Management Of Spondyloarthritis Research Articles

Advances and Challenges in Spondyloarthritis Imaging for Diagnosis and Assessment of Disease

In recent years there has been an increased focus on use of imaging for diagnosis and assessment of spondyloarthritis (SpA). Magnetic resonance imaging (MRI) has attracted particular interest for its potential to improve diagnostic certainty for early, non-radiographic disease and to assist clinical decision-making. This report summarizes recent developments toward definition of positive sacroiliac joint and spine MRIs for SpA, with erosion as the major determinant for disease classification. The report also highlights recent SpA imaging work relevant to daily practice, focusing on limitations and challenges of SpA imaging and, in particular, on unsolved practical difficulties of using MRI in SpA. Recent data suggest that SpA imaging in daily practice may not be confined to identification and assessment of disease; it may also become essential for monitoring, clinical decision making, and selecting the most appropriate treatment for patients with SpA. Improved use of imaging may have much potential to enable better management of SpA.

SP0151 Update on MRI in Axial SpA, INCL. Differential Diagnoses and Follow-Up

MRI is now an established imaging modality in the diagnosis and management of spondyloarthritis (SpA). It offers a number of benefits including the ability to detect pre-radiographic disease which in...

SP0200 Update on MRI in Axial SpA, INCL. Differential Diagnoses and Follow-Up

MRI is now an established imaging modality in the diagnosis and management of spondyloarthritis (SpA). It offers a number of benefits including the ability to detect pre-radiographic disease which in...

Axial Spondyloarthritis Treatment Recommendations, Registries, Epidemiology and Peer-Education Highlight the 10th Annual Meeting of SPARTAN

The 10th annual meeting of the SPondyloArthritis Research and Treatment Network (SPARTAN), held in Portland, Oregon, on July 27–28, 2012, and the publication of these manuscripts come at a time of transformational changes in the field of spondyloarthritis (SpA) in general and axial SpA in particular. These changes—in our understanding of the epidemiology, genetics, pathophysiology and optimum assessment and management of SpA—are occurring as we grapple with the true magnitude of the problems of back pain (including inflammatory back pain) and axial SpA in the United States, which were brought to our attention by the recent National Health and Nutritional Examination Survey (NHANES) reports.

SP0123 Imaging in diagnosis and management

The optimal management of chronic inflammatory arthritis such as rheumatoid arthritis (RA) and spondyloarthritis (SpA) requires tools that allow early and accurate disease diagnosis, prediction of poor prognosis and responsive...

Key Advances in Spondyloarthritis and the Role of the Spondyloarthritis Clinic in the Singapore General Hospital

For the past 20 years, the world has witnessed remarkable advances in the field of spondyloarthritis (SpA) from better understanding of the genetics and pathophysiology of SpA, utilisation of magnetic resonance imaging (MRI) for early diagnosis, to the discovery of advanced therapeutics for patients with non-steroidal anti-inflammatory drugs (NSAID)-refractory SpA. This is a vast improvement from the past where treatment was limited to NSAIDs and was frequently unsatisfactory for both physician and patient, and where diagnosis was made based on clinical evaluation and structural changes on plain radiographs. These advances have inevitably revolutionised the management of SpA in Singapore and patients can now look forward to an earlier diagnosis of their condition and better treatment. This review summarises the key advances in the field of SpA and describes the aims of the SpA clinic in the Singapore General Hospital (SGH).

How to Translate Basic Knowledge into Clinical Application of Biologic Therapy in Spondyloarthritis

Spondyloarthritis (SpA) is a family of many diseases, and these diseases share some clinical, genetic, and radiologic features. The disease process in the spine at the beginning is spinal inflammation, in which TNFα is the principal cytokine involved. Therefore, the dramatic clinical and pathologic response of anti-TNFα therapy in SpA is based upon the presence of increased TNFα in synovial tissues and sacroiliac joints, which perpetuates chronic inflammation. The increased Toll-like receptors (TCR) 2 and 4 in the serum, peripheral blood mononuclear cells, or synovial tissues of ankylosing spondyloarthritis (AS) or SpA patients suggest that SpA is highly associated with innate immunity. Any drug including anti-TNFα blocker which can downregulate the TCR, infiltrated neutrophils, or CD163+ macrophages in the synovial tissue is the rationale for the management of SpA. Like rheumatoid arthritis, the increased TH22 and TH17 cells either in blood, synovial fluid, or synovial tissues were also demonstrated in SpA. Thus, TH17 and TH22 may be reasonable cellular targets for therapeutic intervention. Drugs (anti-IL6R or anti-IL6) which can reduce the binding of IL6 and IL6R to the cell surface may be beneficial in SpA. Many proteins are implicated in the new bone formation (syndesmophyte) or ankylosis in AS or SpA. The enhanced BMP and Wnt pathway will activate osteoblasts which promote the new bone formation. However, no drug including anti-TNFα can stop or prevent the syndesmophyte in AS. In summary, looking for new targeting therapies for either anti-inflammation (beyond anti-TNF) or anti-bone formation (including anti-TGFβ or PDGF) is warranted in the future.

Update on the Management of Spondyloarthritis in Asian Countries

Spondyloarthritis (SpA) is a group of interrelated but phenotypically distinct chronic inflammatory arthritis. To describe the management of SpA in Asian countries, we performed systematic literature searches through MEDLINE / PubMed, EMBASE and Google Scholar using the following keywords: spondyloarthritis, management, treatment, classification criteria, physical exercise, non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, thalidomide, glucocorticoids, tumor necrosis factor blockers, bisphosphonates. Studies conducted in Asian countries in the past 3 years were included. Low quality evidences, which had too small sample size or lacked controlled group, were excluded. Through the analysis of the included literature, it was concluded that management of SpA in Asia has changed in recent years. More frequent uses of magnetic resonance imaging (MRI) in diagnosing SpA and successful uses of tumor necrosis factor (TNF) blockers in active, refractory diseases have significantly improved the management of SpA in Asia. In addition, there are some characteristic clinical therapies in Asian countries. Thalidomide has been shown to be an effective and safe drug in the treatment of SpA patients. Traditional Chinese Medicine (TCM) is a promising clinical therapy in the treatment of SpA. With these advances, the management of SpA has considerably progressed. But defining better strategies and techniques for early diagnosis and developing new treatment to prevent or delay the process of new bone formation remain the major challenges facing the rheumatologists in Asian countries.

Variability in Resource Consumption in Patients With Spondyloarthritis in Spain. Preliminary Descriptive Data From the emAR II Study

ObjectiveOur objective was to describe the variability in the management of spondyloarthritis (SA) in Spain in terms of healthcare resources and their use. MethodsA review of 1168 medical files of patients seen in randomly selected Spanish hospital rheumatology departments. We analyzed demographic variables and variables related to the consumption of health resources. ResultsThe total number of visits to rheumatology were 5908 with a rate of 254 visits/100 patient-years. The total number of visits to rheumatology specialty nurses was 775, with a rate of 39 visits/100 patient-years, and there were 446 hospitalizations, representing a rate of 22 per 100 patient-years. The number of admissions due to SA was 89, with a rate of 18 admissions/100 patient-years. Total visits to other specialists were 4307 with a rate of 200/100 patient-years. The total number of orthopedic surgeries was 41, which leads to a rate of 1.8 surgeries/100 patient-years. ConclusionsThe data regarding visits to the rheumatologist and prosthetic surgery of patients with in Spain are similar to most studies published in our environment, however, other aspects concerning the use of health resources are different compared to other countries. These data may help to understand and improve organizational aspects of management of SA in Spanish hospitals.

Variabilidad en el consumo de recursos en pacientes con espondiloartritis en España. Datos descriptivos preliminares del estudio emAR II

ObjectiveOur objective was to describe the variability in the management of spondyloarthritis (SA) in Spain in terms of healthcare resources and their use. MethodsA review of 1168 medical files of patients seen in randomly selected Spanish hospital rheumatology departments. We analyzed demographic variables and variables related to the consumption of health resources. ResultsThe total number of visits to rheumatology were 5,908 with a rate of 254 visits/100 patient-years. The total number of visits to rheumatology specialty nurses was 775, with a rate of 39 visits/100 patient-years, and there were 446 hospitalizations, representing a rate of 22 per 100 patient-years. The number of admissions due to SA was 89, with a rate of 18 admissions/100 patient-years. Total visits to other specialists was 4,307 with a rate of 200/100 patient-years. The total number of orthopedic surgeries was 41, which leads to a rate of 1.8 surgeries/100 patient-years. ConclusionsThe data regarding visits to the rheumatologist and prosthetic surgery of patients with in Spain is similar to most studies published in our environment, however, other aspects concerning the use of health resources are different compared to other countries. This data may help to understand and improve organizational aspects of management of SA in Spanish hospitals.

MRT-Untersuchungen bei axialer und peripherer Spondyloarthritis

The diagnosis of ankylosing spondylitis (AS) is based on the modified New York criteria and therefore on defined structural changes in the sacroiliac joint as detected by conventional radiographs. However, x-rays are not able to detect early stages of the disease in which inflammation predominates and irreversible structural changes have not yet taken place. This probably contributes to a substantial time delay until a diagnosis is made. Magnetic resonance imaging (MRI) is able to visualize active and chronic changes in axial and peripheral spondyloarthritis (SpA) even before the occurrence of structural changes. The ability to demonstrate both active and, in a limited way, also structural changes makes MRI a diagnostic tool of increasing importance in the management of SpA. However, conventional radiographs are still the gold standard for the assessment of structural changes in SpA. A combination of both imaging techniques is recommended in clinical practice.

Current therapeutics for spondyloarthritis

Introduction:Ankylosing spondylitis (AS) belongs to a clinically related group of disorders named spondyloarthritis (SpA) that mainly affect the axial skeleton and present with specific extra-articular manifestations. The therapeutic management of AS and other SpA has considerably progressed over the past 10 years.Areas covered:This paper provides a review of the available treatments for AS including traditional treatments (NSAIDs, sulfasalazine and methotrexate, local corticosteroids) and biological therapies (TNF-α antagonists), as well as nonpharmacological procedures (education and physical therapy) and specific recommendations for this therapeutic management.Expert opinion:NSAIDs remain the first-line treatment in patients with AS, especially with axial disease. There is an increasing amount of evidence showing the short-term and long-term efficacy of TNF-α antagonists in AS, with the control of pain, extra-articular manifestations and spinal inflammation as evidenced by MRI. By contrast, there is no proof for the control of radiographic progression at the spine with these agents. An early diagnosis is now possible using the new classification criteria for SpA. However, it remains to be established if an early intervention might control the progression of the disease. Since about 20 – 25% of patients are considered as nonmajor responders to TNF-α blockers, there is an unmet need for developing new biological therapies. Targeting the IL-17 pathway may be an interesting option. International recommendations for the management of AS by the Assessment of Spondyloarthritis (ASAS) group were recently updated and discussed the respective place of each current therapeutic option in AS.

Ultrasound imaging in spondyloarthropathies

Through recent technological advances, ultrasound allows high-resolution visualisation of inflammatory and destructive changes in tendon and joint structures. Over the last few years, the added value of the use of ultrasound for evaluating entheseal involvement in spondyloarthritis (SpA) patients has been demonstrated. Several studies have described the ultrasound features of enthesitis in SpA, revealing the high frequency of clinically asymptomatic abnormal findings. It is, therefore, highly relevant to consider the validity of ultrasonographic measures of entheseal inflammation and damage. This article focusses on ultrasound appearance of peripheral enthesitis, and underlines the advantages and current limitations of the technique for the management of SpA.

The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis

The field of spondyloarthritis (SpA) has experienced major progress in the last decade, especially with regard to new treatments, earlier diagnosis, imaging technology and a better definition of outcome parameters...

Progress in spondylarthritis. Spondyloarthritis: lessons from imaging.

The advent of magnetic resonance imaging (MRI) and advanced sonographic techniques has led to a resurgence of interest in the role of imaging in the evaluation and management of spondyloarthritis. Radiography remains the cornerstone of diagnosis although MRI is more sensitive in early stages of the disease. Inflammatory changes in the sacroiliac joints and spine can now be reliably quantified and can also predict the subsequent development of radiographic changes in the corresponding locations. MRI-based scoring systems for inflammation are highly responsive, facilitating proof-of-concept studies of new therapies for spondyloarthritis. Assessment of chronic changes is much less reliable using MRI, while assessment using radiography lacks sensitivity to change. Assessment of disease modification therefore remains a principle challenge in the development of new therapies for ankylosing spondylitis. Ultrasound may be the preferred approach to the assessment of peripheral inflammation, especially enthesitis. Scintigraphy and computed tomography offer few advantages over MRI.

Do bisphosphonates and statins have a role in spondyloarthritis management?

Bisphosphonates and statins target the mevalonate pathway of biosynthesis of prenyl groups, which are necessary for the lipid modification of small GTP-binding proteins (eg, Ras, Rac, Rho) that transduce a wide array of extracellular growth and differentiation signals from cell surface receptors to the nucleus. Interference with this pathway has been shown to confer beneficial anti-inflammatory properties in vitro and in animal models of inflammation. Primarily open-label data in spondylo-arthritis suggests mild to moderate efficacy on symptoms and function but their primary clinical role may be as adjunctive therapy to manage systemic osteoporosis and risk for cardiovascular events.

Diagnostic précoce des spondylarthropathies

Spondyloarthritis (SpA) encompass different diseases with common characteristics, ankylosing spondylitis (AS) being the most typical. Undifferentiated SpA may evolve into AS. In France, SpA and rheumatoid arthritis could have the same prevalence. AS has a profound impact on the quality of live and function of patients as well as social and economic consequences for the society. There is a mean delay of five to eight years between onset of symptoms and diagnosis of AS. This is due to the fact that radiographic sacroiliitis is delayed. The purpose of an earlier diagnosis is emphasized by the need for a better management, the new diagnostic method including magnetic resonance imaging and ultrasonography, and by the efficacy of anti-TNF therapy. The current criteria (New-York, Amor, ESSG) are classification but not diagnostic criteria. Their sensitivity is insufficient for an early diagnosis of SpA. Several groups are studying methods to ensure an early diagnosis. The group of Berlin has proposed, for patients suffering inflammatory chronic back pain, an algorithm using clinical, radiological and biological signs with, if necessary, search of HLA-B27 and MRI of sacroiliac joints. But this system is theoretical and the group of Maastricht found it of little effectiveness. Furthermore, it does not take account patients with symptoms beginning out of the spine. We believe that only the follow-up of cohorts constituted of patients with early SpA will enable us to improve our knowledge regarding diagnostic criteria and new tools for early diagnosis, as well as outcome, prognosis and early management of SpA and AS.

How does imaging help the clinician in the evaluation and management of spondyloarthritis?

How does imaging help the clinician in the evaluation and management of spondyloarthritis?

Ninth Asia Pacific League Of Associations For Rheumatology (APLAR) Congress, Beijing, China, 21-26 May, 2000

The Congress covered the broad field of rheumatology, with participants from China, the Asia Pacific League of Associations for Rheumatology (APLAR) region and the rest of the world. The programme consisted of a mix of plenary lectures, concurrent symposia, workshops, free paper sessions and poster presentations. Basic sciences were well represented, with the general theme of inflammatory cytokines being of particular interest. One plenary lecture and a number of other presentations addressed the problem of atherosclerosis and rheumatic diseases. Diseases prominent in the region, such as Behcet's disease and Takayasu's disease, were represented with large series. Other areas of interest were musculoskeletal infections in HIV-positive patients and the management of spondyloarthritis. Although the use of the most recently developed drugs is restricted in the APLAR region because of cost factors, there were symposia on the latest pharmacological advances such as COX-2 technology, leflunomide and anti-tumour necrosis factor (TNF) therapy.