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.

Effect of Gut Involvement in Patients With High Probability of Early Spondyloarthritis: Data From the DESIR Cohort

Un nouvel article scientifique intitulé «Effect of Gut Involvement in Patients With High Probability of Early Spondyloarthritis: Data From the DESIR Cohort» a été publié dans le journal J Rheumatol.

Daniel Wendling, Xavier Guillot, Clément Prati, Corinne Miceli-Richard, Anna Molto, Rik Lories, Maxime Dougados.

Abstract

Objective: Inflammatory bowel disease (IBD) is a well-known extraarticular feature of spondyloarthritis (SpA). The aims of this study were to evaluate factors associated with IBD and incidence over 5 years of followup in the DESIR cohort.

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 followup, with uni- and then multivariable analysis.

Results: At baseline, of 708 patients, 35 had IBD (prevalence 4.94%, CI 95% 3.3-6.5). IBD was associated (multivariable) with history of uveitis, levels of Dickkopf-1, and tumor necrosis factor, 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, Bath Ankylosing Spondylitis Disease Activity Index, and smoking. There was no association with magnetic resonance imaging scores, enthesitis, psoriasis, and bone mineral density. Twenty-three incident cases of IBD were recorded: estimated occurrence rate of 0.95/100 (95% CI 0.57-1.35) patient-years (PY). Incidence of IBD is associated (multivariable) with HLA-B27 (OR 0.36, 95% CI 0.22-0.59), fulfillment of modified New York criteria (OR 3.35, 95% CI 1.85-6.08), and familial history of IBD (OR 3.31, 95% CI 1.62-6.77).

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

Keywords: EPIDEMIOLOGY; GASTROINTESTINAL DISEASES; INFLAMMATORY BOWEL DISEASE; SPONDYLOARTHRITIS.

Integrated Longitudinal Analysis Does Not Compromise Precision and Reduces Bias in the Study of Imaging Outcomes: A Comparative 5-year Analysis in the DESIR Cohort

Un nouvel article scientifique intitulé «Integrated Longitudinal Analysis Does Not Compromise Precision and Reduces Bias in the Study of Imaging Outcomes: A Comparative 5-year Analysis in the DESIR Cohort» a été publié dans le journal Semin Arthritis Rheum.

1. Alexandre Sepriano, Sofia Ramiro, Désirée van der Heijde, Maxime Dougados, Pascal Claudepierre , Antoine Feydy, Monique Reijnierse, Damien Loeuille, Robert Landewé.

Abstract

Objective:

To assess if an integrated longitudinal analysis using all available imaging data affects the precision of estimates of change in patients with axial spondyloarthritis (axSpA), with completers analysis as reference standard.

Methods:

Patients from the DESIR cohort fulfilling the ASAS axSpA criteria were included. Radiographs and MRIs of the sacroiliac joints and spine were obtained at baseline, 1, 2 and 5 years. Each image was scored by 2 or 3 readers in 3 ‘reading-waves’ (or campaigns). Each outcome was analyzed: i. According to a ‘combination algorithm’ (e.g. ‘2 out of 3′ for binary scores); and ii. Per reader. Change over time was analyzed with generalized estimating equations by 3 approaches: (a)’integrated-analysis’ (all patients with ≥1 score from ≥1 reader from all waves); (b1)Completers-only analysis (patients with 5-year follow-up, using scores from individual readers); (b2)Completers analysis using a ‘combination algorithm’ (as (b1) but with combined scores). Approaches (b1) and (b2) were considered the ‘reference’.

Results:

In total, 413 patients were included. The ‘integrated analysis’ was more inclusive with similar levels of precision of the change estimates as compared to both completers analyses. In fact, for low-incident outcomes (e.g.% mNY-positive over 5-years), an increased incidence was ‘captured’, with more precision, by the ‘integrated analysis’ compared to the completers analysis with combined scores (% change/year (95%CI): 1.1 (0.7; 1.5) vs 1.2 (0.5; 1.8), respectively).

Conclusion:

An efficient and entirely assumption-free ‘integrated analysis’ does not jeopardize precision of the estimates of change in imaging parameters and may yield increased statistical power for detecting changes with low incidence.

Keywords: Axial spondyloarthritis; Imaging; Statistical methods.

5-year Follow-Up of Spinal and Sacroiliac MRI Abnormalities in Early Axial Spondyloarthritis: Data From the DESIR Cohort

Un nouvel article scientifique intitulé «5-year Follow-Up of Spinal and Sacroiliac MRI Abnormalities in Early Axial Spondyloarthritis: Data From the DESIR Cohort» a été publié dans le journal RMD Open.

Queeny Madari , Alexandre Sepriano, Sofia Ramiro, Anna Molto, Pascal Claudepierre, Daniel Wendling, Maxime Dougados, Desirée van der Heijde, Floris A van Gaalen.

Abstract

Objective:

To study changes on MRI of the spine and sacroiliac joint (SIJ) in early axial spondyloarthritis (axSpA) over time.

Methods:

In the Devenir des Spondyloarthropathies Indifférenciées Récentes cohort, MRI-spine and MRI-SIJ at baseline and 2 and 5 years were scored by central readers for bone marrow oedema (BME), fatty lesions, erosions, sclerosis, ankylosis and spinal bone spurs. The average mean number of lesions was reported or the agreement of ≥2 out of 3 readers for binary outcomes. Net progression was calculated by subtracting the patients that ‘improved’ from those that ‘worsened’ divided by the total number of patients.

Results:

Over 5 years, in 155 patients with axSpA (mean age 33.5 (SD 8.9) years, symptom duration 1.4 (0.8) years, 63% human leucocyte antigen+, 14% modified New York+), BME on MRI-SIJ decreased by a mean Spondyloarthritis Research Consortium of Canada score of 1.4 (SD 6.5) (p=0.009). The largest BME decrease was observed in patients using biological disease-modifying antirheumatic drugs at 5 years. Spinal BME increased by 0.3 (4.6) (p=0.41). Fatty lesions and/or erosions on MRI-SIJ increased by a mean of 1.0 (SD 2.6) (p<0.001). Spinal fatty lesions and/or erosions increased by 0.2 (SD 0.5) (p<0.001). Compared with baseline, at 5 years, 7.3% less patients had BME on MRI-SIJ according to the Assessment of Spondyloarthritis International Society definition, while 6.6% more patients had ≥5 fatty lesions and/or erosions. At 5 years, 0.7% less patients had ≥5 spinal BME lesions and 0.7% less patients had ≥5 spinal fatty lesions.

Conclusion:

Over 5 years, BME on MRI-SIJ decreased and spinal BME remained similar, but numerically, little progression of structural lesions on MRI of the SIJ and spine was seen.

Keywords: MRI; ankylosing spondylitis; spondyloarthritis.

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