Presence Of Inflammatory Back Pain 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.

A Survey Exploring Inflammatory Back Pain in Patients With Inflammatory Bowel Disease.

Background Diagnostic delay of axial spondyloarthritis (axSpA) is a widely recognized issue worldwide, providing a great burden for patients with this disease. AxSpA is present in a significant proportion of patients with inflammatory bowel disease (IBD). This UK study primarily aims to identify the presence of inflammatory back pain (IBP) in patients attending IBD clinic.Further aims of this study include investigating if participants had received further referrals and diagnoses for their IBPand considering factors contributing to diagnostic delay. Methods Patients were recruited from a Royal Free London NHS Trust hospital's IBD clinic. Each participant completed a 23-question survey. The Berlin criteria were applied to the questions to investigate the presence of IBP. Further questions were asked about their IBD diagnosis and treatment, the healthcare professionals they had seen for their back pain, and other extra-articular features associated with axSpA. Results Seventy-five patients completed the online survey sent out via email. Forty percent (n = 30) of participants were female and 60% (n = 45) were male.Sixty-one percent (n = 36) of participants from the colitis clinic reported they had back pain, and 41% of the participants reported back pain for over three months. Of these, 39% (12) of participants fulfilled the Berlin criteria for IBP. Of patients experiencing back pain for over three months, we found that 10% (3) fulfilled the Berlin criteria but had not received a diagnosis for their IBP.All patients who had fulfilled the Berlin criteriabut had not received a diagnosis for their IBPhadseen their general practitioner(GP) and an allied healthcare professional, but not a rheumatologist. Conclusions This study highlights the presence of possibly undiagnosed axSpA in patients with IBD.The reasons for the diagnostic delay of axSpA are multifactorial. We consider specific patient characteristics, lack of awareness and education of the condition, and issues in the referral process. There is a need to improve education and awareness of axSpA, reconsider referral processes, and consider new initiatives such as joint specialty clinics to identify and treat axSpA on time.

Evaluation of the possibility of axial psoriatic arthritis patients meet classification criteria for axial spondyloarthritis and ankylosing spondylitis

Objective – to analyze whether axial psoriatic arthritis (axPsA) patients meet classification criteria for axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS).Subjects and methods. 104 patients (66 men and 38 women) with PsA according to CASPAR criteria were examined, all patients had back pain. Patients were evaluated for presence of inflammatory back pain (IBP) by ASAS criteria. Back pain not meeting the ASAS criteria was taken to be chronic back (chrBP). Patients underwent hands, feet and pelvis, cervical spine and lumbar spine X-rays. Erosions, osteolysis, and periarticular osteo-proliferative lesions were evaluated. Radiographically significant sacroiliitis (r-sSI) was defined as bilateral grade ≥2 or unilateral grade ≥3. 19 patients without r-sSI underwent sacroiliac joints MRI. 93 patients underwent HLA B27 examination. The number of patients who met the criteria for axSpA (ASAS) and the modified New York (mNY) criteria for AS was determined.Results. IBP was identified in 67 (64.4%), chrBP in 37 (35.6%) patients; 31 (29.8%) patients were of advanced age (over 40) at the onset of IBP/chrBP; 57 (58.8%) cases had r-sSI; 6 (31.6%) patients had MRI-SI; syndesmophytes were detected in 57 (58.8%) cases. Among 40 patients without r-sSI, 19 (47.5%) had syndesmophytes. In 38 (39.2%) out of 97 patients r-sSI was detected along with syndesmophytes, while 19 (19.6%) out of 97 patients had isolated r-sSI without spondylitis, and 19 (19.6%) out of 97 patients had isolated syndesmophytes without r-sSI. HLA B27 was present in 28 (30.1%) cases. 51 (55.4%) patients met criteria for axSpA. 41 (44.6%) patients didn’t meet criteria for axSpA, however 27 (65.9%) of them had syndesmophytes. 48 (48.5%) PsA patients met mNY criteria for AS.Among these patients a set of specific features was revealed: 18 (37.5%) had no IBP, 18 (37.5%) were of advanced age (over 40) at the onset of IBP/ chrBP, 34 (70.8%) had dactylitis, 38 (79.2%) – erosive polyarthritis, 23 (48.8%) – periarticular osteo-proliferative lesions, 14 (30.2%) – osteolysis, 23 (48,9%) – “chunky” non-marginal syndesmophytes, 40 (82,6%) – nail psoriasis, 28 (66,6%) patients were HLA-B27 negative.Conclusion. 45% of axPsA patients don’t meet criteria for axSpA. Characteristic features have been identified to differentiate axPsA from AS.

Patient Survey Exploring the Burden of Inflammatory Back Pain in Patients With Uveitis.

Background In the UK, diagnostic delays remaina challenge in axial spondyloarthritis (axSpA). Studies have shown that acute anterior uveitis is the most common extra-articular manifestation associated with axSpA. As part of a National Axial Spondyloarthritis Society (NASS) Aspiring to Excellence quality improvement project, this study aimed to ascertain the burden of inflammatory back pain (IBP) in patients attending a uveitis clinic and to establish the number of these patients who had not been referred to a rheumatologist, thereby contributing to the diagnostic delay. The secondary aims were to explore the factors contributing to the diagnostic delay. Methods A 22-question patient survey was created to identify the burden of back pain in patients attending a specialist uveitis clinic at a London NHS Trust. Participants were recruited when attending their clinic appointments. Survey content included patient demographics and whether they had experienced back pain for longer than three months. The Berlin Criteria was used to identify the presence of inflammatory back pain, and it was also ascertained whether participants had a previous diagnosis of axSpA. Participants were asked if they had seen any healthcare professionals regarding their back pain and the total number of consultations they had had with each profession. Results A cohort of 50 patients who attended the uveitis clinic at the Royal Free London NHS Trust completed the survey between February and July 2022. The mean age of the respondents was 52 years with a mean length of time with uveitis of 6.57 years. Of them, 64% were female and 36% were male. Forty per cent (40%) of participants (20 respondents) reported experiencing back pain for more than three months and 12% (six respondents) had a diagnosis of axSpA. Of those who reported back pain for more than three months, the mean age of onset of back pain was 28.6 years. Of the 14 participants (28%) who had back pain and were not diagnosed with axSpA, nine (18%) fulfilled the Berlin criteria for IBP. All participants had seen a GP or allied health professional specifically for their back pain. On average, respondents had seen two allied healthcare professionals, but only 40% (eight) of respondents with back pain had been seen by a rheumatologist. Conclusions In this study, thedata highlights that inflammatory back pain is common in patients with uveitis and themajority of patients with inflammatory back pain had not been referred to a rheumatology service and potentially haveundiagnosed axSpA. Contributing factors to this potential delay in diagnosis include a lack of awareness of axSpA and its presenting features and associated conditions and a lack of onward referral for a specialist rheumatology opinion. This highlights the need for public, patient and healthcare professional education and the development of timely referral pathways to reduce delays in diagnosis.

POS1102 THE PREVALENCE OF INFLAMMATORY BACK PAIN IN PATIENTS WITH SKIN PSORIASIS WITHOUT PSORIATIC ARTHRITIS. DATA FROM DERMATOLOGICAL REAL-WORLD SETTING.

BackgroundPsoriasis (PsO) is an inflammatory disease associated with psoriatic arthritis (PsA). PsA affects peripheral and axial joints1,2. Psoriasis can precede the onset of PsA by approximately 3 to 8 years, axial involvement often undiagnosed3. There are limited data about the prevalence of inflammatory back pain (IBP) in PsO patients (pts) without clinical symptoms of PsA4.ObjectivesTo study the prevalence of IBP in PsO pts without PsA symptomsMethods108 PsO pts without PsA over a 10-month period (March 2021 to December 2021) were incluided. Participants filled out a questionnaire on IBP. Additionaly the prevalence of stiffness in the back and neck was estimated. IBP was defined as an affirmative answer to the question ‘Did you suffer from low back pain for ≥3 months?’ and IBP criteria was based on criteria ASAS (the ASsessment in Ankylosing Spondylitis) and was confirmed if at least 3 out of the following 4 criteria were present: (a) onset before age 40, (b) insidious onset, (c) improvement with exercise, (d) associated with morning stiffnessResultsIt was found that more than 40% of patients complained of pain or stiffness in the back. Stiffness and pain in the neck were observed in every fourth patient on average. Of those patients who complained of pain in the back or neck, 37% noted that they had pain at rest (when they get up in the morning or lie down for a long time), and 21.3% had inflammatory pain at night (when patients are forced to woke up, they needed to do exercises) (Table 1). It was found that the risks of developing spondylitis with neck pain, neck stiffness, back pain, back stiffness were higher in 4,549 times (95% CI [1,720; 12,031]), in 19,444 times (95% CI [6,480; 58,343]) 15 times (95% CI [4.646; 48.427]) and 34.857 times (95% CI [7.583; 160.230]), respectively.ConclusionIBP was found in more than 40% PsO patients. Every fourth PsO patients complained of stiffness and pain in the neck. The presence of these symptoms significantly increased the risk of developing PsA with spondylitis. The presence of IBP should be taken into account for early diagnosis of PsA in the dermatological practice.

AB0927 CLINICAL AND RADIOGRAPHIC PHENOTYPE OF AXIAL PSORIATIC ARTHRITIS

BackgroundThe latest data show that axial psoriatic arthritis (PsA) is less symptomatic, as compared with ankylosing spondylitis, and is associated with distinct radiographic features (1).ObjectivesTo analyze clinical characteristics of PsA patients (pts) with axial involvement, using data from a real-life outpatient cohort.Methods50 pts (M/F–30 /20) with PsA according to CASPAR criteria were included. All pts had either a present or past history of back pain, which rheumatologist suspected to be axial involvement. Pts’ age 42.0 [34.0; 54.0], disease duration 3.5 [0.3; 32.5] years. Pts underwent standard clinical examination of PsA activity: Ме BASDAI was 6.2 [3.8; 8.0], ASDAS-СRP 3.5 [2.5; 4.8], DAPSA 38,1 [20,2; 52,2], CRP 12.4 [0.3; 94.6] mg/L. All pts were evaluated for presence of inflammatory back pain (IBP) by ASAS criteria. HLA B27 antigen status was observed. Physical examination included Bath Ankylosing Spondylitis Metrology Index (BASMI). Pts underwent X-ray of sacroiliac joints (pelvic radiographs), cervical and lumbar spine, and hands and feet. Radiographic sacroiliitis (rSI) was defined as bilateral grade ≥ 2 or unilateral grade ≥ 3. All radiographs were interpreted by two experienced musculoskeletal radiologists. Me [Q25; Q75], Pierson-χ2 tests were performed. All p<0.05 were considered to indicate statistical significance.ResultsIBP was detected in 31 (62.0%) pts, while 19 (38.0%) pts didn’t meet IBP criteria – they had chronic back pain (CBP); 12 (24.0%) of all pts had episodic mild back pain. In 15 (30.0%) pts back pain started at age of above 40. RSI was found in 29 (58.0%) pts, while mostly symmetrical in 23/29 (79.3%) cases. Unilateral grade 2 sacroiliitis was found in 4 (8.0%) pts. 13/29 (44.8%) pts developed rSI without IBP. 38 (76%) pts had erosive arthritis, 18 (36%) pts had numerous erosions. HLA-В27 antigen was positive in 16 (32.0%) of pts. A correlation was revealed between the presence of rSI and limited spine mobility by BASMI (r=0.347). Association was found between rSI and numerous erosions (p=0.003), as well as between rSI and juxtaarticular new bone formation on hands and feet X-rays (р = 0.02). Syndesmophytes were found in 28 (56%) cases. 11 (22%) pts developed syndesmophytes without rSI. Asymmetrical syndesmophytes in the lumbar spine were found in 7/13 (53.8%) pts, vertebral non-bridging syndesmophytes in the lumbar and/or cervical spine in 16 (57.1%) pts. Restricted neck rotation was found in 85% of cases. Syndesmophytes in the cervical spine were found twice as often (26 pts) as in the lumbar spine (13 pts); 14 (28%) pts had isolated involvement of the cervical spine. An association was detected between asymmetrical syndesmophytes and radiographic changes on hands and feet X-rays such as osteolysis (р = 0.005) and juxtaarticular new bone formation (р = 0.05).ConclusionAxial PsA is often asymptomatic, one third of pts develop back pain at age above 40. HLA-B27 positivity was found in only 32% of pts. Pts with rSI are more likely to have severe peripheral arthritis with multiple joint erosions. Radiographic SI is associated with juxtaarticular new bone formation, which may indicate common mechanisms of bone formation in axial and peripheral skeleton. Syndesmophytes may occur in absence of sacroiliitis. Cervical spine involvement is more frequent in axial PsA pts. Asymmetrical syndesmophytes characteristic of PsA, are associated with typical, for PsA, radiographic changes on hands and feet X-rays, such as osteolysis and juxtaarticular new bone formation.

POS0310 DO AXIAL PSORIATIC ARTHRITIS PATIENTS MEET ASAS CLASSIFICATION CRITERIA FOR AXIAL SPONDYLOARTHRITIS?

BackgroundThere isn’t any generally accepted definition and diagnostic criteria for axial psoriatic arthritis (axPsA). According to most recent data, classification criteria for axial spondyloarthritis (axSpA) may not be applied to axPsA (1).ObjectivesTo analyze, in clinical practice, whether axPsA patients (pts) meet classification criteria for axSpA and ankylosing spondylitis (AS).Methods52 pts (M/F–32/20), a hospital cohort, with PsA according to CASPAR criteria were observed. All pts had back pain at one time or another, which rheumatologist suspected to be axial involvement. Pts’ age 43.0 [35.0; 54.0], disease duration 3.4 yrs [0.2; 32.0]. Ме BASDAI 5.3 [3.6; 7.0]; ASDAS-СРБ 3.3 [2.2; 4.1]; DAPSA 36,3 [19,3; 50,5]; CRP 9.6 [0.1; 86.6] mg/L; ESR 31 [3; 99] mm/h. Enthesitis was found in 69.2% and dactylitis in 61.5% of pts. All pts had psoriasis with Ме BSA (body surface area) of 4 [1; 9]%, Ме PASI (Psoriasis Area Severity Index) of 9.6 [5.6; 17.4]. Nail psoriasis was found in 38 (73.1%) pts, 40.4% of them had onycholysis. All pts were evaluated for presence of inflammatory back pain (IBP) by ASAS criteria. Pts underwent sacroiliac joints (SIJ) X-ray (pelvic radiographs), cervical and lumbar spine, hands and feet X-rays, so that 50 pts had complete sets of radiographs. Radiographic sacroiliitis (rSI) was defined as bilateral grade ≥ 2 or unilateral grade ≥ 3. Pts without rSI underwent SIJ MRI on Philips Multiva 1.5 T scanner. Active MRI sacroiliitis (MRI-SI) was categorized using ASAS 2016 criteria. Radiographic spondylitis (rSp) was defined as ≥1 marginal/paramarginal syndesmophyte(s) of the cervical and/or lumbar spine. All radiographs and MRI results were interpreted by two experienced musculoskeletal radiologists. 45 pts underwent HLA B27 examination. Me [Q25; Q75] and Pierson-χ2 tests were performed. All p<0.05 were considered to indicate statistical significance.ResultsIBP was found in 34 (66.7%) and rSI in 30 (57.7%) pts. 15 (30.0%) pts had rSI along with rSp, while in 15 (30.0%) pts rSI was without it, and 9 (18.0%) pts had rSp alone. 2 pts of the 17 examined, had MRI-SI. HLA B27 was present in 15 (33.3%) pts examined. 37 (71.2%) pts met ASAS criteria for axSpA as follows: 22 pts met the imaging arm (rSI or MRI-SI + ≥ 1SpA feature), 5 pts met the clinical arm (HLA B27+ ≥ 2 other SpA features) and 10 pts met both of those. 10 (19.2%) pts didn’t meet ASAS criteria for axSpA: they had neither rSI/ MRI-SI nor HLA B27; however, 9 of them had syndesmophytes. 30 pts had rSI with 21 of them (40.4% of all pts) meeting modified New York (mNY) criteria for AS, because along with rSI, they had at least 1 of the 3 clinical criteria (IBP for > 3 months, limitation of lumbar motion in sagittal and frontal planes, limitation of chest expansion). The pts who met both CASPAR and mNY criteria, however had typical axPsA features: 85.7% of them had polyarthritis with multiple joint erosions, 61.9% had osteolysis and/or juxtaarticular new bone formation, 61.9% dactylitis, 33.3% non-marginal asymmetrical syndesmophytes, 44.4% were HLA B27 negative, 43.3% didn’t have IBP; all pts developed psoriasis many years before the onset of PsA.ConclusionAmong PsA pts with axial involvement there is an alternative phenotype group (18% of our cohort) with neither sacroiliitis (rSI/ MRI-SI) nor HLA B27. Such pts do not meet ASAS criteria for axSpA. The alternative phenotype is characterized by isolated spondylitis (syndesmophytes) without sacroiliitis. Axial disease cannot be ruled out in PsA pts without spinal radiographs, regardless of symptoms. Pts meeting both CASPAR and mNY criteria and featuring typical axPsA symptoms cannot be diagnosed as having AS along with concomitant psoriasis, because axPsA and AS with psoriasis seem to be two different diseases. There is an urgent need for a unified definition of axial involvement in PsA.

P24 Ankylosing spondylitis & uveitis - challenges in management

Case report - IntroductionAnkylosing spondylitis is a chronic inflammatory condition involving spine, chest and sacroiliac joints. It can be associated with extra spinal manifestations which include uveitis and enthesitis, as well as other features of an inflammatory spondyloarthropathy including psoriasis and inflammatory bowel disease. It is characterised by the presence of inflammatory back pain, limited range of spinal movement, sacroiliitis on imaging, excess spinal bone formation and a high prevalence of HLA-B27. The main aims of treatment are to improve symptoms and retain function as well as to prevent disease complications.Case report - Case descriptionA 49-year-old male diagnosed with ankylosing spondylitis at the age of 23 (HLA-B27 positive, classical radiographic features on plain radiographs and MRI), with background of meningitis and subsequent epilepsy (not on treatment since the age of 13), severe hip osteoarthritis and osteoporosis. He has peripheral elbow and knee synovitis. At the age of 27 he developed sight-threatening bilateral recurrent anterior uveitis complicated by cystoid macular oedema (causing central vision loss). Initial management included anti-inflammatories and steroids. He progressed to biologics but developed a rash on adalimumab. He was switched to infliximab in 2010. In 2015 it was switched due to reduced response to golimumab which was non-beneficial. Subsequently he was switched to etanercept but after 3 months it was discontinued due to eye flare. The patient’s therapy was switched to certolizumab, which was non-beneficial for spine and discontinued. In 2016, infliximab was retried as the patient thought it worked best. Unfortunately, in 2018 patient developed Infliximab antibodies and treatment was changed to secukinumab. After 9 months this was stopped owing to ongoing active eye and spine disease. Adalimumab was re-tried; however, it was discontinued as it was showing no benefit. In 2020 Eeanercept (Benepali) was re-tried; however, only for 4 months because of severe flare of joint and eye disease. Tofacitinib was commenced but was non-beneficial and hence it was discontinued. Currently he continues on ixekizumab, oral prednisolone and also receives steroid eye and joint injections. On commencing biologics he was on methotrexate; however, the patient stopped. He was switched to mycophenolate mofetil which he remained on for 10 years. It was switched to methotrexate to try and control peripheral inflammatory joint disease better (re-tried for the second time) which the patient has recently discontinued as he felt it was non-beneficial.Case report - DiscussionThe case is very challenging. The patient’s disease continues to flare despite changing therapies. He continues to get flares in his back disease, eye disease and peripheral synovitis. His latest BASDI was 5.1 and VAS was 9/10. Measurements: intermalleolar distance 15cm, modified Schober’s 4cm, right lateral flexion 3.8cm and left lateral flexion 11cm. His latest MRI of whole spine and SI joints (in 2020) showed signs of previously active seronegative spondyloarthropathy with established cervical and thoracic ankyloses as well as bilateral sacroiliac joint ankylosis. There is a need for repeated steroid injections to the knees as well as the eyes. He continues on oral prednisolone which was first started in 2006. This is associated with multiple side effects, i.e., osteoporosis. The patient has already completed 8 years of bisphosphonate therapy. He is under regular review with the osteoporosis clinic. His bone density scan showed worsening bone mineral density and bisphosphonates had to be restarted. The patient adjusted medications depending on his symptoms. Recently he also discontinued methotrexate as he felt it was of no benefit to him at all. We are very limited at present to find combined medications to manage both the patient’s inflammatory back disease and inflammatory eye disease.Case report - Key learning pointsThis patient was diagnosed with ankylosing spondylitis 26 years ago. To date he has tried 5 different anti-TNF agents (two of which have also been re-tried at a different time point). This failed to control his disease as he continued to experience flares in either inflammatory back or eye disease. The biologic classes were also changed – he has tried one IL-17A agent as well as a JAK-I. Unfortunately, they both failed to control his disease. He currently continues on a second IL-17A; however, he still requires steroid eye and joint injections as well as systemic steroids. Throughout the years he has tried different DMARDs – most recently methotrexate. Unfortunately, the patient decided to discontinue it as he felt it was of no benefit to him. All of the above indicates that there is still a need to find a collaborative treatment option that will control the patient’s inflammatory back disease, inflammatory eye disease and peripheral synovitis. The aim would be, if possible, to decrease the steroid dose as well (currently on prednisolone 15mg daily) in order to prevent the steroid-associated side effects.

Patients with Axial Spondyloarthritis Show an Altered Flexion/Relaxation Phenomenon.

Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterized by the presence of inflammatory back pain. In patients with chronic low back pain, the lumbar flexion relaxation phenomenon measured by surface electromyography (sEMG) differs from that in healthy individuals. However, sEMG activity in axSpA patients has not been studied. The purpose of this study was to analyze the flexion relaxation phenomenon in axSpA patients. A study evaluating 39 axSpA patients and 35 healthy controls was conducted. sEMG activity at the erector spinae muscles was measured during lumbar full flexion movements. sEMG activity was compared between axSpA patients and the controls, as well as between active (BASDAI ≥ 4) and non-active (BASDAI < 4) patients. The reliability (using intraclass correlation coefficients (ICC)), criterion validity and discriminant validity using the area Under the curve (AUC) for the inverse flexion/relaxation ratio (1/FRR) were evaluated. Significant differences (p < 0.05) were observed between axSpA patients and the control group in lumbar electric activity, especially during flexion, relaxation, and extension and in FRR and 1/FRR (0.66 ± 0.39 vs. 0.25 ± 0.19, respectively). In addition, significant differences were found between active and non-active but also between non-active and healthy subjects. The sEMG showed good reliability (ICC > 0.8 for 1/FRR) and criterion validity. ROC analysis showed good discriminant validity for axSpA patients (AUC = 0.835) vs. the control group using 1/FRR. An abnormal flexion/relaxation phenomenon exists in axSpA patients compared with controls. sEMG could be an additional objective tool in the evaluation of patient function and disease activity status.

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.

Sacroiliitis Detected by Magnetic Resonance Imaging in Patients With Systemic Sclerosis.

Objectives This study aims to evaluate the magnetic resonance imaging (MRI) findings of sacroiliac joints in a selected group of patients with systemic sclerosis (SSc).Patients and methods This retrospective study included 30 patients (2 males, 28 females; mean age 44.1±12.5 years; range, 24 to 70 years) with SSc who underwent MRI of sacroiliac joints. Lesions were defined according to Assessment of SpondyloArthritis International Society (ASAS)/Outcome Measures in Rheumatology MRI group criteria. Clinical features, conventional radiograms of sacroiliac joints, presence of inflammatory back pain, human leukocyte antigen B27 (HLA-B27), and C-reactive protein (CRP) levels were extracted from patient records.Results Eleven of thirty patients (37%) revealed sacroiliitis on MRI (five with chronic, three with active sacroiliitis, and three with both active and chronic forms). On conventional radiographic examination, six patients had sacroiliitis (20%). In all of these six patients, sacroiliitis was also detected on MRI. CRP levels and number of patients with inflammatory back pain were found to be higher in the patients with active sacroiliitis (p<0.05). Seven patients were diagnosed as spondyloarthritis according to ASAS criteria.Conclusion Sacroiliitis was detected more frequently by MRI compared to conventional radiographic examination. MRI is suggested to be the preferred method for evaluating sacroiliitis in SSc patients.

A review on ankylosing spondylitis

Ankylosing spondylitis (AS) is a long-term inflammation of the joints of the spine which is complex, potentially debilitating disease that is insidious in onset, progressing to radiological sacroiliitis over a period of years. The pathogenesis of AS is poorly understood. However, immunomediated mechanisms involving human leukocyte antigen-B27, inflammatory cellular infiltrates, cytokines like tumor necrosis factor α and interleukin-10, and genetic and environmental factors are thought to have key roles. The presence of inflammatory back pain plus at least two other typical features of spondyloarthropathy such as enthesitis and uveitis is highly predictive of early AS. Nonsteroidal anti-inflammatory drugs (NSAIDs) effectively relieve inflammatory symptoms and are presently first line drug treatment. However, NSAIDs have an influence only on the symptomatic effect and has no effect on the disease. For symptoms unresponsive to NSAIDs, the second-line treatment includes corticosteroids and various disease modifying antirheumatic drugs are used.

Diagnostic accuracy of inflammatory back pain for axial spondyloarthritis in rheumatological care

ObjectiveInflammatory back pain (IBP), the key symptom of axial spondyloarthritis (axSpA), including ankylosing spondylitis, has been proposed as a screening test for patients presenting with chronic back pain in primary...

Inflammatory or Neuropathic Pain: Characteristics and Their Relationships with Disease Activity and Functional Status in Axial Spondyloarthritis Patients.

To assess inflammatory back pain (IBP) and neuropathic pain (NP) in patients with axial spondyloarthritis (axSpA) and explore their relationships with disease activity and functional status. Descriptive, cross-sectional study. A convenience sample of 132 patients with axSpA was recruited from a university-affiliated hospital in China. The presence of IBP or NP, pain intensity and quality, pain interference, disease activity, and functional status were assessed. Univariate analyses and binary logistic regressions were used to identify factors related to IBP or NP. Fifty patients (37.9%) had IBP, and 22 (16.7%) had NP. Scores of pain intensity and pain interference, disease activity, and functional limitation were significantly higher in patients with IBP or NP than those without either (P < 0.05). The quality of IBP or NP was mainly presented as sensory descriptors, and patients with IBP had a higher level of "tiring-exhausting" in affective descriptors (P < 0.05). There was a significant correlation between IBP and disease activity (odds ratio [OR] = 1.813, 95% confidence interval [CI] = 1.196-2.750). NP was related to functional limitation (OR = 1.544, 95% CI = 1.098-2.171). Though pain quality (sensory and affective pain descriptors) show differently in patients with IBP or NP, the axSpA patients with IBP or NP experience more severe pain intensity and pain interference, higher disease activity, and greater functional limitation. The presence of IBP or NP could reflect higher disease activity or greater functional limitation in patients with axSpA.

SPECIFIC FEATURES OF AXIAL SKELETON INVOLVEMENT IN EARLY PSORIATIC ARTHRITIS (The REMARCA TRIAL)

Objective: to optimize the diagnosis of spinal column involvement in early psoriatic arthritis (ePsA). Subjects and methods. 40 ePsA patients (17 men and 23 women) fulfilling the respective CASPAR criteria were examined. Their median age was 36.5 [28.5; 49.5] years; median PsA duration – 13.5 [5; 24] months. The activity of ePsA was assessed using DAS and DAS28. Presence of inflammatory back pain (IBP) according to ASAS criteria and HLA-B27 was evaluated in all the patients; 38 of them underwent pelvic X-ray to reveal significant sacroiliitis (SSI) (Stage II bilateral or Stage III–IV unilateral SSI) and 37 had magnetic resonance imaging (MRI) of sacroiliac joints. A radiologist determined blindly the presence of active sacroiliits (ASI) as bone marrow edema/osteitis. Results and discussion. In ePsA, median DAS and DAS28 were 3.99 [2.99; 4.92] and 4.22 [3.37; 4.8], respectively. IBP was detected in 22 (55%) patients; it was prolonged in 12 (54.5%); IBP episodes were noted in 10 (45.5%). MRI revealed ASI n 15 (40.5%) of the 37 patients; SSI in 11 (28.9%); 17 (42.5%) patients were HLA-B27 positive. In ePsA, there was a very high association of ASI and SSI with IBP (Q = 0.91, р 0.9) and SSI and DAS (Q=0.42, р>0.3). A significant association was revealed between ASI and SSI (Q=0.67, р<0.002). Conclusion. In ePsA, ASI and SSI are identified in 40.5 and 28.9% of cases, respectively. ASI and SSI are closely related to IBP rather than to HLA-B27. The activity of peripheral arthritis does not affect the rate of ASI detected on MRI and SSI in patients with ePsA.

AB0736 Strategy for the Early Detection and Referral of Patients with Suspected Spondyloarthritis

ObjectivesTo design a strategy for early detection and referral of patients with suspected spondyloarthritis (SpA) by primary care physicians (PCP).MethodsWe used a modified RAND/UCLA methodology and systematic review (SR). A...

AB0725 Ankylosing Spondylitis in Women, Clinical Features

ObjectivesTo evaluate the clinical features and course of ankylosing spondylitis (AS) in women according to the City rheumatological center in Kazan.MethodsThe study involved two groups of patients with AS: 23...

MAGNETIC RESONANCE IMAGING OF THE SACROILIAC JOINT IN DIFFERENTIAL DIAGNOSIS OF EARLY POLYARTICULAR PSORIATIC AND RHEUMATOID ARTHRITIS (STUDY DATA REMARKA)

Diagnosis of lesions of the spine and sacroiliac joints may be helpful in discrimination between early psoriatic arthritis (ePsA) and early rheumatoid arthritis (eRA). Objective. To assess the significance of inflammatory back pain (IBP), HLA-B27, and active sacroiliitis (ASI) confirmed by magnetic resonance imaging (MRI) for differential diagnosis of polyarticular ePsA and eRA. Materials and Methods. The study included 29 patients with ePsA (13 males and 16 females, mean age 36.52 ± 11.27 years, average duration of the disease 13.03 ± 9.77 months) and 25 patients with eRA (7 males and 18 females, mean age 52.68 ± 14.7 years, average duration of the disease 4.0 ± 1.72 months). Presence of IBP (according to the ASAS criteria) and HLA-B27 were assessed (in 27 patients with PsA and in 20 patients with RA); ASI signs were assessed based on the MRI data (bone marrow edema/osteitis). DAS, DAS28, M ± SD, Fisher's exact test, t-test, χ2, the Yule coefficients of association (Q: level from -1 to +1) and Phi were calculated; differences were considered to be statistically significant at p <0.05. Results. In patients with ePsA, ASI was detected by MRI significantly more frequently than in patients with eRA (41.4% and 12% of cases respectively, p < 0.016). No correlation between the presence of ASI and DAS28 was observed in both groups. In the ePsA group, IBP was detected in 17 patients (58.6%); it was long-term in 10 (58.8%) of the patients and episodic – in 7 (41.2%) patients. Back pain with mechanical rhythm was observed in 3 (12%) patients with eRA. HLA-B27 was detected in 9 (33.3%) of 27 patients with ePsA and in 3 (15%) of 20 patients with eRA (p < 0.014). In patients with ePsA, a very high level of association between ASI and IBP (Q = 0.91, Phi = 0.56; p < 0.003) and a high level of association between ASI and HLA-B27 (Q = 0.75, Phi = 0.56; p < 0.039) were detected. MRI showed no association between the presence of HLA-B27 and ASI signs in patients with RA. Conclusions. ASI is detected by MRI significantly more often in patients with ePsA; however, it can also be observed in patients with eRA. In patients with ePsA, ASI is closely associated with IBP and HLA-B27; this fact can be used for differential diagnosis of polyarticular ePsA and eRA. The activity level of peripheral arthritis does not affect detectability of ASI by MRI in patients with ePsA.

Diffuse Idiopathic Skeletal Hyperostosis in Psoriatic Arthritis

To determine the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in patients with psoriatic arthritis (PsA) and to identify the features associated with its occurrence. Patients were recruited from the University of Toronto PsA observational cohort initiated in 1978. All patients fulfilled the CASPAR criteria. Radiographs of peripheral joints and spine were obtained every 2 years. DISH was defined as flowing bony bridges in at least 4 contiguous thoracic vertebrae. Each PsA patient with DISH was matched by sex to 3 PsA patients without DISH. Demographics, disease characteristics, and radiographic features were compared using McNemar test, Fisher's exact test, chi-square test, and paired t test as appropriate. Logistic regression analyses models with stepwise regression were conducted. DISH was observed in 78 (8.3%) of 938 patients with PsA. Patients with DISH were older and had longer disease duration, higher body mass index (BMI), and higher uric acid levels. Diabetes and hypertension were more prevalent in patients with DISH than in those without. The severity of radiographic damage to peripheral joints was also greater in patients with DISH. The presence of inflammatory back pain, HLA-B*27 allele, and sacroiliitis was similar in both groups. Patients with DISH had more syndesmophytes and calcaneal spurs. Older age, higher BMI, and the presence of radiographic damage to peripheral joints were associated with DISH in multivariate analysis. The diagnosis of DISH is possible in the presence of axial PsA. DISH was associated with known DISH-related factors including older age and high BMI, as well as the presence of radiographic damage to peripheral joints.

SAT0254 Performance of the Assessment of Spondyloarthritis International Society (ASAS) Spondyloarthritis Classification Criteria in a Clinical Cohort of Patients

BackgroundASAS classification criteria have been developed and validated to make an early classification of patients presenting with symptoms of spondyloarthritis (SpA), and to better distinguish between patients with predominantly axial...