août 20, 2019 | Posted by admin 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.
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juin 24, 2019 | Posted by admin 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
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juin 15, 2019 | Posted by admin 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.
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juin 13, 2019 | Posted by admin 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
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juin 6, 2019 | Posted by admin 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
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juin 1, 2019 | Posted by admin 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.
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mai 28, 2019 | Posted by admin 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
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avril 1, 2019 | Posted by admin Un nouvel article scientifique intitulé «Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?» a été publié dans le journal Rheumatology (Oxford).
van Lunteren M, van der Heijde D, Sepriano A, Berg IJ, Dougados M, Gossec L, Jacobsson L, Ramonda R, Rudwaleit M, Sieper J, Landewé R, van Gaalen FA.
OBJECTIVES:
A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known.
METHODS:
In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indifférenciéés Récentes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis.
RESULTS:
In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23%, 39% and 38% had an ASAS-PFH, 52%, 58% and 43% were HLA-B27 positive, and 62%, 47% and 54% were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95% CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95% CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95% CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95% CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95% CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95% CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis.
CONCLUSION:
In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.
© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.
KEYWORDS:
axial spondyloarthritis; diagnosis; family history
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mars 16, 2019 | Posted by admin Un nouvel article scientifique intitulé «Measuring spinal mobility in early axial spondyloarthritis: does it matter?» a été publié dans le journal Rheumatology (Oxford).
Marques ML, Ramiro S, Goupille P, Dougados M, van Gaalen F, van der Heijde D.
OBJECTIVES:
To investigate the frequency and order of impairment of spinal mobility measures (SMMs) and their cross-sectional and longitudinal usefulness in early axial spondyloarthritis.
METHODS:
SMMs measurements of patients from the DESIR (5-year data) and SPACE (2.6 (1.9) years of follow-up) cohorts were analysed. Cross-sectional (group level) and longitudinal (individual level) analyses were performed comparing SMMs to pre-defined cut-offs derived from healthy individuals. Subgroup analyses were used to study patient and disease characteristics potentially influencing spinal mobility. Reliability was analysed using intraclass correlation coefficients and the smallest detectable change.
RESULTS:
In 328 DESIR and 148 SPACE patients, lateral spinal flexion (LSF) and mSchober were the most impaired SMMs. If both (LSF and mSchober) were measured, 84% (DESIR) and 74% (SPACE) of the patients with impairment in ≥1 SMM would be captured. LSF and Bath AS Metrology Index best discriminated between subgroups of patients (higher impairment in patients ever treated with biologics, with higher disease activity and presence of baseline syndesmophytes): e.g. 31% of LSF impairment in patients with Ankylosing Spondylitis Disease Activity Score (ASDAS) < 2.1 in ≥2/3 visits vs 49% in those with ASDS ≥ 2.1. A high variability in SMMs within the same patient over time was observed, even when restricting the analysis to patients with low disease activity. Reliability of SMMs was ‘fair’ to ‘good’ (inter-reader intraclass correlation coefficients (2, 1): 0.55-0.84; intrareader intraclass correlation coefficients (2, 1): 0.49-0.72). Smallest detectable changes were in general high, e.g. 5.1 cm for LSF.
CONCLUSION:
Cross-sectional use of SMMs, at the group level, is informative in patients with early axial spondyloarthritis. However, the high variation of SMMs over time impairs their use, at the individual patient level.
© 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:
early axial spondyloarthritis; outcome assessment; spinal mobility
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mars 7, 2019 | Posted by admin Un nouvel article scientifique intitulé «Evaluation of the predictive validity of the ASAS axial spondyloarthritis criteria in the DESIR cohort» a été publié dans le journal Clin Exp Rheumatol.
Meghnathi B, Saraux A, Dougados M, Moltó A.
OBJECTIVES:
To evaluate the predictive validity of the Assessment of SpondyloArthritis international Society (ASAS) axial spondyloarthritis (axSpA), Amor, European Spondylarthropathy Study Group (ESSG) and modified New York (mNY) classification criteria.
METHODS:
Patients from the DESIR cohort (inflammatory back pain suggestive of axSpA for >3 months but <3 years duration), followed for up to 5 years. Positive predictive value (PPV) of the set of criteria collected at baseline (ASAS, and its arms, Amor, ESSG and mNY: fulfilled/not fulfilled) were tested against the rheumatologist’s axSpA diagnosis (fulfilled/not fulfilled) after 5 years of follow-up.
RESULTS:
In total, among the 708 patients included in the DESIR cohort at baseline, data on rheumatologist’s diagnosis at 5 years was available in 411 patients; amongst them, 352 (85.6%) had an axSpA diagnosis according to the rheumatologist; 268 patients fulfilled the ASAS axial SpA (axSpA) criteria at baseline and of these, 245 were diagnosed as SpA after 5 years follow-up (PPV: 91%). The PPV of the ASAS « imaging » arm and « clinical » arm was 97% and 82%, respectively. Other criteria also showed similar PPV – Amor (91%), ESSG (90%) and mNY (99%).
CONCLUSIONS:
Positive predictive validity of the ASAS criteria for axSpA (including both arms) at 5 years was excellent; it is worth noting that the performances of the other criteria were also very good in the DESIR cohort.
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