Spondyloarthritis Group Research Articles

The distinctive characteristics of ultrasonic imaging of enthesitis in spondyloarthritis patients

To explore the distinctive ultrasonographic characters of enthesitis in patients with spondyloarthritis (SpA) and evaluate the diagnostic value of ultrasonography in SpA by comparing ultrasonography of enthesis in the lower limbs of patients with SpA, rheumatoid arthritis (RA) and osteoarthritis (OA). Entheses in the lower limbs (quadriceps tendon, proximal patellar ligament, distal patellar ligament, achilles tendon and plantar aponeurosis) were detected in SpA, RA, OA patients and health controls by ultrasonographic examination. A total of 46 SpA, 23 RA and 12 OA patients were enrolled in this study, with 26 SpA and 7 RA patients complaining of heel pain (P<0.05). There were 126 enthesal sites (126/460, 27.2%) were detected abnormal in SpA group, compared with 54 of 230 (23.5%) sites in RA group and 27 of 120 (22.5%) sites in OA group (P>0.05). Sixty five (70.7%) sites of the distal patellar ligaments were abnormal in SpA group, while that were 19 (41.3%) in RA group (P<0.05) and 13 (54.2%) in OA group. Twenty six sites of tendon thickness and 22 sites of bone erosion in the distal patellar ligaments were found in SpA group, while only one site of each in RA group (P<0.05) and 4 sites of tendon thickness in OA group (P<0.05) were found.Tendon thickness, bursal synovitis and bone erosion coexisting in one distal patellar ligament indicated SpA, the sensitivity, specificity and the area under the curve (AUC) of which were 70.7%, 65.5% and 0.740, respectively. Tendon thickness and bone erosion of entheses were more likely the distinctive ultrasonographic characters of enthesitis in SpA patients. Tendon thickness, bursal synovitis and bone erosion in the distal patellar ligament could be an ideal tool for SpA diagnosis.

PSORIATIC ARTHRITIS: CLASSIFICATION, CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT

The lecture gives basic information about psoriatic arthritis (PsA), a chronic inflammatory disease of the joints, spine, and enthesises from a group of spondyloarthritis. It describes the epidemiology of the disease and considers current ideas on its pathogenesis and factors influencing the development of PsA in psoriatic patients. The classification and clinical forms of PsA are presented. The major clinical manifestations of the disease are indicated to include peripheral arthritis, enthesitis, dactylitis, and spondylitis. The diagnosis of the disease is noted to be established on the basis of its detected typical clinical and radiological signs, by applying the CASPAR criteria. A dermatologist, rheumatologist, and general practitioner screen PsA, by actively detecting complaints, characteristic clinical and radiological signs of damage to the joints, and/or spine, and/or enthesises and by using screening questionnaires. There are data that patients with PsA are observed to be at higher risk for a number of diseases type 2 diabetes mellitus hypertension, coronary heart disease, obesity, metabolic syndrome, inflammatory bowel diseases, etc. The aim of current pharmacotherapy for PsA is to achieve remission or minimal activity of clinical manifestations of the disease, to delay or prevent its X-ray progression, to increase survival, to improve quality of life in patients, and to reduce the risk of comorbidities. The paper considers groups of medicines used to treat the disease, among other issues, information about biological agents (BA) registered in the Russian Federation for the treatment of PsA. Most patients are mentioned to show a good response to this therapy option just 3–6 months after treatment initiation; however, some of them develop primary inefficiency. In this case, switching one BA to another is recommended. Some patients using a BA develop secondary treatment inefficiency, which is firstly due to the appearance of neutralizing antibodies and to the decrease of blood drug concentrations. Concurrent methotrexate therapy is noted to improve adherence to BA therapy in patients with PsA.

Prevalence of spondyloarthritis symptom in inflammatory bowel disease patients: A questionnaire survey

Objectives. We clarified the prevalence of spondyloarthritis (SpA) symptom in inflammatory bowel disease (IBD).Methods. We performed the questionnaire survey of SpA symptom in IBD patients on their office visit.Results. One hundred and thirty seven patients were evaluated. The SpA features group included 46 (33.6%) patients (32 Men). Among them there were 22 Crohn's disease (CD) patients and 24 ulcerative colitis (UC) patients. The patients had a mean age of 48.3 years with a mean disease duration of 12.3 years. Non-SpA group (66.4%) included 91 patients (49 Men). Among them there were 27 CD patients and 64 UC patients. The patients had a mean age of 43.3 years with a mean disease duration of 9.2 years. In univariate analysis, the SpA group (33.6%) had longer disease duration than non-SpA group (p < 0.05). However, age at onset and sex were not significantly different among the groups. Multivariate analysis showed that disease duration was independently associated with SpA symptom (OR, 1.05; 95% CI, 1–1.09; p = 0.036).Conclusions. The prevalence of SpA symptom was relatively higher than what we had expected. Physicians should consider SpA when they observe IBD patients with arthralgia, and refer them to an appropriate department if needed.

Nonradiographic axial spondyloarthritis background and confounding factors of this new terminology: an appraisal.

The advent of biologic therapy in the treatment of rheumatic diseases has intensified the need to further define and characterize spondyloarthritis (SpA). There has been a long debate over nomenclature of the SpA subtypes. There are those who are considered "lumpers," favoring the notion that different entities of the SpA groups are manifestations of the same disease, and "splitters," those who believe the different SpA groups represent separate diseases with shared clinical features. The influential work by Moll et al. has led to separation of entities and recognition of etiological processes of SpA subtypes. Among these subtypes has emerged nonradiographic axial spondyloarthritis (nr-axSpA), which is believed to be either an early form of ankylosing spondylitis (AS) or perhaps a different disease entity altogether. Recently attention has shifted to the characterization of early SpA, with special emphasis on nonradiographic axial SpA. The Assessment of Spondyloarthritis International Society (ASAS) has developed new criteria for the classification of this disease entity. Along with the advent of these criteria have come several unanswered questions. Although data suggests that nr-axSpA will evolve into AS over time, the natural evolution of disease is still undetermined since a proportion of cases do not progress. A number of questions also remain regarding features of patients with AS compared to those with nonradiographic disease. This appraisal highlights the differences in disease characteristics between men and women in regards to measures of disease activity, inflammatory markers, and radiologic findings. Recent studies also suggest fibromyalgia as a potential confounding factor in assessing disease activity and establishing a diagnosis of axSpA in the female population. Nonradiographic axial SpA is a relevant disease subgroup of axial SpA, and several questions have been left unanswered with more research needed regarding diagnosis (particularly in women), treatment, and long-term disease course.

Anti-tumor necrosis factor drug survival in axial spondyloarthritis is independent of the classification criteria.

To compare the impact of meeting specific classification criteria [modified New York (mNY), European Spondyloarthropathy Study Group (ESSG), and Assessment of SpondyloArthritis international Society (ASAS) criteria] on anti-tumor necrosis factor (anti-TNF) drug retention, and to determine predictive factors of better drug survival. All patients fulfilling the ESSG criteria for axial spondyloarthritis (SpA) with available data on the axial ASAS and mNY criteria, and who had received at least one anti-TNF treatment were retrospectively retrieved in a single academic institution in Switzerland. Drug retention was computed using survival analysis (Kaplan-Meier), adjusted for potential confounders. Of the 137 patients classified as having axial SpA using the ESSG criteria, 112 also met the ASAS axial SpA criteria, and 77 fulfilled the mNY criteria. Drug retention rates at 12 and 24 months for the first biologic therapy were not significantly different between the diagnostic groups. Only the small ASAS non-classified axial SpA group (25 patients) showed a nonsignificant trend toward shorter drug survival. Elevated CRP level, but not the presence of bone marrow edema on magnetic resonance imaging (MRI) scans, was associated with significantly better drug retention (OR 7.9, ICR 4-14). In this cohort, anti-TNF drug survival was independent of the classification criteria. Elevated CRP level, but not positive MRI, was associated with better drug retention.

THU0154 Biomarker Sets PREDICT Therapeutic Response to Tnf-Inhibitors in Rheumatoid Arthritis and Spondyloarthritis Patients: A Theragnostic Approach in A Multicenter Cohort

BackgroundTNF inhibitors (TNFi) are first-line treatments for patients suffering from rheumatoid arthritis (RA) and spondyloarthritis (SpA). However, it is currently impossible to predict response to Infliximab (IFX), Adalimumab (ADA) or...

THU0296 Influenza and Pneumococcal Vaccination in Patients on Biotherapies. A Report on 594 Patients from Four Hospitals

ObjectivesTo evaluate pneumococcal (PV) and influenza (IV) vaccination status in patients (pts) on biotherapies by researching influencing factors.MethodsPts on biotherapies seen between February and July 2013 were questioned about PV...

The classification and diagnostic criteria of ankylosing spondylitis

Ankylosing spondylitis is the prototype of immune-mediated inflammatory rheumatic diseases grouped under the term spondyloarthritis (SpA). An early diagnosis has now become increasingly important because effective therapies are available and anti-TNF drugs are even more effective if used in early stages of the disease. In ankylosing spondylitis, the 1984 modified New York criteria have been used widely in clinical studies and daily practice but are not applicable in early disease when the characteristic radiographic signs of sacroiliitis are not visible but active sacroiliitis is readily detectable by magnetic resonance imaging (MRI). Thus there has been a need for new classification or diagnostic criteria to identify inflammatory spondyloarthritis at early stage of the disease. This led to the concept of axial SpA to include the entire spectrum of patients with axial disease both, with and without radiographic damage. New classification criteria for the wider group of SpA have been proposed by ASAS (Assessment of Spondylo Arthritis International Society); and the patients are sub-grouped into (1) a predominantly axial disease, termed axial SpA including AS and non-radiographic axial SpA; (2) peripheral SpA. The clinical course and disease process of non-radiographic axial spondyloarthritis remains unclear. However the development of the SpA criteria by ASAS particularly for axial SpA, is an important step for early diagnosis and better management of these patients.

PReS-FINAL-2168: Comparison of safety and retention rate of TNF antagonist therapy in juvenile-onset and adult-onset ankylosing spondylitis: data from the spanish registry biobadaser 2.0

Ankylosing spondylitis (AS) is a chronic inflammatory disease that belongs to the group of spondyloarthritis, which involves the spine, peripheral joints and entheses. Juvenile-onset AS affects children under the age of 16 years and present a clinical course different from adult-onset AS. Several randomized clinical trials have shown that TNF antagonists are an effective alternative treatment in adult-onset AS. Similar results have been reported in juvenile-onset AS, but have been fewer studies conducted in this group of patients.

Enteropathic arthritis in Brazil: data from the Brazilian registry of spondyloarthritis

Inflammatory bowel diseases (Crohn's disease and ulcerative rectocolitis) have extraint- estinal manifestations 25% of the patients, with the most common one being the entero- pathic arthritis. MethodsProspective, observational, multicenter study with patients from 29 reference cen- ters participating in the Brazilian Registry of Spondyloarthritis (RBE), which incorporates the RESPONDIA (Ibero-American Registry of Spondyloarthritis) group. Demographic and clinical data were collected from 1472 patients and standardized questionnaires for the as- sessment of axial mobility, quality of life, enthesitic involvement, disease activity and func- tional capacity were applied. Laboratory and radiographic examinations were performed. The aim of this study is to compare the clinical, epidemiological, genetic, imaging, treat- ment and prognosis characteristics of patients with enteropathic arthritis with other types of spondyloarthritis in a large Brazilian cohort. ResultsA total of 3.2% of patients were classified as having enteroarthritis, 2.5% had spon- dylitis and 0.7%, arthritis (peripheral predominance). The subgroup of individuals with en- teroarthritis had a higher prevalence in women (P < 0.001), lower incidence of inflammatory axial pain (P < 0.001) and enthesitis (P = 0.004). HLA-B27 was less frequent in the group with enteroarthritis (P = 0.001), even when considering only those with the pure axial form. There was a lower prevalence of radiographic sacroiliitis (P = 0.009) and lower radiographic score (BASRI) (P = 0.006) when compared to patients with other types of spondyloarthritis. They also used more corticosteroids (P < 0.001) and sulfasalazine (P < 0.001) and less non- steroidal anti-inflammatory drugs (P < 0.001) and methotrexate (P = 0.001). ConclusionThere were differences between patients with enteroarthritis and other types of spondyloarthritis, especially higher prevalence of females, lower frequency of HLA-B27, associated with less severe axial involvement.

Artrite enteropática no Brasil: dados do registro brasileiro de espondiloartrites

Inflammatory bowel diseases (Crohn's disease and ulcerative rectocolitis) have extraint- estinal manifestations 25% of the patients, with the most common one being the entero- pathic arthritis. MethodsProspective, observational, multicenter study with patients from 29 reference cen- ters participating in the Brazilian Registry of Spondyloarthritis (RBE), which incorporates the RESPONDIA (Ibero-American Registry of Spondyloarthritis) group. Demographic and clinical data were collected from 1472 patients and standardized questionnaires for the as- sessment of axial mobility, quality of life, enthesitic involvement, disease activity and func- tional capacity were applied. Laboratory and radiographic examinations were performed. The aim of this study is to compare the clinical, epidemiological, genetic, imaging, treat- ment and prognosis characteristics of patients with enteropathic arthritis with other types of spondyloarthritis in a large Brazilian cohort. ResultsA total of 3.2% of patients were classified as having enteroarthritis, 2.5% had spon- dylitis and 0.7%, arthritis (peripheral predominance). The subgroup of individuals with en- teroarthritis had a higher prevalence in women (P < 0.001), lower incidence of inflammatory axial pain (P < 0.001) and enthesitis (P = 0.004). HLA-B27 was less frequent in the group with enteroarthritis (P = 0.001), even when considering only those with the pure axial form. There was a lower prevalence of radiographic sacroiliitis (P = 0.009) and lower radiographic score (BASRI) (P = 0.006) when compared to patients with other types of spondyloarthritis. They also used more corticosteroids (P < 0.001) and sulfasalazine (P < 0.001) and less non-steroidal anti-inflammatory drugs (P < 0.001) and methotrexate (P = 0.001). ConclusionThere were differences between patients with enteroarthritis and other types of spondyloarthritis, especially higher prevalence of females, lower frequency of HLA-B27, associated with less severe axial involvement.

SAT0262 Comorbidities Associated with Psoriatic Arthritis - A Longitudinal Observational Cohort Study.

BackgroundPsoriasis and Psoariatic arthritis (PsA) are chronic inflammatory diseases associated with other health concerns such as obesity, type II diabetes, dyslipidemia, hypertension and cardiovascular diseases. This association can be due...

AB0906 Prevalence and characteristics of coronary disease and cardiovascular risk factors in a cohort of patients with spondyloarthropathies and biologic therapy

BackgroundWe performed a descriptive study of our patients with spondyloarthropathies (SpA) in biologic therapy attending to the presence of coronary disease and cardiovascular risk factors.MethodsPatients with spondyloarthropathies and anti-TNF treatment...

FRI0463 Factors associated with anxiety and depression in spondyloarthritis patients: results from the swedish population based spa scania cohort

BackgroundAnxiety and depression are more common among patients with rheumatic diseases and can influence treatment options and outcome. However insight in factors associated with anxiety and depression in patients with...

FRI0460 Differences and similarities of spondyloarthritis classification subgroups defined by the assessment of spondyloarthritis international society (ASAS)

BackgroundSince the Assessment of SpondyloArthritis international Society (ASAS) developed new classification criteria, spondyloarthritis (SpA) is no longer divided into different phenotypic subtypes such as ankylosing spondylitis and psoriatic arthritis, but...

THU0508 Incidence of Inflammatory Joint Diseases in Northern Savo Area in Finland in 2010

BackgroundMonitoring of the incidence of inflammatory joint diseases may provide new insight into the etiology of these diseases.ObjectivesAll rheumatologists practising in the Northern Savo rheumatological outpatient departments collected data on...

OP0097 Cigarette smoking predicts radiographic progression in the spine in patients with axial spondyloarthritis in a dose-dependent manner

BackgroundCigarette smoking has been associated with functional impairment [1, 2] and radiographic severity of ankylosing spondylitis (AS) [3, 4]. Moreover, smoking status at baseline was found recently to be an...

AB0547 Bone mineral density (bmd) assessment in patients with symptoms suggestive of spondyloarthritis: an accurate tool for diagnosis

BackgroundSeveral diseases can mimick spondyloarthritis (SpA) symptoms. Patients may be overdiagnosed in the presence of HLA B27. Patients with spondyloarthritis (SpA) have an increased risk of osteoporosis which can be...

SAT0253 Patients With Non-As Axial SPA Have Similar Prevalence Compared to as, But Worse Perceived Health. Results from a Population Based Study.

BackgroundNon-radiographic axial spondyloarthritis (SpA) is emerging as a treatable disease comparable to ankylosing spondylitis (AS), but less well studied. Previous studies have described a reversed gender distribution, with AS being...

AB0865 Frequency of fibromyalgia in patients with spondyloarthritis

BackgroundThe occurrence of fibromyalgia (FM) with other rheumatologic diseases has been estimated with the following frequencies; Psoriatic arthritis 24%, rheumatoid arthritis 25%, systemic lupus erythematosus 30% and Chron’s disease 49%....