Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?

Un nouvel article scientifique intitulé «Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?» a été publié dans le journal Rheumatology (Oxford).

van Lunteren M, van der Heijde D, Sepriano A, Berg IJ, Dougados M, Gossec L, Jacobsson L, Ramonda R, Rudwaleit M, Sieper J, Landewé R, van Gaalen FA.

OBJECTIVES:

A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known.

METHODS:

In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indifférenciéés Récentes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis.

RESULTS:

In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23%, 39% and 38% had an ASAS-PFH, 52%, 58% and 43% were HLA-B27 positive, and 62%, 47% and 54% were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95% CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95% CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95% CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95% CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95% CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95% CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis.

CONCLUSION:

In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.

KEYWORDS:

axial spondyloarthritis; diagnosis; family history

Measuring spinal mobility in early axial spondyloarthritis: does it matter?

Un nouvel article scientifique intitulé «Measuring spinal mobility in early axial spondyloarthritis: does it matter?» a été publié dans le journal Rheumatology (Oxford).

Marques ML, Ramiro S, Goupille P, Dougados M, van Gaalen F, van der Heijde D.

OBJECTIVES:

To investigate the frequency and order of impairment of spinal mobility measures (SMMs) and their cross-sectional and longitudinal usefulness in early axial spondyloarthritis.

METHODS:

SMMs measurements of patients from the DESIR (5-year data) and SPACE (2.6 (1.9) years of follow-up) cohorts were analysed. Cross-sectional (group level) and longitudinal (individual level) analyses were performed comparing SMMs to pre-defined cut-offs derived from healthy individuals. Subgroup analyses were used to study patient and disease characteristics potentially influencing spinal mobility. Reliability was analysed using intraclass correlation coefficients and the smallest detectable change.

RESULTS:

In 328 DESIR and 148 SPACE patients, lateral spinal flexion (LSF) and mSchober were the most impaired SMMs. If both (LSF and mSchober) were measured, 84% (DESIR) and 74% (SPACE) of the patients with impairment in ≥1 SMM would be captured. LSF and Bath AS Metrology Index best discriminated between subgroups of patients (higher impairment in patients ever treated with biologics, with higher disease activity and presence of baseline syndesmophytes): e.g. 31% of LSF impairment in patients with Ankylosing Spondylitis Disease Activity Score (ASDAS) < 2.1 in ≥2/3 visits vs 49% in those with ASDS ≥ 2.1. A high variability in SMMs within the same patient over time was observed, even when restricting the analysis to patients with low disease activity. Reliability of SMMs was ‘fair’ to ‘good’ (inter-reader intraclass correlation coefficients (2, 1): 0.55-0.84; intrareader intraclass correlation coefficients (2, 1): 0.49-0.72). Smallest detectable changes were in general high, e.g. 5.1 cm for LSF.

CONCLUSION:

Cross-sectional use of SMMs, at the group level, is informative in patients with early axial spondyloarthritis. However, the high variation of SMMs over time impairs their use, at the individual patient level.

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

KEYWORDS:

early axial spondyloarthritis; outcome assessment; spinal mobility

Evaluation of the predictive validity of the ASAS axial spondyloarthritis criteria in the DESIR cohort

Un nouvel article scientifique intitulé «Evaluation of the predictive validity of the ASAS axial spondyloarthritis criteria in the DESIR cohort» a été publié dans le journal Clin Exp Rheumatol.

Meghnathi B, Saraux A, Dougados M, Moltó A.

OBJECTIVES:

To evaluate the predictive validity of the Assessment of SpondyloArthritis international Society (ASAS) axial spondyloarthritis (axSpA), Amor, European Spondylarthropathy Study Group (ESSG) and modified New York (mNY) classification criteria.

METHODS:

Patients from the DESIR cohort (inflammatory back pain suggestive of axSpA for >3 months but <3 years duration), followed for up to 5 years. Positive predictive value (PPV) of the set of criteria collected at baseline (ASAS, and its arms, Amor, ESSG and mNY: fulfilled/not fulfilled) were tested against the rheumatologist’s axSpA diagnosis (fulfilled/not fulfilled) after 5 years of follow-up.

RESULTS:

In total, among the 708 patients included in the DESIR cohort at baseline, data on rheumatologist’s diagnosis at 5 years was available in 411 patients; amongst them, 352 (85.6%) had an axSpA diagnosis according to the rheumatologist; 268 patients fulfilled the ASAS axial SpA (axSpA) criteria at baseline and of these, 245 were diagnosed as SpA after 5 years follow-up (PPV: 91%). The PPV of the ASAS « imaging » arm and « clinical » arm was 97% and 82%, respectively. Other criteria also showed similar PPV – Amor (91%), ESSG (90%) and mNY (99%).

CONCLUSIONS:

Positive predictive validity of the ASAS criteria for axSpA (including both arms) at 5 years was excellent; it is worth noting that the performances of the other criteria were also very good in the DESIR cohort.

Similar alteration for mental and physical aspects in health-related quality of life over 5 to 8 years in 1347 patients with early arthritis and early inflammatory back pain

Un nouvel article scientifique intitulé «Similar alteration for mental and physical aspects in health-related quality of life over 5 to 8 years in 1347 patients with early arthritis and early inflammatory back pain» a été publié dans le journal Arthritis Res Ther.

Puyraimond-Zemmour D1,2,3, Granger B4,5, Molto A6,7, Gaujoux-Viala C8, Guillemin F9, Ruyssen-Witrand A10,11, Dougados M6,7, Fautrel B4,12, Gossec L.

INTRODUCTION:

Health-related quality of life (HRQoL) is a priority for patients. The objectives were to describe the changes in HRQoL over 5-8 years in patients with early arthritis (EA) or early inflammatory back pain (IBP) and to explore factors associated to HRQoL.

PATIENTS AND METHODS:

In 2 prospective observational French cohorts (ESPOIR for EA patients and DESIR for early IBP patients), HRQoL was assessed regularly over 5-8 years, using the SF36 physical and mental composite scores (PCS and MCS, range 0-100). Disease activity was assessed by DAS28-ESR and ASDAS-CRP. Univariate and multivariate linear mixed-effect models and trajectory-based mapping were applied.

RESULTS:

In all, 1347 patients (701 EA and 646 early IBP) were analysed: mean age 48.4 ± 12.2 and 33.9 ± 8.7 years respectively; mean disease duration 3.4 ± 1.7 and 18.2 ± 10.8 months; and 76.3% and 55.0% females. At baseline, in EA, mean PCS and MCS were respectively 40.2 ± 9.1 and 40.4 ± 11.2 and, in early IBP, were respectively 38.5 ± 8.5 and 39.8 ± 10.9. Over follow-up, HRQoL mean levels improved mostly over the first 6 months (p <  0.001). Two trajectories were evidenced in both diseases. The ‘good HRQoL’ trajectory groups, i.e. 54-61% of patients, reached levels of HRQoL close to population norms. DAS28-ESR and ASDAS-CRP over time were related to PCS (range of explained variance 9-43%, p <  0.001 in the mixed models) but not to MCS.

CONCLUSION:

HRQoL was altered similarly for both physical and mental aspects in EA and early IBP. Disease activity only partly explained HRQoL: the drivers of HRQoL should be further explored.

KEYWORDS:

Axial spondyloarthritis; Early arthritis; Early inflammatory back pain; Patient outcomes assessment; Quality of life; Rheumatoid arthritis

Association between IL23R and ERAP1 polymorphisms and sacroiliac or spinal MRI inflammation in spondyloarthritis: DESIR cohort data

Un nouvel article scientifique intitulé «Association between IL23R and ERAP1 polymorphisms and sacroiliac or spinal MRI inflammation in spondyloarthritis: DESIR cohort data» a été publié dans le journal Arthritis Res Ther.

Ruyssen-Witrand A, Luxembourger C, Cantagrel A, Nigon D, Claudepierre P, Degboe Y, Constantin A.

BACKGROUND:

To investigate the association between 12 single nucleotide polymorphisms (SNPs) located on ERAP1 and IL23R with the presence of inflammation on the sacroiliac joint (SIJ) or spinal magnetic resonance imagery (MRI) in an early onset spondyloarthritis (SpA) cohort.

METHODS:

All the patients included in the DESIR cohort with an axial SpA and available DNA at baseline were enrolled in this study (n = 645 patients) and underwent a clinical examination, CRP assay, SIJ and spinal MRI scans. Six SNPs located on ERAP1 (rs30187, rs27044, rs27434, rs17482078, rs10050860, rs2287987) and six SNPs located on IL23R (rs1004819, rs10489629, rs1343151, rs2201841, rs10889677, rs11209032) were genotyped. Univariable analyses were performed to test the association between the genotypes and SIJ and spinal MRI inflammation, as well as disease activity based on Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) and CRP.

RESULTS:

One SNP located on ERAP1 (rs27434) and haplotype CCT of ERAP1 were associated with SIJ inflammation detected by MRI, but these associations were below the Bonferroni corrected threshold of significance. However, one SNP (rs1004819) located on IL23R was associated with SIJ MRI inflammation (rs1004819: TT 42.3%, CT 40.5%, CC 26.5%, p = 0.0005). This locus was also significantly associated with Spondyloarthritis Research Consortium of Canada scores while no association with another inflammatory parameter such as BASDAI, ASDAS-CRP, CRP or Berlin MRI score was identified in this population.

CONCLUSION:

One locus of the IL23R gene was associated with SIJ MRI inflammation and might be a marker of more active disease in recent onset SpA.

TRIAL REGISTRATION:

clinicaltrials.gov, NCTO 164 8907.

KEYWORDS:

Polymorphisms; Sacroiliitis; Spondyloarthritis

Clinical peripheral enthesitis in the DESIR prospective longitudinal axial spondyloarthritis cohort

Un nouvel article scientifique intitulé «Clinical peripheral enthesitis in the DESIR prospective longitudinal axial spondyloarthritis cohort» a été publié dans le journal Clin Exp Rheumatol.

Nadon V, Moltó A, Etcheto A, Bessette L, Michou L, D’Agostino MA, Claudepierre P, Wendling D, Haraoui P, Dougados M.

OBJECTIVES:

We aimed to describe the prevalence and characteristics of peripheral enthesitis in recent onset axial spondyloarthritis, estimate the incidence of peripheral enthesitis over time, and determine the factors associated with the presence of peripheral enthesitis.

METHODS:

708 patients with recent onset axial spondyloarthritis were enrolled in the DESIR cohort ( prospective multi-centre, longitudinal). Data regarding the patients and spondyloarthritis characteristics at baseline with a specific focus on enthesitis and occurrence of peripheral enthesitis were collected during the five years of follow-up.

RESULTS:

At inclusion, 395 patients (55.8%) reported peripheral enthesitis. The locations were mainly the plantar fascia (53.7%) and the Achilles tendon (38.5%). During the 5-year follow-up period, 109 additional patients developed peripheral enthesitis resulting in an estimated (Kaplan-Meier method) percentage of 71% (95% CI: 68-75). Variables associated with peripheral enthesitis in the univariate analysis were: older age, male gender, absence of HLA B27, MRI sacroiliitis and fulfilled Modified NY criteria, presence of anterior chest wall pain, peripheral arthritis, dactylitis, psoriasis, high BASDAI, BASFI, mean score ASAS-and the use of NSAIDs. Only the history of anterior chest wall pain and of peripheral arthritis were retained in the multivariate analysis (odds ratio (OR)=1.6 [95% confidence interval [1.1-2.3], and OR=2.1 [1.4-3.0], respectively).

CONCLUSIONS:

This study highlights the high prevalence of peripheral enthesitis in recent onset axial spondyloarthritis, and suggests that in combination with peripheral arthritis, enthesitis might have an impact on the burden of the disease.

Is active sacroiliitis on MRI associated with radiographic damage in axial spondyloarthritis? Real-life data from the ASAS and DESIR cohorts

Un nouvel article scientifique intitulé «Is active sacroiliitis on MRI associated with radiographic damage in axial spondyloarthritis? Real-life data from the ASAS and DESIR cohorts» a été publié dans le journal Rheumatology (Oxford).

Sepriano A, Ramiro S, Landewé R, Dougados M, van der Heijde D, Rudwaleit M.

Objectives:

To assess any association between bone marrow oedema on MRI of the sacroiliac joints (MRI-SIJ) according to local readings in daily practice and the development of structural damage on radiographs of the SIJ (X-SIJ) in axial spondyloarthritis (axSpA).

Methods:

Patients with axSpA from the Assessment of the SpondyloArthritis international Society (ASAS) and DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR) multicentre cohorts were included. MRI-SIJ and X-SIJ were obtained at baseline, and X-SIJ at follow-up after a mean 4.6 years (ASAS) and 5.1 years (DESIR). All images were scored by local readers. Structural damage in the X-SIJ was defined according to the modified New York criteria. The percentage of structural net progression (number of ‘progressors’ minus the number of ‘regressors’ divided by the total number of patients) was assessed and the effect of bone marrow oedema on MRI-SIJ on X-SIJ damage evaluated by multivariable logistic regression.

Results:

In total, 125 (ASAS-cohort) and 415 (DESIR-cohort) patients had baseline MRI-SIJ and complete X-SIJ data available. According to local readings, progression and ‘improvement’ in X-SIJ was seen in both the ASAS- and DESIR-cohort, yielding a net progression that was higher in the former than in the latter (19.2% and 6.3%). In multivariable analysis, baseline bone marrow oedema on MRI-SIJ was strongly associated with X-SIJ structural progression in both ASAS (odds ratio = 3.2 [95% CI: 1.3; 7.9]), and DESIR (odds ratio = 7.6 [95% CI: 4.3; 13.2]).

Conclusion:

Inflammation on MRI-SIJ is associated with future radiographic progression according to local readings despite an expected increased imprecision invoked by local readings.

SFR 2018

De nouveaux travaux ont été présentés lors du congrès de la Société Française de Rhumatologie (SFR) qui s’est déroulé du 09 au 11 décembre 2018 :

Oral :

Les patients ayant une lombalgie inflammatoire ont plus souvent une sacroiliite en radiographie ou en IRM lorsqu’ils ont une vertèbre de transition lombosacrée. Carvajal et al.

Les variations des biomarqueurs de la régulation de la formation osseuse sont associées à l’évolution de l’inflammation et aux traitements anti-inflammatoires dans la spondyloarthrite axiale récente. Descamps et al.

Posters commentés

Pons et al. Les anti-TNFa sont efficaces en pratique clinique, sur le long terme, en particulier chez les hommes HLAB27+, ayant des signes objectifs d’inflammation : analyse de la cohorte DESIR.

Posters électroniques

Wendling et al. Dactylite dans la spondyloarthrite récente : données de la cohorte DESIR.

Lopez-Medina et al. Évaluation des arthrites périphériques et des arthralgies dans la spondyloarthrite axiale : les données de la cohorte DESIR.

Pons et al. Évaluation dans la pratique courante de l’efficacité du deuxième et du troisième anti-TNFa dans la spondylarthrite axiale récente : analyse de la cohorte DESIR.

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

ACR 2018

Des nouveaux travaux ont été présentés lors du congrès du collège américain (ACR) de rhumatologie qui s’est déroulé du 19 au 27 octobre 2018 à Chicago (Etats-Unis) :

Oral: n=02

Is All MRI-SIJ Inflammation the Same? Gradient of Structural Damage with Increasing Cumulative Inflammation at the SIJ Quadrant Level in Axial Spondyloarthritis – 5-Year Data from the DESIR Cohort. Santiago Rodrigues Manica

Spinal Radiographic Progression in Early Axial Spondyloarthritis: 5-Year Data from the DESIR Cohort. Sofia Ramiro

Poster: n=02

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. Alexandre Sepriano

Is a Positive Family History of Spondyloarthritis Relevant for Diagnosing Axial Spondyloarthritis Once HLA-B27 Status Is Known? Data from the ASAS, DESIR, and SPACE Cohorts. Miranda van Lunteren