Can we use structural lesions seen on MRI of the sacroiliac joints reliably for the classification of patients according to the ASAS axial spondyloarthritis criteria? Data from the DESIR cohort

Un nouvel article scientifique intitulé «Can we use structural lesions seen on MRI of the sacroiliac joints reliably for the classification of patients according to the ASAS axial spondyloarthritis criteria? Data from the DESIR cohort » a été publié dans le journal Ann Rheum Dis.

Bakker PA1, van den Berg R1, Lenczner G2, Thévenin F3, Reijnierse M4, Claudepierre P5, Wendling D6, Dougados M7, van der Heijde D1

Ann Rheum Dis. 2016 Aug 4.  doi: 10.1136/annrheumdis-2016-209405

Abstract

OBJECTIVES:

Investigating the utility of adding structural lesions seen on MRI of the sacroiliac joints to the imaging criterion of the Assessment of SpondyloArthritis (ASAS) axial SpondyloArthritis (axSpA) criteria and the utility of replacement of radiographic sacroiliitis by structural lesions on MRI.

METHODS:

Two well-calibrated readers scored MRI STIR (inflammation, MRI-SI), MRI T1-w images (structural lesions, MRI-SI-s) and radiographs of the sacroiliac joints (X-SI) of patients in the DEvenir des Spondyloarthrites Indifférenciées Récentes cohort (inflammatory back pain: ≥3 months, <3 years, age <50). A third reader adjudicated MRI-SI and X-SI discrepancies. Previously proposed cut-offs for a positive MRI-SI-s were used (based on <5% prevalence among no-SpA patients): erosions (E) ≥3, fatty lesions (FL) ≥3, E/FL ≥5. Patients were classified according to the ASAS axSpA criteria using the various definitions of MRI-SI-s.

RESULTS:

Of the 582 patients included in this analysis, 418 fulfilled the ASAS axSpA criteria, of which 127 patients were modified New York (mNY) positive and 134 and 75 were MRI-SI-s positive (E/FL≥5) for readers 1 and 2, respectively. Agreement between mNY and MRI-SI-s (E/FL≥5) was moderate (reader 1: κ: 0.39; reader 2: κ: 0.44). Using the E/FL≥5 cut-off instead of mNY classification did not change in 478 (82.1%) and 469 (80.6%) patients for readers 1 and 2, respectively. Twelve (reader 1) or ten (reader 2) patients would not be classified as axSpA if only MRI-SI-s was performed (in the scenario of replacement of mNY), while three (reader 1) or six (reader 2) patients would be additionally classified as axSpA in both scenarios (replacement of mNY and addition of MRI-SI-s). Similar results were seen for the other cut-offs (E≥3, FL≥3).

CONCLUSIONS:

Structural lesions on MRI can be used reliably either as an addition to or as a substitute for radiographs in the ASAS axSpA classification of patients in our cohort of patients with short symptom duration.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

KEYWORDS:

Ankylosing Spondylitis; Low Back Pain; Magnetic Resonance Imaging; Spondyloarthritis

Newsletter Patient N°15

Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter patients rédigée par le Pr Saraux, rhumatologue au CHU de Brest.
Pour y avoir accès, merci de cliquer ici.

Rate and predisposing factors of sacroiliac radiographic progression after a 2 years follow-up period in recent onset spondyloarthritis

Un nouvel article scientifique intitulé « Rate and predisposing factors of sacroiliac radiographic progression after a 2 years follow-up period in recent onset spondyloarthritis.» a été publié dans le journal Arthritis Rheumatol.

Dougados M, Demattei C, van den Berg R, Hoang VV, Thevenin F, Reijnierse M, Loeuille D, Feydy A, Claudepierre P, van der Heijde D.

Arthritis Rheumatol. 2016 Mar 18. doi: 10.1002/art.39666.

Abstract

OBJECTIVES:

to evaluate in radiographic (r) and non-radiographic (nr) axial (ax) spondyloarthritis (SpA) 1) the rate of radiographic sacroiliac joints (SIJ) structural progression 2) to evaluate the predisposing factors of such progression over 2 years.

METHODS:

Patients:Recent onset axial SpA(DESIR cohort).

OUTCOME MEASURES:

Radiographic SIJ score according to the mNew-York criteria (mNY). Potential predisposing factors: Demographics, smoking status, HLAB27 positivity, inflammation at MRI of the SIJ, disease activity and treatment intake .

ANALYSIS:

The main analysis consisted in the evaluation of the switch from nr-to r-axSpA but also other definitions of radiographic progression.

RESULTS:

of the 708 enrolled patients, 449 had baseline and 2-year pelvic radiographs(males: 47%, age: 34±9 years old, B27 positive: 61%, MRI-SIJ positive: 29%) . The % of switch from nr-to-r-axSpA (16/326: 4.9%) and from r-to-nr-axSpA: 7/123 (5.7%) was low. The mean changes in the total SIJ score (o-8) was small 0.1± 0.8 but highly statistically significant (p<0.001). The potential baseline predisposing factors for developing mNY criteria in the multivariate analysis were current smokers, HLAB27 positivity and MRI-SIJ positivity with the following respective odds-ratio: 3.3 [1.0 - 11.5], 12.6 [2.3 - 274] and 498 [9.3 - 904].

CONCLUSION:

Our study suggest that in early SpA: a)The structural progression does exist but is quite small and observed in a small number of patients b) Both environmental (smoking status), genetic (HLAB27 positivity) and inflammatory (MRI-SIJ) markers might be independent predisposing factors of progression. This article is protected by copyright. All rights reserved.

KEYWORDS: Imaging; Spondyloarthritis; X-Rays

Two Phenotypes are Identified by Cluster Analysis in Early Inflammatory Back Pain Suggestive of Spondyloarthritis. Results from the Desir Cohort.

Un nouvel article scientifique intitulé «Two Phenotypes are Identified by Cluster Analysis in Early Inflammatory Back Pain Suggestive of Spondyloarthritis. Results from the Desir Cohort.» a été publié dans le journal Arthritis Rheumatol.

Costantino F, Aegerter P, Dougados M, Breban M, D’Agostino MA

Arthritis Rheumatol. 2016 Feb 11. doi: 10.1002/art.39628.

Abstract

OBJECTIVE:

To examine whether in patients with early inflammatory back pain (IBP) suggestive of spondyloarthritis (SpA), disease manifestations at baseline would combine according to distinguishable ordered phenotypes.

METHODS:

Baseline clinical and demographic characteristics, as well as imaging and biological data of patients included in the French multicenter DESIR cohort were analyzed by multiple correspondence analysis and cluster analysis to identify subgroups of patients, based on shared characteristics.

RESULTS:

Cluster analysis allowed us to classify the 679 patients of the cohort with no missing data into 2 major groups: one with a predominance of isolated axial manifestations and the other with associated peripheral symptoms. The application of the same analysis to selected subsets of the cohort such as HLA-B27 positive and negative patients, and patients fulfilling the Assessment of SpondyloArthritis international Society classification criteria for axial SpA, resulted again in an optimal division of the samples into 2 recurrent clusters of patients, similar to those observed in the whole cohort.

CONCLUSION:

Cluster analysis of SpA manifestations among patients with early IBP highly suggestive of SpA, allowed us to clearly identify at baseline 2 different clinical phenotypes, one with predominant axial, and the other with predominant peripheral manifestations. Ongoing follow up will allow determining whether these clusters may correspond to different severity patterns. This article is protected by copyright. All rights reserved.

Factors associated with a bad functional prognosis in early inflammatory back pain: results from the DESIR cohort.

Un nouvel article scientifique intitulé «Factors associated with a bad functional prognosis in early inflammatory back pain: results from the DESIR cohort.» a été publié dans le journal RMD Open.

Lukas C, Dougados M, Combe B.

RMD Open. 2016 Feb 8;2(1):e000204. doi: 10.1136/rmdopen-2015-000204. eCollection 2016.

Abstract

BACKGROUND:

Spondyloarthritis (SpA) is a heterogeneous disease with hardly predictable potential courses. We aimed at determining prognostic factors of bad functional outcome at 2 years in patients with early inflammatory back pain (IBP).

METHODS:

Data from patients included in the French multicentre devenir des spondylarthropathies indifférenciées récentes (DESIR) cohort, that is, suffering from IBP starting before 50 years of age and lasting for 3-36 months, were used. A bad functional outcome at 24 months was defined as an increase in bath ankylosing spondylitis functional index (BASFI), or BASFI at 2 years higher than the 75th centile in the cohort. Demographic, clinical, biological and radiological data collected at inclusion were compared in patients with bad functional outcome versus others, by χ(2) test, then by a multivariate logistic regression model with stepwise selection of relevant factors.

RESULTS:

513 patients (54.4% females, 72.2% fulfilling ASAS criteria) were assessed. Of those, 130 (25.3%) fulfilled the aforementioned criteria of a bad functional outcome (BASFI increase ≥4 units or ≥36 at 2 years). Multivariate analysis revealed that not fulfilling ASAS criteria, female sex, age >33 years, lower educational level, active smoking status and high disease activity according to bath ankylosing spondylitis disease activity index (BASDAI) at baseline were independently associated with a bad functional outcome at 24 months. Sensitivity analyses restricted to patients fulfilling ASAS criteria for SpA resulted in similar results.

CONCLUSION:

We observed, in a large prospective cohort of patients with early IBP, formerly described bad prognostic factors, especially a low educational level, an older age and a high disease activity at onset, and revealed that active smoking status and female sex were also independently associated with a poor outcome. Fulfilment of ASAS criteria, on the other hand, was predictive of a better outcome, most likely due to the more consensual management of a defined disease.

KEYWORDS:

Epidemiology; Patient perspective; Spondyloarthritis

Evaluation of physiotherapy in a prospective cohort of early axial spondyloarthritis. Data from the DESIR cohort.

Un nouvel article scientifique intitulé « Evaluation of physiotherapy in a prospective cohort of early axial spondyloarthritis. Data from the DESIR cohort» a été publié dans le journal Joint Bone Spine.

Escalas C, Dalichampt M, Dougados M, Poiraudeau S.

Joint Bone Spine. 2015 Dec 8. pii: S1297-319X(15)00244-4. doi: 10.1016/j.jbspin.2015.05.008.

Abstract

OBJECTIVE:

To evaluate the effect of physiotherapy on functional limitation in an observational cohort of early axial spondyloarthritis.

METHODS:

Design: prospective population-based cohort study.

PATIENTS:

708 patients with early axial spondyloarthritis between 2007 and 2010 naive of TNF blockers.

INTERVENTION:

early physiotherapy defined by at least eight supervised sessions of physical therapy during the first six months.

MEASUREMENTS:

the primary outcome was functional improvement defined by a relative improvement of at least 20% in BASFI at six months. Secondary outcomes were improvement in BASFI at one and two years and ASAS20 response criteria at six months.

STATISTICAL ANALYSIS:

a propensity score of having physiotherapy was developed and multivariate analysis using propensity score weighting were used to assess the effect of physiotherapy on outcome.

RESULTS:

Overall, 166 (24%) patients had physiotherapy during the first six months. After using propensity score weighting, there was no functional improvement on the primary outcome in patients treated with early physical therapy (relative risk [IC95%]: 1.15 [0.91-1.45]). No differences were observed on secondary outcomes (relative risk [IC95%]: 0.94 [0.80-1.11]).

CONCLUSIONS:

It seems there is no functional benefit for patients with early spondyloarthritis to be treated early by physiotherapy in daily practice, even though the efficacy of physiotherapy has been shown in several randomized controlled studies.

Newsletter Patient N°14

Bonjour,

Nous mettons en ligne aujourd’hui la nouvelle Newsletter patients rédigée par Véronique, patiente de la cohorte.

Pour y avoir accès, merci de cliquer ici.

Bilan des projets scientifiques soumis et acceptés (juin 2015)

Un nouveau bilan du nombre de projets soumis et acceptés par le comité scientifique depuis le début de l’étude est accessible ici

Brief Report: Nonsteroidal Antiinflammatory Drug-Sparing Effect of Tumor Necrosis Factor Inhibitors in Early Axial Spondyloarthritis: Results From the DESIR Cohort.

Un nouvel article scientifique intitulé « Brief Report: Nonsteroidal Antiinflammatory Drug-Sparing Effect of Tumor Necrosis Factor Inhibitors in Early Axial Spondyloarthritis: Results From the DESIR Cohort» a été publié dans le journal Arthritis Rheumatology.

Moltó AGranger BWendling DBreban MDougados MGossec L.

Arthritis Rheumatol. 2015 Sep;67(9):2363-8. doi: 10.1002/art.39208.

OBJECTIVE:

To evaluate the effect of tumor necrosis factor (TNF) inhibitors on nonsteroidal antiinflammatory drug (NSAID) intake in a cohort of patients with early axial spondyloarthritis (SpA) over the first 2 years of followup.

METHODS:

The Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohort is a prospective, multicenter, observational study cohortof patients with early inflammatory back pain. The management and treatment of these patients were decided by their treating rheumatologists. Data regarding NSAID intake (yes/no) and the Assessment of SpondyloArthritis international Society NSAID score were collected at each visit over 2 years of followup. Patients receiving a TNF inhibitor were matched with those receiving usual care, based on a propensity score. The NSAID-sparingeffect of TNF inhibitors was estimated by comparing the percentage of patients reaching several end points (e.g., a decrease in the NSAID score to <10 over 2 years) and by modeling NSAID intake using mixed models.

RESULTS:

Among the 627 patients who were followed up, 181 (28.9%) received a TNF inhibitor, and these patients were matched to 181 patients who received usual care. The baseline characteristics of the patients in the 2 groups were comparable (∼40% of the patients were male, and the mean age was 34 years). Initially, 90.2% of patients receiving TNF inhibitors and 90.0% of those receiving usual care had been treated with NSAIDs during the previous 6 months. The number of patients who received an NSAID decreased over time in both groups, but the decrease was greater in the group receiving TNF inhibitors (P = 0.04). The decrease in the median NSAID score was significantly greater in the TNF inhibitor group (54.9 versus 41.9), and the percentage of patients in whom the NSAID score decreased by >50% or to <10 or in whom NSAID treatment was discontinued was greater in the TNF inhibitor group (67.6% versus 46.2%).

CONCLUSION:

Treatment with TNF inhibitors was associated with a decrease in the proportion of patients taking NSAIDs and with a rapid and sustained decrease in NSAID intake. This study is the first to confirm the NSAID-sparing effect of TNF inhibitors in patients with early axial SpA in a real-life clinical setting.

Increase in Dickkopf-1 Serum Level in Recent Spondyloarthritis. Data from the DESIR Cohort.

Un nouvel article scientifique intitulé « Increase in Dickkopf-1 Serum Level in Recent Spondyloarthritis. Data from the DESIR Cohort» a été publié dans le journal PLoS One.

Nocturne G, Pavy SBoudaoud SSeror RGoupille PChanson Pvan der Heijde Dvan Gaalen F, Berenbaum FMariette XBriot KFeydy A,Claudepierre PDieudé PNithitham JTaylor KECriswell LADougados MRoux CMiceli-Richard C.

PLoS One. 2015 Aug 27;10(8):e0134974. doi: 10.1371/journal.pone.0134974. eCollection 2015.

Abstract

OBJECTIVES:

To investigate DKK-1 and SOST serum levels among patients with recent inflammatory back pain (IBP) fulfilling ASAS criteria for SpA and associated factors.

METHODS:

The DESIR cohort is a prospective, multicenter French cohort of 708 patients with early IBP (duration >3 months and <3 years) suggestive of AxSpA. DKK-1 and SOST serum levels were assessed at baseline and were compared between the subgroup of patients fulfilling ASAS criteria for SpA (n = 486; 68.6%) and 80 healthy controls.

RESULTS:

Mean SOST serum levels were lower in ASAS+ patients than healthy controls (49.21 ± 25.9 vs. 87.8 ± 26 pmol/L; p<0.0001). In multivariate analysis, age (p = 5.4 10-9), CRP level (p<0.0001) and serum DKK-1 level (p = 0.001) were associated with SOST level. Mean DKK-1serum levels were higher in axial SpA patients than controls (30.03 ± 15.5 vs. 11.6 ± 4.2 pmol/L; p<0.0001). In multivariate analysis, DKK-1 serumlevels were associated with male gender (p = 0.03), CRP level (p = 0.006), SOST serum level (p = 0.002) and presence of sacroiliitis on radiography (p = 0.05). Genetic association testing of 10 SNPs encompassing the DKK-1 locus failed to demonstrate a significant contribution of genetics to control of DKK-1 serum levels.

CONCLUSIONS:

DKK-1 serum levels were increased and SOST levels were decreased among a large cohort of patients with early axial SpA compared to healthy controls. DKK-1 serum levels were mostly associated with biological inflammation and SOST serum levels.