novembre 29, 2023 | Posted by admin
Un nouvel article scientifique intitulé «Do subjective components of disease activity contribute to heterogeneity in opioid prescriptions in inflammatory rheumatic diseases? Results from ESPOIR and DESIR cohorts» a été publié dans le journal Clin Exp Rheumatol.
Kumaradev S, Roux C, Sellam J, Perrot S, Pham T, Moltó A, Dugravot A.
Objectives:
To determine whether subjective components of disease activity are associated with heterogeneity in opioid prescription in inflammatory rheumatic diseases (IRDs) after accounting for objective inflammatory markers.
Methods:
Data from two prospective observational cohorts of early IRDs (ESPOIR for rheumatoid arthritis (RA) and DESIR for spondyloarthritis (SpA)) were included. Opioid prescription duration (converted to monthly binary opioid prescription), disease activity (Disease activity score 28 (DAS28) for RA; Axial spondyloarthritis disease activity score-C-reactive protein (ASDAS-CRP) for SpA) and its components were measured respectively at 13 and 9 occasions spanning 10- and 6-years of follow-up. Group-based trajectory modelling defined opioid-prescription trajectories and mixed-models characterised the evolution of disease activity and its subjective components by opioid-prescription trajectories.
Results:
Four distinct opioid-prescription trajectories: no/low (60.5% and 54.3%), declining (14.7% and 15.8%), augmenting (11.9% and 10.7%), and persistent (12.9% and 19.1%) were identified in RA and SpA respectively (60% were prescribed opioids at least once). Those with regular opioid prescriptions (up to 30%) are often older, less educated, have higher BMI and worse disease. No/low trajectory was the reference for examining evolution of disease activity and subjective components (n=810 RA, n=679 SpA). In IRDs, consistently higher disease activity throughout follow-up were seen with persistent (DAS28(β=0.4-0.8); ASDAS-CRP(β=0.4-0.6)), and augmenting (DAS28(β=0.2-0.5); ASDAS-CRP(β=0.3-0.6)) trajectories and until 3- or 4-years of follow-up (DAS28(β=0.3-0.4); ASDAS-CRP(β=0.2-0.3)) with declining trajectory. Like-wise, despite accounting for objective inflammation, subjective components had worse scores over follow-up in augmenting and persistent trajectory.
Conclusions:
Non-inflammatory pain mechanisms amplify subjective outcomes, thus, worsening composite measures like disease activity.
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novembre 27, 2023 | Posted by admin
Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter patients rédigée par le Pr Anne Tournadre, rhumatologue au CHU Gabriel-Montpied à Clermont-Ferrand.
Pour y avoir accès, merci de cliquer ici.
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juin 3, 2023 | Posted by admin
Lors du congrès de l’EULAR 2023 qui s’est déroulé du 31 mai au 3 juin 2023 à Milan , 5 abstracts ont été acceptés pour une présentation :
▫ Comparison of metrological properties of the s-scaiss versus the sparcc scoring system for the detection/quantification of inflammation at mri-sij in spondylarthritis: data from the desir cohort. R. Almodovar gonzález, P. Zarco-montejo, A. Bueno, C. García-monco, E. Pérez-fernández, C. López-medina, M. Dougados, R. Mazzucchelli,
▫ Facing the issues of change in entry visit diagnosis and lost of follow-up over time in inception cohorts: data from the axial spondylarthritis (axspa) desir cohort. C. Serrand, M. Dougados, T. Lequerre, S. Alonso, A. Moltó
▫ Factors associated with treatment pathways in early axial spondyloarthritis: a multistate analysis of the 10-year follow-up of the desir cohort. E. Portier, S. Chevret, A. Ruyssen-witrand, A. Walter petrich, M. Dougados, A. Moltó
▫ Long term (10 year) clinical outcome of recent onset axial spondyloarthritis (axspa): data from the desir cohort. M. Dougados, C. Serrand, S. Alonso, T. Lequerre, A. Moltó
▫ Sensitivity to change of structural lesions in early axial spondyloarthritis after 10 years of follow up. Data from desir cohort. C. López-medina, A. Moltó, A. Sepriano, S. Ramiro, M. Dougados
DETERMINANTS OF CLINICALLY IMPORTANT WORSENING IN EARLY AXIAL SpA: ANALYSIS OF THE DESIR COHORT OVER 5 YEARS,
F. Hamitouche, S. Kumaradev, D. Van der Heijde, S. Ramiro, A. Sepriano, A. Moltó
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mai 18, 2023 | Posted by admin
Un nouvel article scientifique intitulé «Bone marrow edema in the sacroiliac joints is associated with the development of structural lesions at the same anatomical location over time in patients with axial spondyloarthritis» a été publié dans le journal Semin Arthritis Rheum.
Rodrigues-Manica S, Sepriano A, Ramiro S, Landewé R, Claudepierre P, Moltó A, Dougados M, van Lunteren M, van der Heijde D.
Objective:
To assess whether the presence of bone marrow edema (BME) leads to the development of structural lesions at the same anatomical location of the sacroiliac joints (SIJ), and to investigate the association between BME patterns over time and structural lesions in patients with early axial spondyloarthritis (axSpA).
Methods:
Patients with axSpA from the DESIR cohort with ≥2 consecutive magnetic resonance imaging (MRI)-SIJ were assessed at baseline, 2 and 5 years. MRI-SIJ images were divided into 8 quadrants. The association between BME and subsequent structural lesions (sclerosis, erosions, fatty lesions, and ankylosis) on MRI in the same quadrant was tested longitudinally. Additionally, patients were grouped according to the pattern of BME evolution across quadrants over time (no BME, sporadic, fluctuating, and persistent). The association between these patterns and 5-year imaging outcomes (eg: ≥5 erosions and/or fatty lesions on MRI-SIJ) was tested.
Results:
In total, 196 patients were included. BME in each quadrant was associated with sclerosis (OR:1.9 (95%CI: 1.1;3.4)), erosions (1.9 (1.5;2.5)) and fatty lesions (1.9 (1.4;2.6)). Ankylosis was uncommon. There was a gradient between increased level of inflammation and subsequent damage: compared to the ‘no BME’ pattern, the sporadic (OR (95% CI): 2.1 (1.0;4.5)), fluctuating (OR:5.6(2.2;14.4)) and persistent (OR:7.5(2.8;19.6)) patterns were associated with higher structural damage on MRI-SIJ at 5-years.
Conclusions:
In early axSpA, inflammation on MRI-SIJ leads to damage at the quadrant level. The higher the exposure to inflammation across quadrants in the SIJs over time the higher the likelihood of subsequent structural damage, suggesting a cumulative effect.
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avril 2, 2023 | Posted by admin
Un nouvel article scientifique intitulé «A deep learning model for the diagnosis of sacroiliitis according to Assessment of SpondyloArthritis International Society classification criteria with magnetic resonance imaging» a été publié dans le journal Diagn Interv Imaging.
Bordner A, Aouad T, Medina CL, Yang S, Molto A, Talbot H, Dougados M, Feydy A.
Purpose:
The purpose of this study was to develop and evaluate a deep learning model to detect bone marrow edema (BME) in sacroiliac joints and predict the MRI Assessment of SpondyloArthritis International Society (ASAS) definition of active sacroiliitis in patients with chronic inflammatory back pain.
Materials and methods:
MRI examinations of patients from the French prospective multicenter DESIR cohort (DEvenir des Spondyloarthropathies Indifférenciées Récentes) were used for training, validation and testing. Patients with inflammatory back pain lasting three months to three years were recruited. Test datasets were from MRI follow-ups at five years and ten years. The model was evaluated using an external test dataset from the ASAS cohort. A neuronal network classifier (mask-RCNN) was trained and evaluated for sacroiliac joints detection and BME classification. Diagnostic capabilities of the model to predict ASAS MRI active sacroiliitis (BME in at least two half-slices) were assessed using Matthews correlation coefficient (MCC), sensitivity, specificity, accuracy and AUC. The gold standard was experts’ majority decision.
Results:
A total of 256 patients with 362 MRI examinations from the DESIR cohort were included, with 27% meeting the ASAS definition for experts. A total of 178 MRI examinations were used for the training set, 25 for the validation set and 159 for the evaluation set. MCCs for DESIR baseline, 5-years, and 10-years follow-up were 0.90 (n = 53), 0.64 (n = 70), and 0.61 (n = 36), respectively. AUCs for predicting ASAS MRI were 0.98 (95% CI: 0.93-1), 0.90 (95% CI: 0.79-1), and 0.80 (95% CI: 0.62-1), respectively. The ASAS external validation cohort included 47 patients (mean age 36 ± 10 [SD] years; women, 51%) with 19% meeting the ASAS definition. MCC was 0.62, sensitivity 56% (95% CI: 42-70), specificity 100% (95% CI: 100-100) and AUC 0.76 (95% CI: 0.57-0.95).
Conclusion:
The deep learning model achieves performance close to those of experts for BME detection in sacroiliac joints and determination of active sacroiliitis according to the ASAS definition.
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février 14, 2023 | Posted by admin
Un nouvel article scientifique intitulé «Influence of Sex on Early Axial Spondyloarthritis: A Six-Year Longitudinal Analysis From a Large National Cohort» a été publié dans le journal Arthritis Care Res (Hoboken).
Aouad K, Tournadre A, Lucasson F, Wendling D, Molto A, Fautrel B, Gossec.
Objective:
The objective was to determine sex differences in disease outcomes in recent axial spondyloarthritis (SpA) over time.
Methods:
We analyzed the first 6 years of follow-up of the prospective French multicenter DESIR cohort. Patients analyzed had <3 years of disease, were naive to disease-modifying antirheumatic drugs, and fulfilled the Assessment of SpondyloArthritis international Society classification criteria for axial SpA. Disease activity (Ankylosing Spondylitis Disease Activity Score [ASDAS] using the C-reactive protein [CRP] level), patient global assessment (PtGA), CRP level, and radiographic sacroiliitis were compared between men and women (self-reported sex) by linear and logistic mixed-effects models. Models were created for trajectories of disease activity over 6 years in men and women, using k-means.
Results:
Of 494 patients analyzed (mean ± SD age 31.9 ± 7.5 years, symptoms duration 20.7 ± 11.7 months), 50.4% were men. Over 6 years of follow-up, both men and women showed clear improvements in ASDAS-CRP, PtGA, and CRP level. Women had higher ASDAS-CRP and PtGA over time compared to men (both P < 0.0001) with overall similar CRP levels (P = 0.089), whereas structural damage increased more in men (P < 0.0001). One-third of both men (33%) and women (34%) belonged to persistent high/very high disease activity trajectories, but ASDAS-CRP was globally higher in women in these trajectories.
Conclusion:
In early axial SpA, clinical outcomes (disease activity and symptoms) were worse in women than men over 6 years of follow-up, whereas CRP was similar and structural damage was more frequent in men. Although similarly distributed, disease activity scores were higher in women in high/very high disease activity trajectories. Sex appears to be an important contextual factor in axial SpA.
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janvier 31, 2023 | Posted by admin
Un nouveau bilan du nombre de projets soumis et acceptés par le comité scientifique depuis le début de l’étude est accessible cliquer ici .
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décembre 28, 2022 | Posted by admin
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.
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décembre 13, 2022 | Posted by admin
De nouveaux travaux ont été présentés lors du congrès de la Société Française de Rhumatologie (SFR) qui s’est déroulé du 11 au 13 décembre 2022 à Versailles :
• Facteurs associés aux différentes stratégies thérapeutiques dans la spondyloarthrite axiale débutante : une analyse multi-états sur 10 ans de la cohorte DESIR. E. Portier, S. Chevret, A. Ruyssen-Witrand, A. Molto.
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novembre 14, 2022 | Posted by admin
Lors du congrès de l’ACR 2022 qui s’est déroulé du 10 au 14 novembre 2022 à Philadelphie, 1 abstract a été accepté :
▫ Determinants of Clinically Important Worsening in Early Axial Spondyloarthritis: Analysis of the DESIR Cohort over 5 Years. Faten Hamitouche , Sushmitha Kumaradev, Désirée van der Heijde, Sofia Ramiro, Alexandre Sepriano and Anna Molto.
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