Fat mass and response to TNFα blockers in early axial spondyloarthritis: an analysis of the DESIR cohort

Un nouvel article scientifique intitulé «Fat mass and response to TNFα blockers in early axial spondyloarthritis: an analysis of the DESIR cohort» a été publié dans le journal Ann Rheum Dis.

Molto A, Tang S, Combe B, Dougados M, Richette P.

No abstract available

Keywords: ankylosing; cardiovascular diseases; spondylitis; therapeutics.

How do clinical and socioeconomic factors impact on work disability in early axial spondyloarthritis? Five-year data from the DESIR cohort

Un nouvel article scientifique intitulé «How do clinical and socioeconomic factors impact on work disability in early axial spondyloarthritis? Five-year data from the DESIR cohort» a été publié dans le journal Rheumatology (Oxford).

Nikiphorou E, Boonen A, Fautrel B, Richette P, Landewé R, van der Heijde D, Ramiro S.

Objectives:

To investigate the impact of clinical and socioeconomic factors on work disability (WD) in early axial spondyloarthritis (axSpA).

Methods:

Patients from the DESIR cohort with a clinical diagnosis of axSpA were studied over 5 years. Time to WD and potential baseline and time-varying predictors were explored, with a focus on socioeconomic (including ethnicity, education, job-type, marital/parental status) and clinical (including disease activity, function, mobility) factors. Univariable analyses, collinearity, and interaction tests guided subsequent multivariable time-varying Cox survival analyses.

Results:

From 704 patients eligible for this study, the estimated incidence of WD amongst those identified at-risk (n = 663, 94%) and across the five-years of DESIR, was 0.05 (95% CI 0.03-0.06) per 1000 person-days. Significant differences in baseline socioeconomic factors, including lower educational status and clinical measures, including worse disease activity, were seen in patients developing WD over follow-up, compared with those who never did. In the main multivariable model, educational status was no longer predictive of WD, whereas the Ankylosing Spondylitis (AS) disease activity score (ASDAS) and the Bath AS functional index (BASFI) were significantly and independently associated with a higher hazard of WD (HR[95%CI] 1.79[1.27-2.54] and 1.42[1.22-1.65], respectively).

Conclusion:

WD was an infrequent event in this early axSpA cohort. Nevertheless, clinical factors were amongst the strongest predictors of WD, over socioeconomic factors, with worse disease activity and function independently associated with a higher hazard of WD. Disease severity remains a strong predictor of adverse work outcome even in early disease, despite substantial advances in therapeutic strategies in axSpA.

Keywords: adverse work outcomes; axSpA; disease activity; socioeconomic factors; work disability.

Factors associated with remission at 5-year follow-up in recent onset axial spondyloarthritis: results from the DESIR cohort

Un nouvel article scientifique intitulé «Factors associated with remission at 5-year follow-up in recent onset axial spondyloarthritis: results from the DESIR cohort» a été publié dans le journal Rheumatology (Oxford).

Pina Vegas L, Sbidian E, Wendling D, Goupille P, Ferkal S, Le Corvoisier P, Ghaleh B, Luciani A, Claudepierre P.

Objective:

The factors contributing to long-term remission in axial spondyloarthritis (axSpA) are unclear. We aimed to characterize individuals with axSpA at 5-year follow-up to identify baseline factors associated with remission.

Methods:

We included all patients from the DESIR cohort (recent onset axSpA) with available Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) at 5-year follow-up. Patients in remission (ASDAS-CRP<1.3) were compared to those with active disease by demographic, clinical, biological and imaging characteristics. A logistic model stratified on tumor necrosis factor inhibitor (TNFi) exposure was used.

Results:

Overall, 111/449 (25%) patients were in remission after 5 years. Among those never exposed to TNFi, 31% (77/247) were in remission compared to 17% (34/202) of those exposed to TNFi. Patients in remission after 5-years were more likely to be male, HLA-B27+, have a lower body mass index (BMI), and a higher education level. Baseline factors associated with 5-year remission in patients never exposed to TNFi, included lower BASDAI (adjusted odds ratio [ORa] 0.9, 95% confidence interval [95%CI] 0.8-0.9) and history of peripheral arthritis (ORa 2.1, 95%CI 1.2-5.3). In those exposed to TNFi, remission was associated with higher education level (ORa 2.9, 95%CI 1.6-5.1), lower enthesitis index (ORa 0.8, 95%CI 0.7-0.9), lower BASDAI (ORa 0.9, 95%CI 0.9-0.9), and lower BMI (ORa 0.8, 95%CI 0.7-0.9).

Conclusion:

This study highlights the difficulty in achieving 5-year remission in those with recent onset axSpA, especially for the more active cases, despite the use of TNFi. Socio-economic factors and BMI are implicated in the outcome at 5 years.

Keywords: Cohort; Prognostic factor; Remission; Spondyloarthritis.

Sociodemographic determinants in the evolution of pain in inflammatory rheumatic diseases: results from ESPOIR and DESIR cohorts

Un nouvel article scientifique intitulé «Sociodemographic determinants in the evolution of pain in inflammatory rheumatic diseases: results from ESPOIR and DESIR cohorts» a été publié dans le journal Rheumatology (Oxford).

Kumaradev S, Roux C, Sellam J, Perrot S, Pham T, Dugravot A, Molto A.

Objective:

To determine whether sociodemographic factors are associated with heterogeneity in pain evolution in inflammatory rheumatic diseases (IRDs) after accounting for disease-specific characteristics in a system with universal health care.

Methods:

This analysis included the data from two prospective observational cohorts of early IRDs (ESPOIR for early rheumatoid arthritis (RA) and DESIR for early spondyloarthritis (SpA)). Data on pain was measured respectively at 13 and 9 occasions spanning 10 and 6 years of follow-up using Short-Form 36 bodily pain amongst 810 participants of ESPOIR, and 679 participants of DESIR. Linear mixed models were used to characterise differences in pain evolution as a function of age (tertiles), sex, ethnicity, education, marital, and professional status after accounting for disease-related, treatment, lifestyle, and health factors.

Results:

While transitioning from early (disease duration ≤6 months for RA and ≤3 years for SpA) to long-standing disease, differences in pain evolution emerged as a function of age (p< 0.001), sex (p= 0.050), and ethnicity (p= 0.001) in RA, and as a function of age (p= 0.048) in SpA; younger age, males, and Caucasians exhibited lower pain in the latter phases of both diseases. Highly educated (RA, β=-3.8, p= 0.007; SpA, β=-6.0, p< 0.001) in both diseases, and Caucasians (β=-5.6, p= 0.021) in SpA presented with low pain early in the disease, with no changes throughout disease course.

Conclusion:

Those older, females, non-Caucasians and lowly educated have worse pain in early and/or long-standing IRDs despite universally accessible health-care. Early identification of at-risk population and implementation of multi-disciplinary strategies may reduce patient-reported health outcome disparities.

Keywords: Pain evolution; pain outcome; rheumatoid arthritis; sociodemographic factors; spondyloarthritis.

Sick leave in early axial spondyloarthritis: the role of clinical and socioeconomic factors. Five-year data from the DESIR cohort

Un nouvel article scientifique intitulé «Sick leave in early axial spondyloarthritis: the role of clinical and socioeconomic factors. Five-year data from the DESIR cohort» a été publié dans le journal RMD Open.

Nikiphorou E, Carvalho PD, Boonen A, Fautrel B, Richette P, Machado PM, van der Heijde D, Landewé R, Ramiro S.

Objectives:

To investigate the occurrence of sick leave (SL) and the impact of clinical and socioeconomic factors on SL in early axial spondyloarthritis (axSpA).

Methods:

Patients with a clinical diagnosis of axSpA from the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort with work-related data and up to 5-year follow-up were studied. Incidence, time to first SL and potential role of baseline and time-varying clinical and socioeconomic factors (age, gender, ethnicity, education, job type, marital and parental status) were analysed. Univariable analyses, followed by collinearity and interaction tests, guided subsequent multivariable time-varying Cox survival model building.

Results:

In total, 704 axSpA patients were included (mean (SD) age 33.8 (8.6); 46% men). At baseline, 80% of patients were employed; of these, 5.7% reported being on SL. The incidence of SL among those at risk during the study period (n=620, 88%) was 0.05 (95% CI 0.03 to 0.06) per 1000 days of follow-up. Mean (SD) time to first SL was 806 (595) days (range: 175-2021 days). In multivariable models, male gender (HR 0.41 (95% CI 0.20 to 0.86)) and higher education (HR 0.48 (95% CI 0.24 to 0.95)) were associated with lower hazard of SL, while higher disease activity (HR 1.49 (95% CI 1.04 to 2.13)), older age, smoking and use of tumour necrosis factor inhibitors were associated with higher hazard of SL.

Conclusions:

In this early axSpA cohort of young, working-age individuals, male gender and higher education were independently associated with a lower hazard of SL, whereas older age and higher disease activity were associated with higher hazard of SL. The findings suggest a role of socioeconomic factors in adverse work outcomes, alongside active disease.

Keywords: ankylosing; epidemiology; inflammation; spondylitis.

EULAR 2021

Lors du congrès de l’EULAR 2021 qui s’est déroulé du 2 au 5 juin 2021 en visioconférence, 6 abstracts ont été acceptés pour une présentation orale ou par poster :

Présentation orale

▫ FACTORS ASSOCIATED WITH REMISSION AT 5 YEARS OF FOLLOW-UP IN EARLY ONSET AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE DESIR COHORT, L. Pina Vegas, E. Sbidian, D. Wendling, P. Goupille, S. Ferkal, P. Le Corvoisier, B. Ghaleh, A. Luciani, P. Claudepierre

▫ IMPACT OF CORRECTING CRP THRESHOLD ACCORDING TO BMI ON DIAGNOSIS, DISEASE ACTIVITY, INDICATION OF BIOLOGICAL TREATMENT AND PREDICTION OF THERAPEUTIC RESPONSE, IN PATIENTS SUSPECTED OF AXIAL SPONDYLOARTHRITIS. RESULTS FROM DESIR COHORT, O. Facorat, J. Morel, B. Combe, P. Richette, C. Lukas

Présentations par affiches.

▫ NO DIFFERENCE BETWEEN THE SEROLOGIES OF DENTAL GERMS AND THE PHENOTYPES OF SPONDYLOARTHRITIS WITHIN THE DESIR COHORT, T. Neel, A. Tournadre, M. Paul, M. Norman, S. Paul, H. Marotte

▫ HOW DO CLINICAL AND SOCIOECONOMIC FACTORS IMPACT ON WORK DISABILITY IN EARLY AXIAL SPONDYLOARTHRITIS? FIVE-YEAR DATA FROM THE DESIR COHORT, E. Nikiphorou, A. Boonen, B. Fautrel, P. Richette, R. B. M. Landewé, D. Van der Heijde, S. Ramiro

▫ SICK LEAVE AND ITS PREDICTORS IN EARLY AXIAL SPONDYLOARTHRITIS: THE ROLE OF CLINICAL AND SOCIOECONOMIC FACTORS. FIVE-YEAR DATA FROM THE DESIR COHORT, E. Nikiphorou, P. Carvalho, A. Boonen, B. Fautrel, P. Richette, P. M. Machado, D. Van der Heijde, R. B. M. Landewé, S. Ramiro

▫ WHAT IS THE DIAGNOSTIC VALUE OF IMPAIRED SPINAL MOBILITY MEASUREMENTS IN INFLAMMATORY BACK PAIN PATIENTS? DATA FROM THE DESIR COHORT, C. Lukas, G. Khoury, M. A. D’agostino, B. Combe, J. Morel

Development and validation of an alternative ankylosing spondylitis disease activity score when patient global assessment is unavailable

Un nouvel article scientifique intitulé «Development and validation of an alternative ankylosing spondylitis disease activity score when patient global assessment is unavailable» a été publié dans le journal Rheumatology (Oxford).

Ortolan A, Ramiro S, van Gaalen F, Kvien TK, Landewe RBM, Machado PM, Ruyssen-Witrand A, van Tubergen A, Bastiaenen C, van der Heijde D.

Objective:

To develop an alternative Ankylosing Spondylitis Disease Activity Score (ASDAS) to be used in research settings in axial SpA (axSpA) when Patient Global Assessment (PGA) is unavailable in databases.

Methods:

Longitudinal data from four axSpA cohorts and two randomized controlled trials were combined. Observations were randomly split in a development (N = 1026) and a validation cohort (N = 1059). Substitutes of PGA by BASDAI total score, single or combined individual BASDAI questions, and a constant value, were established in the development cohort. Conversion factors for each substitute were defined by Generalized Estimating Equations, obtaining seven ‘alternative’ formulae. Validation was performed in the validation cohort according to the OMERACT filter, taking into consideration: (i) truth (agreement with original-ASDAS in the continuous score, by intraclass correlation coefficient and in disease activity states, by weighted kappa); (ii) discrimination [standardized mean difference of ASDAS scores between high/low disease activity states defined by external anchors, e.g. Patient Acceptable Symptom State; agreement (kappa) in the percentage of patients reaching ASDAS improvement criteria according to alternative vs original formulae]; and (iii) feasibility.

Results:

Comparing various options, alternative-ASDAS using BASDAI total as PGA replacement proved to be: truthful (intraclass correlation coefficient = 0.98, kappa = 0.90), discriminative [ASDAS scores between Patient Acceptable Symptom State no/yes: standardized mean difference = 1.37 (original-ASDAS standardized mean difference = 1.43); agreement with original-ASDAS in major improvement/clinically important improvement criteria: kappa = 0.93/0.88] and feasible (BASDAI total often available, as questions required for the ASDAS; conversion coefficient ≈ 1).

Conclusion:

Alternative-ASDAS using BASDAI total score as PGA replacement is the most truthful, discriminative and feasible instrument.

Keywords: axial spondyloarthrits; disease activity; patient-reported outcomes; validation.

Structural changes in the sacroiliac joint on MRI and relationship to ASDAS inactive disease in axial spondyloarthritis: a 2-year study comparing treatment with etanercept in EMBARK to a contemporary control cohort in DESIR

Un nouvel article scientifique intitulé «Structural changes in the sacroiliac joint on MRI and relationship to ASDAS inactive disease in axial spondyloarthritis: a 2-year study comparing treatment with etanercept in EMBARK to a contemporary control cohort in DESIR» a été publié dans le journal Arthritis Res Ther.

Maksymowych WP, Claudepierre P, de Hooge M, Lambert RG, Landewé R, Molto A, van der Heijde D, Bukowski JF, Jones H, Pedersen R, Szumski A, Vlahos B, Dougados M.

Background:

Limited information is available on the impact of treatment with a tumor necrosis factor inhibitor (TNFi) on structural lesions in patients with recent-onset axial spondyloarthritis (axSpA). We compared 2-year structural lesion changes on magnetic resonance imaging (MRI) in the sacroiliac joints (SIJ) of patients with recent-onset axSpA receiving etanercept in a clinical trial (EMBARK) to similar patients not receiving biologics in a cohort study (DESIR). We also evaluated the relationship between the Ankylosing Spondylitis Disease Activity Score (ASDAS) and change in MRI structural parameters.

Methods:

The difference between etanercept (EMBARK) and control (DESIR) in the net percentage of patients with structural lesion change was determined using the SpondyloArthritis Research Consortium of Canada SIJ Structural Score, with and without adjustment for baseline covariates. The relationship between sustained ASDAS inactive disease, defined as the presence of ASDAS < 1.3 for at least 2 consecutive time points 6 months apart, and structural lesion change was evaluated.

Results:

This study included 163 patients from the EMBARK trial and 76 from DESIR. The net percentage of patients with erosion decrease was significantly greater for etanercept vs control: unadjusted: 23.9% vs 5.3%; P = 0.01, adjusted: 23.1% vs 2.9%; P = 0.01. For the patients attaining sustained ASDAS inactive disease on etanercept, erosion decrease was evident in significantly more than erosion increase: 34/104 (32.7%) vs 5/104 (4.8%); P < 0.001. A higher proportion had erosion decrease and backfill increase than patients in other ASDAS status categories. However, the trend across ASDAS categories was not significant and decrease in erosion was observed even in patients without a sustained ASDAS response.

Conclusions:

These data show that a greater proportion of patients achieved regression of erosion with versus without etanercept. However, the link between achieving sustained ASDAS inactive disease and structural lesion change on MRI could not be clearly established.

Keywords: ASDAS; Anti-TNF; Axial spondyloarthritis; Etanercept; MRI; Sacroiliac joint.

Long-term association between disease activity and disability in early axial spondyloarthritis: results from the DESIR cohort

Un nouvel article scientifique intitulé «Long-term association between disease activity and disability in early axial spondyloarthritis: results from the DESIR cohort» a été publié dans le journal Arthritis Care Res (Hoboken).

Pedro D Carvalho, Adeline Ruyssen-Witrand, Ana Marreiros, Pedro M Machado.

Objectives:

Our primary objective was to study the long-term association between disease activity and disability in axial spondyloarthritis (axSpA). Our secondary objective was to define patient profiles according to their level of disability.

Methods:

We analysed data collected during the first five years of follow-up of a large early axSpA cohort – the Devenir des Spondylarthropathies Indifferénciées Récentes (DESIR) cohort. Multivariable models were built to study the association between Ankylosing Spondylitis Health Assessment Questionnaire (HAQ-AS) and Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), adjusting for potential confounders. Hierarchical multivariable analysis was conducted using the Chi-square Automatic Interaction Detector (CHAID) method, to help determine how variables best cluster to explain HAQ-AS.

Results:

Data from 644 patients and 5152 visits were analysed. HAQ-AS was longitudinally, independently and positively associated with ASDAS-CRP [adjusted (adj) B=0.205, (95% confidence interval (CI)= 0.187 to 0.222], enthesitis score (adjB=0.011, CI=0.008 to 0.015), Bath Ankylosing Spondylitis Metrology Index (BASMI) (adjB=0.087, CI=0.069 to 0.105) and female gender (adjB=0.172, CI=0.120 to 0.225). The CHAID decision tree revealed ASDAS-CRP as the first variable with discriminative power on HAQ-AS. The cut-offs that separated different patient disability profiles were obtained.

Conclusion:

Disease activity contributes longitudinally to disability and is hierarchically superior to any other variable in explaining this health domain. Enthesitis and spinal mobility are also key drivers of disability in early axSpA. ASDAS-CRP cut-offs that separated different patient disability profiles largely mimicked the cut-offs previously defined for ASDAS-CRP disease activity states.

Uveitis occurrence in early inflammatory back pain. Five years data from the prospective French nationwide DESIR cohort

Un nouvel article scientifique intitulé «Uveitis occurrence in early inflammatory back pain. Five years data from the prospective French nationwide DESIR cohort» a été publié dans le journal Joint Bone Spine.

Daniel Wendling, Clément Prati, Thierry Lequerré, Corinne Miceli, Maxime Dougados, Anna Molto, Xavier Guillot.

Objective:

Uveitis is a frequent extra rheumatological manifestation in axial Spondyloarthritis (SpA). The aim of study was to evaluate the prevalence and incidence of uveitis over the first five years of a prospective nationwide cohort of patients with high suspicion of early axial SpA, and to evaluate its associated factors.

Methods:

DESIR is a prospective observational cohort of patients with recent onset inflammatory back pain (more than 3 months, less than 3 years), suggestive of axial SpA, All available factors in the database were compared between patients with and without uveitis at 5 years, by uni and then multivariate analysis. Baseline factors associated with new cases of uveitis occurrence over the 5 years were also analyzed.

Significance: p less than 0.05.

Results:

After 5 years, 91 patients (out of 480 with complete follow-up) had at least one uveitis episode, giving an estimated prevalence of 18.9% [95% CI : 15.4-22.4]. In multivariate analysis, uveitis was significantly associated with dactylitis, and elevated ESR. New incident uveitis occurred in 31 cases over 5 years, giving an estimated incidence rate of 1.29 [0.84 - 1.74] / 100 patient-years. Incidence of new uveitis was associated in multivariate analysis with baseline factors: diagnosis of SpA, sacro iliac MRI inflammatory SPARCC score, dactylitis, syndesmophyte score. No significant association was found with HLA-B27, DMARDs, BASDAI, ASDAS, BASFI.

Conclusion:

Five-years data of the DESIR cohort allowed an estimation of incidence rate of uveitis of 1.3/100p-y; over five years, uveitis was associated with dactylitis, biologic and sacro iliac MRI inflammation.

Keywords:

Uveitis; cohort; dactylitis; spondyloarthritis.