Spondyloarthritis In Clinical Practice Research Articles

Natural language processing to identify and characterize spondyloarthritis in clinical practice

ObjectiveThis study aims to use a novel technology based on natural language processing (NLP) to extract clinical information from electronic health records (EHRs) to characterise the clinical profile of patients...

How to Monitor Disease Activity of Axial Spondyloarthritis in Clinical Practice.

Treatment guided by periodic and quantitative data assessment results in better outcomes compared to using clinical gestalt. While validated generic as well as specific disease activity measures for axial spondyloarthritis (axSpA) are available, there is vast scope to improve their actual utilization in routine clinical practice. In this review, we discuss available disease activity measures for axSpA, describe results from the survey conducted among general rheumatologists as well as Spondyloarthritis Research and Treatment Network (SPARTAN) members about disease activity measurement in daily practice, and discuss ways to improve axSpA disease activity using technological advances. We also discuss the definitions of active disease and target for the treatment of axSpA. The 2019 American College of Rheumatology (ACR)/Spondylitis Association of America (SAA)/Spondyloarthritis Research and Treatment Network (SPARTAN) axSpA treatment guidelines conditionally recommend the regular monitoring of disease activity using a validated measure such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) or Ankylosing Spondylitis Disease Severity Index (ASDAS). Assessment of Spondyloarthritis International Society (ASAS)-European Alliance of Associations for Rheumatology (EULAR) guidelines recommend ASDAS as the most appropriate instrument for the assessment of disease activity, preferably calculated using C-reactive protein (CRP). ASAS has selected a core set of variables which were updated recently and have been endorsed by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group in order to bring homogeneity in assessment of axSpA. In a recent study, Patient-Reported Outcomes Measurement Information System (PROMIS®) measures were able to discriminate inactive, moderate, and high-very high ASDAS activity groups. A newly developed semi-objective index P4 (pain, physical function, patient global, and physician global) correlates well with BASDAI and ASDAS in axSpA and can also be used for other rheumatic diseases in busy clinical practices. Regular disease activity monitoring is critical for long-term management of axSpA and shared decision-making. The integration of electronic health records and smart devices provides a great opportunity to capture patient-reported data. Automated capture of electronic patient-reported outcome measures (ePROMs) is a highly efficient way and results in consistent regular monitoring and may improve the long-term outcomes. While currently used measures focus only on musculoskeletal symptoms of axSpA, a composite disease activity measure that can also incorporate extra-articular manifestations may provide a better assessment of disease activity.

Клинический случай болезни Шейермана-Мау как ренессанс вековой истории

Modern strategy for management of spondyloarthritis (SpA) is aimed at the earliest possible diagnosis and treatment of diseases. Emergence of nonradiographic SpA in clinical practice necessitates differential diagnosis of this condition from a wide range of diseases including juvenile spondylodysplasia. The article presents a clinical case of newly-diagnosed Scheuermann-Mau disease in an adult patient

Recommendations for the Management of Comorbidity in Patients With Axial Spondyloarthritis in Clinical Practice

ObjectivesTo identify priorities among comorbidities in axial spondyloarthritis (AxSpA) and recommend how to follow them from an eminently practical perspective. MethodsA multidisciplinary group was selected (10 rheumatologists—6 of them experts in AxSpA—, 2 general practitioners, an internist, a cardiologist, a gastroenterologist and a psychologist). In a first discussion meeting, the scope and users were established and a list of comorbidities was voted based on frequency and impact. The panellists had to defend the inclusion of each comorbidity/item in the document with consistent arguments. Four panellists and two methodologists developed systematic reviews on controversial topics. In a second meeting, the results of the reviews and the arguments concerning the items to be included were presented. After the meeting, the final document was drafted. ResultsThe final document includes two checklists, one for health professionals and another for patients; they incorporate cardiovascular risk, renal comorbidities, gastrointestinal risk, lifestyle, risk of infections and vaccinations, pulmonary involvement, concomitant medication, psycho-affective disorders, osteoporosis, and risk of fracture. In addition, the document reflects the arguments favouring the inclusion of each item and how to record the items for subsequent collection. The panel considered it also appropriate to likewise establish «practices to avoid» applicable to comorbidity in AxSpA. ConclusionsTwo checklists and a list of situations to avoid were generated to facilitate the management of comorbidities in AxSpA. In a future step, their utility and acceptance will be tested by a broad group of users that includes doctors, patients and nurses.

188 Real-world data on the use of certolizumab pegol for the treatment of axial spondyloarthritis in clinical practice in Europe: 24-week interim results from a prospective non-interventional cohort study

188 Real-world data on the use of certolizumab pegol for the treatment of axial spondyloarthritis in clinical practice in Europe: 24-week interim results from a prospective non-interventional cohort study

Effect of Comedication With Conventional Synthetic Disease‐Modifying Antirheumatic Drugs on Retention of Tumor Necrosis Factor Inhibitors in Patients With Spondyloarthritis: A Prospective Cohort Study

ObjectiveTo evaluate whether use of comedication with conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA).MethodsPatients with SpA from the Rheumatic Diseases Portuguese Register who started treatment with their first TNFi between 2001 and 2014 were included in this study. Cox regression analysis was used to estimate the effect of comedication with csDMARDs on TNFi retention in 2 types of models: a model in which baseline (time‐fixed) variables were included, and a second model incorporating time‐varying variables, including sociodemographic features, measures of disease activity, measures of physical function, and cotreatment with other drugs (nonsteroidal antiinflammatory drugs and oral steroids). To control for possible confounding by indication, the effect of csDMARD comedication on TNFi retention was also tested after adjustment for the treatment propensity score.ResultsIn total, 954 patients were included in the study, of whom 289 (30.3%) discontinued treatment with their first TNFi after a median follow‐up time of 2.5 years (range 0.08–13 years). Inefficacy was the most common reason for TNFi discontinuation (55.7% of patients). In the multivariable analyses, comedication with csDMARDs had no measurable effect on TNFi retention, neither in the baseline model (hazard ratio [HR] 0.83, 95% confidence interval [95% CI] 0.59–1.16) nor during follow‐up in the model adjusted for time‐varying covariates (HR 1.07, 95% CI 0.68–1.68). The effect of csDMARD comedication remained nonsignificant after propensity score adjustment.ConclusionComedication with csDMARDs does not prolong TNFi retention in patients with SpA in clinical practice, suggesting that there is no benefit conferred by the concomitant use of these drugs.

EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice

A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both...

Diagnosis of spondyloarthritis: should we need new criteria?

A large number of classification criteria for spondyloarthritis (SpA) are simultaneously used in modern rheumatology in the almost complete absence of diagnostic criteria. This poses a number of problems, among which there are two most important ones: 1) the frequent use of classification criteria to make a diagnosis in real clinical practice; 2) the possibility of stating different nosological entities of SpA in one patient in the presence of the same clinical picture. Objective : to investigate the specific features of the diagnosis of SpA and the use of its classification criteria in clinical practice. Subjects and methods . The investigation enrolled 119 patients with the established diagnosis of ankylosing spondylitis (AS), psoriatic arthritis (PsA), undifferentiated axial or peripheral SpA. Whether their clinical picture complied with the modified New York criteria, the European Spondyloarthropathy Study Group (ESSG) criteria, the Amor criteria, and the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial and peripheral SpA and whether the Russian version of the modified New York criteria complied with the Classification criteria of Psoriatic ARthritis (CASPAR) were determined in the patients. Results . Sixty-three patients diagnosed with AS (M45), 44 with PsA (M07.0-07.3), 8 with undifferentiated SpA (M46.9), and 4 with nonradiographic axial SpA (M46.8) were followed up by attending physicians. The latter diagnosed AS in 10 patients who met the ASAS criteria for axial PsA but not the modified New York criteria. Twenty-one patients diagnosed as having PsA simultaneously met both the CASPAR criteria and the modified New York criteria, which could establish the diagnosis of AS in these cases. Eighty-one (68.0%) out of the 119 patients met the Amor criteria; 98 (82.3%) patients, the ESSG criteria; 91 (76.5%), the ASAS criteria for axial SpA; 18 (15.1%), the ASAS criteria for peripheral SpA; 76 (63.8%), the modified New York criteria; 88 (73.9%), the Russian version of the modified New York criteria; 42 (32.3%), the CASPAR criteria. No intersection of criteria was observed in only 5 patients; 113 (94.9%) patients met ≥2 criteria; 96 (80.7%), ≥3 criteria; 81 (68.1%), ≥4 criteria; 66 (55.5%), simultaneously ≥5 criteria; and 18 (15.1%), simultaneously 6 criteria. Conclusion . Most patients with SpA meet ≥2 classification criteria, which gives the chance to state ≥2 nosological entities in the same patient. This demonstrates the elaboration of diagnostic criteria that can make a clear distinction between different forms of SpA in clinical practice.

PMS78 - Quality of Life in Patients With Axial Spondyloarthritis in Clinical Practice In Sweden: Baseline Results From A Longitudinal Study

PMS78 - Quality of Life in Patients With Axial Spondyloarthritis in Clinical Practice In Sweden: Baseline Results From A Longitudinal Study

FRI0127 Eular Recommendations for the Use of Imaging in Spondyloarthritis in Clinical Practice

ObjectivesTo develop evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis.MethodsThe task force comprised an expert group of 21 rheumatologists, radiologists and...

Tools for monitoring spondyloarthritis in clinical practice

Spondyloarthritis (SpA) usually follows a chronic disease course that requires regular medical care and monitoring to control for increased disease activity and to maintain physical function. This Review describes the instruments and imaging techniques available for monitoring SpA in clinical practice. Specifically, questionnaires, physical examination and laboratory tests that can be used to measure physical function, disease activity and pain are discussed. Furthermore, the value of different imaging techniques, including conventional radiography, MRI and ultrasonography, for use in the clinic is described. In the past decade, most of the work on standardizing the monitoring of outcome measures in SpA has focused on ankylosing spondylitis, and similar developments are currently in progress for the monitoring of psoriatic arthritis. This Review, therefore, will focus on these disorders.