Spondyloarthritis Patients Research Articles

The clinical utility of faecal calprotectin in patients with differentiated and undifferentiated spondyloarthritis: Relevance and clinical implications

ObjectivesThere is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. Material and methodsA total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. ResultsThe differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ulcerative colitis and Crohn's disease patients had increased FCP levels compared to other SpA subgroups and USpA patients (p<0.001). The mean FCP levelwas significantly higher in the SpA patients compared to USpA and controls (p<0.001). ConclusionsElevated FCP levels may identify patients who are most likely to have SpA already in the unclassified phase of the disease. Further studies in different series of patients are needed to evaluate the potential diagnostic and prognostic roles of FCP in both differentiated and undifferentiated phases of the disease.

The Clinical Utility of Faecal Calprotectin in Patients with Differentiated and Undifferentiated Spondyloarthritis: Relevance and Clinical Implications.

There is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. A total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. The differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ulcerative colitis and Crohn's disease patients had increased FCP levels compared to other SpA subgroups and USpA patients (p<0.001). The mean FCP levelwas significantly higher in the SpA patients compared to USpA and controls (p<0.001). Elevated FCP levels may identify patients who are most likely to have SpA already in the unclassified phase of the disease. Further studies in different series of patients are needed to evaluate the potential diagnostic and prognostic roles of FCP in both differentiated and undifferentiated phases of the disease.

Associated Factors with the Severity of Hip Involvement in Spondyloarthritis and Efficacy of TNF α Inhibitors in these Patients.

Hip involvement in patients with spondyloarthritis is responsible for disability and functional impairment. Its treatment is not codified. Our study aimed to determine the associated factors with moderate and severe hip involvement in spondyloarthritis patients. It also aimed to assess the efficacy of tumour necrosis factor inhibitors (TNFi) on hip disease. We conducted a cross-sectional study, including 44 spondyloarthritis patients with hip involvement. Hip involvement was diagnosed based on radiographic findings. We assessed the following parameters: Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), patient global assessment (PGA), and Lequesne index. We compared these parameters and the mean radiographic joint space width between the time of the study to those right before the use of TNFi. Hip involvement was bilateral in 31 patients. The mean age was 44.56±12.21 years. There were 29 men. Severe and moderate involvement (BASRI-hip>3) was reported in 21 hips from 75 affected. These patients were older and had longer diagnosis delays than patients with BASRI- hip<3. They had a higher body mass index and more limited spine mobility (BASMI). Functional hip impairment assessed by the Lequesne index was higher in these patients. TNFi prescribed in 23 patients with hip involvement, led to an improvement in the Lequesne index (12.75 vs 7.5, p: 0.001) and PGA (7 vs 2, p: 0.001). However, the mean joint space width remained unchanged (3.8 vs 3.7mm, p: 0.532). Our study showed that higher body mass and Lequesne indexes are associated with moderate and severe hip involvement. TNFi may improve both the Lequesne index and PGA and stabilize the radiological findings.

Five Years’ Experience of Multidisciplinary Approach to Chronic Inflammatory Diseases by Rheumatology, Dermatology and Gastroenterology Departments

Introduction: Chronic inflammatory diseases (CIDs) are lifelong complex disorders that affect quality of life, and this study aimed to summarize 5 years of experience with a multidisciplinary approach for these complex diseases as a result of medical council meetings.&#x0D; Methods: Hospital-based, medical records review study was conducted. A total of 45 monthly medical council meetings were held between 2014-2019 with the participation of the rheumatology, dermatology and gastroenterology departments of the same university. Patients with complex conditions that were seen in each department's own polyclinic composed the council. This study only included 308 patients referred by the rheumatology group.&#x0D; Results: Females made up 66.5 % of the 308 patients. The median age was 45 (19-77). PsA (psoriatic arthritis) and other SPA (spondyloarthritis) patients composed 49.3% of the total. A total of 68.18% of the patients were presented only to consult with the dermatology department. The most common reason for presenting patients was to discuss options for treatment (41.5%). The diagnosis of psoriasis was confirmed in 48 of 67 (71.6%) patients who presented with a pre-diagnosis. The diagnosis was changed in 34.74% of the patients, whereas the diagnosis became completely different in 11.36% of the patients. &#x0D; Conclusions: Many patients with challenging diagnosis and treatment processes are encountered in daily practice. The combination of different disciplines makes it possible to provide more rapid and effective solutions. In this study, we aimed to emphasize the increasing importance of such multidisciplinary approaches

Presence of subclinical inflammation in axial spondyloarthritis patients with NSAID/anti-TNF-α drug-induced clinical remission.

To investigate the rate of subclinical inflammation in patients with axial spondyloarthritis (axSpA) with nonsteroidal anti-inflammatory drug (NSAID)/anti-tumor necrosis factor (TNF)-α drug-induced clinical remission and to explore factors influencing clinical and imaging remission. One hundred twenty-five patients with axSpA followed up for at least 6months were enrolled in this prospective study and randomly divided into two groups. Ninety patients were treated with anti-tumor necrosis factor (TNF)-α or anti-TNF-α combined with nonsteroidal anti-inflammatory drugs (NSAIDs) (anti-TNF-α treatment group), and thirty-five patients were treated with only NSAIDs (non anti-TNF-α treatment group). The improvements in the clinical remission rate, imaging remission rate, and disease parameters before and after the different treatments were compared. Risk factors for clinical and imaging remission were analyzed by multivariate logistic regression analysis. The clinical and imaging remission rate was increased after treatment especially in the anti-TNF-α group (P < 0.001). The remission rate of imaging in the group with clinical remission was higher than that in the group with clinical non-remission (P < 0.05). After treatment, the remission rates of imaging in the clinical remission and non-remission group were significantly higher than those before treatment (P < 0.0001). The results of multivariate logistic regression analysis showed that higher CRP was a risk factor for failure of clinical remission in axSpA (OR = 2.034, 95% CI:1.595 ~ 2.617, P < 0.001), while higher ASDAScrp was a risk factor for failure of imaging remission (OR = 1.306, 95% CI:1.026 ~ 1.688, P < 0.05). Anti-TNF-α treatment was a protective factor for both clinical (OR = 0.234, 95% CI:0.091 ~ 0.605, P < 0.05) and imaging remission (OR = 0.511, 95% CI:0.286 ~ 0.914, P < 0.05). Even after regular treatment, some clinical remission patients continued to have evidence of subclinical inflammation. Higher CRP and ASDAScrp are risk factors for clinical and imaging non-remission in axSpA respectively, Continuous NSAID treatment (more than 1year) can effectively improve clinical and MRI inflammation in patients, but anti-TNF-α treatment is more beneficial for clinical and imaging remission. Key Points • Some patients achieving ASDAScrp remission status continue to have inflammation when assessed with objective imaging techniques. • MRI can sensitively measure bone marrow inflammation and may provide a more accurate assessment of remission. • Controlling inflammation, especially reducing CRP and ASDAScrp levels, is a key factor for achieving clinical and imaging remission in patients with axSpA.

NON-IMMUNE MEDIATED MUSCULOSKELETAL DISEASE IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW OF THE LITERATURE

Abstract BACKGROUND Musculoskeletal (MSK) disease is the most common extra-intestinal manifestation of inflammatory bowel disease (IBD); however, the full spectrum of MSK manifestations remains poorly characterized. The published literature is predominately focused on peripheral and axial inflammatory spondyloarthritis (SpA). However, the prevalence of more common, non-inflammatory MSK conditions, such as osteoarthritis (OA) and fibromyalgia (FM), has not been formally reported. In the general population, the prevalence of OA and FM are 10-14% and 2-3%, respectively. OBJECTIVE To evaluate the prevalence of OA and FM in the published literature in IBD. METHODS A systematic literature review of articles assessing the prevalence of MSK disease in IBD was performed using multiple databases through September 2021. References of included articles were searched for additional pertinent studies. RESULTS 773 abstracts were screened and 94 studies included. Studies were heterogeneous precluding meta-analysis. Regarding study design, 36% were retrospective, 51% cross-sectional and 13% longitudinal. Median age at the time of the study was 41 years (range 29-51) and 49% (range 31%-100%) were male. The median number of IBD patients in each study was 243 (range 44-56,097). The prevalence of SpA (range) in the reviewed studies was: ankylosing spondylitis (AS) 3.5% (1%-27%), axial SpA 9.2% (1%-46%), and peripheral SpA 15.6% (1%-49%). Only 20/94 studies (21%) stated the term OA in any part of the paper. Of these, 20% excluded OA, 15% used the term OA but did not specifically exclude or identify patients with OA in the results, 5% reported that OA data was unavailable and 60% described the prevalence of OA in the results. In the studies that described OA in the results, median prevalence of OA was 12% (range 0.4%-23.4%). Only 7/94 studies (8%) described FM in any part of the paper, and all described the prevalence of FM in the results with a median prevalence of 2.2% (range 0.8%-12%). CONCLUSION While OA and FM are common conditions in the general population, most studies did not formally evaluate for these conditions in patients with IBD. When assessed, the median prevalence of OA was consistent with the general population, and additionally higher than the prevalence of AS and axial SpA in patients with IBD. The prevalence of FM was consistent with the general population. Although both rheumatologists and gastroenterologists need to recognize the importance of SpA, it is as important to understand that the most common MSK disease in IBD may be non-inflammatory. This distinction is critical, as treatment of IBD patients incorrectly diagnosed with inflammatory SpA may subject patients unnecessarily to medication adverse events, while undertreatment of patients with unrecognized SpA may lead to preventable disease morbidity.

Elevated Serum D-Dimer May Reflect the Presence of Gut Inflammation in Spondyloarthritis.

BackgroundTo investigate the association of D-dimer with gut inflammation in spondyloarthritis (SpA).MethodsSixty-five patients with SpA and 70 healthy controls were included. Demographic, clinical, and laboratory parameters were collected. The differences of clinical and laboratory parameters were compared between patients with SpA and healthy controls, and between patients with SpA, with and without gut inflammation. The associations of D-dimer with laboratory data were analyzed. The predictive value of D-dimer was obtained by a receiver operator characteristic (ROC) curve analysis. The independent risk factors for gut inflammation in SpA were investigated by binary logistic regression analysis.ResultsPatients with SpA had higher D-dimer than healthy controls (P = 0.016). D-dimer was positively correlated with platelet (PLT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), and negatively correlated with hemoglobin (Hb). Besides, significant differences were observed in D-dimer between SpA patients with and without gut inflammation (P < 0.001). Furthermore, SpA patients with gut inflammation were more likely to have peripheral joint involvement than those without gut inflammation (P < 0.001). The AUC of D-dimer was 0.865 at cut-off value of 0.29 mg/L, with a sensitivity of 82.6%, and a specificity of 81%. Elevated D-dimer (OR = 15.451, 95% CI: 3.030–78.780, P = 0.001) was independently associated with gut inflammation in SpA.ConclusionD-dimer may be a potential biomarker for identifying SpA patients with gut inflammation.

Sustained low disease activity measured by ASDAS slow radiographic spinal progression in axial spondyloarthritis patients treated with TNF-inhibitors: data from REGISPONSERBIO

BackgroundTo evaluate the influence of the disease activity on radiographic progression in axial spondyloarthritis (axSpA) patients treated with TNF inhibitors (TNFi).MethodsThe study included 101 axSpA patients from the Spanish Register of Biological Therapy in Spondyloarthritides (REGISPONSERBIO), which had clinical data and radiographic assessment available. Patients were classified into 2 groups based on the duration of TNFi treatment at baseline: (i) long-term treatment (≥4 years) and (ii) no long-term treatment (< 4 years). Radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with known chronology. Disease activity differences between patients’ groups at each time point were assessed using a linear mixed-effect model.ResultsRadiographic progression was defined as an increase in ≥2 mSASSS units. At inclusion, approximately half of the patients (45.5%) were receiving long-term treatment with TNFi (≥4 years). In this group of subjects, a significant difference in averaged Ankylosing Spondylitis disease Activity Score (ASDAS) across follow-up was found between progressors and non-progressors (2.33 vs 1.76, p=0.027, respectively). In patients not under long-term TNFi treatment (54.5%) though, no significant ASDAS differences were observed between progressors and non-progressors until the third year of follow-up. Furthermore, no significant differences were found in progression status, when disease activity was measured by Bath Ankylosing spondylitis Disease Activity Index (BASDAI) and C reactive protein (CRP).ConclusionsPatients on long-term TNFi treatment with a mean sustained low disease activity measures by ASDAS presented lower radiographic progression than those with active disease.

Development of a screening tool to identify patients with axial spondyloarthritis: a cognitive interview study.

To further refine the wording of screening questions and examine their face validity through cognitive interviews with axial spondyloarthritis (axSpA) and chronic mechanical back pain patients. In-depth, semi-structured cognitive interviews were conducted with 30 patients (10 axSpA; 20 chronic mechanical back pain patients) to assess the face validity and comprehensibility of the screening questions. The interview protocol focused on 12 questions/domains including participants' feedback/thoughts on the duration of suffering from back pain, age at onset of back pain, pace of back pain development, improvement of pain with movement or rest, nocturnal back pain improving upon awakening, pain in other parts of the body, responsiveness of pain to nonsteroidal anti-inflammatory drug (NSAID) use, history of autoimmune conditions, and domains such as sleep, sitting, and stiffness. The Flesch-Kincaid grade level and Flesch reading ease scores were then analyzed for the revised versions of screening questions. Participants preferred questions that allowed them to provide more details regarding the frequency of their symptoms. Questions were refined for clarity and eliminated if participants considered them to be irrelevant (e.g., NSAIDs). Two sample screeners were derived from twelve questions each with an overall reading grade of 7.5 and reading ease of 65.7%. It is feasible to design a screening tool that is accessible to most (e.g., reading level) and clear to individuals with back pain. An evidence-based approach to demonstrate the validity of the screening tool will be critical for it to be implemented widely into clinical practice. Key Points • Our study developed two sample screeners that are clear to individuals with back pain and accessible to most with an overall Flesch-Kincaid reading grade of 7.5 and Flesch reading ease of 65.7%. • Questions that were considered irrelevant to participants were eliminated such as responsiveness of pain to nonsteroidal anti-inflammatory drug (NSAID). • It is feasible to design a screening tool that is accessible to most (e.g., reading level) and clear to individuals with back pain.

Clinical Features and Prevalence of Spondyloarthritis in a Cohort of Italian Patients Presenting with Acute Nongranulomatous Anterior Uveitis.

Purpose To describe the clinical features of acute nongranulomatous anterior uveitis (NGAU) patients and to estimate the prevalence of concomitant spondyloarthritis (SpA). Methods Retrospective study of consecutive patients affected by NGAU referred to the Ocular Immunology Unit of the AUSL-IRCCS di Reggio Emilia, Italy, between January 2016 and January 2019. All patients underwent ophthalmic evaluation and blood test with HLA-B27 typing and were referred to a rheumatologist to identify any undiagnosed SpA. SpA was classified according to the Assessment of SpondyloArthritis international Society (ASAS) criteria in axial or peripheral SpA. Patients were divided into two groups: NGAU with associated SpA (SpA+) and NGAU without SpA (SpA-). Clinical and demographic features of the two groups, including sex, HLA-B27, family history of rheumatic disease, uveitis laterality, course, and severity of ocular inflammation, complications, and treatment, were compared. Results Ninety-nine patients with NGAU were enrolled, of whom 36 (36%) with a diagnosis of SpA: 14 with peripheral SpA and 22 with axial SpA. The prevalence of SpA was higher in HLA-B27-positive patients than in HLA-B27-negative patients (50% vs. 15%, p < 0.0001). The multivariate logistic regression (R2 = 0.28) for SpA diagnosis identified as significant predictive factors: age at diagnosis (odds ratio [OR] = 0.95, 95% confidence interval [CI]: 0.91-0.99) and HLA-B27+ (OR = 5.32, 95% CI: 1.80-15.70). Conclusions Our results confirmed the high prevalence of undiagnosed SpA in patients with NGAU, suggesting that, regardless of HLA-B27 status, in the presence of IBP and/or peripheral arthritis, patients with NGAU must be referred to the rheumatologist to allow earlier diagnosis.

Frequency and anatomic distribution of magnetic resonance imaging lesions in the sacroiliac joints of spondyloarthritis and non-spondyloarthritis patients.

Background:Lesions detected by magnetic resonance imaging (MRI) of the sacroiliac joints are critical to the diagnosis of non-radiographic axial spondyloarthritis. However, inflammatory and structural lesions may be encountered in other conditions.Objectives:The objective of this study was to evaluate and compare the frequency and localization of inflammatory and structural lesions on MRIs of the sacroiliac joint of spondyloarthritis (SpA) and non-spondyloarthritis (non-SpA) patients.Design:This is a retrospective study including 200 patients, each having undergone an MRI of the sacroiliac joints.Methods:Two experienced readers evaluated the whole set of images to detect erosions, subchondral sclerosis, fatty lesions, bone marrow edema (BME) and ankylosis according to the definitions established by the ASAS MRI working group. We divided sacroiliac joints into five segments: upper, antero-middle, intermediate-middle, postero-middle and lower.Results:A total of 96 subjects with SpA (mean age 37.4 ± 11.8 years) and 104 without SpA (mean age 39.9 ± 11.6 years) were included. Of the 96 SpA patients, 65% had inflammatory buttock pain compared with 25% in the non-SpA group. BME was seen in 65% of SpA patients, mainly in the intermediate-middle segment, and in 20% of non-SpA patients, predominantly in the antero-middle segment. Subchondral sclerosis occurred in 44% of non-SpA patients, mostly in the antero-middle segment, and in 36% of SpA patients. Fatty lesions were present in 34% of SpA and in 21% of non-SpA patients. Erosions were seen in 25% of non-SpA and in 60% of SpA patients. BME and structural lesions were minimally observed in the postero-middle segment in non-SpA patients.Conclusion:Inflammatory and structural lesions were observed in all segments of the joint in SpA, mainly in the middle segments, while lesions predominantly affected the antero-middle segment in non-SpA, and were uncommon in the postero-middle segment.

Human leukocyte antigen-B alleles in spondyloarthritides: A single-center, prospective, cross-sectional study

Objective: The objective of this study is to study distribution of human leukocyte antigen (HLA)-B alleles in Spondyloarthritis (SpA) and to find its clinical relevance in the patient management.Materials and Methods: A prospective, cross-sectional, pilot study was carried out on 100 participants at the single center of Northern India (Sir Ganga Ram Hospital, New Delhi). Assessment in ankylosing spondylitis (ASAS) classification criteria for axial/peripheral spondyloarthritis (SPA) (conventionally AS-ankylosing spondylitis), classification criteria for reactive arthritis (ReA), and CASPAR (classification criteria for psoriatic arthritis) criteria for psoriatic arthritis were used to sub-classify patients. Inflammatory bowel disease (IBD) patients who classified for ASAS criteria for SPA were classified as IBD-related SPA. Demographic data, disease characteristics, and relevant investigations were noted. HLA-B genotyping was carried out by the polymerase chain reaction method. HLA-B genotyping of 100 healthy kidney transplant donors were taken as controls. Fisher's exact test was used. P < 0.05 was considered as statistically significant.Results: Out of 100 patients, 58 were male and 42 were female. SPA (AS), ReA, PSA, and IBD-related SPA were 65, 12, 16, and 07, respectively. HLA-B 27+ve participants were 57. HLA-B40 and HLA-B52 were present in 25 and 19 participants, respectively. HLA-B27 allele was associated with SPA, PSA, and IBD-related SPA (P < 0.01, 0.034, and 0.037, respectively). In HLA-B27-ve cases, the frequency of HLA-B40 was increased (P value – 0.033, odds ratio [OR] with 95% confidence interval-2.44, [1.09, 5.48]). Similarly, the frequency of HLA-B15 and HLA-B13 were increased in PSA (P value – 0.034, 0.020 with OR – 4.09, 6.33, respectively). The presence of HLA-B27 allele favored axial ± peripheral disease while its absence favored peripheral disease (P value– 0.019). HLA-B27+ve participants had more active disease compared to HLA-B27-ve and HLA-B40+ve cases (P < 0.01 and 0.013, respectively).Conclusion: The utility of HLA-B alleles other than HLA-B27 is limited in SpA patients' management. To find their use in diagnosis, prognosis and treatment need further studies.xs

Simultaneous sacroiliitis and symphysitis pubis

This is the description of a rare, documented association of sacroiliitis with symphysitis pubis. A 37-year-old woman experienced low back pain since 2009 with inflammatory characteristics (worse at rest, improvement during movement) associated with morning stiffness of 2 hours. Her X-ray demonstrated sacroiliitis. A magnetic resonance image (MRI) showed bilateral bone edema of the sacroiliac joints with enhancement after gadolinium injection (Fig. 1). At the same time, a magnetic resonance image revealed edema on her symphysitis pubis better showed after contrast infusion and reduction of joint space (Fig. 2). HLA-B27 was positive. C-reactive protein and erythrocyte sedimentation rate were within normal range, 0.44 mg/l and 11 mm/1st hour, respectively. Rheumatoid factor and antinuclear antibodies were negative. A diagnosis of spondyloarthritis was made and she was treated with non-steroidal antiinflammatory drugs. She experienced slight improvement of her symptoms and she is waiting for anti-TNF therapy. Spondyloarthritis patients may have involvement of their symphysitis pubis. In fact, Helliwell et al. [1] have radiologically evaluated 91 subjects with spondyloarthritis and revealed that 31 % of ankylosing spondylitis patients, 30 % of enteropathic spondyloarthritis, 25 % of psoriatic arthritis and 14 % of reactive arthritis have symphisitis. The authors performed single radiographies in that study. We were not able to find any study that evaluated the frequency of symphisitis pubis in spondyloarthritis patients using modern techniques such as MRI. Recently, we described a case of symphisitis pubis after pregnancy [2].

Increased risks of aortic regurgitation and atrial fibrillation in radiographic axial spondyloarthritis patients: a 10-year nationwide cohort study.

Background:To compare the incidences of aortic regurgitation, atrial fibrillation (AF), and atrioventricular (AV) block II–III between radiographic axial spondyloarthritis (r-axSpA) patients and the general population (GP).Methods:National Health Insurance Services data were used. R-axSpA patients (N = 8877) and the age- and sex-matched GP (N = 26,631) were followed from August 2006 to December 2019. Incidence rates and standardized incidence ratios (SIRs) of aortic regurgitation, AF, and AV block II–III were compared between these groups. Ten-year incidence rates and hazard ratios (HRs) were calculated by the Kaplan–Meier method and Cox regression analysis.Results:Incidence rates of aortic regurgitation, AV block II–III, and AF in the r-axSpA group were 0.42, 0.21, and 4.0 per 1000 person-years (PYs), respectively. In the r-axSpA group, the SIR for aortic regurgitation was highest among 40- to 49-year-old men (4.11). Incidence rates of aortic regurgitation and AF were higher in the r-axSpA group than in the GP group (0.42 versus 0.18 per 1000 PYs 4.00 versus 3.13 per 1000 PYs, both p < 0.001, respectively), whereas the difference was insignificant for AV block II–III (0.21 versus 0.14 per 1000 PYs, p = 0.222). In multivariate analysis, r-axSpA was associated with a higher hazard (risk) for the development of aortic regurgitation and AF [HR (95% confidence interval) = 2.55 (1.49–4.37) and 1.20 (1.04–1.39), respectively], but the difference was insignificant for AV block II–III [HR (95% confidence interval) = 1.17 (0.59–2.31)].Conclusions:Compared with the GP, r-axSpA patients are at increased risk of aortic regurgitation and AF, but not AV block II–III. These patients should be carefully monitored for occurrence of aortic regurgitation and AF.

Vision‐related quality of life in spondyloarthritis patients with history of acute anterior uveitis under treatment with golimumab: preliminary results of the GO‐VISION observational study

AbstractPurposeAcute anterior uveitis (AAU) is one of the most common extra‐articular manifestations of spondyloarthritis (SpA), causing significant burden in quality of life (QoL). Golimumab (GLM) is a tumor necrosis factor‐inhibitor proven to be effective and safe in SpA. The GO‐EASY Study provided evidence that GLM decreases the AAU occurrence rate in SpA. Our aim is to study the impact of GLM in the change of vision‐related (VR) QoL in subjects with SpA and past or current AAU.MethodsOngoing prospective multicentre observational study (including 8 centres in Portugal) of SpA patients with history of AAU treated with GLM followed‐up for 12 months. We intend to recruit in total 30 patients and we report herein the 6 months outcomes for the first 9 patients enrolled. The occurrence of AAU was assessed in the 2 years before GLM treatment was started and the first 6 months of follow‐up and calculated for the period at risk for a new AAU. VR QoL was assessed with the self‐administered National Eye Institute Visual Functioning Questionnaire‐25 (NEI VFQ‐25). Adverse events were noted.ResultsNine patients (66.7% female, 100% TNFi‐naive, mean age 46.1 ± 14.4 years (range 22–65)) have completed 6 months of follow‐up. Three patients (33%) were also under oral methotrexate. The mean number of AAU flares in the 2 years preceding the start of GLM was 2.2 ± 1.3 (1–4). During the first 6 months of GLM treatment, the AAU incidence rate was reduced from 1.54 to 0.11 per 100 patient‐years (incidence ratio‐ratio 13.46, 95% CI 2.15–558.00; p &lt; 0.01). At baseline and at 24 weeks after GLM onset, the mean overall index NEI VFQ‐25 total score was 70.2 and 83.2, respectively; improvement in the NEI VFQ‐25 total score was +13 ± 18.2. No significant or new adverse events occurred.ConclusionsPreliminary data from the GO‐VISION study suggest that GLM is safe and effective in patients with SpA and history of AAU, being able to reduce the AAU occurrence rate and potentially increasing VR QoL.

Uveitis in peripheral spondyloarthritis patients: an ancillary analysis of the ASAS-PerSpA study.

Background:Acute anterior uveitis (AAU) is the most frequent extra-musculoskeletal manifestation in spondyloarhtritis (SpA). Previous data on AAU focused on axial disease; therefore, it is not well known whether the clinical characteristics of patients with AAU and recurrent AAU differ between patients with axial and peripheral SpA.Objective:Primary objective was to compare the clinical characteristics of patients with AAU from patients without AAU in axial and peripheral spondyloarthritis (SpA) patients. Secondary objectives were to describe the clinical features of patients with AAU in the subset of patients with peripheral SpA (pSpA) and the clinical characteristics of patients with recurrent AAU in SpA patients.Design:This is an ancillary analysis of the ASAS-PerSpA study which included 3152 patients, 2719 patients with axSpA and 433 with pSpA according to rheumatologist judgement.Methods:Recurrent AAU was defined as the presence of two or more episodes of AAU ever. Univariable and multivariable binary logistic regression analyses were conducted to identify factors associated with the presence of AAU ever and the presence of recurrent AAU.Results:Overall, 663 patients (21%) presented AAU. Of them, 444 (66.9%) presented recurrent episodes. In patients with SpA, HLA-B27 positivity is the most important factor linked to the presence of AAU, odds ratio (OR) = 2.70 (95% CI = 2.04–3.6). In patients with pSpA, HLA-B27 positivity was also the most relevant factor linked to the presence of AAU, OR = 6.08 (95% CI = 2.72–15.68). Moreover, disease duration, younger age and higher body mass index (BMI) were the only factors slightly linked to the presence of recurrent episodes, OR = 1.03 (95% CI = 1.01–1.04), OR = 1.01 (95% CI = 1.00–1.03) and OR = 1.04 (95% CI = 1.01–1.08), respectively.Conclusion:HLA-B27 positivity is the most relevant factor linked to AAU risk in SpA patients, and this association is even stronger in those patients with pSpA. Moreover, our study did not find an association between HLA-B27 positivity and recurrent AAU in SpA patients.

Effectiveness and safety of secukinumab in axial spondyloarthritis: a 24-month prospective, multicenter real-life study.

Objectives:To evaluate, in a multicentric Italian cohort of axial spondyloarthritis (axSpA) patients on Secukinumab (SEC) followed for 24 months: (1) the long-term effectiveness and safety of SEC; (2) the drug retention rate and low disease activity (LDA) measured as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) < 4/Ankylosing Spondylitis Disease Activity Score (ASDAS) < 2.1 and very low disease activity (VLDA) measured as BASDAI < 2/ASDAS < 1.3; (3) any differences in outcomes according to line of biological treatment (naïve/non-naïve), gender (male/female), subtype of axSpA [radiographic axSpA (r-axSpA)/non-radiographic axSpA (nr-axSpA)].Methods:Consecutive axSpA patients treated with SEC were evaluated prospectively. Disease characteristics, previous/ongoing treatments, comorbidities, and follow-up duration were collected. Disease activity/functional/clinimetric scores and biochemical-values were recorded at baseline (T0), 6 (T6), 12 (T12), and 24 (T24) months. Effectiveness was evaluated over-time with descriptive statistics; multivariate Cox and logistic regression models were used to evaluate predictors of drug discontinuation and LDA at T6. Infections and adverse events were recorded.Results:A total 249 patients (47.8% male; median age 51) were enrolled; 40.9% had HLA-B27; 53.8% had r-axSpA, and 46.2% nr-axSpA. SEC was prescribed in 28.9% naïve and in 71.1% non-naïve patients. SEC effectiveness was shown as an improvement in several outcomes, such as ASDAS [T0 = 3.5 (2.9–4.4) versus T24 = 1.9 (1.2–2.4); p = 0.02] and BASDAI [T0 = 6.5 (5.0–7.5) versus T24 = 2.8 (1.8–4.0); p = 0.03]. At T24, naïve patients showed better physical functioning and lower disease activity than non-naïve. After 24 months of treatment, 90.7% of naïve and 75.3% of non-naïve patients achieved LDA (BASDAI < 4). Treatment was discontinued in 24.5% patients, mainly due to primary/secondary loss of effectiveness, and in 6.8% due to adverse events. Retention rate at T24 was 75% in the whole population, with some difference depending on gender (p = 0.002).Conclusion:In a real-life clinical setting, SEC proved to be safe and effective in axSpA, mainly in naïve-patients, with a notable drug retention rate. No differences were observed between r-axSpA and nr-axSpA.

High inflammatory burden predicts cardiovascular events in patients with axial spondyloarthritis: a long-term follow-up study.

Background:Axial spondyloarthritis (axSpA) patients are at higher risk of cardiovascular (CV) disease (CVD) than the general population, partly due to consequences of inflammation or its treatment. But relationship between inflammation in axSpA and cardiovascular events (CVE) is unknown.Objectives:To examine whether inflammatory burden over time can predict CVE independent of baseline CV risk factors in axSpA patients.Design:A cohort analysis was performed in patients who had been recruited since January 2001. The primary outcome was a first CVE occurring between January 2001 and December 2020.Methods:Three CVD risk scores were computed at baseline. The performance of the original and modified (*1.5 multiplication factor) CV risk algorithms were assessed. Time-varying Cox proportional hazard models and Kaplan–Meier survival analysis were used to assess whether inflammatory burden (Bath ankylosing spondylitis disease activity index [BASDAI] and inflammatory markers), nonsteroidal anti-inflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs (DMARDs) can predict the development of first CVE.Results:463 patients (35 [26–45] years, male: 360 [77.8%]) were recruited. After a median follow-up of 12 (7–19) years, 61 patients (13.2%) experienced a first CVE. Traditional/modified CV risk scores underestimated CV risk. Erythrocyte sedimentation rate (ESR) ⩾ 20 mm/h was associated with a significantly higher risk of CVE during follow-up (HR: 2.07, 95%CI [1.10, 3.98], p = 0.008). Active disease as indicated by a rising BASDAI also showed positive trend towards a higher risk of developing CVE over time. After adjusting for CV risk scores in the multivariable models, high ESR level (ESR ⩾ 20 mm/h) over time remained significantly associated with a higher risk of developing CV events.Conclusion:Increased inflammatory burden as reflected by elevated ESR levels (ESR ⩾ 20) was associated with increased risk of CVE, while the use of NSAIDs and DMARDs were not.

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.

Managing comorbidities in spondyloarthritis patients – to what extent do rheumatologists carry the burden?

Objective. The spondyloarthritis group comprises chronic inflammatory conditions that share clinical, genetic and radiographic features. The impact of comorbidities on disease activity is not entirely known. The aim of this study is to identify the frequency and management of comorbidities in SpA patients. Materials and methods. A six-month retrospective study included 235 SpA patients for whom demographic, disease data and associated comorbidities were collected, according to EULAR’s designated categories. Statistical analysis was performed using Microsoft Excel. Results. 71% were males, with a mean age of 42.3, suffering from SpA for more than 15 years. 60% patients were overweight or obese, 25% had been diagnosed with hypertension, 28% were smokers. 18% suffered from dyslipidemia and 9% had type II diabetes. 16% had hepatitis B while 2% had C viral infection, 14% had previous mild to moderate urinary or pulmonary infections. Osteoporosis was confirmed in 6% and malignancies in 2.5% cases. Conclusions. The most frequently encountered comorbidities were cardio-vascular events, followed by gastro-intestinal disorders. SpA patients require early comorbidity detection with the aid of their rheumatologist and a multidisciplinary care to avoid additional disease burden.