate. Associated patient characteristics are known risk factors for MACEs and VTE events. TRIAL REGISTRATION NUMBERS RA (SELECT-NEXT: NCT02675426; SELECT-MONOTHERAPY: NCT02706951; SELECT-BEYOND: NCT02706847; SELECT-COMPARE: NCT02629159; SELECT-EARLY: NCT02706873, SELECT-CHOICE: NCT03086343), PsA (SELECT-PsA 2: NCT03104374; SELECT-PsA 1: NCT03104400), and AS (SELECT-AXIS 1: NCT03178487).
Collapse
Affiliation(s)
| | - Ernest Choy
- Division of Infection and Immunity, CREATE Centre, Cardiff University, Cardiff, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Eduardo Mysler
- Department of Rheumatology, OMI (Medical Research Organization), Buenos Aires, Argentina
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Kunihiro Yamaoka
- Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Ralph Lippe
- AbbVie Deutschland GmbH & Co KG, Wiesbaden, Germany
| | | | | | | | | | - Jeffrey R Curtis
- Department of Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
30
|
Fakih O, Balblanc JC, Lohse A. Rare mimicker of sacroiliitis. Ann Rheum Dis 2023; 82:1368. [PMID: 37072153 DOI: 10.1136/ard-2023-224164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Affiliation(s)
- Olivier Fakih
- Service de rhumatologie, Hôpital Nord Franche-Comté, Trévenans, France
| | | | - Anne Lohse
- Service de rhumatologie, Hôpital Nord Franche-Comté, Trévenans, France
| |
Collapse
|
31
|
Aureal M, Seauve M, Laplane S, Lega JC, Cabrera N, Coury F. Incidence of infections in patients with psoriatic arthritis and axial spondyloarthritis treated with biological or targeted disease-modifying agents: a systematic review and meta-analysis of randomised controlled trials, open-label studies and observational studies. RMD Open 2023; 9:e003064. [PMID: 37714666 PMCID: PMC10510924 DOI: 10.1136/rmdopen-2023-003064] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To estimate the incidence of infections among patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA), two distinct phenotypes included in the large group of spondyloarthritis (SpA), treated with tumour necrosis-factor-inhibitors, interleukin-17-inhibitors, Janus kinase-inhibitors, IL-23 or IL-12/23-inhibitors (IL-12/23i), phosphodiesterase 4-inhibitors or cytotoxic T-lymphocyte associated protein 4-Ig. METHODS A meta-analysis of randomised controlled trials (RCTs), open-label extension and observational studies was conducted. Serious infections were defined as infections that were life-threatening, required intravenous antibiotics and/or hospitalisation. Non-serious infections did not meet these severity criteria. The incidence rates (IR) were reported for each diagnosis by treatment class and study type using random-effect model to create a 95% CI. RESULTS Among 23 333 PsA patients and 11 457 axSpA patients, there were 1.09 serious infections per 100 patient-years (PY) (95% CI 0.85 to 1.35) with similar IR in PsA (0.96 per 100 PY 95% CI 0.69 to 1.28) and axSpA (1.09 per 100 PY 95% CI 0.76 to 1.46). The IR was lower in RCTs (0.77 per 100 PY 95% CI 0.41 to 1.20) compared with observational studies (1.68 per 100 PY 95% CI 1.03 to 2.47). In PsA patients, the lowest IR value was observed with IL-12/23i (0.29 per 100 PY 95% CI 0.00 to 1.03). There were 53.0 non-serious infections per 100 PY (95% CI 43.47 to 63.55) in 7257 PsA patients and 5638 axSpA patients. The IR was higher in RCTs (69.95 per 100 PY 95% CI 61.59 to 78.84) compared with observational studies (15.37 per 100 PY 95% CI 5.11 to 30.97). CONCLUSION Serious infections were rare events in RCTs and real-life studies. Non-serious infections were common adverse events, mainly in RCTs. PROSPERO REGISTRATION NUMBER CRD42020196711.
Collapse
Affiliation(s)
- Melanie Aureal
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
| | - Milene Seauve
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
| | - Soline Laplane
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
| | - Jean-Christophe Lega
- Department of Internal and Vascular Medicine, Hospices Civils de Lyon, Lyon, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France
| | - Natalia Cabrera
- University of Lyon, Laboratoire de Biométrie et Biologie Évolutive UMR - CNRS 5558, Lyon, France
| | - Fabienne Coury
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France
- University of Lyon, INSERM UMR 1033, Lyon, France
| |
Collapse
|
32
|
Braun J. Correspondence on "ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update". Ann Rheum Dis 2023; 82:e205. [PMID: 36737105 PMCID: PMC10423486 DOI: 10.1136/ard-2023-223935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Juergen Braun
- Rheumapraxis Berlin, Ruhr University Bochum, Berlin, Germany
| |
Collapse
|
33
|
Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, Landewé RB, van der Heijde D. Response to: Correspondence on "ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update" by Braun et al. Ann Rheum Dis 2023; 82:e206. [PMID: 36878690 DOI: 10.1136/ard-2023-223937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Elena Nikiphorou
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- King's College Hospital, London, UK
- Centre for Rheumatic Diseases, King's College London, London, UK
| | | | - Augusta Ortolan
- Department of Medicine DIMED, University of Padova, Rheumatology Unit, Padua, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
| | - Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Maastricht University, Maastricht, The Netherlands
| | | | - Robert Bm Landewé
- Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Rheumatology & Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | |
Collapse
|
34
|
Beckers E, Hermans K, Van Tubergen A, Boonen A. Fatigue in patients with rheumatic and musculoskeletal diseases: a scoping review on definitions, measurement instruments, determinants, consequences and interventions. RMD Open 2023; 9:e003056. [PMID: 37541741 PMCID: PMC10407379 DOI: 10.1136/rmdopen-2023-003056] [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: 02/06/2023] [Accepted: 05/21/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES To scope published reviews addressing fatigue in rheumatoid arthritis (RA), spondyloarthritis, osteoarthritis and fibromyalgia in areas relevant for clinical practice: (1) definition, (2) measurement instruments and diagnosis, (3) determinants, (4) consequences and (5) effectiveness of interventions. METHODS A systematic literature search of reviews was performed in five bibliographical databases. A hierarchical data extraction was applied based on review type (Cochrane reviews (CRs), followed by non-Cochrane systematic reviews (SRs) and narrative reviews (NRs)) and year of publication. Extracted data were summarised in elaborated narrative syntheses. Results were discussed with a patient panel. RESULTS One hundred and thirty-four reviews were included (19 CRs, 44 SRs, 71 NRs). No agreed on definition was reported for general fatigue, nor for types of fatigue. Twenty-five measurement instruments were found, all self-reported. Five instruments proposed a threshold for excessive fatigue. Pain, physical function and depressive symptoms were the most frequently studied disease-related determinants of fatigue; female sex and stress the most frequent contextual determinants. Work performance, followed by impact on pain, physical activity and social roles were the most frequently studied consequences. Whenever quantified, associations between fatigue with determinants and consequences were on average small. For non-pharmacological interventions, if effect sizes were reported, these were negligible to small and for pharmacological interventions negligible to moderate. Patients recommended actions for research and practice. CONCLUSION Syntheses of reviews point to the complexity of fatigue. The extensive amount of evidence could be used to offer tailored management plans to patients in clinical practice and inform future research agendas.
Collapse
Affiliation(s)
- Esther Beckers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Kasper Hermans
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Astrid Van Tubergen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| |
Collapse
|
35
|
Reinisch W, Hellstrom W, Dolhain RJEM, Sikka S, Westhovens R, Mehta R, Ritter T, Seidler U, Golovchenko O, Simanenkov V, Garmish O, Jeka S, Moravcová R, Rajendran V, Le Brun FO, Arterburn S, Watkins TR, Besuyen R, Vanderschueren D. Effects of filgotinib on semen parameters and sex hormones in male patients with inflammatory diseases: results from the phase 2, randomised, double-blind, placebo-controlled MANTA and MANTA-RAy studies. Ann Rheum Dis 2023; 82:1049-1058. [PMID: 37137672 PMCID: PMC10359529 DOI: 10.1136/ard-2023-224017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The phase 2 MANTA and MANTA-RAy studies aimed to determine if the oral Janus kinase 1 preferential inhibitor filgotinib affects semen parameters and sex hormones in men with inflammatory diseases. METHODS MANTA (NCT03201445) and MANTA-RAy (NCT03926195) included men (21-65 years) with active inflammatory bowel disease (IBD) and rheumatic diseases (rheumatoid arthritis, spondyloarthritis or psoriatic arthritis), respectively. Eligible participants had semen parameters in the normal range per the WHO definition. In each study, participants were randomised 1:1 to receive once-daily, double-blind filgotinib 200 mg or placebo for 13 weeks for pooled analysis of the primary endpoint (proportion of participants with a ≥50% decrease from baseline in sperm concentration at week 13). Participants who met the primary endpoint were monitored over an additional 52 weeks for 'reversibility'. Secondary endpoints included change from baseline to week 13 in: sperm concentration, total motility, normal morphology, total count and ejaculate volume. Sex hormones (luteinising hormone, follicle stimulating hormone, inhibin B and total testosterone) and reversibility were exploratory endpoints. RESULTS Across both studies, 631 patients were screened, and 248 were randomised to filgotinib 200 mg or placebo. Baseline demographics and characteristics were similar within indications between treatment groups. Numerically similar proportions of filgotinib-treated versus placebo-treated patients met the primary endpoint (8/120 (6.7%) vs 10/120 (8.3%)), Δ-1.7% (95% CI -9.3% to 5.8%)). There were no clinically relevant changes from baseline to week 13 in semen parameters or sex hormones, or patterns of reversibility between treatment groups. Filgotinib was well tolerated, with no new safety events. CONCLUSIONS Results suggest that once daily filgotinib 200 mg for 13 weeks has no measurable impact on semen parameters or sex hormones in men with active IBD or inflammatory rheumatic diseases.
Collapse
Affiliation(s)
- Walter Reinisch
- Medical University of Vienna, Department of Internal Medicine III, Division Gastroenterology & Hepatology, Vienna, Austria
| | - Wayne Hellstrom
- Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Suresh Sikka
- Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - René Westhovens
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | | | | | - Ursula Seidler
- Department of Gastroenterology, Hannover Medical School, Hannover, Germany
| | - Oleksandr Golovchenko
- Medical Clinical Investigational Center of Medical Center Health Clinic LLC, Vinnytsia, Ukraine
| | - Vladimir Simanenkov
- State Budgetary Healthcare Institution "City Hospital #26", Saint-Petersburg, Russian Federation
| | - Olena Garmish
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Kyiv, Ukraine
| | - Sławomir Jeka
- Clinic of Rheumatology and Systemic Connective Tissue Disorders, J. Biziel University Hospital No. 2, Bydgoszcz, Poland
| | - Radka Moravcová
- Department of Rheumatology, First Faculty of Medicine, Charles University and Rheumatology Institute, Prague, Czech Republic
| | | | | | | | | | | | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| |
Collapse
|
36
|
Abstract
The human lymphocyte antigen B27 (HLA B27) is a member of the HLA class I family of genes in the major histocompatibility complex whose name goes back to its discovery in studies of transplanted tissue compatibility. Its prevalence in the mid-European population is about 8%. The association of HLA B27 alleles with ankylosing spondylitis (AS), a highly heritable disease, which is part of the spectrum of axial spondyloarthritis (axSpA), was discovered 50 years ago. HLA B27 explains less than 30% of the total genetic load. About 60%-90% of axSpA patients worldwide carry HLA B27. The prevalence of the disease is linked to the frequency of HLA B27 in the population which implies that there are relevant differences. Among the roughly 200 subtypes known there are two which are not disease associated. The function of HLA class I molecules is to present peptides to the immune system to defend the organism against microbes targeted by CD8+T cells. This is much supported by the role of the endoplasmic reticulum aminopeptidase 1 (ERAP 1) in AS, an enzyme that is responsible for the intracellular trimming of peptides, since polymorphisms of this gene are only associated with HLA-B27+ disease. The arthritogenic peptide hypothesis trying to explain the pathogenesis of AS is based on that very immune function assuming that also self peptides can be presented. HLA-B27 also plays an important role in classification, diagnosis and severitiy of axSpA.
Collapse
Affiliation(s)
| | - Joachim Sieper
- Department of Rheumatology, Charite Universitatsmedizin Berlin, Berlin, Germany
| |
Collapse
|
37
|
Huang YT, Jenkins DA, Peek N, Dixon WG, Jani M. High frequency of long-term opioid use among patients with rheumatic and musculoskeletal diseases initiating opioids for the first time. Ann Rheum Dis 2023; 82:1116-1117. [PMID: 37193609 DOI: 10.1136/ard-2023-224118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/19/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Yun-Ting Huang
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - David A Jenkins
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Niels Peek
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance, Salford, UK
| | - Meghna Jani
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance, Salford, UK
| |
Collapse
|
38
|
Chaudhary H, López-Medina C, Khan MA, Dougados M, Magrey M. Clinical profile and treatment utilisation based on HLA-B*27 status in axial spondyloarthritis: results from ASAS-PerSpA study. RMD Open 2023; 9:e003179. [PMID: 37491128 PMCID: PMC10373694 DOI: 10.1136/rmdopen-2023-003179] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/21/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE We aimed to characterize differences of clinical features, extra-musculoskeletal manifestations and treatment utilizations based on the patients' HLA-B*27 status in a global axSpA cohort and identify predictors of HLA-B*27 negativity in these patients. METHODOLOGY In post-hoc analysis of the ASAS-PerSpA study, patients fulfilling the 2009 ASAS classification criteria for axSpA and typed for HLA-B*27 were included. The patient characteristics cwere compared between the HLA-B*27(+) and HLA-B*27(-) subgroups. Multivariablete logistic regression was conducted to identify predictors of HLA-B*27 negativity. RESULTS Of 2910 patients with axSpA from 24 countries, 2269 were tested for HLA-B*27 [1753 HLA-B*27(+) and 516 HLA-B*27(-)]. The proportion of males was higher in the HLA-B*27 (+) compared to the HLA-B*27 (-) subgroup (72.1 vs 54.3%). Patient population with HLA-B*27 (+) more often had positive family history for axSpA (29.8 vs 15.3%), and younger age at diagnosis, 31.6 years (SD 10.9) vs 37.7 years (SD 12.1). HLA-B*27 (-) patients had significantly higher peripheral arthritis (47.5 vs 42.1%, p<0.05), psoriasis (19.4 vs 10.2), enthesitis (56.6 vs 49.8%) and IBD (12.8 vs 3.4) (p<0.001). The exposure to csDMARDS in HLA-B*27 (-) patients was higher (61.2 vs 55.0%, p< 0.05). On multivariable analysis, HLA-B*27 (-) status was positively associated with enthesitis, psoriasis and IBD with an OR 1.27 (1.02-1.57), 1.84 (1.36-2.48) and 4.84 (3.23-7.30) respectively, and inversely associated with uveitis, OR 0.37 (0.27-0.50). CONCLUSION HLA-B*27 (-) axSpA patients had a longer delay in diagnosis, more frequently had peripheral arthritis, enthesitis, IBD, psoriasis, and were more often treated with csDMARDs compared to HLA-B*27 (+) subgroup.
Collapse
Affiliation(s)
- Haseeb Chaudhary
- Department of Rheumatology, Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, IMIBIC, Univerisity of Cordoba, Cordoba, Spain
- Department of Rheumatology, Hôpital Cochin. Assistance Publique - Hôpitaux de ParisINSERM (U1153): Clinical epidemiology and biostatistics PRES Sorbonne Paris-Cité, Université de Paris, Paris, France
| | - Muhammad Asim Khan
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes Faculté de Médecine, Paris, France
| | - Marina Magrey
- Department of Rheumatology, Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| |
Collapse
|
39
|
Stal R, Ramiro S, van der Heijde D, van Gaalen FA, Baraliakos X, Machado PM, de Hooge M, van den Berg R, Reijnierse M, Braun J, Landewé R, Sepriano A. Do fatty lesions explain the effect of inflammation on new syndesmophytes in patients with radiographic axial spondyloarthritis? Results from the SIAS cohort and ASSERT trial. RMD Open 2023; 9:e003118. [PMID: 37407237 DOI: 10.1136/rmdopen-2023-003118] [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: 02/28/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To determine how much of the effect of vertebral corner inflammation on development of syndesmophytes is explained by vertebral corner fat deposition. METHODS Patients with radiographic axial spondyloarthritis (r-axSpA) from the SIAS (Sensitive Imaging in Ankylosing Spondylitis) cohort and ASSERT (Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy) trial were assessed at T0, T1 (SIAS: 1 year; ASSERT: 24 weeks) and T2 (2 years). Syndesmophytes assessed in each vertebral corner by whole spine low-dose CT (SIAS) or spinal radiographs (ASSERT) at T0 and T2 were considered present if seen by two of two readers. Inflammation (T0) and fat deposition (T0 and T1) on MRI were present if seen by ≥2 of 3 readers (SIAS) or 2 of 2 readers (ASSERT). Vertebral corners showing fat deposition or a syndesmophyte at baseline were ignored. Mediation analysis was applied to determine what proportion of the total effect of inflammation on syndesmophyte formation could be explained via the path of intermediate fat deposition. RESULTS Forty-nine SIAS patients (with 2667 vertebral corners) and 168 ASSERT patients (with 2918 vertebral corners) were analysed. The presence of inflammation at T0 increased the probability of a new syndesmophyte in the same vertebral corner at T2 by 9.3%. Of this total effect, 0.2% (2% (0.2 of 9.3) of the total effect) went via intermediate new fat deposition. In ASSERT, the total effect was 7.3%, of which 0.8% (10% of the total effect) went via new fat deposition. CONCLUSION In r-axSpA, vertebral corner inflammation may lead to syndesmophyte formation but in a minority of cases via visible fat deposition.
Collapse
Affiliation(s)
- Rosalinde Stal
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Pedro M Machado
- Centre for Rheumatology, University College London, London, UK
| | - Manouk de Hooge
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- VIB Center of Inflammation Research, Ghent University, Ghent, Belgium
| | - Rosaline van den Berg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Robert Landewé
- Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Clinical Immunology & Rheumatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
40
|
Navarro-Compán V, Benavent D, Capelusnik D, van der Heijde D, Landewé RB, Poddubnyy D, van Tubergen A, Baraliakos X, Van den Bosch FE, van Gaalen FA, Gensler L, López-Medina C, Marzo-Ortega H, Molto A, Pérez-Alamino R, Rudwaleit M, van de Sande M, Sengupta R, Weber U, Ramiro S. ASAS consensus definition of early axial spondyloarthritis. Ann Rheum Dis 2023:ard-2023-224232. [PMID: 37321799 DOI: 10.1136/ard-2023-224232] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 03/30/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To develop a consensual definition for the term 'early axial spondyloarthritis-axSpA'-and 'early peripheral spondyloarthritis-pSpA'. METHODS The ASAS (Assessment of SpondyloArthritis international Society-Spondyloarthritis EARly definition) steering committee convened an international working group (WG). Five consecutive steps were followed: (1) systematic literature review (SLR); (2) discussion of SLR results within the WG and ASAS community; (3) a three-round Delphi survey inviting all ASAS members to select the items that should be considered for the definition; (4) presentation of Delphi results to the WG and ASAS community and (5) ASAS voting and endorsement (2023 annual meeting). RESULTS Following the SLR, consensus was to proceed with an expert-based definition for early axSpA (81% in favour) but not for pSpA (54% against). Importantly, early axSpA should be based on symptom duration taking solely axial symptoms into account. 151-164 ASAS members participated in the Delphi surveys. Consensus was achieved for considering the following items within early axSpA definition: duration of symptoms ≤2 years; axial symptoms defined as cervical/thoracic/back/buttock pain or morning stiffness; regardless of the presence/absence of radiographic damage. The WG agreed that in patients with a diagnosis of axSpA 'early axSpA' should be defined as a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA. The ASAS community endorsed this proposal (88% in favour). CONCLUSIONS Early axSpA has newly been defined, based on expert consensus. This ASAS definition should be adopted in research studies addressing early axSpA.
Collapse
Affiliation(s)
| | - Diego Benavent
- Rheumatology, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - Dafne Capelusnik
- Universiteit Maastricht Care and Public Health Research Institute, Maastricht, The Netherlands
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Robert Bm Landewé
- Department of Rheumatology & Clinical Immunology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charite Universitatsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Center, Berlin, Germany
| | - Astrid van Tubergen
- Maastricht University Care and Public Health Research Institute, Maastricht, The Netherlands
- Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Xenofon Baraliakos
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
- Ruhr-Universitat Bochum, Bochum, Germany
| | - Filip E Van den Bosch
- Internal Medicine and Pediatrics, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
- Ghent University, Gent, Belgium
| | | | - Lianne Gensler
- Medicine, Division of Rheumatology, University of California, San Francisco, California, USA
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Helena Marzo-Ortega
- Rheumatology, Leeds Biomedical Research Centre, Leeds, UK
- University of Leeds Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Anna Molto
- APHP, INSERM U-1158, Rheumatology, Hospital Cochin, Paris, France
- Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
| | | | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhohe, Bielefeld, Germany
| | - Marleen van de Sande
- Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Raj Sengupta
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulrich Weber
- Practice Buchsbaum, Rheumatology, Schaffhausen Hospitals, Schaffhausen, Switzerland
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| |
Collapse
|
41
|
Ciurea A, Götschi A, Kissling S, Bernatschek A, Bürki K, Exer P, Nissen MJ, Möller B, Scherer A, Micheroli R. Characterisation of patients with axial psoriatic arthritis and patients with axial spondyloarthritis and concomitant psoriasis in the SCQM registry. RMD Open 2023; 9:rmdopen-2022-002956. [PMID: 37277211 DOI: 10.1136/rmdopen-2022-002956] [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: 12/21/2022] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Within the spectrum of spondyloarthritides, axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) present with overlapping features. Axial involvement in PsA (axial PsA) is treated according to recommendations for axSpA, as specific studies in axial PsA are scarce. We compared characteristics of patients with axSpA (particularly of patients with axSpA and concomitant psoriasis (pso)) with those of patients with axial PsA. METHODS Patients with axSpA and PsA in the Swiss Clinical Quality Management (SCQM) registry were included if information on pso and axial involvement was available. Patients with AxSpA were stratified by axSpA with and without pso (axSpA±pso) and patients with PsA were stratified to axial PsA or strictly peripheral PsA. RESULTS Previous or current psoriasis was observed in 479/4489 patients with axSpA (10.7%). Of 2631 patients with PsA, 1153 (43.8%) presented with axial involvement (opinion of the treating rheumatologist). Compared with patients with axSpA+pso, patients with axial PsA were older at symptom onset and at inclusion in SCQM, were less frequently HLA-B27 positive, had back pain less frequently and a higher prevalence of dactylitis and peripheral arthritis. A positive family history of pso or PsA was more frequent in axial PsA, while a positive family history of axSpA was more frequent in patients with axSpA+pso. Disease activity, function and mobility were comparable in axSpA+pso versus axial PsA. CONCLUSION Patients with axial PsA differ from patients with axSpA+pso in important demographic and clinical characteristics, and genetically, but present with a comparable disease burden. Treatment studies specifically dedicated to axial PsA seem warranted.
Collapse
Affiliation(s)
- Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Götschi
- DataScience, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland
| | - Seraphina Kissling
- DataScience, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland
| | - Alexander Bernatschek
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kristina Bürki
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
| | - Burkhard Möller
- Department of Rheumatology and Immunology, University Hospital Bern, Bern, Switzerland
| | - Almut Scherer
- DataScience, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
42
|
Frede N, Rieger E, Lorenzetti R, Venhoff AC, Kanne AM, Finzel S, Jandova I, Glaser C, Thiel J, Voll RE, Venhoff N. Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms. RMD Open 2023; 9:rmdopen-2022-002912. [PMID: 37208029 DOI: 10.1136/rmdopen-2022-002912] [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: 12/02/2022] [Accepted: 05/03/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVES Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) may have a profound impact on sleep and health-related quality of life. The aim of this study was to assess sleep quality and quality of life and determine associated factors in patients treated with spondyloarthritides (SpA). METHODS Cross-sectional questionnaire-based assessment of sleep behaviour, quality of life, functional impairment and depression (Regensburg Insomnia Scale, WHO Quality of Life questionnaire, Funktionsfragebogen Hannover questionnaire, Beck Depression Inventory II, Patient health questionnaire 9) and retrospective medical chart analysis of a monocentric cohort of 330 patients with SpA (n=168 PsA and n=162 axSpA). RESULTS 46.6% of patients with SpA demonstrated abnormal sleep behaviour. Linear regression models showed HLA-B27 positivity, Bath Ankylosing Spondylitis Disease Activity Index, depressive symptoms, functional capacity and disease duration to be predictive of insomnia symptoms in axSpA, respectively, depressive symptoms, female sex and Disease Activity Score 28 in patients with PsA. Patients with unrestful sleep had a significantly reduced health-related quality of life (p<0.001) as well as significantly more depressive symptoms (p<0.001). Satisfaction with health was rated significantly lower (p<0.001), indicating poor sleep as a burden on general well-being.In particular, female patients had a significantly worse sleep quality with a prolonged sleep latency (p=0.009), increased sleep disturbances (p=0.014) and unrestful sleep (p<0.001) as well as a reduced physical and mental health-related quality of life (p=0.015, p<0.001) and more depressive symptoms (p=0.015). CONCLUSION Despite treatment, many patients with SpA demonstrate abnormal sleep behaviour with symptoms of insomnia and a reduced quality of life with significant differences between male and female patients. An interdisciplinary and holistic approach may be needed to address unmet needs.
Collapse
Affiliation(s)
- Natalie Frede
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Eva Rieger
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Raquel Lorenzetti
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ana C Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Anna-Maria Kanne
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ilona Jandova
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Cornelia Glaser
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Division of Rheumatology and Clinical Immunology, Medical University Graz, Graz, Austria
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
43
|
van der Heijde D, Deodhar A, Baraliakos X, Brown MA, Dobashi H, Dougados M, Elewaut D, Ellis AM, Fleurinck C, Gaffney K, Gensler LS, Haroon N, Magrey M, Maksymowych WP, Marten A, Massow U, Oortgiesen M, Poddubnyy D, Rudwaleit M, Shepherd-Smith J, Tomita T, Van den Bosch F, Vaux T, Xu H. Efficacy and safety of bimekizumab in axial spondyloarthritis: results of two parallel phase 3 randomised controlled trials. Ann Rheum Dis 2023; 82:515-526. [PMID: 36649967 PMCID: PMC10086273 DOI: 10.1136/ard-2022-223595] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 11/07/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Axial spondyloarthritis (axSpA) is a complex disease with diverse manifestations, for which new treatment options are warranted. BE MOBILE 1 (non-radiographic (nr)-axSpA) and BE MOBILE 2 (radiographic axSpA (r-axSpA)) are double-blind, phase 3 trials designed to evaluate efficacy and safety of bimekizumab, a novel dual interleukin (IL)-17A and IL-17F inhibitor, across the axSpA spectrum. METHODS In parallel 52-week trials, patients with active disease were randomised 1:1 (nr-axSpA) or 2:1 (r-axSpA) to bimekizumab 160 mg every 4 weeks:placebo. From week 16, all patients received bimekizumab 160 mg every 4 weeks. Primary (Assessment of SpondyloArthritis international Society ≥40% improvement (ASAS40)) and secondary endpoints were assessed at week 16. Here, efficacy and treatment-emergent adverse events (TEAEs) are reported up to week 24. RESULTS 254 patients with nr-axSpA and 332 with r-axSpA were randomised. At week 16, primary (ASAS40, nr-axSpA: 47.7% bimekizumab vs 21.4% placebo; r-axSpA: 44.8% vs 22.5%; p<0.001) and all ranked secondary endpoints were met in both trials. ASAS40 responses were similar across TNFi-naïve and TNFi-inadequate responder patients. Improvements were observed in Ankylosing Spondylitis Disease Activity Score (ASDAS) states and objective measures of inflammation, including high-sensitivity C-reactive protein (hs-CRP) and MRI of the sacroiliac joints and spine. Most frequent TEAEs with bimekizumab (>3%) included nasopharyngitis, upper respiratory tract infection, pharyngitis, diarrhoea, headache and oral candidiasis. More fungal infections (all localised) were observed with bimekizumab vs placebo; no major adverse cardiovascular events (MACE) or active tuberculosis were reported. Incidence of uveitis and adjudicated inflammatory bowel disease was low. CONCLUSIONS Dual inhibition of IL-17A and IL-17F with bimekizumab resulted in significant and rapid improvements in efficacy outcomes vs placebo and was well tolerated in patients with nr-axSpA and r-axSpA.
Collapse
Affiliation(s)
| | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Maxime Dougados
- Department of Rheumatology, Hôpital Cochin, University Paris Cité, Paris, France
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
| | | | | | - Karl Gaffney
- Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK
| | - Lianne S Gensler
- Department of Medicine/Rheumatology, University of California, San Francisco, California, USA
| | - Nigil Haroon
- University Health Network, Schroeder Arthritis Institute, Department of Medicine/Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Marina Magrey
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Tetsuya Tomita
- Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka City, Osaka, Japan
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University and VIB Center for Inflammation Research, Ghent, Belgium
| | | | - Huji Xu
- Affiliated to Second Military Medical University, Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Shanghai, China
| |
Collapse
|
44
|
Chen S, Li Z, Chen D, Cui H, Wang J, Li Z, Li X, Zheng Z, Zhan Z, Liu H. Piezo1-mediated mechanotransduction promotes entheseal pathological new bone formation in ankylosing spondylitis. Ann Rheum Dis 2023; 82:533-545. [PMID: 36543525 DOI: 10.1136/ard-2022-223428] [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: 10/02/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to identify the role of Piezo1-mediated mechanotransduction in entheseal pathological new bone formation and to explore the underlying molecular mechanism. METHODS Spinal ligament tissues were collected from 14 patients with ankylosing spondylitis (AS) and 14 non-AS controls and bulk RNA sequencing was conducted. Collagen antibody-induced arthritis models were established to observe pathological new bone formation. Pharmacological inhibition and genetic ablation of Piezo1 was performed in animal models to identify the essential role of Piezo1. Entheseal osteo-chondral lineage cells were collected and in vitro cell culture system was established to study the role and underlying mechanism of Piezo1 in regulation of chondrogenesis, osteogenesis and its own expression. RESULTS Piezo1 was aberrantly upregulated in ligaments and entheseal tissues from patients with AS and animal models. Pharmaceutical and genetic inhibition of Piezo1 attenuated while activation of Piezo1 promoted pathological new bone formation. Mechanistically, activation of CaMKII (Calcium/calmodulin dependent protein kinase II) signalling was found essential for Piezo1-mediated mechanotransduction. In addition, Piezo1 was upregulated by AS-associated inflammatory cytokines. CONCLUSION Piezo1-mediated mechanotransduction promotes entheseal pathological new bone formation through CaMKII signalling in AS.
Collapse
Affiliation(s)
- Siwen Chen
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Zihao Li
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Dongying Chen
- Deparment of Rheumatology and Immunology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Haowen Cui
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Jianru Wang
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Zemin Li
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Xiang Li
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Zhaomin Zheng
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Zhongping Zhan
- Deparment of Rheumatology and Immunology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Hui Liu
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| |
Collapse
|
45
|
Stal R, Ramiro S, Baraliakos X, Braun J, Reijnierse M, van den Berg R, van der Heijde D, van Gaalen FA. Good construct validity of the CT Syndesmophyte Score (CTSS) in patients with radiographic axial spondyloarthritis. RMD Open 2023; 9:rmdopen-2022-002959. [PMID: 36914212 PMCID: PMC10016293 DOI: 10.1136/rmdopen-2022-002959] [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: 12/22/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES To assess construct validity of the CT Syndesmophyte Score (CTSS) for the measurement of structural spinal damage in patients with radiographic axial spondyloarthritis. METHODS Low-dose CT and conventional radiography (CR) were performed at baseline and 2 years. CT was assessed with CTSS by two readers and CR with modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) by three readers. Two hypotheses were tested: (1) syndesmophytes scored with CTSS are also detected with mSASSS at baseline or 2 years later; (2) CTSS is non-inferior to mSASSS in correlations with spinal mobility measures. Presence of a syndesmophyte was determined per reader per corner for all anterior cervical and lumbar corners on CT at baseline and CR at baseline and 2 years. Correlations of CTSS and mSASSS with six spinal/hip mobility measurements plus Bath Ankylosing Spondylitis Metrology Index (BASMI) were tested. RESULTS Data from 48 patients (85% male, 85% HLA-B27+, mean age 48 years) were available for hypothesis 1 and 41/48 were available for hypothesis 2. At baseline, syndesmophytes were scored with CTSS in 348 (reader 1, 38%) and 327 (reader 2, 36%) corners out of 917. Of these, depending on reader pairs, 62%-79% were also seen on CR at baseline or after 2 years. CTSS correlated well (rs 0.46-0.73), and with higher correlation coefficients than mSASSS (rs 0.34-0.64), with all spinal mobility measures and BASMI. CONCLUSIONS The good agreement between syndesmophytes detected by CTSS and mSASSS and the strong correlation of CTSS with spinal mobility support the construct validity of the CTSS.
Collapse
Affiliation(s)
- Rosalinde Stal
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | | | | | | | | |
Collapse
|
46
|
Kiltz U, Hoeper K, Hammel L, Lieb S, Hähle A, Meyer-Olson D. Work participation in patients with axial spondyloarthritis: high prevalence of negative workplace experiences and long-term work impairment. RMD Open 2023; 9:rmdopen-2022-002663. [PMID: 36927848 PMCID: PMC10030742 DOI: 10.1136/rmdopen-2022-002663] [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: 08/11/2022] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that typically affects people in their second and third decades of life, which are important years for establishing a professional career. We aim to study outcomes of work participation (WP) and their associations with demographic and clinical confounders, in addition to prevalence of negative workplace experiences in axSpA. METHODS In total, 770 patients with axSpA participated in the multicentre, observational ATTENTUS-axSpA survey in Germany. Demographic information, clinical parameters and patient-related outcomes (including disease activity and function) with a focus on WP were prospectively recorded. RESULTS A high prevalence of negative workplace experiences was reported among the 770 patients analysed. Overall, 23.4% of patients were not employed and 6.5% received disability pensions. Current work cessation was prevalent in 120 patients, and 28 of those were out of work for 10 years or longer. Of the 590 currently employed patients, 31.9% reported absenteeism and 35.9% reported presenteeism for >1 month within the past year. Multivariate logistic regression identified low disease activity (Bath Ankylosing Spondylitis Disease Activity Index), better physical function (Bath Ankylosing Spondylitis Functional Index) and better global functioning (Assessment of SpondylAarthritis International Society-Health Index) as the main predictors for unimpaired WP (n=242). Importantly, biological treatment, disease duration, age, sex, education level and body mass index were not reliable predictors. DISCUSSION Despite improvements in pharmacological treatment options, we still observed substantially impaired WP in patients with axSpA. These data emphasise the high unmet need for targeted strategies to provide improved medical and social care.
Collapse
Affiliation(s)
- Uta Kiltz
- Ruhr-Universität Bochum, Bochum, Germany
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Kirsten Hoeper
- Rheumatologie and Immunologie, Regionales Kooperatives Rheumazentrum Niedersachsen eV, Hannover, Germany
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Ludwig Hammel
- Deutsche Vereinigung Morbus Bechterew e.V, Schweinfurt, Germany
| | | | | | - Dirk Meyer-Olson
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Germany
- Rheumatologie, m&i Fachklinik Bad Pyrmont, Bad Pyrmont, Germany
| |
Collapse
|
47
|
van der Togt CJT, Van den Bemt B, Aletaha D, Alten R, Chatzidionysiou K, Galloway J, Isaac J, Mulleman D, Verschueren P, Vulto AG, Welsing PMJ, Verhoef L, den Broeder AA. Points to consider for cost-effective use of biological and targeted synthetic DMARDs in inflammatory rheumatic diseases: results from an umbrella review and international Delphi study. RMD Open 2023; 9:rmdopen-2022-002898. [PMID: 36863753 PMCID: PMC9990692 DOI: 10.1136/rmdopen-2022-002898] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/08/2023] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVES To develop evidence-based points to consider for cost-effective use of biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in the treatment of inflammatory rheumatic diseases, specifically rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. METHODS Following EULAR procedures, an international task force was formed, consisting of 13 experts in rheumatology, epidemiology and pharmacology from seven European countries. Twelve strategies for cost-effective use of b/tsDMARDs were identified through individual and group discussion. For each strategy, PubMed and Embase were systematically searched for relevant English-language systematic reviews and, for six strategies, additionally for randomised controlled trials (RCTs). Thirty systematic reviews and 21 RCTs were included. Based on the evidence, a set of overarching principles and points to consider was formulated by the task force using a Delphi procedure. Level of evidence (1a-5) and grade (A-D) were determined for each point to consider. Individual voting on the level of agreement (LoA; between 0 (completely disagree) and 10 (completely agree)) was performed anonymously. RESULTS The task force agreed on five overarching principles. For 10 of 12 strategies, the evidence was sufficient to formulate one or more points to consider, leading to 20 in total, regarding response prediction, drug formulary use, biosimilars, loading doses, low-dose initial therapy, concomitant conventional synthetic DMARD use, route of administration, medication adherence, disease activity-guided dose optimisation and non-medical drug switching. Ten points to consider (50%) were supported by level 1 or 2 evidence. The mean LoA (SD) varied between 7.9 (1.2) and 9.8 (0.4). CONCLUSION These points to consider can be used in rheumatology practices and complement inflammatory rheumatic disease treatment guidelines to incorporate cost-effectiveness in b/tsDMARD treatment.
Collapse
Affiliation(s)
- Céleste J T van der Togt
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands .,Department of Rheumatology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Bart Van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboudumc, Nijmegen, The Netherlands
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Rieke Alten
- Internal Medicine, Rheumatology, Schlosspark-Klinik GmbH, Berlin, Germany
| | | | - James Galloway
- Department of Rheumatology, King's College London, London, UK
| | - John Isaac
- Department of Rheumatology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Denis Mulleman
- Department of Rheumatology, University of Tours, Tours, France.,Service de Rhumatologie, CHRU Tours, Tours, France
| | - P Verschueren
- Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Arnold G Vulto
- Department of Pharmacy, Erasmus MC, Rotterdam, The Netherlands
| | - Paco M J Welsing
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Lise Verhoef
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | |
Collapse
|
48
|
Götestam Skorpen C, Lydersen S, Salvesen KÅ, Koksvik HSS, Jakobsen B, Wallenius M. Caesarean section in women with axial spondyloarthritis and psoriatic arthritis: a population-based study. RMD Open 2023; 9:rmdopen-2022-002760. [PMID: 36863750 PMCID: PMC9990672 DOI: 10.1136/rmdopen-2022-002760] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND There is sparse documentation on pregnancy outcomes in women with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Data on disease activity are often lacking, preventing the direct investigation of the effect of inflammation on pregnancy outcomes. A caesarean section (CS) implies a higher risk for complications than vaginal delivery. It delays mobilisation after birth necessary to counteract inflammatory pain and stiffness. OBJECTIVE To explore a possible association of inflammatory active disease and CS rates in women with axSpA and PsA. METHODS Data from the Medical Birth Registry of Norway (MBRN) were linked with data from RevNatus, a Norwegian nationwide observational register recruiting women with inflammatory rheumatic diseases. Singleton births in women with axSpA (n=312) and PsA (n=121) included in RevNatus 2010-2019 were cases. Singleton births, excluding mothers with rheumatic inflammatory diseases, registered in MBRN during the same period time (n=575 798) served as population controls. RESULTS CS occurred more frequently in both axSpA (22.4%) and PsA (30.6%) groups compared with population controls (15.6%), with even higher frequencies in inflammatory active axSpA (23.7%) and PsA (33.3%) groups. Compared with population controls, women with axSpA had higher risk for elective CS (risk difference 4.4%, 95% CI 1.5% to 8.2%) but not emergency CS. Women with PsA had higher risk for emergency CS (risk difference 10.6%, 95% CI 4.4% to 18.7%) but not elective CS. CONCLUSION Women with axSpA had higher risk for elective and women with PsA for emergency CS. Active disease amplified this risk.
Collapse
Affiliation(s)
- Carina Götestam Skorpen
- Rheumatology, Helse More og Romsdal HF, Alesund, Norway .,Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Mental Health, Regional Center for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St Olavs Hospital Universitetssykehuset i Trondheim, Trondheim, Norway
| | - Hege Suorza Svean Koksvik
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Dept of Rheumatology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Bente Jakobsen
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Dept of Rheumatology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Marianne Wallenius
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Dept of Rheumatology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway.,Institute of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
49
|
Machado PM, Schäfer M, Mahil SK, Liew J, Gossec L, Dand N, Pfeil A, Strangfeld A, Regierer AC, Fautrel B, Alonso CG, Saad CGS, Griffiths CEM, Lomater C, Miceli-Richard C, Wendling D, Alpizar Rodriguez D, Wiek D, Mateus EF, Sirotich E, Soriano ER, Ribeiro FM, Omura F, Rajão Martins F, Santos H, Dau J, Barker JN, Hausmann J, Hyrich KL, Gensler L, Silva L, Jacobsohn L, Carmona L, Pinheiro MM, Zelaya MD, Severina MDLÁ, Yates M, Dubreuil M, Gore-Massy M, Romeo N, Haroon N, Sufka P, Grainger R, Hasseli R, Lawson-Tovey S, Bhana S, Pham T, Olofsson T, Bautista-Molano W, Wallace ZS, Yiu ZZN, Yazdany J, Robinson PC, Smith CH. Characteristics associated with poor COVID-19 outcomes in people with psoriasis, psoriatic arthritis and axial spondyloarthritis: data from the COVID-19 PsoProtect and Global Rheumatology Alliance physician-reported registries. Ann Rheum Dis 2023; 82:698-709. [PMID: 36787993 PMCID: PMC10176347 DOI: 10.1136/ard-2022-223499] [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: 10/17/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To investigate factors associated with severe COVID-19 in people with psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). METHODS Demographic data, clinical characteristics and COVID-19 outcome severity of adults with PsO, PsA and axSpA were obtained from two international physician-reported registries. A three-point ordinal COVID-19 severity scale was defined: no hospitalisation, hospitalisation (and no death) and death. ORs were estimated using multivariable ordinal logistic regression. RESULTS Of 5045 cases, 18.3% had PsO, 45.5% PsA and 36.3% axSpA. Most (83.6%) were not hospitalised, 14.6% were hospitalised and 1.8% died. Older age was non-linearly associated with COVID-19 severity. Male sex (OR 1.54, 95% CI 1.30 to 1.83), cardiovascular, respiratory, renal, metabolic and cancer comorbidities (ORs 1.25-2.89), moderate/high disease activity and/or glucocorticoid use (ORs 1.39-2.23, vs remission/low disease activity and no glucocorticoids) were associated with increased odds of severe COVID-19. Later pandemic time periods (ORs 0.42-0.52, vs until 15 June 2020), PsO (OR 0.49, 95% CI 0.37 to 0.65, vs PsA) and baseline exposure to TNFi, IL17i and IL-23i/IL-12+23i (OR 0.57, 95% CI 0.44 to 0.73; OR 0.62, 95% CI 0.45 to 0.87; OR 0.67, 95% CI 0.45 to 0.98; respectively; vs no disease-modifying antirheumatic drug) were associated with reduced odds of severe COVID-19. CONCLUSION Older age, male sex, comorbidity burden, higher disease activity and glucocorticoid intake were associated with more severe COVID-19. Later pandemic time periods, PsO and exposure to TNFi, IL17i and IL-23i/IL-12+23i were associated with less severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with PsO, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics.
Collapse
Affiliation(s)
- Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK .,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Martin Schäfer
- Epidemiology and Health Services Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
| | - Satveer K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Jean Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France.,AP-HP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Anja Strangfeld
- Epidemiology and Health Services Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany.,Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Anne Constanze Regierer
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Bruno Fautrel
- Rheumatology, Pitié-Salpêtrière hospital, AP - HP, Paris, France
| | | | - Carla G S Saad
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Claudia Lomater
- Academic Rheumatology Centre, Università degli Studi di Torino, Torino, Italy
| | - Corinne Miceli-Richard
- Assistance Publique, Hôpital Cochin, Hôpitaux de Paris & Université de Paris, Paris, France.,Unité Mixte AP-HP/ Institut Pasteur, Institut Pasteur, Paris, France
| | - Daniel Wendling
- Rheumatology, Franche-Comté University and University Teaching Hospital (CHRU), Besançon, France
| | | | - Dieter Wiek
- People with Arthritis and Rheumatism (PARE), EULAR, Zurich, Switzerland
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal.,European Alliance of Associations for Rheumatology (EULAR), Kilchberg, Switzerland
| | - Emily Sirotich
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Francinne Machado Ribeiro
- Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Felipe Omura
- Clínica Omura Medicina Diagnóstica, São Paulo, Brazil
| | | | - Helena Santos
- Instituto Português de Reumatologia, Lisbon, Portugal.,EpiDoC Unit, CEDOC, Nova Medical School, Lisbon, Portugal
| | - Jonathan Dau
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Jonathan N Barker
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jonathan Hausmann
- Program in Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimme L Hyrich
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Lianne Gensler
- University of California, San Francisco, California, USA
| | - Ligia Silva
- Rheumatology, Centro Hospitalar de Trás-os-montes e Alto Douro (CHTMAD), Vila Real, Portugal
| | - Lindsay Jacobsohn
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Marcelo M Pinheiro
- Rheumatology, Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - María de Los Ángeles Severina
- Centro Privado de Medicina Nuclear and Clinica Villa Dalcar, Córdoba, Argentina.,Clinica Villa Dalcar, Río Cuarto, Córdoba, Argentina
| | - Mark Yates
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Maureen Dubreuil
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Nigil Haroon
- Rheumatology, University Health Network, Toronto, Ontario, Canada.,Senior Scientist, Schroder Arthritis Institute, University of Toronto, Toronto, Ontario, Canada
| | - Paul Sufka
- Healthpartners, St. Paul, Minnesota, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Rebecca Hasseli
- Department of Internal Medicine II, University Hospitals Giessen, Giessen, Germany.,Justus Liebig University Giessen, Giessen, Germany
| | - Saskia Lawson-Tovey
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | | | - Thao Pham
- Rheumatology, Aix-Marseille-University, Marseille, France.,Rheumatology, APHM, Marseille, France
| | - Tor Olofsson
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Wilson Bautista-Molano
- Rheumatology Division, University Hospital Fundación Santa Fé de Bogotá, Bogota, Colombia.,School of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Zachary S Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Zenas Z N Yiu
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Philip C Robinson
- School of Clinical Medicine, University of Queensland, Herston, Queensland, Australia.,Rheumatology, Royal Brisbane and Woman's Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| |
Collapse
|
50
|
Marques ML, Pereira da Silva N, van der Heijde D, Stal R, Baraliakos X, Braun J, Reijnierse M, Bastiaenen C, Ramiro S, van Gaalen FA. Inflammation, bone loss and 2-year bone formation at the same vertebra in axial spondyloarthritis: a multilevel MRI and low-dose CT analysis. RMD Open 2023; 9:rmdopen-2022-002836. [PMID: 36759008 PMCID: PMC9923353 DOI: 10.1136/rmdopen-2022-002836] [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: 11/02/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To investigate whether in radiographic axial spondyloarthritis (r-axSpA) inflammation is associated with lower trabecular bone density (TBD), and subsequently, if a lower TBD increases the likelihood of 2-year bone formation at the same vertebra. METHODS Whole spine (C3-L5) data from patients included in the multicentre 2-year Sensitive Imaging in Ankylosing Spondylitis cohort was used. Two readers measured baseline TBD by Hounsfield units (HU) on low-dose CT (ldCT). Baseline MRI bone marrow oedema (BME) status scores and ldCT syndesmophyte formation and/or growth change-from-baseline scores were assessed by three and two readers, respectively. Average of readers' continuous measurements or readers' agreement in binary scores generated within the same vertebra (1-present in ≥1 quadrant/0-absent in all quadrants) were used. Multilevel generalised estimating equations models were used, the unit of analysis being the vertebra. RESULTS In 50 patients with r-axSpA, TBD HU decreased from cranial to caudal vertebrae. Baseline MRI-BME was present in 300/985 (30%) and syndesmophytes in 588/910 (65%) vertebrae, both most prevalent at thoracolumbar region. Syndesmophyte formation or growth was observed in 18% of at-risk vertebrae (124/691). A significant confounder-adjusted association was found between inflammation and lower TBD (regression coefficient=-51; 95% CI-63 to -39). TBD was not associated with 2-year syndesmophyte formation or growth (adjusted OR 1.00; 95% CI 0.99 to 1.00). CONCLUSION In r-axSpA, while vertebral inflammation was associated with lower vertebral TBD, lower vertebral TBD itself did not increase the risk for new bone formation at the same vertebra. In preventing syndesmophyte progression, targeting local inflammation seems more important than targeting vertebral trabecular bone loss.
Collapse
Affiliation(s)
- Mary Lucy Marques
- Rheumatology department, Leiden University Medical Center, Leiden, Netherlands .,Rheumatology department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Nuno Pereira da Silva
- Radiology department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - Rosalinde Stal
- Rheumatology department, Leiden University Medical Center, Leiden, Netherlands
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Monique Reijnierse
- Radiology department, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sofia Ramiro
- Rheumatology department, Leiden University Medical Center, Leiden, Netherlands,Rheumatology department, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Floris A van Gaalen
- Rheumatology department, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|