Classification Criteria For Spondyloarthritis Research Articles

Probability of the 10-year Risk of Hip and Major Osteoporotic Fracture in Non-radiographic Axial Spondyloarthritis.

Fracture risk in non-radiographic spondyloarthritis is underestimated. A reliable tool such as the Fracture Risk Assessment tool (FRAX) may assess this risk probability. This study aimed to assess the fracture risk by the FRAX score in patients with nr-axSpA and to determine factors associated with high fracture risk. We conducted a retrospective study of nr-axSpA patients meeting the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for spondyloarthritis. All patients had Bone Mineral Density (BMD) by dual-energy X-ray absorptiometry (DEXA). The 10- year probability of major osteoporotic fracture (MOF) and hip fracture (HF) was calculated using the Fracture Risk Assessment Tool (FRAX). Among 40 patients with nr-axSpA, 27 were women (67.5%). Their mean age was 43.7 ± 12.1 years. The mean disease duration was 3.15 ± 2.7 years. Eighteen patients (45%) had osteopenia, and 12 patients (30%) had osteoporosis. The median HF FRAX was 0% [0-1.2]. The median MOF FRAX was 0.5% [0.3-1.8]. MOF FRAX was positively correlated with age (p = 0.002), disease onset age (p = 0.006), disease duration (p = 0.024), and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) (p < 0.0001), and negatively correlated with daily calcium intake (p < 0.0001). HF FRAX was positively correlated with mSASSS (p < 0.0001) and negatively correlated with daily calcium intake (p = 0.005). Our study confirmed the frequency of bone loss during nr-axSpA and showed that osteoporotic risk fracture was related not only to traditional risk factors for osteoporosis but also to disease-related factors.

MRI for axial SpA: Diagnosis, disease activity assessment, and recent advances.

Magnetic resonance imaging (MRI) is a sensitive imaging modality to detect early inflammatory changes in axial spondyloarthritis (SpA). Over a decade has passed since the inclusion of MRI assessment in the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial SpA. Evidence and clinical experience of MRI in axial SpA have accumulated rapidly since. This has led to a better understanding of the clinical utility of MRI in early diagnosis, disease activity assessment, and monitoring of treatment response in axial SpA. Furthermore, technological advancements have paved the way for the development of novel MRI sequences for the quantification of inflammation and image optimization. The field of artificial intelligence has also been explored to aid medical imaging interpretation, including MRI in axial SpA. This review serves to provide an update on the latest understanding of the evolving roles of MRI in axial SpA.

The Role of Early Treatment in the Management of Axial Spondyloarthritis: Challenges and Opportunities.

Axial spondyloarthritis (axSpA) is a chronic, inflammatory rheumatic disease that primarily affects the axial skeleton, often inflicting severe pain, diminished mobility, and a compromised quality of life. The advent of Assessment of SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis (SpA) have enabled the classification of patients with axSpA in the non-radiographic stage but poorly perform if mistakenly used for diagnostic purposes. Despite notable progress in early diagnosis facilitated by referral strategies and extensive magnetic resonance imaging (MRI) utilization, diagnostic delays persist as a concerning issue. This underscores the urgency to narrow the diagnostic gap and highlights the critical role of early diagnosis in mitigating the long-term structural damage associated with this condition. Research into the impact of non-steroidal anti-inflammatory drugs (NSAIDs) and biologic disease-modifying antirheumatic drugs (bDMARDs) on inflammatory symptoms and radiographic progression has been extensive. A compelling body of evidence suggests that early intervention leads to superior disease outcomes. However, most of these studies have centered on patients with established diseases rather than those in the early stages. Consequently, findings from studies on early pharmacological intervention remain inconclusive, and the potential for modifying the disease trajectory is still debatable. Without precise data from clinical trials, insights from basic science regarding the pathogenic mechanisms might point toward potential targets that warrant early intervention in the disease process. This review underscores the urgency of early diagnosis and intervention in axSpA, highlighting ongoing research gaps and the need for further exploration to improve patient outcomes.

Development and validation of a screening tool for SPondyloArthritis Screening in Sub-Saharan Africa: SpASSS questionnaire

ObjectiveTo develop and validate a screening tool to identify patients with a high likelihood for Spondyloarthritis (SpA) in the Democratic Republic of the Congo (DR Congo).MethodsThe development of the SpA Screening questionnaire in Sub Saharian Africa (SpASSS) questionnaire followed 3 steps: The item generation was carried out by a systematic literature review according to the PRISMA guidelines on the clinical manifestations of SpA, interviewing clinical experts and the classification criteria for Spondyloarthritis. The candidate questions were tested in a population of 50 consecutive patients with confirmed diagnosis of spondyloarthritis, in a control population of rheumatic disease excluding SpA and in a group of 200 non-rheumatic participants, randomly chosen in the general population for question reduction and validation. Descriptive statistical analyses were performed to assess socio-demographic characteristics and response distribution for each item. Their diagnostic performance was investigated using ROC curves. For validation, principal component analysis was performed using factor analysis. Referral strategy score for SpA was determined by adjusted Cronbach’s alpha coefficient.ResultsMean ± SD age of SpA cases was 41.8 ± 14.4 years, 56% were men compared to diseased controls 60.0 ± 12.5 years, 28.7% men (p < 0.001). 14/20 items showed a statistically significant difference (p < 0.05) between SpA cases and control groups. All items were factorable and 6 components were identified. Only the two first components (C1 with 8 items, C2 with 3 items) showed a significant threshold for reliability in detection of suspected SpA with a Cronbach's alpha of 0.830 and 0.708. All validated items of these two components showed the global reliability threshold with α-adjusted Cronbach calculated at 66.9%. The performance for correctly screening SpA was demonstrated with an area under the curve of 0.938 (0.884–0.991) and 0.794 (0.728–0.861) for C1 and C2 respectively.ConclusionsThis validation and item reduction of the SpASSS questionnaire for SpA might identify patients to refer for case ascertainment and will help conducting future epidemiological and clinical studies in the DR Congo.Strengths and limitations of this study• To the best of our knowledge, this is the first study in Sub-Saharan Africa based on local data to develop a screening tool for SpA in the population for epidemiological and clinical use.• Referral strategies based on context-specific data are necessary to provide accurate case definition and epidemiological data, thus reducing methodological bias.• In the SpA group, no discrimination was made regarding SpA subtypes, disease duration, activity and severity.

Influence of Sex on Early Axial Spondyloarthritis: A Six-Year Longitudinal Analysis From a Large National Cohort.

The objective was to determine sex differences in disease outcomes in recent axial spondyloarthritis (SpA) over time. We analyzed the first 6 years of follow-up of the prospective French multicenter DESIR cohort. Patients analyzed had <3 years of disease, were naive to disease-modifying antirheumatic drugs, and fulfilled the Assessment of SpondyloArthritis international Society classification criteria for axial SpA. Disease activity (Ankylosing Spondylitis Disease Activity Score [ASDAS] using the C-reactive protein [CRP] level), patient global assessment (PtGA), CRP level, and radiographic sacroiliitis were compared between men and women (self-reported sex) by linear and logistic mixed-effects models.Models were created for trajectories of disease activity over 6 years in men and women, using k-means. Of 494 patients analyzed (mean ± SD age 31.9 ± 7.5 years, symptoms duration 20.7 ± 11.7 months), 50.4% were men. Over 6 years of follow-up, both men and women showed clear improvements in ASDAS-CRP, PtGA, and CRP level. Women had higher ASDAS-CRP and PtGA over time compared to men (both P < 0.0001) with overall similar CRP levels (P=0.089), whereas structural damage increased more in men (P < 0.0001). One-third of both men (33%) and women (34%) belonged to persistent high/very high disease activity trajectories, but ASDAS-CRP was globally higher in women in these trajectories. In early axial SpA, clinical outcomes (disease activity and symptoms) were worse in women than men over 6 years of follow-up, whereas CRP was similar and structural damage was more frequent in men. Although similarly distributed, disease activity scores were higher in women in high/very high disease activity trajectories. Sex appears to be an important contextual factor in axial SpA.

Predictors of not Achieving Remission or Low Disease Activity in Axial Spondyloarthritis Patients from Middle Eastern Countries: A Prospective, Multicenter, Real-world Study.

ObjectivesWe sought to identify the predictors of not achieving remission or low disease activity (LDA) among axial spondyloarthritis (SpA) patients in four Middle Eastern countries.MethodsIn this multicenter prospective real-world study, adult patients with axial SpA diagnosed clinically during January–June 2019, and who met the Assessment of SpondyloArthritis International Society classification criteria for axial SpA, were enrolled from the participating centers of four countries—Lebanon, Oman, Qatar, and the UAE. Patient demographics, disease history, comorbidities, treatment, and compliance data were obtained at baseline. The primary outcome was to determine the percentage of patients who did not achieve the clinical target of remission or LDA as indicated by Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) < 2.1 after a three-month follow-up period. Secondary outcomes were assessing the demographic and clinical characteristics of ‘achievers’ and ‘non-achievers’ and to study the predictors of ASDAS-CRP ≥ 2.1 in different clinical subsets.ResultsThe participants were 309 patients of both sexes, with a median age of 43 years. Women had a slight majority (53.7%). At the end of the study, 72.2% of patients achieved the clinical target of ASDAS-CRP < 2.1. Non-achievers were significantly more likely to have enthesitis, positive human leukocyte antigen B 27 status, psoriasis, peripheral involvement, fibromyalgia, and a lower score on Compliance Questionnaire for Rheumatology (CQR). Multiple regression analysis showed that low CQR score, enthesitis, psoriasis, and family history of SpA were independent predictors of ASDAS-CRP ≥ 2.1.ConclusionsThis real-world study suggests that low compliance, positive human leukocyte antigen B 27 status, peripheral involvement, and presence of enthesitis, psoriasis, and fibromyalgia are predictors of not achieving remission or LDA in axial SpA patients.

POS0161 WORK STATUS IN PATIENTS WITH INFLAMMATORY RHEUMATIC MUSCULOSKELETAL DISEASES: RESULTS OF A BELGIAN COMPARATIVE STUDY

BackgroundInflammatory Rheumatic Musculoskeletal Diseases (RMD) constitute a heterogeneous group of chronic disorders with a potential major individual and socio-economic burden. RMD patients often report work-related difficulties (e.g. productivity loss, sick leave, work disability) which contribute significantly to indirect costs and may lead to additional premiums or exclusion when contracting private insurances. However, work-related epidemiological data in Belgium date back to a pre-biologics era, albeit that diagnosis, management and treatment strategies have drastically improved in the last decade.ObjectivesTo investigate actual work participation status of inflammatory RMD patients in Belgium, and to benchmark these data to the general Flemish population.MethodsDuring an outpatient visit at the rheumatology clinic of Ghent University Hospital, a tertiary hospital in the Flemish region, adult patients with spondyloarthritis (SpA), rheumatoid arthritis (RA), and systemic sclerosis (SSc) were questioned on their socio-economic status (May 2018 to June 2021). SpA patients fulfilled the ASAS classification criteria for axial or peripheral SpA. RA patients fulfilled the 2010 ACR/EULAR classification criteria or had undifferentiated arthritis most suggestive for RA. SSc patients fulfilled the LeRoy and Medsger’s criteria. Employment rate, weekly working hours and work disability were compared to the general Flemish population (Dutch-speaking part of the country) in 2019 (https://statbel.fgov.be/en); data on sick leave were deduced from the 2018 national Health Interview Survey.ResultsAmong the 483 participants, 262/275 (95%) SpA, 63/102 (62%) RA, and 83/106 (78%) SSc were at a work-productive age (&lt;65 y/o). Table 1 summarizes socio-demographic and clinical characteristics.Table 1.SpA (n=262)RA (n=63)SSc (n=83)Male148 (56%)15 (24%)18 (22%)Age (y)40.7±11.053.5±10.849.9±10.6Symptom duration (y)*7.8 (4.7-15.7)3.9 (1.4-5.8)5.8 (2.8-11.5)Age at diagnosis (y)32.6±11.148.3±12.043.9±10.7Biomarker†170 (70%)52 (82%)46 (55%)Disease activity††1.9±1.02.1±1.04 (1-8)Functional index**2.3±2.267±14-EQ-5D scale0.79±0.220.80±0.180.74±0.24Biologics treatment123 (58%)15 (24%)7 (8%)Educational levelLow100 (38%)36 (57%)53 (64%)High162 (62%)27 (43%)30 (36%)Classification criteriaASAS:ACR/EULAR 2010:Leroy &amp; Medsger:axSpA: 192 (73%)46 (73%)LSSC: 21 (25%)perSpA: 70 (27%)LcSSc: 47 (57%)DcSSc: 15 (18%)† HLA B27 (SpA), RF/ACPA (RA), SSc-related auto-antibodies (SSc). †† ASDAS-CRP (SpA), DAS28 (RA), mRSS (SSc). *Disease duration from first non-Rayneud phenomenon in SSc. **BASFI (SpA), Michigan Hand Outcomes Questionnaire (RA).Crude employment rates were 82% in SpA, 56% in RA and 63% in SSc. Age- and sex-adjusted employment rates (indirect standardization) were respectively 75%, 68%, and 66%, corresponding to a standardized employment ratio of 1.00 (95% CI 0.87 – 1.14) for SpA, 0.89 (0.64 – 1.24) for RA, and 0.88 (CI 0.67 – 1.15) for SSc.SpA patients worked 39.5±10.9h/week, compared to 40.9±16.9h in RA and 33.0±12.4h in SSc (p=0.003). Flemish employees worked on average 39.7h (full-time) and 25.7h (part-time) per week.In the working population, 48% of SpA patients, 53% RA and 78% SSc reported sick leave in the previous year, compared to 42% in Flanders. Long-term work disability was reported by respectively 10%, 17% and 20% of patients (p=0.03) compared to 9% in the reference population.The median retention time on the labour market was not significantly different between SpA (42.1 years), RA (42.1 years) and SSc (41.2 years) (p=0.94, Figure 1).Figure 1.retention time on the labour market since start of patient’s professional career.ConclusionOur data refute the common perception that patients with RMDs, especially inflammatory joint diseases, have significantly worse work outcomes compared to the general population. In an era of early diagnosis and treatment, more recent datasets could be used to realistically estimate the odds of these important health economic outcomes.AcknowledgementsThe Ghent University Hospital is member of the Flemish Network on rare connective tissue diseases and of the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET).Disclosure of InterestsNone declared

Prevalence and risk factors for uveitis in spondyloarthritis.

To determine the prevalence and risk factors for uveitis in spondyloarthritis (SpA) patients. A total of 225 patients who fulfilled Assessment of Spondyloarthritis International Society classification criteria for axial and peripheral SpA were enrolled. The diagnosis of uveitis was confirmed by an ophthalmologist. From medical records and from clinical evaluation associated information like disease duration, and human leukocyte antigen B27 was collected. Relevant laboratory tests were done and disease severity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score - erythrocyte sedimentation rate and C-reactive protein. Characteristics of uveitis positive and uveitis negative groups were compared. Multivariate logistic regression analysis was done for the risk factors, and P values <.05 were considered significant. Prevalence of uveitis was 18.7%. The disease duration was 9.3±7years and 5.4±4.5years in uveitis and no uveitis groups respectively (P≤.001). Family history of SpA was positive in 45.2% in the uveitis group (P≤.001). The frequency of axial SpA was 92.9% and 73.8% in the uveitis and no uveitis groups respectively (P≤.008). The mean BASDAI was 2.4±1.9 and 3.3±2.8 in uveitis and no uveitis groups respectively (P=.050). In multivariate logistic regression analysis, among the selected variables, family history of SpA (odds ratio [OR] =3.697; 95% CI =1.616-8.457; P=.002) and duration of disease (OR =1.089; 95% CI =1.004-1.181; P=.039) were independently associated with the occurrence of uveitis. The prevalence of uveitis was 18.7%. The family history and the disease duration of SpA were independently associated with uveitis.

Rheumatoid arthritis and spondyloarthritis prevalence in four European countries - a comparative study

Introduction/Objective. The objective was to compare rheumatoid arthritis (RA), spondyloarthritis (SpA) and subtypes of SpA prevalence in four European countries. Methods. A 33-items detection questionnaire, containing self-reported diagnosis, classification criteria for RA and SpA, personal and family history, was translated using cross-cultural adaptation and validated in France, Turkey, Lithuania and Serbia, where it was used on a population sample. Suspected cases were evaluated and confirmed by a rheumatologist. Prevalence estimates were age- and sex-standardized to European standard population. Results. In total, 33,454 people older than 18 years were screened and 31,454 interviewed: France 14,671, Lithuania 6,558, Serbia 6,213, Turkey 4,012. Standardized RA prevalence varied from 0.29% (95% CI: 0.17?0.40) in France to 0.57% (0.31?0.84) in Turkey; this inequality was mostly caused by differences in women prevalence (from 0.42% in France to 1.02% in Turkey) SpA prevalence was similar in France (0.30%), Serbia (0.35%) and Turkey (0.37%), but in Lithuania it was 0.89%, which could be caused by geographic and genetic differences, as SpA prevalence was higher in North and East Europe, as well as the human leukocyte antigen B27 presence. SpA prevalence was equally presented by gender for France and Serbia. Regarding SpA subtypes, ankylosing spondylitis prevalence varied from 0.07?0.30% (Serbia?Lithuania), PsA 0.10?0.26% (France?Lithuania), reactive arthritis was 0.09?0.18% (Serbia?Lithuania). Previously nondiagnosed SpA cases were found in 6.9% in France, 25.9% in Lithuania and 31.2% in Serbia. Conclusion. East?West decreasing tendency for the female RA prevalence was noted. SpA was higher in North-Eastern Europe than in its Western and Southern part. One quarter of the SpA patients in Lithuania and one third in Serbia were not previously diagnosed. The SpA population prevalence was higher than expected and similar to RA.

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

POS0245 PERFORMANCE OF STANDARDIZED SCORES FOR DISEASE ASSESSMENT AND PAIN IN PATIENTS WITH SPONDYLOARTHRITIS AND FIBROMYALGIA

Background:The pathogenesis of spondyloarthritis (SpA) including axial SpA (axSpA) and psoriatic arthritis (PsA) differs from fibromyalgia (FM). However, symptoms partially overlap and both patient groups suffer from pain and stiffness. In addition, SpA patients may also develop a secondary form of FM. Classification criteria for SpA and diagnostic criteria for FM are used to differentiate between these subsets. Patient reported outcomes (PRO) often generated by questionnaires are used to assess severity and other disease features.Objectives:To study whether PROs developed for axSpA, PsA, and related physician-based information behave in a similar way in patients diagnosed with FM without an additional chronic inflammatory rheumatic disease (CIRD) as in patients with a primary diagnosis of SpA without or with secondary FM.Methods:Patients were consecutively recruited. The main inclusion criterion was a clinical diagnosis of FM (without CIRD), axSpA or PsA (without or with secondary FM) and the indication for a treatment adaptation (escalation or change within the same class) for any reason, based on the judgement of experienced rheumatologists. Standardized assessment tools and lab parameters (BASDAI, ASDAS-CRP, DAPSA, patient´s and global assessment (NRS), CRP, BASFI, Fibromyalgia Impact questionnaire (FIQ), Leeds Enthesitis Index (LEI), Maastricht Ankylosing Spondylitis (MASES) and SpA Research Consortium of Canada (SPARCC) Enthesitis Score were assessed and compared between subgroups.Results:The baseline demographics of 300 recruited patients (100 FM. 100 axSpA and 100 PsA) are shown in Table 1. All patients with FM (primary or secondary to SpA) showed the highest scores in almost all assessments, and this was independent of the main diagnosis (Table 2). In comparison, patients with axSpA or PsA without secondary FM showed significantly lower scores in all PROs as compared to those with primary and secondary FM, with exception of (i) scores of ASDAS-CRP and (ii) duration of morning stiffness (Question 6 of BASDAI), which were not affected by the presence of secondary FM (Table 2).Conclusion:Secondary FM is leading to significantly higher levels of SpA-specific scores. ASDAS-CRP was the only score that was not influenced by the presence of secondary FM in patients with axSpA even though it was also increased in patients with primary FM, while similar results were found for the duration but not the level of morning stiffness. On the other hand, FM-specific questionnaires also showed high scores in patients with axSpA and PsA with concomitant FM but not in those without.Table 1.Baseline characteristics of all diagnosis subtypes and comparison (p-values) to primary FM diagnosis. ‘+’: diagnosis with concomitant FM, ‘-‘: diagnosis without concomitant FMTable 2.Mean values (±standard deviation) of the assessed diseasespecific indices and comparison (p-values) to primary FM diagnosis.Disclosure of Interests:None declared

Enthesitis is a clue to the diagnosis of spondyloarthritis, focus on psoriatic arthritis

Enthesitis is a common clinical feature of spondyloarthritis (SpA), characterized by inflammation of the tendon or ligament attachment site to a bone or joint capsule. The importance of detecting enthesitis for the diagnosis of SpA is confirmed by its inclusion in the classification criteria for psoriatic arthritis (PsA) – CASPAR – and in the classification criteria for SpA of the international group for the study of spondyloarthritis – ASAS. Enthesitis may be the first clinical sign of SpA, as well as the leading symptom that significantly influences the therapeutic choice. Enthesitis occurs in 30–50% of patients with SpA and is associated with high disease activity, more severe pain and worse quality of life. The frequency of enthesitis detected by ultrasound in patients with PsA is approximately 4 times higher than in patients with ankylosing spondylitis and is associated with the severity of the disease. The review presents current data on the pathophysiology, diagnosis and treatment of enthesitis. Recent studies emphasize the role of imaging methods for the diagnosis of enthesitis due to their higher sensitivity and specificity compared to clinical examination. There is very limited information on the effect of synthetic disease-modifying antirheumatic drugs on enthesitis, while targeted drugs and biologic therapy have shown high efficacy in its treatment compared to placebo. Preliminary evidence suggests that targeting interleukin (IL) 17 or IL12/23 may be more effective in enthesises inflammation suppression than tumor necrosis factor α inhibition.

Clinical performance of ASAS Health Index in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: real-world evidence from Multicenter Nationwide Registry.

The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is used as a new instrument in measuring the function, disability and health of patients with spondyloarthritis (SpA). However, the real-world evidence of ASAS HI is very limited. In the present study, our objective is to evaluate the psychometric properties and performance of ASAS HI in the real-world setting as well as comparing ASAS HI with the current instruments to assess the construct validity and determine the cut-off points in patients with both ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). A total of 991 patients with axSpA who fulfilled either the ASAS classification criteria for axial SpA (axSpA) or the Modified New York Criteria (mNY) for AS were recruited from the Biologic and targeted Synthetic antirheumatic drugs Registry (BioStaR) SpA. The construct validity of ASAS HI against the Bath Ankylosing Spondylitis Disease Activities Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) the Bath Ankylosing Spondylitis Functional index (BASFI) was performed. Using the receiver operating characteristic (ROC) curves analysis, the cut-off points were calculated. Of all the recruited patients, 851 (85.9%) were AS and 140 (14.1%) were nr-axSpA. The difference in the mean ASAS HI scores of the patients with AS and the ones with nr-axSpA were not statistically significant (6.12 ± 4.29 and 6.42 ± 4.86, respectively). The mean ASAS HI score was significantly higher in females and small city residents. The ASAS HI had a strong construct validity against ASDAS-CRP, BASDAI and BASFI. A cut-off point of ≤ 4 was determined to discriminate good and moderate, as well as ≥ 12 to discriminate moderate and poor health status. In conclusion, ASAS HI is a reliable instrument to evaluate health and functioning for both patients with AS and nr-axSpA in clinical practice.

Diagnostic efficacy of ultrasound detection of enthesitis in peripheral spondyloarthritis

Objective: We investigated the diagnostic efficacy of power Doppler ultrasound (PDUS) to detect enthesitis in Japanese patients with peripheral spondyloarthritis (SpA).Methods: This was a single-center cohort study of patients with peripheral symptoms suggestive of SpA. Articular synovia, tendons, and entheses were assessed by PDUS at baseline. Clinical, laboratory, and radiologic findings and classification criteria for SpA were also evaluated.Results: 136 patients were consecutively evaluated. A definite diagnosis was obtained in 111 patients, including 72 with SpA and 39 non-SpA. Among the patients with SpA, PDUS demonstrated articular synovitis in 40 of the 72 patients (56%), tenosynovitis or peritendinitis in 48 (67%), and enthesitis in 63 (88%). Considering PDUS alone, enthesitis in at least one site was the most useful means of differentiating SpA from non-SpA (sensitivity 87.5%; specificity 82.1%; accuracy 85.6%; positive likelihood ratio 4.88). Combining that finding along with fulfillment of Amor, European Spondyloarthropathy Study Group, or Assessment of SpondyloArthritis international Society criteria for peripheral SpA increased the specificity of the diagnosis (92.5%, 92.3%, and 97.4%, respectively).Conclusion: PDUS enthesitis is useful for the diagnosis of SpA with peripheral symptoms. Combining PDUS enthesitis with established SpA classification criteria is beneficial in diagnosing peripheral SpA.

Frequency of inflammatory back pain and sacroiliitis in Egyptian patients with rheumatoid arthritis

BackgroundThe aim of this study is to determine the frequency of inflammatory back pain and associated ankylosing spondylitis in rheumatoid arthritis patients.ResultsSacroiliitis was found in 22% of rheumatoid arthritis patients. The frequency of rheumatoid arthritis patients who fulfilled classification criteria for spondyloarthritis or ankylosing spondylitis was 58%, in whom HLA-B27 was positive in 21 patients (35.2%) and was correlated with MRI sacroiliitis. Twenty pecent of rheumatoid arthritis patients had ankylosing spondylitis (56%) and 27% had axial spondyloarthritis.ConclusionFrequencies of inflammatory back pain and sacroiliitis in Egyptian rheumatoid arthritis patients were high.

Correlation of enthesitis indices with disease activity and function in axial and peripheral spondyloarthritis: a cross-sectional study comparing MASES, SPARCC and LEI

BackgroundThe presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). There is currently no consensus on which clinical score should be used to assess enthesitis in SpA. The objective of the present work was to compare the correlation of three enthesitis indices (MASES, SPARCC and LEI) with measures of disease activity and function in a heterogeneous population of patients with axial and peripheral SpA.MethodsA cross-sectional study was conducted in three Brazilian public university hospitals; patients fulfilling ASAS classification criteria for peripheral or axial SpA were recruited and measures of disease activity and function were collected and correlated to three enthesitis indices: MASES, SPARCC and LEI using Spearman’s Correlation index. ROC curves were used to determine if the the enthesitis indices were useful to discriminate patients with active disease from those with inactive disease.ResultsTwo hundred four patients were included, 71.1% (N = 145) fulfilled ASAS criteria for axial SpA and 28.9% (N = 59) for peripheral SpA. In axial SpA, MASES performed better than LEI (p = 0.018) and equal to SPARCC (p = 0.212) regarding correlation with disease activity (BASDAI) and function (BASFI). In peripheral SpA, only MASES had a weak but statistical significant correlation with DAS28-ESR (rs 0.310 p = 0.05) and MASES had better correlation with functional measures (HAQ) than SPARCC (p = 0.034).ConclusionIn this sample composed of SpA patients with high coexistence of axial and peripheral features, MASES showed statistical significant correlation with measures of disease activity and function in both axial and peripheral SpA.

Is There a Role for MRI to Establish Treatment Indications and Effectively Monitor Response in Patients with Axial Spondyloarthritis?

MRI has an important role in the assessment of axial spondyloarthritis (axSpA), particularly early in the disease course, before radiographic damage is apparent. For this reason, MRI was incorporated into the 2009 ASAS/OMERACT classification criteria for spondyloarthritis. However, there are current controversies regarding its use. Important questions include whether the spine should be used in the routine diagnosis and classification of axSpA, whether MRI should replace radiographs as the imaging modality of choice in axSpA, and whether MRI findings in axSpA have prognostic significance.

A referable clinical pattern of spondyloarthritis-associated uveitis

Objective. The aim of the study was to identify a clinical pattern of spondyloarthritis (SpA)-associated uveitis in order to facilitate proper rheumatologic referral by ophthalmologists. Methods. Demographic data were recorded and acute phase reactants were measured using standard methods between May and August 2017, for all adult patients (age > 18 years) presenting with acute uveitis (standardization of uveitis nomenclature). Afterwards, they were referred to a rheumatology clinic to be screened for the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria of SpA. SpA and non-SpA patients were then compared using appropriate statistical tests (significant if p < 0.05). All the patients offered a written informed consent and the study was approved by the local ethics committee. Results. The sample included 67 subjects, of whom 32 (47.8%) were classified with SpA, of whom 21 were known with this diagnosis (median disease duration of 13.6 years), while 11 (34.4% of the SpA subgroup) fulfilled the ASAS classification criteria for SpA without a prior diagnosis. Compared to non-SpA patients, SpA patients were more frequently male urban dwellers, they were significantly younger, they had a higher prevalence of HLA-B27 and recurrent uveitis, and they had higher median of C-reactive protein and lower median of white blood counts. Conclusions. Uveitis is an important revelatory manifestation of SpA. Young men presenting in an ophthalmology department with acute anterior uveitis and inflammatory back pain should be referred to a rheumatology unit. Abbreviations: AAU = Acute Anterior Uveitis, AS = Ankylosing Spondylitis, ASAS = Assessment Of Spondyloarthritis International Society, CRP = C-Reactive Protein, ESR = Erythrocyte Sedimentation Rate, HLA = Human Leukocyte Antigen, IBP = Inflammatory Back Pain, IBD = Inflammatory Bowel Disease, IL = Interleukin, MRI = Magnetic Resonance Imaging, Nsaids = Non-Steroidal Anti-Inflammatory Drugs, SD = Standard Deviation, Spa = Spondyloarthritis, Tnfα = Tumour Necrosis Factor Alpha, WBC = White Blood Count.

Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis

ObjectivesTo evaluate construct validity, interpretability, reliability and responsiveness as well as determination of cut-off points for good and poor health within the original English version and the 18 translations of...

Ankylosing spondylitis and axial spondyloarthritis: recent insights and impact of new classification criteria.

Development of the Assessment in Spondyloarthritis International Society (ASAS) classification criteria for axial spondyloarthritis (SpA) was one of the major breakthroughs in the field over the past decade. Despite some concerns related to the specificity of the criteria, they stimulated research into the early stage of the disease. This resulted in major advances in the understanding of the course of the disease, revealing predictors of progression, improvement in early diagnosis and treatment in axial SpA. In this review, we summarize the recent developments resulting from the introduction of the ASAS classification criteria for axial SpA and the implications for research and clinical practice.