Assessment Of SpondyloArthritis International Society Criteria Research Articles

Comparative characteristics of axial spondyloarthritis and psoriatic arthritis with axial involvement

Objective – to compare clinical characteristics of patients with axial spondyloarthritis (axSpA)/ankylosing spondylitis (AS) and with axial psoriatic arthritis (axPsA).Subjects and methods. 100 patients were examined: 45 – with axSpA/AS (group 1), 55 – with axPsA (group 2). Patients of group 1 were included according to axSpA/AS criteria, patients of group 2 – according to CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria, and having axial involvement (axPsA). Axial involvement was detected in case of radiologically significant sacroiliitis (bilateral grade ≥2 or unilateral grade ≥3) or active MRI sacroiliitis, or ≥1 syndesmophyte(s) of the cervical and/or lumbar spine. Patients were evaluated for presence of inflammatory back pain (IBP) by ASAS (Assessment of Spondyloarthritis International Society) criteria.Results and discussion. Patients of group 1 were younger (p<0.001), more often HLA-B27 positive (p<0.001), had more IBP (p=0.001). Patients of group 2 had older age (>40 years) at back pain onset (p<0.001), more often peripheral arthritis (p<0.001), dactylitis (p=0.004), and skin psoriasis (p<0.001). Nail psoriasis was found only in group 2 patients (p<0.001). Group 1 patients had more often heel enthesitis (p=0.005). Group 2 patients had worse axial disease activity scores: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index; p=0.006) and ASDAS-СRP (Ankylosing Spondylitis Disease Activity Score with C-reactive protein level determination; р<0.001); and worse patient reported outcomes: BASFI (Bath Ankylosing Spondylitis Functional Index; p=0.004), patients’ pain (p=0.005) and patients’ global assessments (p=0.036). Patients of group 2 had more syndesmophytes of the lumbar (р=0.009) and cervical (р=0.007) spine. Only in group 2 patients, chunky “non-marginal” syndesmophytes were found (in 32.1%), as well as spinal lesions without sacroiliitis (in 20.0%). Patients of group 2 had more joint erosions (р=0.001), osteolysis (р=0.015), juxta-articular bone formation (р<0.001) and joint ankyloses (р=0.02). All patients of group 1 and only 80% of group 2 (р=0.003) met ASAS criteria for axSpA. AxSpA/AS and axPsA seem to be two different diseases. In our cohort of patients, axPsA patients had worse disease status compared to axSp and AS.

P167 Bimekizumab achieved sustained improvements in efficacy outcomes in patients with axial spondyloarthritis, regardless of prior tumour necrosis factor inhibitor treatment: week 52 pooled results from the phase 3 studies BE MOBILE 1 and BE MOBILE 2

Abstract Background/Aims Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F in addition to IL17A. In the phase 3 BE MOBILE 1 and 2 studies, BKZ treatment resulted in rapid and sustained improvements in efficacy outcomes through 52 weeks (wks) in patients with active nonradiographic axial spondyloarthritis (nr-axSpA) and radiographic (r)axSpA (i.e., ankylosing spondylitis [AS]). Here, we assess the efficacy of BKZ in tumour necrosis factor inhibitor (TNFi)-naïve or -inadequate responder (IR) patients with active nr-axSpA and raxSpA through Wk52. Methods In BE MOBILE 1 (nr-axSpA; NCT03928704) patients met Assessment of SpondyloArthritis international Society (ASAS) classification criteria and in BE MOBILE 2 (r-axSpA; NCT03928743) patients fulfilled modified New York and ASAS criteria. Patients were randomised to receive subcutaneous BKZ 160mg every 4wks (Q4W) or placebo (PBO) then BKZ 160mg Q4W from Wk16. This post-hoc analysis reports pooled mean efficacy data, including disease activity, MRI inflammation, physical function, and quality of life (QoL), through Wk52, stratified by TNFi status (naïve/IR). TNFi-IR patients were defined as those who experienced intolerance, or IR, to prior treatment given at an approved dose for ≥12wks. Results This pooled analysis included 505 TNFi-naïve and 81 TNFi-IR patients. 302/505 (59.8%) TNFi-naïve and 47/81 (58.0%) TNFi-IR patients were randomised to BKZ. Higher proportions of BKZ-randomised patients vs PBO achieved Wk16 ASAS40 (TNFinaïve: 46.0% vs 23.2%, TNFi-IR: 44.7% vs 14.7%; multiple imputation) and AS Disease Activity Score (ASDAS) <2.1 or low disease activity (47.9% vs 20.3%, 30.2% vs 15.6%; observed case). In continuous BKZ-treated patients, responses increased to Wk52 (ASAS40: 59.9%, 55.3%; ASDAS<2.1: 62.0%, 54.1%). Greater reductions from baseline in ASDAS-CRP and MRI inflammation by Wk16 were achieved with BKZ vs PBO in both TNFi-naïve/-IR patients; in continuous BKZ-treated patients this was sustained or further improved through 52wks. Comparable improvements in physical function, nocturnal spinal pain and ASQoL were observed through 52wks with BKZ in TNFinaïve/-IR patients (Table). Conclusion Across the full axSpA disease spectrum, BKZ treatment resulted in clinically relevant improvements in key efficacy outcomes vs PBO, including suppression of inflammation and improvements in physical function and QoL, regardless of prior TNFi exposure. Improvements were sustained to Wk52. Disclosure M. Magrey: Consultancies; AbbVie, BMS, Eli Lilly, Novartis, Pfizer and UCB Pharma. Grants/research support; AbbVie, BMS and UCB Pharma. M. Van de Sande: Consultancies; AbbVie, Novartis and UCB Pharma. Member of speakers’ bureau; Janssen, Novartis and UCB Pharma. Grants/research support; Eli Lilly, Novartis and UCB Pharma. M. Breban: Consultancies; Novartis and UCB Pharma. Grants/research support; MSD. F. Van den Bosch: Consultancies; AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB Pharma. Member of speakers’ bureau; AbbVie, Amgen, Janssen, Merck, Novartis, Pfizer and UCB Pharma. C. Fleurinck: Other; Employee of UCB Pharma. U. Massow: Other; Employee of UCB Pharma. N. de Peyrecave: Other; Employee of UCB Pharma. T. Vaux: Other; Employee of UCB Pharma. X. Baraliakos: Consultancies; AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer and UCB Pharma. Member of speakers’ bureau; AbbVie, BMS, Chugai, Eli Lilly, Galapagos, MSD, Novartis, Pfizer and UCB Pharma. Grants/research support; Novartis and UCB Pharma. Other; Paid instructor for AbbVie, BMS, Chugai, Eli Lilly, Galapagos, MSD, Novartis, Pfizer and UCB Pharma. H. Marzo-Ortega: Consultancies; AbbVie, Biogen, Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB Pharma. Honoraria; AbbVie, Biogen, Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB Pharma. Grants/research support; Janssen, Novartis and UCB Pharma.

Prevalence of spondyloarthritis in inflammatory bowel disease according ASAS and ultrassonography and its correlation with plasma calprotectin

BackgroundEnteropathic spondyloarthritis is underdiagnosed and inflammatory biomarkers and ultrasonography (US) could be useful for screening inflammatory bowel disease (IBD) patients. The objective of this study was to evaluate the prevalence of spondyloarthritis (SpA) in IBD patients, according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and the correlation of results of US of entheses and joints with plasma calprotectin levels.MethodsThis was an observational cross-sectional study. Patients from the IBD outpatient clinic of a reference center were evaluated according to ASAS criteria classification, results of US of entheses and joints, and inflammatory biomarker measurements (erythrocyte sedimentation rates, C-reactive protein levels, fecal and plasma calprotectin levels). A p value lower than 0.05 was considered significant.ResultsA total of 30.5% of the studied sample (n = 118) of patients with IBD presented at least one inflammatory musculoskeletal manifestation. The overall prevalence of enteropathic SpA was 13.55%, with 10.16% axial SpA and 4.23% peripheral SpA according to the ASAS criteria. A total of 42.1% of patients had an MASEI score greater than 18, 35.2% had synovitis, and 14.7% had tenosynovitis on US, increasing the frequency of diagnosis of enteropathic SpA to 22.8%. Plasma calprotectin levels were similar to those in healthy controls, and correlated only with the fecal calprotectin level (p 0.041).ConclusionsA total of 13.5% of patients met the criteria in accordance with the ASAS criteria for enteropathic SpA, which increased to 22.8% with the addition of US. The prevalence of enthesitis, synovitis and tenosynovitis by US of symptomatic joints and entheses were 42%, 35% and 14.7% respectively. Plasma calprotectin was correlated with fecal calprotectin but not with inflammatory biomarkers or US or ASAS criteria.

Radiographic Progression in Sacroiliac Joints in Patients With Axial Spondyloarthritis: Results From a Five-Year International Observational Study.

To evaluate progression from nonradiographic (nr-) to radiographic axial spondyloarthritis (r-axSpA) over 5 years in patients with recently diagnosed (≤1 year) axSpA fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. A prospsective, observational study (Patients with Axial Spondyloarthritis: Multi-Country Registry of Clinical Characteristics) was conducted in rheumatology practices in 29 countries. Baseline and follow-up radiographs of sacroiliac joints were centrally evaluated by three readers according to the grading system of the modified New York criteria for patients initially classified as nr-axSpA. Radiographic progression from nr-axSpA to r-axSpA was evaluated by Kaplan-Meier analysis. Cox proportional regression analyses for progression from nr-axSpA to r-axSpA were also conducted. Among 2,165 patients with axSpA, 1,612 (74%) were classified as having r-axSpA (1,050 [65%]) or nr-axSpA (562 [35%]) by central reading. Of 246 patients with nr-axSpA (mean [SD] symptom duration: 4.4 [6.2] years) who had at least one follow-up sacroiliac joint radiograph, progression from nr-axSpA to r-axSpA at any follow-up visit was observed in 40 patients (16%) over 5 years. Mean time to radiographic progression was 2.4 years (ranging from 0.9 to 5.1 years). Progression to r-axSpA was associated with male sex (hazard ratio [HR] 3.16 [95% CI 1.22-8.17]), fulfillment of the imaging arm of the ASAS classification criteria (HR 6.64 [1.37-32.25]), and good response to nonsteroidal anti-inflammatory drugs (HR 4.66 [1.23-17.71]). 16% of patients with nr-axSpA progressed to r-axSpA within 5 years. Male sex, fulfillment of the imaging arm of the ASAS criteria, and good response to nonsteroidal anti-inflammatorydrugs were predictors of radiographic progression in patients with recently diagnosed axSpA.

Early axial spondyloarthritis according to the ASAS consensus definition: characterisation of patients and effectiveness of a first TNF inhibitor in a large observational registry

ObjectiveTo characterise the population fulfilling the Assessment of SpondyloArthritis international Society (ASAS) consensus definition of early axial spondyloarthritis (axSpA) and to determine the effectiveness of a first tumour necrosis factor...

Abstract 20 — Performance of Various Definitions for Active MRI: Lesions in Sacroiliac Joint and Spine in Discriminating Patients with Axial Psoriatic Arthritis

Background Unlike axial spondyloarthritis, no classification criteria exist for axial psoriatic arthritis (axPsA). In 2021, the Assessment of SpondyloArthritis International Society (ASAS) revised the magnetic resonance imaging (MRI) criteria for active sacroiliitis (2021 criteria: bone marrow edema [BME] present in [Formula: see text]4 sacroiliac joint [SIJ] quadrants or [Formula: see text]3 consecutive SIJ slices[1]). This study aimed to compare the utility of this new cut-off in discriminating PsA patients with/without axPsA versus the 2009 ASAS criteria[2] for active-MRI-SIJ (BME [Formula: see text] 2 consecutive slices or [Formula: see text]1 location in a single slice). Methods Consecutive patients who fulfilled the classification criteria for PsA were recruited into this cross-sectional study, regardless of back pain. Sixty-seven patients underwent radiography (including pelvis, cervical/thoracic/lumbar-spine) and MRI-SIJ. Additionally, 47 underwent whole-spine MRI. AxPsA diagnosis was based on clinical information and imaging findings, as determined by an expert rheumatologist and a radiologist, and used as the reference standard. Two independent readers evaluated the MRI images based on two criteria for active sacroiliitis (BME cut-off: [Formula: see text] 4[1] vs [Formula: see text] 2[2]) and spondylitis (BME cut-off: [Formula: see text] 5[3] vs [Formula: see text] 3[4]). The agreement between the two MRI BME cut-offs for active sacroiliitis/spondylitis and the reference standard was evaluated. Results Sixty-seven patients (mean age: 47±12 years, 44 (65.7%) male, psoriasis and PsA disease duration: 13.5±10.3 and 3.8±6.1 years respectively) were recruited (Table 1). Twenty-three (34.3%) were diagnosed with axPsA, including 13 (56.5%) with radiographic sacroiliitis and 10 (43.5%) with non-radiographic axPsA. 12/67 (17.9%) had active MRI-sacroiliitis based on the 2021 ASAS criteria, while 4/47 (8.5%) had spondylitis based on the 2016 proposed definition[3]. Compared with the reference standard, the agreement increased after applying a more stringent threshold to define active sacroiliitis (BME cut-off: [Formula: see text] 4 vs [Formula: see text] 2; Kappa: 0.514 vs 0.392, respectively; Fig. 1A-B). The agreement with the reference standard further increased by applying a more stringent criteria for active spondylitis in addition to active sacroiliitis (BME cut-off for MRI-SIJ and spine: [Formula: see text] 4 and [Formula: see text] 5 vs [Formula: see text] 2 and [Formula: see text] 3; Kappa: 0.717 vs 0.342, respectively; Fig. 1C-D), resulting in higher specificity (active-sacroiliitis: 97.7% vs 81.8%; active-sacroiliitis and/or spondylitis: 100% vs 72.7%) and higher positive predictive value (91.7% vs 61.9%; 100% vs 50.0%, respectively). Conclusion At least four BME lesions on MRI-SIJ and five inflammatory lesions on MRI-spine allow acceptable discrimination of axPsA and no axPsA while assuring [Formula: see text]95% specificity.

Characteristics of Late-Onset Spondyloarthritis: Data from the Moroccan Registry of Biological Therapies in Rheumatic Diseases.

Introduction The Assessment of SpondyloArthritis InternationalSociety (ASAS) criteria for axial and peripheral spondyloarthritis (SpA) allow for the classification of patients with an age of onset of disease of less than 45 years. However, SpA can start after this age. This study aimed to assess the characteristics of late-onset SpA (SpA>45 years) in the Moroccan registry of biological therapies in rheumatic diseases (RBSMR). Methods A cross-sectional study was conducted using the baseline data of the RBSMR.The protocol for the original RBSMR study was reviewed and approved by the Ethics Committee for Biomedical Research Mohammed V University - Rabat, Faculty of Medicine and Pharmacy of Rabat (approval number for the study was 958/09/19, and the date of approval was September 11, 2019), and all patients had given their written consent. Patients who met the 2009 ASAS criteria for SpA were included. They were divided into two groups: early-onset SpA (≤ 45 years) and late-onset SpA (>45 years). Clinical, biological, radiological, and therapy data of the two groups were compared.Statistical analysis was performed using SPSS v25 software (IBM Corp. Armonk, NY).Parameters with a p-value ≤0.05 were considered significant. Results Our population consisted of 194 patients. Thirty-one patients (16%) had late-onset SpA. Comparison between patients with early-onset (≤45 years) and late-onset SpA(>45 years) revealed that late-onset SpA had a higher tender joint count (p=0.01), a higher swollen joint count (p=0.02), depression (p=0.00), fibromyalgia (p=0.001), hypercholesterolemia (p=0.01), and a lower frequency of coxitis (p=0.008). Logistic regression analysis confirmed that late-onset SpA was associated with a higher tender joint count (OR=0.93, CI 95%: 0.88-0.98), a higher swollen joint count (OR=0.92, CI 95%: 0.85-0.99), depression ( OR=0.19, CI 95%:0.04-0.38), fibromyalgia (OR=1.75, CI 95%: 1.74-17.85), and a lower frequency of coxitis ( OR=0.29,CI 95%: 0.11-0.75). Conclusion As life expectancy increases, late-onset SpA will become increasingly common. It is therefore imperative to determine its characteristics. In the RBSMR study, late-onset SpA was associated with a high number of tender and swollen joints, depression, fibromyalgia, and a lower frequency of coxitis.

Facet Joint Involvement in Early MRI Positive Axial Spondyloarthritis

Abstract Background The disease course of non-radiographic axial spondyloarthritis (nr-axSpA), usually detected by magnetic resonance imaging (MRI), is often unclear at the time of diagnosis. We investigated which MRI findings in the sacroiliac joints (SIJs) and lumbar spine including the facet joints can be observed over a two-year period in patients with newly diagnosed active inflammatory lesions in the SIJs fufilling the Assessment of SpondyloArthritis International Society criteria (ASAS) for Axial Spondyloarthritis (axSpA). Methods Patients (n=56, age<45 years, 30 female and 26 male, symptom duration 3–30 months) consecutively diagnosed with unilateral or bilateral sacroiliitis through MRI during an 18-month period and meeting the ASAS criteria for axial SpA were followed up for two years. Clinical examination, laboratory tests and an MRI of the sacroiliac joints (SIJs), lumbar spine and facet joints were performed at diagnosis (t0), after one year (t1) and after two years (t2). Results At t0, 31 patients (55%) with a bone marrow edema (BME) in the SIJs already had detectable changes in the facet joints, including signs of inflammation or degenerative changes. At t2, patients with facet joint involvement in t0 not only had more significant changes in the SIJs but also significantly more changes in the vertebral bodies, including BME, fat lesions and vertebral body erosions than patients without changes in the facet joints at t0. All vertebral changes described might be potential indicators of progression to radiographic axSpA (r-axSpA). These MRI findings are seen more frequently over a short period of time than previously thought. Conclusions MRI progression in the SIJs over a two-year period is associated with increasing damage to the facet joints and vertebral bodies. Involvement of the facet joints in the early stages of the disease may indicate increasing changes in the vertebral bodies and thus a less favourable course of axSpA.

Prognostic value of the clinical and imaging arm of the ASAS criteria for progression of structural sacroiliac joint lesions.

To investigate the prognostic value of the two arms of the Assessment of SpondyloArthritis international Society (ASAS) criteria regarding the progression of structural lesions in the sacroiliac joints (SIJs). Information on baseline fulfilment of the ASAS criteria and baseline and follow-up magnetic resonance imaging of the SIJ in 603 patients aged 18-40 years referred with low back pain to an outpatient spine were collected. Magnetic resonance imaging positivity was defined as bone marrow oedema (BMO) in two or more consecutive slices or two or more lesions in one slice, as described in the ASAS definition of sacroiliitis. Of 71 participants fulfilling the ASAS criteria at baseline, 66 (93%) fulfilled the 'imaging arm' and 14 (20%) fulfilled the 'clinical arm'. The 'clinical arm' predicted the progression of erosions with an odds ratio of 55 (compared with not fulfilling the ASAS criteria), while the 'imaging arm' predicted the progression of erosions with an odds ratio of 8. Moreover, in 24% of the patients in the 'imaging arm', all having BMO at the SIJ at baseline, the BMO disappeared without neither erosions nor ankylosis emerging. We found that the 'clinical arm' was a strong predictor for the progression of SIJ erosion, while the 'imaging arm' had a more modest prognostic value for structural progression.

Clinical and instrumental characteristics of axial involvement in psoriatic arthritis in real-life clinical practice

Objective: to evaluate clinical and instrumental characteristics of axial lesion in psoriatic arthritis (PsA) in real-life clinical practice.Subjects and methods. Examination were made in 52 patients (32 men and 20 women) with back pain recorded either at the time of their admission or in their medical histories. The inflammatory back pain (IBP) was diagnosed according to the Assessment of SpondyloArthritis international Society (ASAS) criteria. Back pain lasting over three months without meeting the ASAS criteria was taken to be chronic back (chrBP). Hands, feet, pelvis, cervical spine (CSP) and lumbar spine (LSP) were X-rayed. Erosions, osteolysis, and periarticular osteo-proliferative lesions were evaluated applying PsA-modified Sharp/van der Heijde score (SHS). Sacroiliitis (SI) was considered radiologically significant (r-sSI) when it was bilateral grade II or higher, or unilateral grade III or higher by Kellgren. 15 patients without r-sSI had their sacroiliac joints (SIJs) scanned using magnetic resonance imaging (MRI). Syndesmophytes, paravertebral ossifications, constriction and ankylosis of the CSP zygapophysial joints were considered to be radiological signs of psoriatic spondylitis. HLA-B27 typing was performed in 45 patients.Results and discussion. IBP was identified in 34 (66.7%), chrBP in 17 (33.3%) patients; 15 patients (28.8%) were of advanced age (over 40) at the onset of IBP/chrBP; 30 cases (57.7%) had r-sSI; in 18 cases SI was not detected. 13 out of 30 r-sSI patients (43.3%) didn’t suffer IBP. Erosions were detected in 38 (76%) patients, osteolysis in 13 (26%) and osteo-proliferative lesions in 18 (36%) patients. Average SHS was 82.79±64.77 correlating with the presence of r-sSI (r=0,46; p<0,05). Correlation of r=0.35 was found between r-sSI and the spine limited mobility according to Bath Ankylosing Spondylitis Metrology Index (BASMI); r-sSI was detected with much higher statistical significance in the presence of periarticular osteo-proliferative lesions than in the absence of such (р=0.02). In PsA patients having periarticular osteolysis, axial lesion in the form of asymmetric syndesmophytes was detected ten times more frequently than in those not having it (OR=10; 95% CI: 1.63–61.327). In CSP, syndesmophytes developed two times more frequently than in LSP (p=0.01). Discrete CSP lesions in the absence of any LSP changes was observed in 30% of cases. SI was MRI detected in 2 (13.3%) patients. In 9 (18.0%) patients axial lesions were observed without SI. 15 patients (33.3%) were HLA-B27 positive. A set of specific PsA axial skeletal involvement features were revealed: possibility of oligosymptomatic clinical presentation; patient’s advanced age at the back pain onset; association with severe destructive peripheral arthritis; and more pronounced CSP lesions as compared to LSP. An alternative phenotype patient group (18%) without X-ray or MRI SI but with spine involvement was identified. Key words: psoriatic arthritis; axial lesion>˂ 0,05). Correlation of r=0.35 was found between r-sSI and the spine limited mobility according to Bath Ankylosing Spondylitis Metrology Index (BASMI); r-sSI was detected with much higher statistical significance in the presence of periarticular osteo-proliferative lesions than in the absence of such (р=0.02). In PsA patients having periarticular osteolysis, axial lesion in the form of asymmetric syndesmophytes was detected ten times more frequently than in those not having it (OR=10; 95% CI: 1.63–61.327). In CSP, syndesmophytes developed two times more frequently than in LSP (p=0.01). Discrete CSP lesions in the absence of any LSP changes was observed in 30% of cases. SI was MRI detected in 2 (13.3%) patients. In 9 (18.0%) patients axial lesions were observed without SI. 15 patients (33.3%) were HLA-B27 positive. A set of specific PsA axial skeletal involvement features were revealed: possibility of oligosymptomatic clinical presentation; patient’s advanced age at the back pain onset; association with severe destructive peripheral arthritis; and more pronounced CSP lesions as compared to LSP. An alternative phenotype patient group (18%) without X-ray or MRI SI but with spine involvement was identified.

POS0965 MAGNETIC RESONANCE ENTEROGRAPHY AS A SCREENING TOOL FOR AXIAL SPONDYLOARTHRITIS IN CROHN’S DISEASE: A PROSPECTIVE SINGLE-CENTER CROSS-SECTIONAL OBSERVATIONAL STUDY USING MRE SCREENING FOLLOWED BY CLINICAL ASSESSMENT (ProSpA-CD)

BackgroundPatients with inflammatory bowel disease (IBD) have an excess burden of axial spondyloarthritis (axSpA) (1), but currently there are no reliable screening tools available. Magnetic resonance enterography (MRE) is an oral contrast MRI of the small bowel used to aid the diagnosis of Crohn’s disease (CD) (2). MRE also captures the sacroiliac joints (SIJs) but the radiological assessment of this is often overlooked. MRE scans therefore contain potentially valuable unreported data, which could be used to screen for axSpA in CD patients.ObjectivesTo determine: (i) the validity, sensitivity, specificity and area under the receiver operating characteristic (ROC) curve (AUC) of MRE as a screening tool for axSpA in CD, using dedicated axial MRI scans with clinical assessment as the gold standard; (ii) the proportion of patients with evidence of axSpA on MRE who fulfill the 2009 Assessment of Spondyloarthritis International Society (ASAS) criteria for axSpA; (iii) whether the presence of extra-intestinal manifestations (EIMs) or CD location can predict the occurrence of axSpA in CD.MethodsProSpA-CD was a pair of linked prospective observational studies conducted at a large secondary care university hospital in the UK. In ProSpA-CD-Screen, patients who had undergone MRE between 2015-2019 were assessed for eligibility. The consenting participants‘ MRE images were evaluated by a rheumatologist and a radiologist, using a scoring system for evidence of axSpA. Participants with evidence of axSpA and a control group of participants without evidence of axSpA were invited to participate in ProSpA-CD-Assess, in which the performance of MRE as a screening test was assessed against a gold standard of clinical assessment, serological testing and dedicated MRI of the spine and pelvis of each participant. ROC curve and logistic regression analyses were performed.ResultsA total of 1344 MRE scans were performed between 2015-2019, of which 501 eligible patients were identified. For ProSpA-CD-Screen, 259 participants were recruited. MRE SIJ abnormalities were identified in 94/259 participants and from these, 90 cases were recruited to ProSpA-CD-Assess. For the control group, 71/165 participants with normal SIJs were recruited to ProSpA-CD-Assess (total cases + controls = 161). A clinical diagnosis of axSpA was made in 41/161 (25.47%) participants, of which 25/161 (15.53%) fulfilled ASAS criteria. We constructed a ROC curve to assess test performance using different thresholds on the MRE scoring system. The optimum threshold corresponded to a sensitivity of 0.60 (95%CI 0.39, 0.79) and specificity of 0.85 (95%CI 0.78, 0.91) for MRE as a screening tool for axSpA (ASAS criteria) with an AUC value of 0.78 (95%CI 0.65, 0.86, p<0.05). We did not find a significant association between axSpA and CD location. Multivariable logistic regression demonstrated significant associations between axSpA (ASAS criteria) and inflammatory back pain (OR 11.03; 95%CI 2.53, 48.10; p<0.05), HLA B27 (OR 9.94; 95%CI 1.84, 53.87; p<0.05), history of dactylitis (OR 51.01; 95%CI 1.07, 2423.90; p<0.05) and plantar fasciitis (OR 9.08; 95%CI 1.30, 63.55; p<0.05).ConclusionWe have shown that MRE as a screening tool for axSpA in a cohort of CD patients has good specificity, but poor sensitivity, suggesting that its use as a screening tool is limited. There was no significant association between axSpA and CD location or CD EIMs.

The performances of the ILAR, ASAS, and PRINTO classification criteria in ERA patients: a comparison study.

Enthesitis-related arthritis (ERA) could be considered the pediatric equivalent of ankylosing spondylitis in adults albeit with certain significant differences. We aim to evaluate the sensitivity and specificity of the International League of Associations for Rheumatology (ILAR), the Assessment of Spondyloarthritis International Society (ASAS), and the preliminary Pediatric Rheumatology International Trials Organization (PRINTO) classification criteria in ERA patients. The medical records of ERA patients who were followed up between January 2005 and September 2020 have been analyzed. The control group consisted of patients with oligoarticular JIA (n = 146), polyarticular JIA (n = 55), and psoriatic arthritis (n = 20). This retrospective study included 108 ERA (73.1% male) and 221 control patients (25.8% male). The median age at diagnosis for ERA and control patients were 12.5 and 4.0years, respectively (p < 0.001). Arthritis was observed more frequently in the control group at diagnosis and in the follow-up (p < 0.001 for both), while enthesitis, sacroiliac joint tenderness, and inflammatory back pain were more common in the ERA group both at diagnosis and in the follow-up (p < 0.001 for all). In sacroiliac imaging, 70.1% of ERA patients had positive findings suggestive of sacroiliitis at diagnosis and 78% in the follow-up. The sensitivities of ILAR, PRINTO, ASAS criteria for axial SpA, and peripheral SpA at diagnosis were 74.0%, 57.4%, 21.3%, and 85.1%, respectively which increased to 82.4%, 78.7%, 35.1%, and 92.5%, respectively at follow-up. The specificities were 100%, 100%, 99.1%, and 90.9%, respectively at both diagnosis and follow-up. The ASAS criteria for peripheral SpA were the most sensitive while ILAR and the preliminary PRINTO criteria were the most specific criteria for classifying ERA patients. The ASAS criteria for peripheral SpA were the most sensitive criteria for classifying ERA patients. The use of ASAS axial SpA criteria may provide early detection of axial involvement.

Characterising axial psoriatic arthritis: correlation between whole spine MRI abnormalities and clinical, laboratory and radiographic findings

ObjectiveTo describe the prevalence of inflammatory and structural lesions using whole spine MRI in patients with psoriatic disease, and to assess their correlation with clinical features and with axial spondyloarthritis...

Complement C3d is not associated with axial spondyloarthritis and magnetic resonance imaging changes at the sacroiliac joint

Objective: To investigate the associations between complement C3d and inflammatory and structural changes by magnetic resonance imaging (MRI) at the sacroiliac joints (SIJ) suggestive of axial spondyloarthritis, according to the Assessment of SpondyloArthritis international Society (ASAS) criteria, in patients with low back pain.Method: This was a cross-sectional study of patients referred to the Spine Centre of Southern Denmark owing to unspecified low back pain (Spines of Southern Denmark cohort). The patients were divided into three groups: group 1: patients fulfilling the ASAS criteria for axial spondyloarthritis (axSpA, n = 96); group 2: patients with either a positive MRI of the SIJ and no spondyloarthritis features, or a negative MRI of the SIJ but positive human leucocyte antigen-B27 and one spondyloarthritis feature (non-axSpA, n = 38); group 3: patients with unspecified low back pain for > 3 months (control group, n = 82). Complement C3d was measured with double-decker rocket immunoelectrophoresis and evaluated in relation to the group division and baseline findings by SIJ MRI.Results: In total, 184 C3d analyses were performed. The mean ± sd level of C3d was 33.8 ± 8.1 AU/mL. There were no differences in C3d levels between the three patient groups, mean values being: axSpA = 34.3 ± 7.9 AU/mL, non-axSpA = 33.5 ± 6.9 AU/mL, and controls = 33.4 ± 9.2 AU/mL. The level of C3d was not related to MRI findings.Conclusions: In these patients, complement C3d was not associated with active or structural SIJ changes on MRI suggestive of axial spondyloarthritis.

The Effect of Etanercept in Nonradiographic Axial Spondyloarthritis by Stratified C-Reactive Protein Levels.

ObjectiveBiological agents have shown markedly different response rates by baseline C‐reactive protein (CRP). Here, we determine the response of patients with nonradiographic axial spondyloarthritis (nr‐axSpA) to etanercept stratified by their baseline CRP level.MethodsThe EMBARK trial was a phase 3, randomized, double‐blind, placebo‐controlled study of etanercept in nr‐axSpA. The primary endpoint was Assessment of Spondyloarthritis International Society (ASAS) 40 at Week 12, the conclusion of the double‐blind phase. It recruited patients who met the ASAS criteria for axial spondyloarthritis, and sacroiliac joint magnetic resonance scans were completed on all patients. In this post hoc analysis, we analyzed outcomes by baseline C‐reactive protein (CRP) level of less than 5 mg/L, 5 mg/L to 10 mg/L, and greater than 10 mg/L. The clinical trial outcome data were accessed via the Vivli platform.ResultsIn the less than 5 mg/L CRP group treated with etanercept, the ASAS20 response, ASAS40 response, Ankylosing Spondylitis Disease Activity Score‐CRP (ASDAS‐CRP), and ASDAS‐ESR (erythrocyte sedimentation rate) outcomes were 49% (P = 0.84), 26% (P = 0.14), 42% (P = 0.002), and 44% (P = 0.006), respectively. In the 5 to 10 mg/L CRP group treated with etanercept, the ASAS20 response, ASAS40 response, ASDAS‐CRP, and ASDAS‐ESR outcomes were 56% (P = 0.99), 31% (P = 0.40), 56% (P = 0.16), and 50% (P = 0.11), respectively. In the greater than10 mg/L CRP group treated with etanercept, the ASAS20 response, ASAS40 response, ASDAS‐CRP, and ASDAS‐ESR outcomes were 74% (P = 0.02), 68% (P = 0.003), 82% (P = 0.005), and 50% (P = 0.001), respectively.ConclusionAlthough there are reduced ASAS20 and ASAS40 response rates in the groups with baseline CRP less than 10 mg/L, there remain clinically relevant responses when the composite outcome measures ASDAS‐CRP or ASDAS‐ESR were used, and this should be considered when deciding on thresholds for reimbursement.

Quantification of Bone Marrow Edema by MRI of the Sacroiliac Joints in Patients Diagnosed with Axial Spondyloarthritis: Results from the ESPeranza Cohort

Objective: To evaluate whether the quantification of bone marrow edema (BMO) of the sacroiliac (SI) joints by magnetic resonance imaging (MRI) improves capacity for axial spondyloarthritis (axSpA) classification in comparison with the assessment of sacroiliitis by Assessment of SpondyloArthritis international Society (ASAS) classification criteria. Method: This prospective study from the ESPeranza cohort involved 66 subjects with an available MRI of the SI joints at baseline. This subgroup includes patients with axSpA (n = 28), peripheral spondyloarthritis (n = 10), and other diagnoses that were not spondyloarthritis (n = 28). Measures of diagnostic usefulness [area under the curve (AUC), sensitivity, specificity, Youden’s J statistic, positive and negative likelihood ratios (LR+ and LR−)] were calculated for MRI of the SI joints according to ASAS criteria and for MRI quantified by means of SCAISS (Spanish tool for semi-automatic quantification of sacroiliac inflammation by MRI in spondyloarthritis). This analysis was stratified in patients who were human leucocyte antigen (HLA)-B27 positive and negative. Results: The AUC value with BMO quantification was 0.919 [95% confidence interval (CI) 0.799–1] for HLA-B27-positive patients and 0.884 (95% CI 0.764–1) for HLA-B27-negative patients. A SCAISS cut-off point of 80 units obtained a specificity of 94.4% and LR+ 7.5, while assessment by ASAS criteria showed a specificity value of 90% and LR+ 6.4. Conclusion: For patients with suspected axSpA, quantification of BMO improves the predictive capacity of MRI of the SI joints, for both HLA-B27-positive and HLA-B27-negative patients.Axial spondyloarthritis (axSpA) has a dramatic impact on physical function and quality of life (1). Despite its significant impact, patients with axSpA are normally diagnosed several years after presenting symptoms (2). In this respect, magnetic resonance imaging (MRI) of the sacroiliac (SI) joints has gained significance over the past decade, particularly in the early stages of the disease. Nowadays, imaging tests and human leucocyte antigen (HLA)-B27 testing are among the most important diagnostic procedures for patients with suspected axSpA.

Tumor Necrosis Factor Inhibitor Dose Reduction for Axial Spondyloarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The present study was undertaken to investigate the effectiveness and safety of dose reduction of tumor necrosis factor inhibitor (TNFi) therapy in the treatment of axial spondyloarthritis (SpA) compared to usual care. We searched the Cochrane Central Register of Controlled Trials, Embase, Medline, and trial registries. We screened, extracted data, and assessed risk of bias in duplicate. Data were pooled using random-effects models; subgroup analyses were performed for type of TNFi, prior TNFi exposure, and follow-up duration. Outcomes of interest were Assessment of SpondyloArthritis international Society (ASAS) response and remission criteria, disease activity, relapse, and safety. We included 6 randomized trials with 747 participants (442 with ankylosing spondylitis and 305 with nonradiographic axial SpA). Compared to the standard dose, there were fewer events with the reduced dose for the ASAS criteria for 40% improvement (risk ratio [RR] 0.62 [95% confidence interval (95% CI) 0.49, 0.78]) and for ASAS partial remission (RR 0.17 [95% CI 0.06, 0.46]). There was a mean increase in the Bath Ankylosing Spondylitis Disease Activity Index score (mean difference [MD] 0.35 [95% CI 0.10, 0.60]) and no difference in C-reactive protein levels (MD 0.16 [95% CI -0.76, 1.07]) with the reduced dose. There were more disease flares/relapses (RR 1.73 [95% CI 1.32, 2.27]) with the reduced dose. There were no differences in infection rates (incidence rate ratio [IRR] 0.98 [95% CI 0.76, 1.25]) or injection/infusion reactions (IRR 0.71 [95% CI 0.42, 1.19]). Patients with axial SpA may experience little to no clinical benefit from reduction of TNFi therapy. Maintaining the standard dose probably improves the sustained effect on disease activity and helps to prevent disease flare.

Performance of Different Criteria Sets for Inflammatory Back Pain in Radiographic and Nonradiographic Axial Spondyloarthritis

Introduction: It is important to recognise inflammatory back pain (IBP) for early diagnosis of ankylosing spondylitis (AS). The aims of this study were to develop a valid, reliable Bengali IBP tool and to assess the performance of different IBP criteria sets, including Calin, Berlin set 8a and 7b, and new Assessment of SpondyloArthritis International Society (ASAS) expert criteria, in radiographic axial spondyloarthritis (axSpA) and nonradiographic axSpA. Method: This case-control study was performed in three phases. The first phase involved development of an IBP tool by adding the fifth parameter of ASAS expert criteria to the National Health and Nutrition Examination Survey (NHANES) 2009–2010 arthritis questionnaires; the second phase assessed reliability by test-retest statistics among 87 participants at a 5-day interval. Finally, according to the imaging arm of ASAS axSpA classification criteria, 50 patients with axSpA were included as cases while 50 patients with chronic mechanical back pain (MBP) were included as a control. Results: The presence of IBP with SpA versus patients with MBP, detected by Calin criteria, were 76.0% versus 10.0%, by Berlin 8a were 72.0% versus 6.0%, by Berlin 7b were 58.0% versus 12.0%, and by ASAS were 64.0% versus 18.0%, respectively. Results suggested the Calin criteria set has the highest sensitivity (76.0%) and Berlin set 8a has the highest specificity (78.9%) in the differentiation of IBP from MBP. Conclusion: The performance of the new ASAS criteria was analogous to the other existing criteria sets. The highest positive likelihood ratio and odds ratio were found for Berlin set 8a criteria. The Berlin set 8a criteria can still be used in primary care practice at the first screening because of high sensitivity.

Ankylosing spondylitis in Senegal: epidemiological, diagnostic, therapeutic and evolutionary features at the Hospital Center University Aristide Le Dantec, Dakar

Introductionla spondylarthrite ankylosante (SA) est une maladie évolutive, pouvant s'aggraver par une invalidité. Le but de notre étude est de décrire les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de la SA dans le service de rhumatologie du Centre Hospitalier Universitaire Aristide LeDantec à Dakar.Méthodesil s´agissait d´une étude transversale descriptive et analytique, avec un recueil de données à la fois prospectif et rétrospectif sur une période de 8 ans, entre janvier 2012 et décembre 2020, sur des patients atteints de SA de diagnostic établi en accord avec les critères diagnostiques d´Amor, de l´ESSG (European Seronegative Spondylarthropathy Group), d´ASAS (Assessment of Spondyloarthritis International Society) et les critères de New York modifié pour la SA. Les données ont été recueillies par le biais d'un questionnaire structuré et analysées à l´aide du logiciel SPSS25 (Statistical Package for the Social Sciences).Résultatssix cent quarante-sept (647) patients ont répondu aux critères d´inclusions; 414 femmes et 233 hommes soit un sex ratio de 1,77F/1H. Différentes formes symptomatiques étaient obtenues: les formes axiales (55,65%), les formes mixtes (44,35%) et les formes systémiques avec manifestation extra-articulaires: uvéites (12,21%), insuffisance aortique (5,71%) et maladie fibrobulleuse des poumons (3,86%). Soixante pourcent (60%) des patients étaient sous antiinflammatoires non stéroïdiens (AINS), 47% sous méthotrexate et 0,92% sous biothérapie. Les indices d´activité de la maladie, les indices fonctionnels et les indices de la qualité de vie ont permis le suivi de la maladie.Conclusionnos résultats ont montré une prédominance féminine. Les formes axiales étaient les plus représentées. Plus de la moitié de nos patients étaient sous antiinflammatoires, 47% sous méthotrexate et 0,92% sous biothérapie. Cette étude a permis de comprendre le poids de la SA dans les spondyloarthrites et son évolution dans le temps.

Additive values of pelvic tomosynthesis in comparison to pelvic radiography alone for the diagnosis of sacroiliitis in patients with suspected axial spondyloarthritis.

To compare inter-reader agreement and diagnostic confidence in detecting sacroiliitis by the modified New York criteria (mNY) on digital radiography (DR) versus digital pelvic tomosynthesis assisted DR (DR+DPT), and to evaluate changes in the presence of axial spondyloarthritis (axSpA) according to the Assessment of Spondyloarthritis International Society (ASAS) criteria. One hundred and thirty-eight patients who underwent both DR and DPT with suspicious axSpA in our rheumatologic clinic were included from February 2017 to February 2018. Three radiologists independently graded sacroiliitis and confidence level on DR first and then re-graded them on DPT in a paired manner. Agreement, confidence, and diagnostic accuracy were evaluated for readers. Changes in the presence of disease by mNY and ASAS criteria were assessed between DR alone and DR+DPT. On DR alone, 73 patients were assessed with radiographic sacroiliitis, and 85 were classified into axSpA by the ASAS criteria; however, 78 and 85, respectively, were classified on DR+DPT. With the assistance of DPT, 17 and 12 patients changed to the disease positivity according to the mNY and ASAS criteria, respectively; the negative results changed to positive in 11 and six patients, respectively. For all readers, agreement improved with DPT (0.79 to 0.89). DR+DPT achieved higher diagnostic accuracy (AUC, P < 0.05). The combination of DR and DPT achieved a higher diagnostic performance than that of DR alone, with better agreement. On DR+DPT, the diagnoses of 9.0% of patients with suspicious axSpA (12 of 134) were changed to the status of disease by the ASAS criteria.