Newsletter Patient N°20

Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter patients rédigée par le Pr Laure GOSSEC, rhumatologue à l’hôpital La pitié-Salpêtrière.
Pour y avoir accès, merci de cliquer ici.

What is axial spondyloarthritis? A latent class and transition analysis in the SPACE and DESIR cohorts

Un nouvel article scientifique intitulé «What is axial spondyloarthritis? A latent class and transition analysis in the SPACE and DESIR cohorts» a été publié dans le journal Ann Rheum Dis.

Sepriano A, Ramiro S, van der Heijde D, van Gaalen F, Hoonhout P, Molto A, Saraux A, Ramonda R, Dougados M, Landewé R.

OBJECTIVES:

To gain expert-judgement-free insight into the Gestalt of axial spondyloarthritis (axSpA), by investigating its ‘latent constructs’ and to test how well these latent constructs fit the Assessment of SpondyloArthritis international Society (ASAS) classification criteria.

METHODS:

Two independent cohorts of patients with early onset chronic back pain (SPondyloArthritis Caught Early (SPACE)) or inflammatory back pain (IBP) (DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR)) were analysed. Latent class analysis (LCA) was used to estimate the (unobserved) potential classes underlying axSpA. The best LCA model groups patients into clinically meaningful classes with best fit. Each class was labelled based on most prominent features. Percentage fulfilment of ASAS axSpA, peripheral SpA (pSpA) (ignoring IBP) or both classification criteria was calculated. Five-year data from DESIR were used to perform latent transition analysis (LTA) to examine if patients change classes over time.

RESULTS:

SPACE (n=465) yielded four discernible classes: ‘axial’ with highest likelihood of abnormal imaging and HLA-B27 positivity; ‘IBP+peripheral’ with 100% IBP and dominant peripheral symptoms; ‘at risk’ with positive family history and HLA-B27 and ‘no SpA’ with low likelihood for each SpA feature. LCA in DESIR (n=576) yielded similar classes, except for the ‘no-SpA’. The ASAS axSpA criteria captured almost all (SPACE: 98%; DESIR: 93%) ‘axial’ patients, but the ‘IBP+peripheral’ class was only captured well by combining the axSpA and pSpA criteria (SPACE: 78%; DESIR: 89%). Only 4% of ‘no SpA’ patients fulfilled the axSpA criteria in SPACE. LTA suggested that 5-year transitions across classes were unlikely (11%).

CONCLUSION:

The Gestalt of axSpA comprises three discernible entities, only appropriately captured by combining the ASAS axSpA and pSpA classification criteria. It is questionable whether some patients with ‘axSpA at risk’ will ever develop axSpA.

KEYWORDS:

axial spondyloarthritis; classification criteria; diagnosis

Dactylitis in early spondyloarthritis. Data from the prospective French national cohort DESIR

Un nouvel article scientifique intitulé «Dactylitis in early spondyloarthritis. Data from the prospective French national cohort DESIR» a été publié dans le journal Joint Bone Spine.

Wendling D, Prati C, Saraux A, Molto A, Pham T, Dougados M, Guillot X.

KEYWORDS:

Clinical presentation; Cohort; Dactylitis; Spondyloarthritis

SFR 2019

De nouveaux travaux ont été présentés lors du congrès de la Société Française de Rhumatologie (SFR) qui s’est déroulé du 08 au 10 décembre 2019 à Versailles :

Oral n= 5 :

• Les phénotypes de spondylarthrite définis par clustering  dans  la  cohorte  DESIR  à  l’inclusion  sont prédictifs de la sévérité de la maladie à 5 ans – Constantino et al.

• La spondylarthrite n’est pas ce que l’on croit : chacun DESIR(e) autre chose -  Wendling, Claudepierre, Molto et al

• Histoire naturelle après 5 ans de suivi de la spondylarthrite axiale radiographique versus non-radiographique : les données de la cohorte DESIR – Lopez-Médina et al

• Survenue  de  dactylite  dans  la  spondylarthrite  récente  :  données  sur  cinq  ans  de  la  cohorte  prospective nationale française DESIR . Wendling et al.

• Grossesses et leurs complications dans la spondylarthrite axiale récente : analyse de la cohorte DESIR . Pons et al.

Clinical manifestations, disease activity and disease burden of radiographic versus non-radiographic axial spondyloarthritis over 5 years of follow-up in the DESIR cohort

Un nouvel article scientifique intitulé «Clinical manifestations, disease activity and disease burden of radiographic versus non-radiographic axial spondyloarthritis over 5 years of follow-up in the DESIR cohort» a été publié dans le journal Ann Rheum Dis.

López-Medina C, Molto A, Claudepierre P, Dougados M.

OBJECTIVES:

To compare the clinical manifestations, disease activity and disease burden between patients with radiographic (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA) over a 5-year follow-up period in the Devenir des Spondylarthropathies Indifferénciées Récentes (DESIR) cohort.

METHODS:

Patients from the DESIR cohort who had X-ray images of the sacroiliac joints available at baseline and did not leave the study during the 5-year follow-up period because of a diagnosis other than axSpA were included. A unilateral rating of ‘obvious sacroiliitis’ by the local reader was considered sufficient for classification as r-axSpA. The incidence of first episodes of peripheral and extra-rheumatic manifestations was compared between the two groups using the incidence rate ratio and Cox regressions adjusted for sex, age and tumour necrosis factor blocker (TNFb) intake. Mean values of patient-reported outcomes (PROs) and days of sick leave over 5 years of follow-up were compared using mixed models adjusted for sex, age, TNFb intake and baseline values.

RESULTS:

In total, 669 patients were included, of whom 185 (27.7%) and 484 (72.3%) were classified as r-axSpA and nr-axSpA, respectively. At baseline, the r-axSpA patients showed a significantly higher prevalence of males. After adjusting for age, sex and TNFb intake, Cox regressions for peripheral and extra-rheumatic manifestations did not show any significant differences between groups. Mixed models also showed similar mean levels in PROs and days of sick leave between groups over time.

CONCLUSION:

The incidence of peripheral and extra-rheumatic manifestations as well as the disease burden over time remained similar between r-axSpA and nr-axSpA groups after adjusting for intermediate variables.

KEYWORDS:

axial spondyloarthritis; patient-reported outcomes; peripheral manifestations

ACR 2019

Des nouveaux travaux ont été présentés lors du congrès du collège américain (ACR) de rhumatologie qui s’est déroulé du 08 au 13 novembre 2019 à Atlanta (Etats-Unis) :

Oral: n=06

• CLUSTER-BASED SPONDYLOARTHRITIS PHENOTYPES DEFINED AT BASELINE ARE PREDICTIVE OF DIFFERENT SEVERITY OUTCOMES AT 5-YEAR IN THE DESIR COHORT – Constantino et al.

• PREGNANCY RATES AND OUTCOMES IN EARLY AXIAL SPONDYLOARTHRITIS: ANALYSIS OF THE DESIR COHORT -  Pons et al

• 5-YEARS TREATMENT EFFECT OF TNF ALPHA INHIBITOR IN EARLY AXIAL SPONDYLOARTHRITIS AND ASSOCIATED FACTORS: AN INVERSE PROBABILITY WEIGHTING ANALYSIS OF THE DESIR COHORT – Pons et al

• WHAT IS AXIAL SPONDYLOARTHRITIS? A LATENT CLASS AND TRANSITION ANALYSIS IN THE SPACE AND DESIR COHORTS. A Sepriano et al.

• ASSOCIATION BETWEEN BONE MARROW EDEMA AND STRUCTURAL PROGRESSION IN THE SAME QUADRANT IN AXIAL SPONDYLOARTHRITIS – 5-YEAR DATA FROM THE DESIR COHORT. M. Rodrigues-Manica et al.

• DO SMOKING AND SOCIO-ECONOMIC FACTORS INDEPENDENTLY INFLUENCE IMAGING OUTCOMES IN AXIAL SPONDYLOARTHRITIS? FIVE-YEAR DATA FROM THE DESIR COHORT. E Nikiphorou et al.

Association of lumbosacral transitional vertebra and sacroiliitis in patients with inflammatory back pain suggesting axial spondyloarthritis

Un nouvel article scientifique intitulé «Association of lumbosacral transitional vertebra and sacroiliitis in patients with inflammatory back pain suggesting axial spondyloarthritis.» a été publié dans le journal Rheumatology (Oxford).

Carvajal Alegria G, Voirin-Hertz M, Garrigues F, Herbette M, Deloire L, Simon A, Feydy A, Reijnierse M, van der Heijde D, Marhadour T, Saraux A.

OBJECTIVE:

Lumbosacral transitional vertebras (LSTVs) are common in the general population, but their potential impact on the sacroiliac joints is unclear. We aimed to determine the prevalence of LSTVs and to assess their associations with sacroiliitis by standard radiography and MRI in a population with suspected axial spondyloarthritis.

METHODS:

The data were from the DESIR cohort of 688 patients aged 18-50 years with inflammatory low back pain for ⩾3 months but <3 years suggesting axial spondyloarthritis. The baseline pelvic radiographs were read by two blinded readers for the presence and type (Castellvi classification) of LSTVs. Associations between LSTVs and other variables collected at baseline and at the diagnosis were assessed using the χ2 test (or Fisher’s exact test) or the Mann-Whitney test.

RESULTS:

LSTV was found in 200/688 (29.1%) patients. Castellvi type was Ia in 54 (7.8%), Ib in 76 (11.0%), IIa in 20 (2.9%), IIb in 12 (1.7%), IIIa in 7 (1.0%), IIIb in 21 (3.0%) and IV in 10 (1.4%) patients. Compared with the group without LSTVs, the group with LSTVs had higher proportions of patients meeting modified New York criteria for radiographic sacroiliitis (19% vs 27%, respectively; P = 0.013) and Assessment of SpondyloArthritis international Society MRI criteria for sacroiliitis (29% vs 39%, respectively; P = 0.019).

CONCLUSION:

In patients with inflammatory back pain suggesting axial spondyloarthritis, LSTVs are associated with both radiographic and MRI sacroiliitis.

KEYWORDS:

MRI; ankylosing spondylitis; inflammation; low back pain; spondyloarthritis

Baseline MRI inflammation is not a determinant of 5-year bone mineral density loss in patients with early spondyloarthritis

Un nouvel article scientifique intitulé «Baseline MRI inflammation is not a determinant of 5-year bone mineral density loss in patients with early spondyloarthritis» a été publié dans le journal Joint Bone Spine.

Fechtenbaum M, Molto A, Roux C, Goupille P, Chevret S, Briot K.

OBJECTIVE:

The aim of this study was to assess the effect of baseline inflammation on Magnetic Resonance Imaging (MRI) on the change in Bone Mineral Density (BMD) over 5 years in patients with early spondyloarthritis (SpA).

METHODS:

From the patients of the DESIR cohort (an early axial SpA cohort), patients with BMD data at both baseline and 5 years, and baseline spine and sacroiliac joints MRI were included. Inflammation was assessed with the SpondyloArthritis Research Consortium of Canada (SPARCC) spine score. Significant BMD loss was defined by a change of >0.03g/cm2. No patients had received TNF blockers before inclusion in the cohort. Univariate and multivariable prognostic analyses were performed. An inverse propensity score weighting method was used to handle confounders.

RESULTS:

One hundred and eighty-three patients were included (mean age 33.9±8.7 years, 58.5% men). A significant bone loss was reported in 51% (n=92) of patients at either lumbar spine or hip. Fourteen (7%) patients had low BMD (Z-score <-2) at the end of the follow-up vs. 28 (15%) at baseline. In multivariable analysis, age was a protective factor of 5 year-BMD loss at any site (OR=0.96, 95% CI [0.93-0.99]). Baseline MRI inflammation has no significant effect on BMD change at any site (OR=0.84, 95% CI [0.46-1.53]).

CONCLUSION:

Half of patients with early SpA have a significant bone loss at either lumbar spine or hip over 5 years. Baseline MRI inflammation is not a determinant of this bone loss.

KEYWORDS:

Bone mineral density; Early spondyloarthritis; Inflammation; Osteoporosis; Propensity score

Newsletter Patient N°19

Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter patients rédigée par le Pr Pascal RICHETTE, rhumatologue à l’hôpital LARIBOISIERE.
Pour y avoir accès, merci de cliquer ici.

Spinal-pelvic orientation: potential effect on the diagnosis of spondyloarthritis.

Un nouvel article scientifique intitulé «Spinal-pelvic orientation: potential effect on the diagnosis of spondyloarthritis.» a été publié dans le journal Rheumatology (Oxford).

Carvajal Alegria G, Deloire L, Herbette M, Garrigues F, Gossec L, Simon A, Feydy A, Reijnierse M, van der Heijde D, Loeuille D, Claudepierre P, Marhadour T, Saraux A.

OBJECTIVE:

To assess associations of spinal-pelvic orientation with clinical and imaging-study findings suggesting axial SpA (axSpA) in patients with recent-onset inflammatory back pain.

METHODS:

Spinal-pelvic orientation was assessed in DESIR cohort patients with recent-onset inflammatory back pain and suspected axSpA, by using lateral lumbar-spine radiographs to categorize sacral horizontal angle (<40° vs ⩾40°), lumbosacral angle (<15° vs ⩾15°) and lumbar lordosis (LL, <50° vs ⩾50°). Associations between these angle groups and variables collected at baseline and 2 years later were assessed using the χ2 test (or Fisher’s exact) and the Mann-Whitney test. With Bonferroni’s correction, P < 0.001 indicated significant differences.

RESULTS:

Of 362 patients, 358, 356 and 357 had available sacral horizontal angle, lumbosacral angle and LL values, respectively; means were 39.3°, 14.6° and 53.0°, respectively. The prevalence of sacroiliitis on both radiographs and MRI was higher in the LL < 50° group than in the LL ⩾50° group, but the difference was not statistically significant. Clinical presentation and confidence in a diagnosis of axSpA did not differ across angle groups. No significant differences were identified for degenerative changes according to sacral horizontal angle, lumbosacral angle or LL.

CONCLUSION:

Spinal-pelvic balance was not statistically associated with the clinical or imaging-study findings suggesting axSpA in patients with recent-onset inflammatory back pain.

© 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:

ankylosing spondylitis; axial spondyloarthritis; lumbar lordosis; sacral slope; sacroiliitis