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

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

Response to: « Diffuse Idiopathic Skeletal Hyperostosis and Ankylosing Spondylitis. Comment on the article by Latourte et al » by Olmedo-Garzón and Ruiz-Ollero

Un nouvel article scientifique intitulé «Response to: « Diffuse Idiopathic Skeletal Hyperostosis and Ankylosing Spondylitis. Comment on the article by Latourte et al » by Olmedo-Garzón and Ruiz-Ollero» a été publié dans le journal Arthritis Care Res (Hoboken).

Latourte A, Moltó A.

Abstract

We would like to thank F.J. Olmedo-Garzón and A. Ruiz-Ollero for their interest in our article examining the presence of imaging features suggestive of axial spondyloarthritis (axSpA) in patients with diffuse idiopathic skeletal hyperostosis (DISH) (1). We have read with great interest their comments on our results indicating a high prevalence of inflammatory lesions (especially bone marrow edema [BME]) at the spine but not at the sacro-iliac joints (SIJ) (2). Similar findings have been observed recently in the ILOS-DESIR study, comparing age-matched patients with recent onset chronic back pain (n=97) vs. recent onset axSpA (n=100). This article is protected by copyright. All rights reserved.

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.