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

EULAR 2019

Lors du congrès de l’EULAR 2019 qui s’est déroulé à Madrid du 12 au 15 juin 2019, 12 abstracts ont été acceptés pour une présentation orale ou par poster :

Présentation orale

▫ 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.

▫ EFFECTIVENESS OF TNFI AFTER A FIRST SWITCH IS LOWER IN PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS: A LONGITUDINAL ANALYSIS OF THE DESIR COHORT. M Pons et al.

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

Présentations par affiches.

▫ 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 M et al.

▫ CLUSTER-BASED SPONDYLOARTHRITIS PHENOTYPES DEFINED AT BASELINE ARE PREDICTIVE OF 5-YEAR SEVERITY OUTCOME IN THE DESIR COHORT. F. Costantino et al.

▫ LONG-TERM ASSOCIATION BETWEEN DISEASE ACTIVITY MEASURED BY ASDAS AND PHYSICAL FUNCTION IN A LARGE EARLY AXIAL SPONDYLOARTHRITIS COHORT. P Machado et al.

▫ MORE THAN 30% PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS PRESENT WITH PERIPHERAL ARTHRITIS: INCIDENCE AND FACTORS ASSOCIATED DURING 5 YEARS OF FOLLOW-UP OF THE DESIR COHORT. C Lopes-Medina

▫ PREGNANCY RATES AND OUTCOMES IN EARLY AXIAL SPONDYLOARTHRITIS: ANALYSIS OF THE DESIR COHORT. M Pons et al.

▫ SUBSTANTIAL CHANGES IN BONE FORMATION REGULATORS BIOMARKERS IN EARLY AXIAL SPONDYLOARTHRITIS – ROLE OF TNF INHIBITORS.  E Descamps et al.

▫ DACTYLITIS IN EARLY SPONDYLOARTHRITIS. DATA FROM THE DESIR COHORT. D Wendling et al.

▫ INCREASING IMPACT ON STRUCTURAL DAMAGE WITH INCREASING CUMULATIVE INFLAMMATION AT THE SI-JOINT QUADRANT LEVEL IN AXIAL SPONDYLOARTHRITIS – 5-YEAR DATA FROM THE DESIR COHORT. M. Rodrigues-Manica et al.

Associations of lumbar scoliosis with presentation of suspected early axial spondyloarthritis.

Un nouvel article scientifique intitulé «Associations of lumbar scoliosis with presentation of suspected early axial spondyloarthritis.» a été publié dans le journal Semin Arthritis Rheum.

Voirin-Hertz M, Carvajal Alegria G, Garrigues F, Simon A, Feydy A, Reijnierse M, van der Heijde D, Loeuille D, Claudepierre P, Marhadour T, Saraux A.

OBJECTIVE:

Scoliosis may impact the mechanical loading and cause secondary changes of the sacroiliac joints and lumbar spine. Our goal was to look how lumbar scoliosis modify the clinical and imaging-study in patients with recent-onset inflammatory back pain (IBP) suggesting axial spondyloarthritis (axSpA).

METHODS:

Baseline weight-bearing lumbar-spine radiographs obtained in the DESIR cohort of patients aged 18-50 years and having IBP for at least 3 months but less than 3 years suggesting axSpA were studied. After training on scoliosis detection based on Cobb’s angle>10° plus Nash-Moe grade≥1, readers blinded to patient data measured spine lumbar scoliosis, sacral horizontal angle, lumbosacral angle and lumbar lordosis on the radiograph of the lumbar and scored sacroiliitis on the radiograph of the pelvis. Baseline MRIs T1 and STIR of the lumbar spine and sacroiliac joints were evaluated for respectively degenerative changes and signs of axSpA.

RESULTS:

Of the 360 patients (50.8% females) 88.7% had lumbar pain and 69.3% met ASAS criteria for axSpA. Mean Cobb’s angle was 3.2°±5.0° and 28 (7.7%) patients had lumbar scoliosis. No statistical differences were observed for radiographic sacroiliitis, MRI sacroiliitis, modified Stoke Ankylosing Spondylitis Spinal Score, Pfirmmann score, high-intensity zone, protrusion, extrusion, MODIC score between patients with and without scoliosis. In both groups, degenerative changes by MRI were rare and predominated at L4-L5 and L5-S1.

CONCLUSION:

In patients with early IBP suggesting axSpA, lumbar scoliosis was not associated with inflammatory or degenerative changes.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:

Ankylosing spondylitis; Axial spondyloarthritis; Degenerative disease; Lumbar lordosis; Lumbar scoliosis; Sacral slope

Evaluation of concomitant peripheral arthritis in patients with recent onset axial spondyloarthritis: 5-year results from the DESIR cohort.

Un nouvel article scientifique intitulé «Evaluation of concomitant peripheral arthritis in patients with recent onset axial spondyloarthritis: 5-year results from the DESIR cohort.» a été publié dans le journal Arthritis Res Ther.

López-Medina C, Dougados M, Ruyssen-Witrand A, Moltó A.

BACKGROUND:

(a) To describe the prevalence and incidence of peripheral arthritis during 5 years of follow-up in recent axial spondyloarthritis (axSpA), (b) to evaluate factors associated with their appearance and (c) to assess their impact on treatment, patient-reported outcomes and sick leave after follow-up.

METHODS:

Data from the early axSpA patients from the DESIR cohort (first 5 years of follow-up) were analysed. Prevalence and incidence of peripheral arthritis at each study visit were calculated. A multivariate analysis was performed to evaluate baseline factors associated with the development of the arthritis. The use of drugs, the impact on patient-reported outcomes and days of sick leave were compared in both groups over time.

RESULTS:

Out of the 708 patients included in DESIR, 255 (36.0%) showed at least one episode of arthritis (151 before the inclusion visit and 104 during the follow-up), with an incidence of 3.7 cases per 100 person-years. Patients with peripheral arthritis were more likely (OR, 95%CI) to be aged ≥ 33 years (1.60, 1.12-2.27), non-smokers (1.58, 1.10-2.27) and HLAB27 negative (1.47, 1.04-2.08) and have presented with at least one episode of dactylitis (8.50, 4.96-14.60) and enthesitis (2.00, 1.41-2.84). Patients with peripheral arthritis showed a significant greater use of TNFb, csDMARDs and corticosteroids over follow-up; higher levels on BASDAI (40.46 vs. 34.28) and BASFI (27.89 vs. 22.52); poorer quality of life; and higher number of days of sick leave (17.97 vs. 12.78) over time.

CONCLUSION:

In recent axSpA, 36% of patients reported peripheral arthritis at any time of the disease, being associated with negative HLAB27, non-smokers and with other peripheral manifestations. Patients with arthritis showed a higher burden of disease.

KEYWORDS:

Axial spondyloarthritis; Clinical presentation; Peripheral arthritis

Impact of gut involvement in patients with high probability of early spondyloarthritis. Data from DESIR cohort.

Un nouvel article scientifique intitulé «Impact of gut involvement in patients with high probability of early spondyloarthritis. Data from DESIR cohort.» a été publié dans le journal J Rheumatol.

Wendling D, Guillot X, Prati C, Miceli-Richard C, Molto A, Lories R, Dougados M.

OBJECTIVE:

Inflammatory bowel disease (IBD) is a well-known extra articular feature of spondyloarthritis (SpA).The aims of this study were to evaluate in DESIR cohort factors associated with IBD and incidence over 5 years follow-up.

METHODS:

DESIR is a prospective observational cohort of patients with recent onset inflammatory back pain suggestive of axial SpA. All available variables in the database were compared between patients with and without IBD at baseline and 5 years, and occurrence over 5 years of follow-up, with uni and then multivariable analysis.

RESULTS:

At baseline, 708 patients, 35 had IBD : prevalence 4.94% [CI 95% : 3.3 - 6.5]. IBD was associated (multivariable) with history of uveitis, levels of DKK-1 and TNF, but not with phenotypic presentation (peripheral arthritis, enthesitis, dactylitis, uveitis) or baseline serum levels of other cytokines. At 5 years, 480 patients were analyzed, 58 with IBD. IBD was associated (multivariable) with fulfillment of modified New York criteria, sick leave, BASDAI, and smoking. No association with MRI scores, enthesitis, psoriasis, BMD. 23 incident cases of IBD were recorded: estimated occurrence rate of 0.95/100 [0.57 - 1.35] patient-years. Incidence of IBD is associated (multivariable) with : HLA B27 : OR 0.36 [0.22 - 0.59], fulfillment of modified New York criteria: OR 3.35 [1.85 - 6.08], familial history of IBD : OR 3.31[1.62 - 6.77] .

CONCLUSION:

In early SpA, IBD occurs with an incidence of 1/100 patient-years, and is associated with poor outcome, familial history of IBD, absence of HLA-B27, fulfillment of modified New York criteria.

Evaluation of the performances of ‘typical’ imaging abnormalities of axial spondyloarthritis: results of the cross-sectional ILOS-DESIR study.

Un nouvel article scientifique intitulé «Evaluation of the performances of ‘typical’ imaging abnormalities of axial spondyloarthritis: results of the cross-sectional ILOS-DESIR study.» a été publié dans le journal RMD Open.

Molto A, Gossec L, Lefèvre-Colau MM, Foltz V, Beaufort R, Laredo JD, Richette P, Dieude P, Goupille P, Feydy A, Dougados M.

Objective:

To evaluate the prevalence and performance as axial Spondyloarthritis (axSpA) diagnostic feature of radiographic and MRI lesions ‘typical’ of axSpA of the sacroiliac joint (SIJ) and spine in a mechanical chronic back pain (CBP) population and in an axSpA cohort.

Methods:

Cross-sectional multicentre study. Patients: (1) recent onset axSpA (DESIR cohort) and (2) mechanical non-axSpA CBP matched for age and gender (ILOS study). Imaging: radiographs and MR scans were performed identically in both groups. All images were centrally read, blinded for diagnosis and for other imaging findings in the same patient. Statistical analysis: prevalence of lesions ‘typical of axSpA’ were compared in both groups. Sensitivity, specificity and positive likelihood ratios (LR+) of each lesion (and combination of lesions) were calculated.

Results:

A total of 98 patients with CBP were included, and compared with 100 patients with recent onset axSpA. SIJ lesions were consistently more frequent in the axSpA group (35.0% vs 11.8% p<0.001, 35.0% vs 8.4% p<0.001% and 32.0% vs 10.0%. p<0.001 for modified New York criteria, MRI sacroiliitis and ≥3 erosions of the SIJ on MRI, respectively), and performed well (LR+ for ≥3 erosions 3.0 (95% CI 1.6 to 5.8)). Spine lesions were comparable across groups: radiographic lesions were rare, while all MRI lesions were frequent.

Conclusion:

Our study confirms that ‘typical’ lesions can also be observed in patients with non-axSpA CBP but that SIJ lesions by all modalities remain the most valuable for diagnosis, including structural lesions of the SIJ. This suggests the potential interest of adding MRI SIJ structural lesions in the definition of MRI abnormalities for axSpA classification.

KEYWORDS:

epidemiology; magnetic resonance imaging; spondyloarthritis