Spondyloarthritis Group Research Articles

Non-radiographic axial spondyloarthritis in Tunisia: main characteristics and detailed comparison with ankylosing spondylitis.

The aim of the present study is to compare the clinical features, disease activity, and physical impairment between non-radiographic axial spondyloarthritis and ankylosing spondylitis in Tunisian patients. This is a retrospective study conducted in a single rheumatology center in Tunisia. Patients with axial spondyloarthritis fulfilling the 2009 ASAS criteria were included. The various spondyloarthritis-related variables were compared between non-radiographic axial spondyloarthritis and ankylosing spondylitis. p Values below 0.05 were considered statistically significant. Among 200 patients with axial spondyloarthritis, 40 had non-radiographic axial spondyloarthritis and 160 had ankylosing spondylitis. The non-radiographic axial spondyloarthritis patients were more frequently female, were younger, and had shorter disease duration. Patients with non-radiographic axial spondyloarthritis experienced enthesitis more frequently compared with ankylosing spondylitis patients. Psoriasis was more frequent in non-radiographic axial spondyloarthritis group, while inflammatory bowel disease was more frequent in ankylosing spondylitis group. The C-reactive protein level and functional score were significantly higher in patients with ankylosing spondylitis compared with non-radiographic axial spondyloarthritis. Tumor necrosis factor inhibitors were offered significantly more often to the ankylosing spondylitis group. There was no statistically significant difference between the 2 groups in other spondyloarthritis parameters. The non-radiographic axial spondyloarthritis is characterized mainly by a marked female prevalence, a higher enthesitis prevalence, and a better physical function. • Patients with nr-axSpA in Tunisia are more frequently female and have shorter disease duration compared with those with AS. • Peripheral manifestations were similar between nr-axSpA and AS patients except for enthesitis which were more frequent within nr-axSpA patients. • The disease activity is similar between the 2 groups of axSpA but the physical function is better within nr-axSpA patients.

ДИФФЕРЕНЦИРОВАННАЯ ТЕРАПИЯ РЕАКТИВНЫХ АРТРИТОВ

Abstract: Reactive arthritis (Rea) belongs to the group of seronegative spondyloarthritis (Spa) and is often associated with the carrier of HLA-B27-antigen, which, together with the presence of a distant focus of infection,increases the risk of developing arthritis. The most common causes of reactive arthritis are latent urogenital infections and acute intestinal infections. diagnosis of Rhea is difficult due to the similarity of the clinical picture with other diseases of the musculoskeletal system that occur with joint damage, as well as, often, the absence of an obvious connection between the joint syndrome and pre-existing infection. If the diagnosis is correct, it is necessary to identify the pathogen and prescribe etiotropic therapy, but even in this case, recovery does not occur in 100% of cases. Approximately 20% of patients may have chronic disease, so it is necessary to first pay more attention to the detection of infections-triggers and treat them at an early stage.

A study of MRI-based radiomics biomarkers for sacroiliitis and spondyloarthritis.

To evaluate the performance of texture-based biomarkers by radiomic analysis using magnetic resonance imaging (MRI) of patients with sacroiliitis secondary to spondyloarthritis (SpA). The determination of sacroiliac joints inflammatory activity supports the drug management in these diseases. Sacroiliac joints (SIJ) MRI examinations of 47 patients were evaluated. Thirty-seven patients had SpA diagnoses (27 axial SpA and ten peripheral SpA) which was established previously after clinical and laboratory follow-up. To perform the analysis, the SIJ MRI was first segmented and warped. Second, radiomics biomarkers were extracted from the warped MRI images for associative analysis with sacroiliitis and the SpA subtypes. Finally, statistical and machine learning methods were applied to assess the associations of the radiomics texture-based biomarkers with clinical outcomes. All diagnostic performances obtained with individual or combined biomarkers reached areas under the receiver operating characteristic curves ≥ 0.80 regarding SpA related sacroiliitis andand SpA subtypes classification. Radiomics texture-based analysis showed significant differences between the positive and negative SpA groups and differentiated the axial and peripheral subtypes (P < 0.001). In addition, the radiomics analysis was also able to correctly identify the disease even in the absence of active inflammation. We concluded that the application of the radiomic approach constitutes a potential noninvasive tool to aid the diagnosis of sacroiliitis and for SpA subclassifications based on MRI of sacroiliac joints.

AB0697 PERFORMANCE OF DIFFERENT CRITERIA SETS FOR INFLAMMATORY BACK PAIN IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS IN DEMOCRATIC REPUBLIC OF CONGO

Background:Inflammatory back pain (IBP) is the most prominent clinical feature for an early diagnosis of axial spondyloarthritis. The performance of the criteria sets for IBP has not yet been assessed in clinical practice in the Democratic Republic of Congo (DRC).Objectives:To assess and to compare the performance of different IBP criteria sets in axial spondyloarthritis (SpA) outpatients attending the rheumatology unit of the University Hospital of Kinshasa, DRC.Methods:One hundred and eight Congolese outpatients with axial SpA defined by rheumatologist’s clinical judgment were included in the spondyloarthritis cohort of the University Hospital of Kinshasa from March 1st2015 to February 28, 2017. Calin criteria, Berlin criteria and ASAS criteria sets for IBP were performed to assess their performance against clinical judgment. Detailed history, clinical examination and imaging of sacroiliac joints by plain radiography were obtained. Sacroiliac joint radiographic lesions were scored with the modified New York criteria. Magnetic resonance imaging and HLA B27 were not performed. Fifty additional patients with a diagnosis of chronic (&gt;3 months) mechanical low back pain (MLBP) were included as control group. The performance of each item and different criterias was evaluated using sensitivity, specificity, and likelihood ratio (LR). Baseline characteristics of the mechanical and inflammatory back pain cohorts were compared with chi-square or Student t tests as appropriate.Results:The mean age was 43.8±15.1 years in SpA patients versus 62.4±9.1 years in controls (MLBP patients) with respective sex ratio (M/F) of 1/0.8 and 1/2.1. There were significantly more male patients in the ankylosing spondylitis (AS) group than in the non-radiographic axial spondyloarthritis group (p&lt;0.01). Among the criteria sets, Calin criteria showed the best sensitivity (92.6%) while the Berlin criteria showed the best specificity (97.6%) in the detection of IBP patients. The new ASAS criteria for IBP compared to the two previous criteria sets did not show good sensitivity nor specificity (sensivity 80%, specificity 62%, LR+ 1.05 (0.90 – 1.22), LR- 0.52 (0.39 – 0.69), 95%CI).Conclusion:The Calin criteria set would be useful for epidemiological and clinical studies in DRC. The ASAS criteria set for IBP is not better than other criteria sets in the screening of IBP for Congolese patients with axSpA.

Impact of Ramadan diurnal intermittent fasting on rheumatic diseases.

Ramadan intermittent fasting is observed by Muslims from sunrise to sunset and alternated with moments of re-feeding. The aims of this study were to assess the impact of Ramadan fasting on rheumatoid arthritis (RA) and spondyloarthritis (SpA) activity and to assess its impact on chronic medications intake in patients with rheumatic diseases. This prospective monocentric study included patients with RA or SpA who fasted during Ramadan of 2019. The disease activity and the managing of chronic medications were assessed and compared between two visits: the first one 6months before starting Ramadan fasting and the second after fasting at least 7days. Fifty-six patients were included: 36 with RA (average age 57.5 ± 10.9years) and 20 with SpA (average age 47 ± 12.6years). In the RA group, the Disease Activity Scores (DAS) 28 ESR, and DAS 28 CRP decreased after fasting respectively from 4.3 ± 1.3 to 3.5 ± 1.4 (p < 0.001) and from 3.4 ± 1.2 to 2.9 ± 1.3 (p = 0.001). In the SpA group, Ankylosing Spondylitis Disease Activity Scores (ASDAS) ESR and ASDAS CRP decreased respectively from 2.3 ± 0.5 to 1.9 ± 0.7 (p = 0.039) and from 1.9 ± 0.5 to 1.8 ± 0.8 (p = 0.388). Fasting did not affect significantly either compliance with chronic medications or tolerance. Fasting can be a possible way to induce rapid improvement of rheumatic diseases activity. In addition, patients with a specific fear of drug intake during this period can be reassured, which will enhance the adherence to treatment. Key Points • Fasting during Ramadan, the ninth month of the Islamic calendar, consists of intermittent fasting observed from sunrise to sunset. • In this set of patients, beneficial effects of intermittent fasting were demonstrated on RA activity, but were less evident in patients with SpA despite a general trend towards improvement. • Fasting did not affect significantly either compliance with chronic medications or tolerance.

Osteomalation under the mask of spondyloarthritis

Objective. To demonstrate the possibility of having a spondyloarthritic mask of osteomalacia in patients of both sexes.Materials and methods. Two clinical cases of osteomalacia occurring under the mask of spondyloarthritis in patients treated at the Clinical Rheumatology Hospital of Saint-Petersburg, Russia, as well as similar cases described in the literature, were analyzed.Results. In the cases described, patients were diagnosed with a disease from the group of spondyloarthritis based on a number of individual symptoms, such as pain in the lower back and stiffness, as well as instrumental examination data. At the same time, with in-depth evaluation, the pain in the lower back did not did not met to the inflammatory pain ASAS criteria, and there were also no signs of general laboratory activity of the disease. The conventional therapy for spondyloarthritis was ineffective. With the re-evaluation of clinical, laboratory and instrumental data, the diagnosis was changed to osteomalacia. Appointment of adequate therapy with vitamin D after a review of the diagnosis resulted in both a regression of clinical symptoms and an improvement in laboratory parameters.Conclusions. If the patient has pain in the lower back, especially without clear signs of inflammatory, no signs of general laboratory activity, further examination is necessary to clarify possible osteomalacia. Spondyloarthritis should be only diagnosed in cases with the secondary nature of symptoms excluded.

P194 Risk factors of axial spondyloarthritis among inflammatory bowel disease patients

Abstract Background Spondyloarthritis (SpA) is the most common extraintestinal manifestation (EIM) in inflammatory bowel disease (IBD) patients. However, the delay for the diagnosis of SpA in IBD patients is still unacceptably long, and may be the main cause of impairment due to ankylosing spondylitis. The aim of this study was to identify predictors of axial SpA in IBD patients, in order to prevent complications. Methods We conducted a retrospective study between 2001 and 2018 including all IBD patients diagnosed with symptomatic axial Spondyloarthritis (SpA) (Group1) and non-SpA patients among IBD (Group2). Diagnosis of SpA was based on ASAS 2009 criteria and confirmed by rheumatologists. Medical data were collected then uni and multivariate statistical analysis (p significant if ≤0.05) were performed. Results Seventy-eight patients with mean age 38 ± 11 years and sex ratio H/F = 1.6 were included. There were 58 (74.4%) Crohn’s disease (CD) patients and twenty patients (25.6%) had ulcerative colitis (UC). The average duration of IBD in all patients was 89.7 ± 69.1 months. SpA group included 26 patients (33.3%), six of whom (23%) had a late-stage disease (ankylosis). Most of the SpA patients (53.8%) had their disease before IBD onset with an average delay of 52.5 ± 68 months between SpA diagnosis and IBD symptoms. In univariate analysis, factors associated with SpA in IBD patients were familial history of IBD (p = 0.025) and the type of IBD (39.7% in CD vs. 15% in UC; p = 0.04). Among CD patients’, structuring-type was significantly associated with SpA (p = 0.04). Multivariate analysis showed that familial history of IBD (OR = 0.17; IC95%; 0.03–0.93; p = 0.04) and CD (OR = 3.72; IC 95%; 0.98–14.15; p = 0.05) were independent risk factors of axial SpA during IBD. EIMs other than SpA were more frequent in group 1 than in group 2 such as peripheral arthropathies (19.2% vs. 8.3% respectively; p = 0.02), anterior uveitis (11.5% vs. 0% respectively; p = 0.01) and erythema nodosum (7.7% vs. 0% respectively; p = 0.04). Conclusion In conclusion, predictors of symptomatic axial SpA were familial history of IBD and CD with structuring behaviour. Early-stage diagnosis is important to avoid ankylosis, which is a major cause of handicap in younger patients.

Management of ankylosing spondylitis; present concepts and guidelines

Ankylosing spondylitis (AS) belongs to spondyloarthritis (SpA) group of inflammatory arthritis, which has common genetic, clinical, and radiological features. The management aims at improving the quality of life, long-term control of inflammation so as to prevent structural damage, preserve functional abilities, and maintain the social life of patients. Treatment strategies and modalities in inflammatory arthritis have tremendously improved in recent times. With the discovery of molecular mechanisms, a new series of targets involving the cytokines, cells, and intracellular signaling pathways have been explored. The introduction of tumor necrosis factor inhibitor drugs heralded a new era of therapeutics for SpA, especially AS. Recently, the licensing of secukinumab, an interleukin 17A inhibitor for the treatment of AS, has given a new pathway to look at. These new targets give us an opportunity to achieve disease remission in both AS and nonradiologic axial SpA. They have also opened up new horizon to look for different research strategies in achieving disease remission using biological drugs in early disease and in stratified manner. International societies have been regularly providing and updating the guidelines for the management of AS. In this review, we discuss the treatment of AS and future trends in the management.

Ultrasonographic Enthesis Evaluation in Patients with Recurrent Acute Anterior Uveitis with and without Spondyloarthropathy

Background: spondyloarthritis (SpA) is a group of chronic diseases recognized by arthritis and extraarticular lesions e.g. uveitis, enthesitis, dermatological affection. About 35% of SpA patients may present with recurrent attacks of acute anterior uveitis (AAU). Purpose: it was to detect whether patients with idiopathic recurrent AAU who were positive or negative for Human Leukocyte Antigen B27 (HLA–B27) had a frequency of enthesis lesions compared to that seen in patients with SpA. Patients and Methods: a prospective study of enthesis evident on musculoskeletal ultrasound examination was done on sixty patients and twenty controls, the eighty were categorized into 4 groups; group 1 included 20 patients with known SpA group 2 included 20 with recurrent AAU HLA–B27 positive and didn’t have SpA aspects group 3 included 20 with recurrent AAU HLA–B27 negative and didn’t have SpA and group 4 included 20 healthy controls. Using Madrid Sonography Enthesitis Index (MASEI) twelve enthesis locations were assessed in each participant. Results: a total of 960 entheses sites were examined by ultrasonography in all 80 participants. The MASEI cut-off limit of ≥18 points was 75%, 60%, 45%, and 10% of the participants in the 4 groups; respectively. The MASEI score was significantly higher in groups 1&2 than in groups 3&4. The differences between the two groups were statistically significant. Conclusion: a high percent of HLA–B27 positive patients with idiopathic recurrent AAU without characteristics of SpA have enthesis lesions with about percent to those seen in patients with known SpA.

Does vitamin D deficiency contribute to higher disease activity in patients with spondyloarthritis?

Introduction: This study aimed to compare serum vitamin D levels in Spondyloarthritis (SpA) patients and control group and to evaluate the associations between vitamin D and disease activity in SpA patients. Methodology: In this study, 86 SpA patients according to the International Criteria and 117 age and sex-matched healthy controls were included. In patients, clinical examination was performed and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were recorded. Serum 25(OH)D3 concentration was measured using ELISA kit. Results: Serum 25(OH)D3 levels in SpA patients were significantly lower than healthy controls (p < 0.001). Vitamin D deficiency and insufficiency frequency in the SpA group was significantly more than control group (p < 0.001). No significant difference was observed in the activity of SpA in different serum levels of 25(OH)D. Also, no significant correlations were observed between serum 25(OH)D3 with clinical findings as well as with BASDAI and BASFI (P > 0.05). Discussion and conclusion: Although our study revealed lower serum 25(OH)D3 levels in SpA patients compared to healthy controls, there were not any significant correlations between its serum levels with severity of disease. However, correction of vitamin D status may be beneficial in controlling inflammation and disease activity.

Spondyloarthritis: modern terminology and definitions

At the first stage of the work, the terms divided into two categories: "outdated" definitions and terms that need to be improved or unified. Subsequently, each member of the Expert Group of Spondyloarthritis at the Association of Rheumatologists of Russia (ExSpA) presented by its own definition of the designated term or agreed with the previous term. At the next stage, the existing definitions were put together. After discussion, experts left a term that scored at least 2/3 of the votes. The special opinion of experts was recorded, whose did not coincide with the majority opinion. An open vote was conducted, when defining an "outdated" term with the unanimous decision of all group members, this term was not recommended for further clinical use. The work carried out allowed us to identify a number of terms that are not recommended for use in clinical practice. Number of terms are defined, which should be used when discussing the problem of spondyloarthritis. The Expert Group of Spondyloarthritis at the Association of Rheumatologists of Russia suggests using or, accordingly, not using a number of terms and their definitions in clinical practice.

Микробиом кишечника и спондилоартриты

The range of causal combinations of various types of intestinal lesions and spondyloarthritis (SpA) is extremely wide: from subclinical pathology to manifest manifestations of Crohn’s disease and ulcerative colitis. In studies of the last decade it is assumed that not only inflammatory bowel diseases (IBD), psoriasis, but also SpA are diseases with activated innate immunity, which provides an early non-specific response mediated by the barrier function of the epithelium. Modern data on the cellular and molecular mechanisms of SpA pathogenesis allow rheumatologists to hypothesize the concept of a “barrier organ disease” as the preclinical stage of development of diseases belonging to the SpA group, which is based on impaired immune tolerance to autologous synanthropic microflora in genetically predisposed individuals.Key words: microbiome; spondyloarthritis; inflammatory bowel disease, pathogenesis

Sex Differences in Response to TNF-Inhibiting Drugs in Patients With Spondyloarthropathies or Inflammatory Bowel Diseases.

Spondyloarthritis (SpA) and inflammatory bowel diseases (IBD) are chronic inflammatory diseases characterized by an aberrant immune response and inflammation with a key role for TNF in their pathogenesis. Accordingly, TNF-inhibiting therapy (TNFi) has dramatically improved the management of these diseases. However, about 30% of patients discontinue TNFi for lack of response, loss of response, and side effects and/or adverse events. Thus, the possibility to identify in advance those patients who will have a good response to TNFi would be extremely beneficial. The aim of this study was to investigate differences between males and females with either SpA or IBD in response to TNFi molecules, i.e., infliximab (IFX) and adalimumab (ADA), considering the reasons for TNFi withdraw. Data of 594 patients, 349 with IBD (M/F: 194/155) and 245 with SpA (M/F: 123/122), previously unexposed to TNFi, were collected. In the IBD group, the rate of female patients discontinuing ADA was significantly higher than that of male patients (p = 0.03). No difference emerged according to the distribution of reason for discontinuation. Otherwise, a similar discontinuation rate between female and male patients receiving IFX therapy was observed. In the SpA group, the overall discontinuation rate was not different between males and females both for ADA and IFX. However, in patients treated with ADA, males interrupted therapy more frequently than females due to lack of response (p = 0.03). In conclusion, the assessment of sex differences in TNFi response could help physicians personalize the therapeutic approach in a sex-oriented perspective.

Features of the course of anterior uveitis associated with HLA-B27 antigen

To perform comparative analysis of the frequency of various complications of anterior uveitis associated with HLA-B27 antigen in patients with and without spondyloarthritis. Retrospective analysis included 189 patients with anterior uveitis (AU) associated with histocompatibility antigen (HLA-B27). The Follow-up period lasted 10 years. 189 patients with AU associated with antigen HLA-B27 were divided into two groups. The first group included 108 patients with various diseases of the spondyloarthritis (SpA) group; the second study group consisted of 81 patient with no signs of SpA. Number of patients with complications was 1.5 times higher in the first group. Complicated cataract, glaucoma, synechiae, myodesopsia occurred significantly more frequently in patients of the first group compared to AU patients of the second group, where idiopathic AU was more prevalent. Cystoid macular edema, corneal degeneration, optic nerve atrophy were observed more often in patients with SpA, but differences between the groups were statistically insignificant. Combination of complications also occurred significantly more often in SpA patients. Comparison of the frequency of AU attacks showed that the amount of uveitis attacks per 100 patient-years was higher in patients with SpA. Mean number of AU attacks per year was also higher in the first study group, but differences between the groups were statistically insignificant. Retrospective analysis of 189 patients with AU associated with HLA-B27 antigen revealed significantly higher frequency of complications, together with more frequent acute episodes in patients with SpA in comparison with patients without it confirming the notion that a systemic inflammatory disease can influence the severity of the course of AU.

Characterization of Patients With Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis in the US-Based Corrona Registry.

ObjectiveTo describe the characteristics of patients with ankylosing spondylitis (AS) and patients with nonradiographic axial spondyloarthritis (SpA) in the US.MethodsDemographics, clinical characteristics, patient‐reported outcomes, and treatment characteristics of patients with AS and those with nonradiographic axial SpA were assessed at the time of enrollment in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. Patients with AS were defined as those who fulfilled the 1984 modified New York criteria for AS; patients with nonradiographic axial SpA were defined as all other patients with axial SpA who did not fulfill the radiology criterion.ResultsOf the 407 patients with a diagnosis of axial SpA who were included in this study, 310 had AS, and 97 had nonradiographic axial SpA. Although patients with nonradiographic axial SpA were younger and showed a trend toward a shorter symptom duration, the nonradiographic axial SpA and AS groups shared a similar disease burden, as reflected by comparisons of disease activity and function, quality of life, pain, fatigue, job absenteeism, and loss of work productivity (all P > 0.05). The proportions of patients with nonradiographic axial SpA and patients with AS who received prior biologic disease‐modifying drugs (DMARDs) (74.2% and 64.8%, respectively) or were currently receiving biologic DMARDs (63.9% and 61.3%, respectively) were also similar (P > 0.05).ConclusionThis was the first nationwide study to characterize patients with AS and nonradiographic axial SpA in the US. Consistent with studies published outside of the US, this study showed that patients with nonradiographic axial SpA and patients with AS shared a comparable degree of disease burden and had similar treatment patterns in clinical practice.

Postpartum Bone Marrow Edema at the Sacroiliac Joints May Mimic Sacroiliitis of Axial Spondyloarthritis on MRI

The objective of our study was to compare MRI findings in the sacroiliac joints of postpartum women (as a model of mechanical changes) and women with known axial spondyloarthritis (as an inflammatory model). For this prospective multicenter age-matched, case-control study, sacroiliac joint MRI examinations of 30 healthy women (mean age, 34.0 years) in the early postpartum period (mechanical group) and 30 age-matched women (mean age, 33.8 years) with known axial spondyloarthritis (retrospective inflammatory group) were compared. Blinded to clinical information, readers assessed MR images using the following scoring systems: Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index, Berlin method, Assessment of Spondyloarthritis International Society (ASAS) criteria, and SPARCC MRI structural score. Descriptive statistics as percentages of the different findings (i.e., bone marrow edema [BME], erosion, fatty bone marrow replacement, backfill, ankylosis) and scores between groups and between delivery modes were compared. In the postpartum group, 63.3% (19/30) of women showed BME around the sacroiliac joints compared with 86.7% (26/30) of women in the spondyloarthritis group (based on ASAS criteria). Erosions were uncommon in the postpartum group (10.0% [3/30] postpartum vs 56.7% [17/30] spondyloarthritis). Fatty bone marrow replacement, backfill, and ankylosis were not seen in the postpartum group. In subjects with positive MRI findings for sacroiliitis based on ASAS criteria, the SPARCC MRI index (mean ± SD, 13.6 ± 14.5 vs 13.0 ± 10.7; p = 0.818) and Berlin method (4.5 ± 3.0 and 5.5 ± 3.5, p = 0.378) were not different between the postpartum and spondyloarthritis groups. Scores were not different between birth modalities. Pregnancy-induced BME at the sacroiliac joints, as a result of prolonged mechanical stress, was present in 63.3% of women who underwent MRI during the early postpartum period and may mimic sacroiliitis of axial spondyloarthritis.

Clinical Associations of Uveitis in Axial Spondyloarthritis Group and Ankylosing Spondylitis Group: Do They Represent the Same Disease?

The aim of this study was to determine the prevalence and associated factors for uveitis in ethnic Chinese patients with axial spondyloarthritis (SpA) and ankylosing spondylitis (AS). This was a cross-sectional study. Patients fulfilling the Assessment of SpondyloArthritis international Society axial SpA criteria were recruited consecutively from 3 rheumatology centers in Hong Kong from March 2014 to July 2017. Clinical and biochemical parameters were collected. History of uveitis was inquired from both history and medical records. All patients received lumbosacral spine x-rays and whole-spine and sacroiliac joint magnetic resonance imaging. Patients were defined as axial SpA if they fulfilled the Assessment of SpondyloArthritis international Society criteria and AS if they fulfilled the modified New York criteria. Clinical and radiological findings were compared between patients with and without uveitis in the 2 groups. Factors associated with uveitis were identified with univariate analyses and multivariate logistic regression analyses. Among 252 patients, 67 patients (26.6%) had a history of uveitis. The male-to-female ratio was 55.4 to 44.6. Disease duration was 12.3 ± 11.7 years. In the axial SpA group, multivariate regression showed that older age (odds ratio [OR], 1.05; p = 0.01), human leukocyte antigen B27 positivity (OR, 11.79; p = 0.01), and history of inflammatory bowel disease (OR, 9.74; p = 0.04) were positively associated with uveitis. In the AS group, multivariate regression showed that back pain duration (OR, 1.05; p = 0.01) and male sex (OR, 3.46; p = 0.03) were associated with uveitis. Axial SpA represents a spectrum of diseases. Its clinical associations with uveitis should be distinguished from those of traditional AS.

Advances in the treatment of uveitis in patients with spondyloarthritis - is it the time for biologic therapy?

Spondyloarthritis (SpA) is a heterogeneous group of diseases that includes ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), inflammatory bowel disease-associated spondyloarthritis (IBD-SpA), and undifferentiated spondyloarthritis (unSpA). This group of diseases shares several clinical, imaging, and genetic features; the integration of these diseases in the group of SpA is needed for an early diagnosis and a prompt treatment. Uveitis is the most common extra-articular manifestation of SpA. HLA-B27-associated acute anterior uveitis (AAU) is the most frequent form of uveitis encountered in the SpA group. The general prevalence of HLA-B27-associated AAU in the group of SpA is about 30% and the general prevalence of SpA in patients with HLA-B27-associated AAU is over 50%. There are several differences in the clinical picture and evolution of HLA-B27-associated AAU in patients with SpA and knowing this is very important for the best therapeutic decision. Tumor necrosis factor α (TNFα) is a very important mediator not only in the pathogenic mechanisms of SpA, but also in the immune reactions that characterize HLA-B27-associated AAU in SpA. There is much evidence of the role of TNFα in SpA and HLA-B27-associated AAU, multiple studies showing efficacy of anti-TNFα drugs not only on rheumatic manifestations but also on ocular involvement. Conventional therapy of HLA-B27-associated AAU with local or systemic glucocorticoids and immunosuppressive drugs (sulfasalazine, methotrexate, azathioprine, etc.) in order to diminish the ocular inflammation is associated with many side effects, some of them being very severe and even life threatening. Therefore, new treatments, especially biologic therapy with anti-TNFα drugs, open a new opportunity for the treatment of these patients. It is very important to emphasize that antibody anti-TNFα agents (infliximab, adalimumab, golimumab) may be more efficient than soluble receptors of TNFα (etanercept) in decreasing the risk of HLA-B27-associated AAU in patients with SpA. The aim of this review made by a group of ophthalmologists and rheumatologists with recent and fruitful experience regarding the anti-TNF treatment of uveitis in patients with SpA is to make the community of ophthalmologists aware of this biologic therapy and that it is the right time to use it. Abbreviations: AU = anterior uveitis; AAU = acute anterior uveitis; AS = ankylosing spondylitis; ASAS = Assessment of SpondyloArthritis Society; DBP = vitamin D binding protein; ESSG = European Spondyloarthropathy Study Group; HLA-B27 = human leukocyte antigen B27; IBD = inflammatory bowel disease; PsA = psoriatic arthritis; ReA = reactive arthritis; SpA = spondyloarthritis; TLRs = Toll-like receptors; TNFα = tumor necrosis factor α; unSpA = undifferentiated spondyloarthritis.

Histocompatibility HLA class I in anterior uveitis patients with and without spondyloarthritis

Anterior uveitis (AU) and ankylosing spondylitis (AS) are associated with histocompatibility human leukocyte antigen (HLA)-B27. Previous genetic studies conducted in different populations have also demonstrated other genetic associations, including HLA, both general and individual ones for AU and AS. Objective: to investigate the association of HLA class I with AU depending on the presence or absence of spondyloarthritis (SpA). Patients and methods . The investigators used the data of HLA class I typing in the patients referred by ophthalmologists for examination to the V.A. Nasonova Research Institute of Rheumatology, as well as the previous databases of patients with AS. The investigation included retrospectively two groups of patients with AU: 1) 52 patients with a confirmed diagnosis of SpA (AU + SpA); 2) 96 patients who had other types of AU (idiopathic AU (n=52), viral uveitis (n=29), multiple sclerosis (n=2) toxoplasmosis (n=2), sarcoidosis (n=1), tuberculosis (n=1), chlamydiasis (n=3), Behcet's disease (n=2), juvenile chronic arthritis (n=3), and Fuchs' heterochromic cyclitis (n=1). A control group consisted of 150 healthy test donors. The distribution of HLA class I (A, B, and Cw) was analyzed when comparing the two groups of patients with AU and each control patient group. Results. HLA-B27 was detected in 96.1% of cases in the AU + SpA group, in 40.6% in the AU group, and in 7.3% in the controls. In HLA-27-positive patients, the risk (odds ratio (OR) for joint disease (AU + SpA) was 315.9 (95% confidence interval (CI), 61.9–2176.7); p&lt;0.0000001; the risk for AU was 8.7 (95% CI, 3.9–19.4); p&lt;0.000001. The HLA-C-locus antigens showed a high incidence of Cw2 antigen in patients with AU + SpA and in those with AU compared to the controls (64.0, 36.3, and 10.0%, respectively): AU + SpA versus the controls (p&lt;0.000001), AU versus the controls (p&lt;0.00001). In the two groups of patients with a high HLA-B27 frequency, this substantially higher rate of Cw2 antigen carriage was natural due to the non-equilibrium coupling phenomenon, including that for B27 and Cw2 antigens. The rate of Cw7 antigen was significantly lower in the AU + SpA group versus the controls: 12.8 and 38.7% (p=0.002). In the group of AU patients without SpA, the rate of this antigen did not differ significantly from that in the control and AU + SpA groups. Conclusion. The analysis of the distribution of HLA class I confirmed the association of B27 antigen with AU in the Russian population. There were no associations with other antigens other than Cw2. Cw7 antigen can play a protective role against SpA, since the frequency of this gene was not lower in AU patients compared to the controls.

Relationship between monocytes to lymphocytes ratio and axial spondyloarthritis

BackgroundAxial spondyloarthritis (axSpA) is a progressive, chronic, inflammatory skeletal disorder affecting the spine and sacroiliac joints. Many studies have shown that neutrophils, lymphocytes, monocytes, platelets, and red blood cells (RBCs) play important roles in the inflammatory process of axSpA. Neutrophils to lymphocytes ratio (NLR) and red blood cell distribution width (RDW) have been reported to be simple and inexpensive markers to indicate the disease activity of axSpA. However, the role of monocytes to lymphocytes ratio (MLR) and platelets to lymphocytes ratio (PLR) in axSpA was rarely mentioned. ObjectiveThe study's aim was to determine the role of MLR and PLR in axSpA patients and to investigate their relationships with disease severity. MethodsAxSpA patients who fulfilled the Assessment in Ankylosing Spondylitis International Society classification criteria published in 2009 were enrolled in this study and divided into nonradiographic axial spondyloarthritis (nr-axSpA) group and ankylosing spondylitis (AS) group. Healthy age and gender-matched subjects were also enrolled as control group. MLR, PLR, NLR, RDW, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) level were assessed. The correlation between the variables with finger-to-floor distance, Modified Schober test, and occiput-to-wall distance were tested with Pearson correlation. Furthermore, area under curve (AUC) value, sensitivity, specificity, and the optimal cutoff values were determined using receiver operating characteristic (ROC) curves. ResultsA total of 148 axSpA patients (67 nr-axSpA patients and 81 AS patients) and 58 healthy subjects were included in the study. The MLR, NLR, PLR, and RDW in axSpA group were higher than those in the control group (P < 0.05). Among them, MLR and RDW were highly increased in AS group compared with the nr-axSpA group (P < 0.05). MLR, NLR, PLR, and RDW were all positively correlated with ESR level and CRP level (P < 0.05). MLR and RDW were positively correlated with finger-to-floor distance and negatively correlated with Modified Schober test (P < 0.05). RDW was positively correlated with occiput-to-wall distance (P < 0.05). ROC curve results showed MLR yielded a higher AUC than NLR, PLR, and RDW (P < 0.05). In addition, the optimal cutoff value of MLR for axSpA was 0.22, with a specificity of 70.9% and sensitivity of 68.4%. ConclusionsMLR was elevated in AS patients compared to nr-axSpA patients and had a close relationship with CRP level, ESR level, and spine movements. MLR may be a reliable, cost-effective, and novel potential parameter to evaluate disease severity in axSpA.