Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort

Un nouvel article scientifique intitulé «Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort.» a été publié dans le journal J Rheumatol.

Harvard S, Guh D, Bansback N, Richette P, Saraux A, Fautrel B, Anis AH.

Abstract
OBJECTIVE:

To evaluate a classification system to define adherence to axial spondyloarthritis (axSpA) anti-tumor necrosis factor (anti-TNF) use recommendations and examine the effect of adherence on outcomes in the DESIR cohort (Devenir des Spondylarthropathies Indifférenciées Récentes).
METHODS:

Using alternate definitions of adherence, patients were classified as adherent « timely » anti-TNF users, nonadherent « late » anti-TNF users, adherent nonusers ( »no anti-TNF need »), nonadherent nonusers ( »unmet anti-TNF need »). Multivariate models were fitted to examine the effect of adherence on quality-adjusted life-years (QALY), total costs, and nonbiologic costs 1 year following an index date. Generalized linear regression models assuming a γ-distribution with log link were used for costs outcomes and linear regression models for QALY outcomes.
RESULTS:

Using the main definition of adherence, there were no significant differences between late anti-TNF users and timely anti-TNF users in total costs (RR 0.86, 95% CI 0.54-1.36, p = 0.516) or nonbiologic costs (RR 0.72, 95% CI 0.44-1.18, p = 0.187). However, in the sensitivity analysis, late anti-TNF users had significantly increased nonbiologic costs compared with timely users (RR 1.58, 95% CI 1.06-2.36, p = 0.026). In the main analysis, there were no significant differences in QALY between timely anti-TNF users and late anti-TNF users, or between timely users and patients with unmet anti-TNF need. In the sensitivity analysis, patients with unmet anti-TNF need had significantly lower QALY than timely anti-TNF users (-0.04, 95% CI -0.07 to -0.01, p = 0.016).
CONCLUSION:

The effect of adherence to anti-TNF recommendations on outcomes was sensitive to the definition of adherence used, highlighting the need to validate methods to measure adherence.

Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort

Un nouvel article scientifique intitulé «Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort.» a été publié dans le journal Ann Rheum Dis.

Dougados M, Sepriano A, Molto A, van Lunteren M, Ramiro S, de Hooge M, van den Berg R, Navarro Compan V, Demattei C, Landewé R, van der Heijde D.

Ann Rheum Dis. 2017 Jul 6. pii: annrheumdis-2017-211596. doi: 10.1136/annrheumdis-2017-211596. [Epub ahead of print]


Abstract
OBJECTIVE:

To estimate sacroiliac joint radiographic (X-SIJ) progression in patients with axial spondyloarthritis (axSpA) and to evaluate the effects of inflammation on MRI (MRI-SIJ) on X-SIJ progression.
METHODS:

X-SIJ and MRI-SIJ at baseline and after 2 and 5 years in patients with recent onset axSpA from the DESIR cohort were scored by three central readers. Progression was defined as (1) the shift from non-radiographic (nr) to radiographic (r) sacroiliitis (by modified New York (mNY) criteria) or alternative criteria, (2) a change of at least one grade or (3) a change of at least one grade but ignoring a change from grade 0 to 1. The effects of baseline inflammation on MRI-SIJ on 5-year X-SIJ damage (mNY) were tested by generalised estimating equations.
RESULTS:

In 416 patients with pairs of baseline and 5-year X-SIJ present, net progression occurred in 5.1% (1), 13.0% (2) and 10.3% (3) respectively, regarding a shift from nr-axSpA to r-axSpA (1), a change of at least one grade (2) or a change of at least one grade but ignoring a change from grade 0 to 1 (3). Baseline MRI-SIJ predicted structural damage after 5 years in human leukocyte antigen-B27 (HLA-B27) positive (OR 5.39 (95% CI 3.25 to 8.94)) and in HLA-B27 negative (OR 2.16 (95% CI 1.04 to 4.51)) patients.
CONCLUSIONS:

Five-year progression of X-SIJ damage in patients with recent onset axSpA is limited but present beyond measurement error. Baseline MRI-SIJ inflammation drives 5-year radiographic changes.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
KEYWORDS:

epidemiology; magnetic resonance imaging; outcomes research; spondyloarthritis

Newsletter Patients N°17

Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter rhumatologues rédigée par le Laure GOSSEC , rhumatologue à l’hôpital Pitié Salpêtrière à Paris .
Pour y avoir accès, merci de consulter le lien suivant: cliquer ici.

Is the current ASAS expert definition of a positive family history useful in identifying axial spondyloarthritis? Results from the SPACE and DESIR cohorts

Un nouvel article scientifique intitulé «Is the current ASAS expert definition of a positive family history useful in identifying axial spondyloarthritis? Results from the SPACE and DESIR cohorts.» a été publié dans le journal Arthritis Res Ther.

Ez-Zaitouni Z, Hilkens A, Gossec L, Berg IJ, Landewé R, Ramonda R, Dougados M, van der Heijde D, van Gaalen F.

Arthritis Res Ther. 2017 May 31;19(1):118. doi: 10.1186/s13075-017-1335-8.

Abstract

BACKGROUND:

The Assessment of SpondyloArthritis international Society (ASAS) definition of a positive family history (PFH) of spondyloarthritis (SpA) includes the following diseases in first- or second-degree relatives: ankylosing spondylitis (AS), acute anterior uveitis (AAU), reactive arthritis (ReA), inflammatory bowel disease (IBD), and psoriasis. However, it is not known if a PFH for each of these diseases contributes to making a diagnosis of axSpA, sacroiliitis on imaging, or fulfilling the ASAS criteria in patients presenting with chronic back pain (CBP). Therefore, the aim of this study was to assess which SpA diseases in family members are associated with human leukocyte antigen B27 (HLA-B27) and axial spondyloarthritis (axSpA) in CBP patients.

METHODS:

CBP patients suspected of axSpA from the SPACE (n = 438) and the DESIR (n = 647) cohort were asked about the presence of SpA diseases in first- or second-degree relatives (AS, AAU, ReA, IBD, and psoriasis). The associations between a PFH and HLA-B27, sacroiliitis on imaging (magnetic resonance imaging (MRI) or radiographs), axSpA diagnosis, and ASAS classification in CBP patients were assessed.

RESULTS:

In the SPACE and the DESIR cohort, a PFH of AS (odds ratio (OR) 5.9 (95% confidence interval (CI) 3.5-9.9), and OR 3.3 (95% CI 2.1-5.2)) and a PFH of AAU (OR 9.8 (95% CI 3.3-28.9) and OR 21.6 (95% CI 2.9-160.1)) were significantly associated with presence of HLA-B27. Furthermore, in both cohorts a PFH of AS and a PFH of AAU were positively associated with fulfilment of the ASAS criteria, but not with sacroiliitis on imaging. In SPACE but not in DESIR a PFH of AAU was positively associated with axSpA diagnosis. In both cohorts a PFH of ReA, IBD, or psoriasis was not positively associated with HLA-B27 positivity, sacroiliitis on imaging, axSpA diagnosis, or meeting the ASAS criteria for axSpA.

CONCLUSIONS:

In our cohorts, a PFH of AS or AAU is useful for case-finding of axSpA as this is correlated with HLA-B27 carriership. However, as a PFH of ReA, IBD, or psoriasis does not contribute to identifying axSpA in CBP patients, these data suggest that the widely used ASAS definition of a PFH of SpA should be updated.

TRIAL REGISTRATION:

Trial registration number, NCT01648907 . Registered on 20 July 2012.

KEYWORDS:

Acute anterior uveitis; Ankylosing spondylitis; Axial spondyloarthritis; Chronic back pain; Diagnostic work-up; Family history; IBD; Psoriasis; Reactive arthritis

Assessment of typical SpA lesions on MRI of the spine: do local readers and central readers agree in the DESIR-cohort at baseline

Un nouvel article scientifique intitulé «Assessment of typical SpA lesions on MRI of the spine: do local readers and central readers agree in the DESIR-cohort at baseline » a été publié dans le journal Clin Rheumatol.

de Hooge M, Pialat JB, Reijnierse M, van der Heijde D, Claudepierre P, Saraux A, Dougados M, Feydy A.

Clin Rheumatol. 2017 Jul;36(7):1551-1559. doi: 10.1007/s10067-017-3643-4. Epub 2017 May 23.

Abstract

Comparing local reading (LocR) with central reading (CentR) of typical spondyloarhritis lesions including bone marrow edema (BME) and structural lesions on magnetic resonance imaging of the spine (MRI-spine), in patients with inflammatory back pain (IBP; ≥3 months, <3 years). Baseline data of 667 patients, age 18-50 years, from the Devenir des Spondylarthopathies Indifferenciees Recentes (DESIR)-cohort were used. Two trained central readers scored anterior and posterior corner BME, fatty lesions, erosions and syndesmophytes on MRI-spine. Presences of lesions, based on average scores, were used for CentR. A local radiologist and/or rheumatologist scored MRI-spine on presence/doubt/absence of ‘inflammation’ and ’structural lesions’. Agreement between central readers and readings was calculated (Cohen’s kappa: κ). Agreement between central readers was moderate (BME κ = 0.55, fatty lesions κ = 0.50) to slight (erosions κ = 0.12, syndesmophytes κ = 0.19). Agreement between LocR and CentR was κ = 0.32 (BME) and κ = 0.13 (structural lesions). In 78/160 patients (48.8%) LocR were in doubt while CentR scored BME lesions, for structural lesions this was 17.8% (28/157 patients). Agreement between 2 central readers for scoring spondyloarhritis-like lesions on MRI-spine was moderate but better compared to LocR and CentR agreement. LocR often doubt about the presence of MRI-spine lesions while central trained readers score lesions.

KEYWORDS:

Inflammation; Magnetic resonance imaging; Spondyloarthritis

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

Reliability of mSASSS scoring in everyday practice in DESIR-cohort study centres: cross-sectional study of agreement with trained readers.

Un nouvel article scientifique intitulé Reliability of mSASSS scoring in everyday practice in DESIR-cohort study centres: cross-sectional study of agreement with trained readers..» a été publié dans le journal Ann Rheum Dis.

Claudepierre P, de Hooge M, Feydy A, Reijnierse M, Saraux A, Dougados M, van der Heijde D

Ann Rheum Dis. 2016 Dec;75(12):2213-2214. doi: 10.1136/annrheumdis-2016-209906. Epub 2016 Sep 20.

KEYWORDS:

Ankylosing Spondylitis; Outcomes research; Spondyloarthritis

Newsletter Rhumatologues N°26

Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter rhumatologues rédigée par le Pr Wendling , rhumatologue au CHU Jean Minjoz à Besançon .
Pour y avoir accès, merci de consulter le lien suivant: cliquer ici.

Newsletter Radiologues N°6

Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter radiologues rédigée par le Dr Feydy, radiologue à Cochin.
Pour y avoir accès, merci de consulter le lien suivant: cliquer ici.

What is the reliability of non-trained investigators in recognising structural MRI lesions of sacroiliac joints in patients with recent inflammatory back pain? Results of the DESIR cohort.

Un nouvel article scientifique intitulé «What is the reliability of non-trained investigators in recognising structural MRI lesions of sacroiliac joints in patients with recent inflammatory back pain? Results of the DESIR cohort.» a été publié dans le journal RMD Open.

Jacquemin C, Rubio Vargas R, van den Berg R, Thévenin F, Lenczner G, Reijnierse M, Ferkal S, Le Corvoisier P, Rahmouni A, Loeuille D, Feydy A, Dougados M, van der Heijde D, Claudepierre P.

RMD Open. 2016 Nov 11;2(2):e000303. eCollection 2016.


Abstract

OBJECTIVE:

The objective of this study was to evaluate the reliability of recognising structural lesions on MRI (erosions, fatty lesions, ankylosis) of the sacroiliac joints (MRI-SIJ) in clinical practice compared to a central reading in patients with a possible recent axial spondyloarthritis (axSpA).

METHODS:

Patients aged 18-50 years, with recent (<3 years) and chronic (≥3 months) inflammatory back pain, suggestive of axSpA were included in the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort. MRI-SIJ structural lesions were scored by non-trained local readers, and by two trained central readers. Local readers scored each SIJ as normal, doubtful or definite lesions. Central readers scored separately each type of lesion. The central reading (mean of the two central readers’ scores) was the external standard. Agreement (κ) was calculated first between local (3 definitions of a positive MRI-SIJ) and central readings (9 definitions), and then between the two central readers.

RESULTS:

664/708 patients with complete available images were included. Agreements between local and central readings were overall ‘fair’, except when considering at least 2 or 3 fatty lesions and at least 3 erosions and/or fatty lesions where agreement was ‘moderate’. Agreement between central readers was similar. MRI-SIJ was positive for 52.6% of patients according to central reading (at least 1 structural lesion) and for 35.4% of patients according to local reading (at least unilateral ‘doubtful’ or ‘definite’ structural lesions).

CONCLUSIONS:

Agreement on a positive structural MRI-SIJ was fair to moderate between local and central readings, as well as between central readers. The reliability improved when fatty lesions were considered.

TRIAL REGISTRATION NUMBER:

NCTO 164 8907.

KEYWORDS:

Epidemiology; Magnetic Resonance Imaging; Spondyloarthritis