Recent Inflammatory Back Pain Research Articles

Prevalence and consequences of psoriasis in recent axial spondyloarthritis: an analysis of the DESIR cohort over 6 years

ObjectivesThe consequences of psoriasis associated to axial spondyloarthritis (axSpA) are unclear. The objectives were to determine the prevalence and the consequences of psoriasis in recent axSpA over 6 years of...

Can power Doppler ultrasound of the entheses help in classifying recent axial spondyloarthritis? Data from the DESIR cohort

Early diagnosis of axial spondyloarthritis (axSpA) remains a challenge due to the lack of specificity of clinical symptoms and variable prevalence of axial imaging findings permitting a definite diagnosis. Power...

What is the reliability of non-trained investigators in recognising structural MRI lesions of sacroiliac joints in patients with recent inflammatory back pain? Results of the DESIR cohort.

ObjectiveThe objective of this study was to evaluate the reliability of recognising structural lesions on MRI (erosions, fatty lesions, ankylosis) of the sacroiliac joints (MRI-SIJ) in clinical practice compared to a central reading in patients with a possible recent axial spondyloarthritis (axSpA).MethodsPatients aged 18–50 years, with recent (<3 years) and chronic (≥3 months) inflammatory back pain, suggestive of axSpA were included in the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort. MRI-SIJ structural lesions were scored by non-trained local readers, and by two trained central readers. Local readers scored each SIJ as normal, doubtful or definite lesions. Central readers scored separately each type of lesion. The central reading (mean of the two central readers’ scores) was the external standard. Agreement (κ) was calculated first between local (3 definitions of a positive MRI-SIJ) and central readings (9 definitions), and then between the two central readers.Results664/708 patients with complete available images were included. Agreements between local and central readings were overall ‘fair’, except when considering at least 2 or 3 fatty lesions and at least 3 erosions and/or fatty lesions where agreement was ‘moderate’. Agreement between central readers was similar. MRI-SIJ was positive for 52.6% of patients according to central reading (at least 1 structural lesion) and for 35.4% of patients according to local reading (at least unilateral ‘doubtful‘ or ‘definite’ structural lesions).ConclusionsAgreement on a positive structural MRI-SIJ was fair to moderate between local and central readings, as well as between central readers. The reliability improved when fatty lesions were considered.Trial registration numberNCTO 164 8907.

Increase in Dickkopf-1 Serum Level in Recent Spondyloarthritis. Data from the DESIR Cohort.

ObjectivesTo investigate DKK-1 and SOST serum levels among patients with recent inflammatory back pain (IBP) fulfilling ASAS criteria for SpA and associated factors.MethodsThe DESIR cohort is a prospective, multicenter French cohort of 708 patients with early IBP (duration >3 months and <3 years) suggestive of AxSpA. DKK-1 and SOST serum levels were assessed at baseline and were compared between the subgroup of patients fulfilling ASAS criteria for SpA (n = 486; 68.6%) and 80 healthy controls.ResultsMean SOST serum levels were lower in ASAS+ patients than healthy controls (49.21 ± 25.9 vs. 87.8 ± 26 pmol/L; p<0.0001). In multivariate analysis, age (p = 5.4 10−9), CRP level (p<0.0001) and serum DKK-1 level (p = 0.001) were associated with SOST level. Mean DKK-1 serum levels were higher in axial SpA patients than controls (30.03 ± 15.5 vs. 11.6 ± 4.2 pmol/L; p<0.0001). In multivariate analysis, DKK-1 serum levels were associated with male gender (p = 0.03), CRP level (p = 0.006), SOST serum level (p = 0.002) and presence of sacroiliitis on radiography (p = 0.05). Genetic association testing of 10 SNPs encompassing the DKK-1 locus failed to demonstrate a significant contribution of genetics to control of DKK-1 serum levels.ConclusionsDKK-1 serum levels were increased and SOST levels were decreased among a large cohort of patients with early axial SpA compared to healthy controls. DKK-1 serum levels were mostly associated with biological inflammation and SOST serum levels.

Early Tumor Necrosis Factor α Antagonist Therapy in Everyday Practice for Inflammatory Back Pain Suggesting Axial Spondyloarthritis: Results From a Prospective Multicenter French Cohort

To determine the frequency of and factors associated with early tumor necrosis factor α (TNFα) antagonist therapy in everyday clinical practice in patients with suspected axial spondyloarthropathy (SpA). We used data from the prospective observational study in the French Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR; Outcome of Recent Undifferentiated Spondylarthropathies) cohort of 708 patients with recent-onset (<3 years) inflammatory back pain (IBP) suggesting axial SpA. TNFα antagonist use was recorded at months 6 and 12 and factors independently associated with TNFα antagonist therapy were identified by multivariate logistic regression. Among the 708 patients (mean age 33.8 years, 46.2% men), 166 (23.4%) patients received TNFα antagonist therapy by month 12, including 120 (73.6%) patients who fulfilled Assessment of SpondyloArthritis international Society (ASAS) axial criteria and 157 (94.6%) who fulfilled at least 1 SpA criteria set; 109 (65.6%) had no sacroiliitis. Factors independently associated with early TNFα antagonist therapy were high Ankylosing Spondylitis Disease Activity Score using the C-reactive protein level (odds ratio [OR]1-point increase 1.60, 95% confidence interval [95% CI] 1.25-2.03, P < 0.001), high physician's global disease activity score (OR 1.37, 95% CI 1.21-1.54, P < 0.001), ASAS nonsteroidal antiinflammatory drug score >50 (OR 1.88, 95% CI 1.24-2.87, P = 0.003), current or past disease-modifying antirheumatic drug use (OR 2.09, 95% CI 1.22-3.59, P = 0.008), systemic corticosteroid use (OR 2.48, 95% CI 1.43-4.34, P = 0.002), and mild to severe radiographic hip abnormalities (OR 9.43, 95% CI 2.11-42.09, P = 0.003). After adjustment on these factors, Achilles enthesis hypervascularization by power Doppler and number of work days missed were associated with TNFα antagonist therapy. In the DESIR cohort, approximately one-fourth of patients with recent IBP suggestive of axial SpA were under anti-TNFα therapy after 1 year of followup. All factors associated with this early initiation reflected higher disease activity, refractoriness, or severity, which suggests compliance of French rheumatologists with current treatment guidelines.

AB0982 Comparison of the Performance of the BASRI and Msasss in Patients with Early Inflammatory Back Pain from the DESIR Cohort

BackgroundFor assessing structural damage in AS on spinal X-rays Bath Ankylosing Spondylitis Radiology Index (BASRI) and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) scoring systems can be usedObjectivesTo present the...

SAT0196 Scoring of Spinal Lesions Compatible with Axial Spondyloarthritis on MRI in Clinical Practice by Local Radiologist or Rheumatologist in Desir; Comparison with Central Reading

BackgroundIn clinical practice radiologists and rheumatologists assess whether lesions compatible with axial SpondyloArthritis (axSpA) are present on spinal MRIObjectivesTo compare the results of local readings (LocR) to centralized reading (CentR)...

FRI0434 Anterior chest wall pain in recent inflammatory back pain. data from the desir cohort.

BackgroundAnterior chest wall pain (ACW) may be suggestive of spondyloarthritis (SpA), but little is known about this clinical feature in recent inflammatory back pain (IBP).ObjectivesTo determine the prevalence of ACW...

OP0094 DKK1 serum level is increased in recent spondyloarthritis and is associated with higher prevalence of syndesmophytes. Data from the desir cohort

BackgroundDickkopf-1 (DKK-1) is an inhibitory protein of the Wnt signalling pathway that could rationally be involved either in AS osteoporosis or in the osteoblastogenesis associated with syndesmophyte construction.ObjectivesTo investigate DKK-1...

SAT0264 Impact of uveitis on the phenotype of patients with recent inflammatory back pain. Data from the desir cohort

BackgroundInfluence of uveitis on clinical, epidemiological and imaging features in patients with inflammatory back pain (IBP) related to spondyloarthritis (SpA) needs to be known.ObjectivesTo determine the prevalence of uveitis in...

Anterior Chest Wall Pain in Recent Inflammatory Back Pain Suggestive of Spondyloarthritis. Data from the DESIR Cohort

To determine the prevalence of anterior chest wall (ACW) pain in patients with recent inflammatory back pain (IBP) suggestive of spondyloarthritis (SpA), and to investigate the influence of ACW pain on the overall features of these patients. The DESIR cohort is a prospective, multicenter French cohort of patients with early IBP suggestive of SpA, including 708 patients (mean age 33.8 yrs, 53.8% females, 57.3% HLA-B27-positive). ACW pain was defined by at least 1 episode of chest wall pain attributed to SpA by the rheumatologist, after ruling out other causes of chest pain. Data on the baseline demographic characteristics, functional status and quality of life, imaging features, bone mineral density, and blood tests were compared in patients with and those without ACW pain. Factors associated with ACW pain were identified by univariate and multivariate analysis (logistic regression). The prevalence of ACW pain in the DESIR cohort (n = 316/708 patients) was 44.6% (95% CI 40.9-48.3). ACW pain occurred after the first symptoms of IBP in 62%. Localization was diffuse in 41% of the positive cases. A stepwise multivariate analysis found an association between ACW pain and the enthesitis score, involvement of thoracic spine, diagnosis of ankylosing spondylitis (AS), and radiographic abnormalities of sacroiliac joints. In recent IBP suggestive of SpA, presence of ACW pain is associated with enthesitis, thoracic spine involvement, radiographic sacroiliitis, diagnosis of AS, and with a more severe disease. ACW pain could be interpreted as a diagnostic feature for AS.

Does the site of magnetic resonance imaging abnormalities match the site of recent-onset inflammatory back pain? The DESIR cohort

ObjectivesTo assess whether the site of axial pain (thoracic spine, lumbar spine or buttock(s)) was associated with the site of MRI lesions in patients with recent inflammatory back pain (IBP)...

Impact of uveitis on the phenotype of patients with recent inflammatory back pain: Data from a prospective multicenter French cohort

To determine the prevalence of uveitis in patients with recent inflammatory back pain (IBP) suggestive of spondylarthritis (SpA), and to investigate the impact of uveitis on the overall features of these patients. The Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR; Outcome of Recent Undifferentiated Spondylarthropathies) cohort is a prospective multicenter French cohort of 708 patients with early IBP suggestive of SpA. Uveitis was defined by an ophthalmologic episode diagnosed as uveitis by an ophthalmologist, or history of a medical diagnosis of uveitis given to the patient. Data on the baseline demographic characteristics, functional status and quality of life, imaging features, bone mineral density (BMD), and blood tests were compared in patients with and without uveitis. Factors associated with the presence of uveitis were identified both by univariate and multivariate analysis (logistic regression). The prevalence of uveitis at inclusion in the DESIR cohort was 8.5%. Uveitis occurred after the first symptoms of IBP in 45% of patients. The presence of uveitis was significantly associated (univariate) with pain in the cervical spine, infection preceding inflammatory disease, a previous diagnosis of inflammatory bowel disease (IBD), the Short Form 36 (SF-36; mental and physical health and social relationship subscales), Achilles enthesitis, elevated leukocyte count, and radiologic hip involvement, but not with fulfillment of classification criteria, HLA-B27, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Disease Activity Score, and BMD. Stepwise multivariate analysis found an association between uveitis and pain in the cervical spine, infection preceding inflammatory disease, a previous diagnosis of IBD, and the physical health limitation of the SF-36 (P < 0.05). In recent IBP suggestive of SpA, uveitis is associated with IBD and infection. This might suggest a role of environmental factors in the incidence of uveitis in SpA.

Psoriasis and phenotype of patients with early inflammatory back pain

BackgroundPsoriasis is an important clinical feature in spondyloarthritis. However, the influence of psoriasis on the clinical, functional and imaging features of patients with inflammatory back pain (IBP) related to spondyloarthritis...