Low incidence of vertebral fractures in early spondyloarthritis: 5-year prospective data of the DESIR cohort

Un nouvel article scientifique intitulé «Low incidence of vertebral fractures in early spondyloarthritis: 5-year prospective data of the DESIR cohort» a été publié dans le journal Ann Rheum Dis.

Sahuguet J, Fechtenbaum J, Molto A, Etcheto A, López-Medina C, Richette P, Dougados M, Roux C, Briot K.

OBJECTIVES:

An increased risk of vertebral fractures (VFs) has been reported in spondyloarthritis (SpA). Our hypothesis is that the prevalence of VFs is lower than reported in previous studies, especially in early SpA. This study aimed at assessing the incidence of radiographical VFs over 5 years in early axial SpA.

METHODS:

The DESIR (DEvenir des Spondylarthropathies Indifférenciées Récentes) cohort, which included patients with inflammatory back pain highly suggestive of axial SpA, is the basis of this study. All radiographs of the DESIR cohort had been assessed at a central facility, by one investigator specialised in the field of the diagnosis of VFs according to Genant’s method. We assessed the prevalence and incidence of VFs and vertebral deformities at baseline and over 5 years.

RESULTS:

Five-year X-rays were available for 432 patients (mean age 34.3±8.7 years, 53% women). Diagnosis of VF was doubtful and needed adjudication for 19 patients (4.4%). 13 patients had prevalent VFs (3.0%) which were located at the thoracic spine (12 were grade 1). At 5 years, five patients had an incident VF (1.15%); seven vertebrae were fractured, mostly located at the thoracic spine (n=6/7), and of grade 1 (n=6/7).

CONCLUSION:

In the DESIR cohort, a population of early SpA, we found a low prevalence and incidence of VFs (3.0% and 1.15 %), respectively. This confirms our hypothesis that the actual prevalence and incidence of VFvertebral fracture in SpA is lower than that reported in the previous studies.

KEYWORDS:

X-rays; inflammation; osteoporosis; spondyloarthritis; vertebral deformation; vertebral fracture

Spinal radiographic progression in early axial Spondyloarthritis: Five-year results from the DESIR cohort

Un nouvel article scientifique intitulé «Spinal radiographic progression in early axial Spondyloarthritis: Five-year results from the DESIR cohort» a été publié dans le journal Arthritis Care Res (Hoboken).

Ramiro S, van der Heijde D, Sepriano A, van Lunteren M, Moltó A, Feydy A, d’Agostino MA, Loeuille D, Dougados M, Reijnierse M, Claudepierre P.

OBJECTIVES:

To analyse the progression of spinal radiographic damage in patients with early axial spondyloarthritis (axSpA).

METHODS:

AxSpA patients from the DESIR cohort with 5-year spinal (cervical and lumbar) radiographs available (n=549). Two- and 5-year mSASSS progression and development of new syndesmophytes (net change: number of patients with positive change minus number of patients with negative change divided by total number of patients) were assessed in subgroups defined at baseline according to the ASAS axSpA criteria and its arms, mNYC and the presence of syndesmophytes.

RESULTS:

Mean mSASSS progression was 0.2(SD 0.9) at 2 years and 0.4(1.8) at 5 years. Five-year progression was higher in the imaging arm (0.6(2.3), MRI+mNYC+ (1.3(4.0)) than in the clinical arm only (0.1(0.7)), and highest in patients with syndesmophytes (2.7(5.0)). At 5 years, 7% of all patients had a net change of any new syndesmophyte; this was 10% for the imaging arm (mNYC+MRI+: 18%), 17% for mNYC+ and 42% for patients with syndesmophytes.

CONCLUSION:

Spinal radiographic progression, though limited in early axSpA, can be captured after 2 years. Inflammation and damage in the SIJ are associated with higher radiographic progression. The presence of baseline syndesmophytes strongly predicts the development of further structural damage already early in the disease. This article is protected by copyright. All rights reserved.

KEYWORDS:

epidemiology; outcome measures; radiology; spondyloarthritis

Evaluation of extreme patient-reported outcome in early spondyloarthritis and its impact on the effect of TNF-α blockers treatment

Un nouvel article scientifique intitulé «Evaluation of extreme patient-reported outcome in early spondyloarthritis and its impact on the effect of TNF-α blockers treatment» a été publié dans le journal Clin Exp Rheumatol.

Meghnathi, Claudepierre, Dougados, Moltó A.

OBJECTIVES:

To describe the prevalence of extreme patient-reported outcomes (PRO) in an early axial spondyloarthritis setting, to compare the phenotype of patients with/without extreme PRO and to evaluate the impact of extreme PRO on the effectiveness of TNF-α blockers (TNFb).

METHODS:

This analysis was performed in the DESIR cohort. Extreme PRO were measured at baseline and were defined as a score ≥8 on at least three of first five BASDAI items. Phenotype of patient’s with/without extreme PRO was compared. Impact of extreme PRO on TNFb effectiveness was evaluated by comparing the retention rate of the first TNFb in both groups by survival curves analysis (log-rank and Cox analysis).

RESULTS:

Extreme PRO were present in 95 out of the 708 patients (13.4%). Patients with extreme PRO were older (mean (SD) age of 35.4(8.6) years vs. 33.5(8.7) years), more frequently females (65.3% vs. 51.9%), had higher BASDAI (7.1 vs. 4.1), reported more frequently history of depression (25.3% vs. 10.2%) and use of anti-depressive drugs (19.0% vs. 7.2%). TNFb treatment was more frequently initiated in the extreme PRO group (48.4% vs. 25.5%), while the proportion of patients still on TNFb at 2 years was significantly lower in the extreme PRO group 18.6% (n=8) vs. 39.5% (n=60). Presence of extreme PRO was independently associated with first TNFb discontinuation (HR 1.8, [95% CI 1.2;2.9], p=0.01)).

CONCLUSIONS:

Although presence of extreme PRO in this early axSpA setting was not very frequent, patients with extreme PRO were more likely to receive a TNFb and less likely to maintain the treatment at 2 years. Further studies evaluating the specific impact of extreme PRO on TNFb treatment in axSpA are warranted.

Can power Doppler ultrasound of the entheses help in classifying recent axial spondyloarthritis? Data from the DESIR cohort

Un nouvel article scientifique intitulé «Can power Doppler ultrasound of the entheses help in classifying recent axial spondyloarthritis? Data from the DESIR cohort» a été publié dans le journal RMD Open.

Poulain C, D’Agostino MA, Thibault S, Daures JP, Ferkal S, Le Corvoisier P, Rahmouni A, Loeuille D, Dougados M, Claudepierre P.

Abstract:

Early diagnosis of axial spondyloarthritis (axSpA) remains a challenge due to the lack of specificity of clinical symptoms and variable prevalence of axial imaging findings permitting a definite diagnosis. Power Doppler ultrasonography (PDUS) of the entheses has demonstrated to be a potential useful tool for the classification and diagnostic management of early SpA independently of the phenotype.

Objectives:

To assess the classification value (sensitivity and specificity) of PDUS-defined enthesitis for identifying patients fulfilling Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA (ASAS+) in patients with recent inflammatory back pain (IBP) (the DESIR (DEvenir des Spondylarthropathies Indifférenciées Récentes) cohort).

Methods:

Baseline PDUS was performed at eight entheseal sites, and PDUS enthesitis was defined by the presence of vascularisation at entheseal insertion.

Results:

402 patients from the DESIR cohort underwent a PDUS evaluation. PDUS enthesitis was detected in 58 (14.4%) patients of whom 40 (14.2%) belonged to the ASAS+ patients and 18 (17%) to the ASAS- patients. The sensitivity of PDUS enthesitis was 13.9% and the specificity was 83.5%, with a positive predictive value of 69% and 26.8% of negative predictive value for meeting ASAS criteria for axSpA. Of the 18 ASAS- patients with positive PDUS, 59% fulfilled Amor’s criteria, 88% European Spondyloarthropathy Study Group criteria and 59% both.

Conclusions:

In a cohort of patients with recent IBP, the prevalence of PDUS enthesitis was low (14.4%); however, its specificity for classifying patients as axSpA according to ASAS criteria was high (83.5%). PDUS enthesitis might be of additional value for classifying as patients with axSpA IBP who do not fulfil ASAS criteria.

KEYWORDS:

ankylosing spondylitis; enthesitis; spondyloarthritis; tendinitis; ultrasonography

Which scoring method depicts spinal radiographic damage in early axial spondyloarthritis best? Five-year results from the DESIR cohort

Un nouvel article scientifique intitulé «Which scoring method depicts spinal radiographic damage in early axial spondyloarthritis best? Five-year results from the DESIR cohort» a été publié dans le journal Rheumatology (Oxford).

Ramiro S, Claudepierre P, Sepriano A, van Lunteren M, Molto A, Feydy A, Antonietta d’Agostino M, Loeuille D, Dougados M, Reijnierse M, van der Heijde D.

Objective:

To compare the performance of different spinal radiographic damage scoring methods in patients with early axial spondyloarthritis (axSpA).

Methods:

Five-year spinal radiographs from the DESIR cohort were scored by three readers (averaged) for the calculation of the Stoke AS Spine Score (SASSS), modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), Radiographic AS Spinal Score (RASSS), BASRI-spine and BASRI-total, and following the OMERACT filter, scores were compared according to truth, discrimination (reliability and sensitivity to change) and feasibility. The proportion of patients with a net change > smallest detectable change and >1 was calculated. The proportion of total variance explained by the patient (true variance) was calculated for the change scores as a measure of reliability, using analysis of variance.

Results:

In total 699 patients were included. Five-year net changes > smallest detectable change (>1) were: RASSS 17% (17%), mSASSS 12% (12%), BASRI-spine and BASRI-total 12% (9%), SASSS 11% (11%). The mSASSS and the RASSS performed the best in terms of capturing the signal (positive change) related to noise (negative change). The proportion of variance explained by the patient was highest for the mSASSS and RASSS (85% for both 5-year progression scores vs 50-55% for other methods). The proportion of patient variance in the thoracic segment of the RASSS was unsatisfactory (46% for progression).

Conclusion:

The existing scoring methods to assess spinal radiographic damage performed well in early phases of axSpA. The mSASSS and RASSS captured most change. There was no clear gain in additionally scoring the thoracic spine for the RASSS. The mSASSS remains the most sensitive and valid scoring method in axSpA, including early phases of the disease.

EULAR 2018

Lors du congrès de l’EULAR 2018 qui s’est déroulé à Amsterdam du 13 au 16 juin 2018, 13 abstracts ont été acceptés pour une présentation orale ou par poster :

Présentation orale

▫ Sustained remission of inflammation is associated with reduced structural damage on sacroiliac joint magnetic resonance imaging in patients with early axial spondyloarthritis: evidence to support the concept of treat-to-target

▫ Is a primary good response to nsaids predictive of the subsequent response to the first tnf inhibitor in patients with recent axial spondyloarthritis?

▫ Inflammation on mri of spine and sacroiliac joints is highly predictive of structural damage in axial spondyloarthritis: the 5 years data of the DESIR cohort

Présentations par affiches.

▫ Changes in health-related quality of life over 5 to 8 years in 1347 patients with early arthritis or early inflammatory back pain

▫ Clinical peripheral enthesitis in the DESIR prospective longitudinal axial spondyloarthritis cohort

▫ Detection of structural lesions on t1 weighted mri versus radiography of the si joints in early axial spondyloarthritis: 2-year data

▫ Do degree of family relationship and ethnicity impact the association between a positive family history for spondyloarthritis and presence of hla-b27? results from the worldwide asas cohort

▫ Erosions at the sacroiliac joints and fatty lesions at the spine are the most discriminant lesions for recent onset axspa recognition

▫ Impact of gut involvement in early spondyloarthritis. the DESIR cohort

▫ Inflammation on MRI of the sacroiliac joints is highly predictive of structural damage in axial spondyloarthritis patients in clinical practice: data from the asas and DESIR cohorts

▫ Inflammatory lesions of the sacroiliac joints, but not of the spine, are of high utility for axspa recognition: results of the ilos-DESIR study

▫ Which imaging outcomes for axspa are most sensitive to change? a 5-year analysis of the DESIR cohort

▫ Which scoring method depicts spinal radiographic damage in (EARLY) axial spondyloarthritis best? five-year results from the DESIR cohort

Prevalence of degenerative changes and overlap with spondyloarthritis-associated lesions in the spine of patients from the DESIR cohort

Un nouvel article scientifique intitulé «Prevalence of degenerative changes and overlap with spondyloarthritis-associated lesions in the spine of patients from the DESIR cohort» a été publié dans le journal RMD Open.

de Bruin F, Treyvaud MO, Feydy A, de Hooge M, Pialat JB, Dougados M, Gossec L, Bloem JL, van der Heijde D, Reijnierse M.

Objectives:

To describe the prevalence of degenerative changes on MRI and conventional radiographs of the spine in a young population with suspicion of axial spondyloarthritis (axSpA) and assess whether it is possible to discriminate between degenerative changes and lesions associated with axSpA.

Methods:

Whole spine MRI and cervical and lumbar radiographs of patients ≥18 years with chronic back pain (≥3 months, ≤3 years, onset <50 years) were assessed for degeneration by two readers, and for SpA lesions by two other readers, all blinded for clinical information and results of the other readers. Degenerative scores were adjudicated in case of disagreement (by a third reader). Patients fulfilling and not fulfilling the Assessment of SpondyloArthritis international Society axSpA criteria were compared for prevalence of degenerative lesions. Scores for degenerative and SpA lesions were compared, and overlap was defined as the presence of both types of lesions in a single vertebral unit (VU).

Results:

In 456/648 (70.4%) patients (46.8% men, mean age 33.6), degenerative lesions were found with similar percentages in patients with no axSpA and with axSpA (72.4% and 69.2%, p=0.45). Modic changes were found more often in patients with no axSpA (29/239, 12.1%) versus patients with axSpA (19/409, 4.6%, p=0.01). Other lesions were evenly distributed. Overlap was minimal in 19 patients (3.0%) and 32/14 674 (0.2%) VUs for SpA reader 1 and in 23 patients (3.6%) and 34/14 674 VUs (0.2%) for SpA reader 2.

Conclusion:

The prevalence of degeneration is high in an early inflammatory back pain cohort. Discrimination between degeneration and axSpA lesions is very well possible with little overlap between degenerative and axSpA readings.

KEYWORDS:

ankylosing spondylitis; low back pain; magnetic resonance imaging; spondyloarthritis

Increase In Il-31 Serum Levels Is Associated With Reduced Structural Damage In Early Axial Spondyloarthritis

Un nouvel article scientifique intitulé «Increase In Il-31 Serum Levels Is Associated With Reduced Structural Damage In Early Axial Spondyloarthritis.» a été publié dans le journal Sci Rep.

Rosine N, Etcheto A, Hendel-Chavez H, Seror R, Briot K, Molto A, Chanson P, Taoufik Y, Wendling D, Lories R, Berenbaum F, van den Berg R, Claudepierre P, Feydy A, Dougados M, Roux C, Miceli-Richard C.

ABSTRACT:

In spondyloarthritis, little is known about the relation between circulating cytokines and patient phenotype. We have quantified serum levels of T helper type 1 cell (Th1), Th2 and Th17 cytokines in patients with recent-onset axial spondyloarthritis (AxSpA) from the DESIR cohort, a prospective, multicenter French cohort consisting of 708 patients with recent-onset inflammatory back pain (duration >3 months but <3 years) suggestive of AxSpA. Serum levels of Th1, Th2, and Th17 cytokines were assessed at baseline in patients from the DESIR cohort fulfilling the ASAS criteria (ASAS+) and were compared with age- and sex-matched healthy controls. At baseline, ASAS+ patients (n = 443) and healthy controls (n = 79) did not differ in levels of most of the Th1, Th2 and Th17 cytokines except for IL-31, and sCD40L, which were significantly higher for ASAS+ patients than controls (p < 0.001 and p = 0.012, respectively). On multivariable analysis of ASAS+ patients, IL-31 level was associated with sCD40L level (p < 0.0001), modified Stoke AS Spine Score (mSASSS) < 1 (p = 0.035). The multivariable analyses showed that IL-31 was an independent factor associated with mSASSS < 1 (p = 0.001) and low bone mineral density (p = 0.01). Increased level of IL-31 might protect against structural damage but is also related to low BMD.

Adherence to recommendations for the use of anti-tumour necrosis factor and its impact over 5 years of follow-up in axial spondyloarthritis.

Un nouvel article scientifique intitulé «Adherence to recommendations for the use of anti-tumour necrosis factor and its impact over 5 years of follow-up in axial spondyloarthritis.» a été publié dans le journal Rheumatology (Oxford).

López-Medina C, Dougados M, Collantes-Estévez, Moltó A.

Abstract

OBJECTIVES:
To describe adherence to recommendations for TNFα blocker (TNFb) initiation and continuation in early axial Spondyloarthropathy (axSpA); and to evaluate the impact of adherence to these recommendations over 5 years of follow-up in the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort.

METHODS:
The first 5 years of follow-up of the DESIR early axSpA cohort were analysed. We evaluated adherence to Assessment of SpondyloArthritis International Society (ASAS) 2003/2006, 2016 and European Medicines Agency recommendations in axSpA patients for: TNFb initiation (patients were adherent if they either commenced TNFb therapy when they met the conditions for initiation or if they did not commence TNFb therapy when conditions were not met) and; TNFb continuation (either when they continued TNFb therapy when conditions to continue were met or when they discontinued when conditions were not met). The impact of adherence to these recommendations on functional disability, quality of life and sick-leave days over 5 years was explored.

RESULTS:
A total of 708 patients were analysed: 440 (62.15%), 389 (54.94%) and 335 (47.32%) were considered adherent to ASAS 2003/2006, 2016 and European Medicines Agency recommendations for TNFb initiation, respectively. Adherence to 2003/2006 and 2016 recommendations for TNFb continuation was observed in 47.37 and 49.39% of patients, respectively. According to over 5 years of follow-up, better outcomes (lower BASFI, higher SF-36 and fewer days of sick leave) were found in patients adhering to recommendations for TNFb commencement and continuation.

CONCLUSION:
Less than 50% of patients were treated in agreement with recommendations for TNFb initiation and continuation. Nevertheless, adherence to such recommendations leads to better functional outcomes and fewer days of sick leave, according to long-term follow-up.

In patients with axial spondyloarthritis, inflammation on MRI of the spine is longitudinally related to disease activity only in men: 2 years of the axial spondyloarthritis DESIR cohort

Un nouvel article scientifique intitulé  » In patients with axial spondyloarthritis, inflammation on MRI of the spine is longitudinally related to disease activity only in men: 2 years of the axial spondyloarthritis DESIR cohort  » a été publié dans le journal Ann Rheum Dis.

Navarro-Compán V, Ramiro S, Landewé R3, Dougados M, Miceli-Richard C, Richette P, van der Heijde D.

Ann Rheum Dis. 2017 Mar 3. pii: annrheumdis-2016-210697. doi: 10.1136/annrheumdis-2016-210697. [Epub ahead of print]

KEYWORDS:

Disease Activity; Magnetic Resonance Imaging; Spondyloarthritis