Spondyloarthritis Research Consortium Of Canada Score Research Articles

Clinical and ultrasonographic enthesitis assessment before and after anti-tumor necrosis factor treatment in patients with spondyloarthritis.

This study aimed to clinically and ultrasonographically evaluate enthesitis in patients with spondyloarthritis (SpA) and to determine enthesitis response to anti-tumor necrosis factor (TNF) treatment. Thirty-one SpA patients (22 males, 9 females; mean age: 39.4±10.9 years; range, 22 to 60 years) who started anti-TNF treatment due to their high disease activity were included in the cross-sectional prospective study between May 2017 and January 2018. Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Quality of Life Questionnaire, Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Metrology Index were recorded. Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Score were utilized for clinical enthesitis evaluation. Patients were ultrasonographically evaluated in accordance with the Madrid Sonographic Enthesitis Index (MASEI) by a blinded sonographer. Patients were clinically and ultrasonographically assessed at baseline and in the third month after the treatment. In the initial evaluation, 24 (77.42%) of the patients had clinical enthesitis, and 30 (96.77%) of the patients had ultrasonographic enthesitis. After anti-TNF treatment, MASES, SPARCC, MASEI-structure, MASEI-thickness, MASEI-bursitis, MASEI-Doppler, MASEI-inflammatory, and MASEI-total scores significantly decreased (p<0.05). There was no significant change in MASEI-damage, MASEI-erosion, and MASEI-calcification scores following the therapy (p>0.05). Anti-TNF treatment may improve clinical and ultrasonographic enthesitis, particularly inflammatory changes. Erosions and calcifications may not ameliorate after three months of anti-TNF treatment.

Deep Learning Algorithm of the SPARCC Scoring System in SI Joint MRI.

The Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system is a sacroiliitis grading system. To develop a deep learning-based pipeline for grading sacroiliitis using the SPARCC scoring system. Prospective. The study included 389 participants (42.2-year-old, 44.6% female, 317/35/37 for training/validation/testing). A pretrained algorithm was used to differentiate image with/without sacroiliitis. 3-T, short tau inversion recovery (STIR) sequence, fast spine echo. The regions of interest as ground truth for models' training were identified by a rheumatologist (HYC, 10-year-experience) and a radiologist (KHL, 6-year-experience) using the Assessment of Spondyloarthritis International Society definition of MRI sacroiliitis independently. Another radiologist (YYL, 4.5-year-experience) solved the discrepancies. The bone marrow edema (BME) and sacroiliac region models were for segmentation. Frangi-filter detected vessels used as intense reference. Deep learning pipeline scored using SPARCC scoring system evaluating presence and features of BMEs. A rheumatologist (SCWC, 6-year-experience) and a radiologist (VWHL, 14-year-experience) scored using the SPARCC scoring system once. The radiologist (YYL) scored twice with 5-day interval. Independent samples t-tests and Chi-squared tests were used. Interobserver and intraobserver reliability by intraclass correlation coefficient (ICC) and Pearson coefficient evaluated consistency between readers and the deep learning pipeline. We evaluated the performance using sensitivity, accuracy, positive predictive value, and Dice coefficient. A P-value <0.05 was considered statistically significant. The ICC and the Pearson coefficient between the SPARCC scores from three readers and the deep learning pipeline were 0.83 and 0.86, respectively. The sensitivity in identifying BME and accuracy of identifying SI joints and blood vessels was 0.83, 0.90, and 0.88, respectively. The dice coefficients were 0.82 (sacrum) and 0.80 (ilium). The high consistency with human readers indicated that deep learning pipeline may provide a SPARCC-informed deep learning approach for scoring of STIR images in spondyloarthritis. 1 TECHNICAL EFFICACY: Stage 2.

Impact of steroid and lidocaine injection in the sacroiliac joint in axial spondyloarthritis patients: a randomized controlled trial

Background: The value of steroid and lidocaine injection of the sacroiliac joint in axial spondyloarthritis patients on magnetic resonance imaging scores and clinical disease outcome measures is not yet well assessed.&#x0D; Patient and methods: Participants were randomly assigned into two groups; Group I received unilateral ultrasound-guided sacroiliac joint injection with .5% lidocaine hydrochloride mixed with triamcinolone. At the same time, group II received subcutaneous saline injection. All participants fulfilled the ASAS criteria for axial SpA and all had bone marrow edema of at least one sacroiliac joint at baseline. Outcomes measures were: Visual Analogue Scale (VAS), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), and Spondyloarthritis Research Consortium of Canada (SPARCC) scores. Participants were assessed at baseline (before and after sacroiliac joint injection) and after three months. This clinical trial was registered on clinicaltrials.gov under the number NCT04895228.&#x0D; Results: In this study, a total of 61 participants were registered. There was a significant difference between both groups regarding pain, spine mobility, SPARCC, and ASDAS scores in favor of group I. Spine mobility showed the earliest improvement, followed by pain whilst SPARCC, and ASDAS scores showed improvement after three months. Higher disease activity, younger age, and shorter disease duration were all associated with better outcomes. Bilateral hip involvement was a predictor of poor response.&#x0D; Conclusion: Sacroiliac joint injection of lidocaine and triamcinolone in axial SpA patients is a cost-effective and practical technique for controlling pain, improving function, disease activity scores, and bone marrow edema with acceptable complications and relatively sustained effect.&#x0D;  

Imrecoxib and celecoxib affect sacroiliac joint inflammation in axSpA by regulating bone metabolism and angiogenesis.

To analyze the changes in the levels of bone metabolism markers related to sacroiliac joint (SIJ) inflammation in patients with axial spondyloarthritis (axSpA) after treatment with imrecoxib and celecoxib and evaluate their relationship with clinical efficacy. A total of 120 patients with axSpA with at least 2 magnetic resonance imaging (MRI) SIJ scans during a 12-week follow-up were enrolled. The levels of bone metabolism markers, including dickkopf-1(DKK-1), sclerostin, vascular endothelial growth factor (VEGF), bone morphogenetic protein-2 (BMP-2), osteoprotegerin (OPG), noggin, β-catenin, and RUNX2, were measured twice, and their association with disease activity and the Spondyloarthritis Research Consortium of Canada (SPARCC) score for SIJ were analyzed by univariate analysis of covariance. A total of 116 patients completed the follow-up. The levels of sclerostin, OPG, noggin, DKK-1, and RUNX2 were increased, whereas those of VEGF and β-catenin were decreased. The levels of sclerostin and OPG were negatively correlated with disease duration. The levels of VEGF and β-catenin were significantly decreased (F = 7.866, P = 0.003; F = 4.106, P = 0.047) in patients with disease remission. A decrease in ESR was significantly correlated with decreased levels of Runx2 and SPARCC scores, with the levels of sclerostin being significantly elevated in the SPARCC-reduced group. There were no statistically significant differences between the imrecoxib and celecoxib groups (P> 0.05). Imrecoxib and celecoxib affect SIJ inflammation, disease activity, and the course of disease by regulating bone metabolism and angiogenesis in axSpA. Key Points •After treatment with imrecoxib and celecoxib, the levels of sclerostin, OPG, noggin, DKK-1, and RUNX2 were increased, whereas those of VEGF and β-catenin were decreased, correlating with the course of disease, disease activity, and SIJ inflammation. • A decrease in ESR was significantly correlated with a decrease in the levels of RUNX2 and SIJ inflammation.. • The levels of sclerostin were more significantly elevated in SIJ inflammation remission group.. •Imrecoxib and celecoxib affect SIJ inflammation by regulating bone metabolism and angiogenesis in axSpA..

A Novel Treatment Method for Ankylosing Spondylitis Combined With Sacroiliac Joint Bone Marrow Edema

Objective: To investigate whether high-energy extracorporeal shock wave therapy (ESWT) combined with conventional oral medicine as a potential novel therapeutic approach for the treatment of ankylosing spondylitis (AS)combined with sacroiliac joint bone marrow edema. Materials &amp; Methods: 40 patients were divided into two groups and were treated with or without ESWT in combination with conventional oral medicine. A visual analog scale (VAS) score of spinal pain, as well as indicators of spinal mobility, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores, inflammatory index (C-reactive protein, blood cell sedimentation rate), and other indicators were compared between the two groups. The Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system was used to evaluate pain and structural damage in the sacroiliac joint. Results: (1) After one month of treatment (T1), VAS, BASDAI, BASFI, and SPARCC scores were lower in both groups than at the start of treatment (T0) (P &lt; 0.05), with greater decreases observed in the treatment group (P &lt; 0.05). (2) Also, at T1, indicators of spinal mobility for the two groups were improved (P &lt; 0.05). (3) ESR and C-reactive protein levels for the two groups decreased significantly at T1 versus T0 (P &lt; 0.05). Conclusion: ESWT combined with oral medication can significantly relieve pain and improve clinical functional symptoms for patients with AS. It can also reduce sacroiliac joint bone marrow edema and control the inflammatory reaction in the sacroiliac joint, which represents a novel, effective, reliable, and safe clinical treatment therapeutic method. Keywords: Ankylosing spondylitis, Sacroiliac joint, extracorporeal shock wave therapy, oral medicine.

Role of macrophage-associated chemokines in the assessment of initial axial spondyloarthritis.

To identify biomarkers that reflect disease activity scores and to investigate the role of macrophage-associated chemokines in initial axial spondyloarthritis (axSpA). Patients with axSpA were enrolled. The SpondyloArthritis Research Consortium of Canada (SPARCC) method was used to score bone marrow oedema (BMO) in the inflammatory lesions on magnetic resonance imaging (MRI). Radiographic assessment of the spine was performed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Clinical variables, including inflammatory markers, serum CC chemokine ligand 2 (CCL2), CCL3, CCL7, CCL8 and C-X3-C motif ligand 1 (CX3CL1), were measured. Correlation analysis between serum levels of these macrophage-associated chemokines and clinical data was performed. There were no significant differences between the axSpA group and the healthy control group in terms of serum levels of CCL2, CCL3 or CCL8. Compared to the healthy control group, the serum levels of CCL7 and CX3CL1 were significantly higher in ankylosing spondylitis (AS) (p = 0.045, p = 0.017, respectively). In the AS subgroup, the serum level of CX3CL1 had a positive correlation with SPARCC scores. In AS, serum CCL7 and CX3CL1 levels are elevated. The serum level of CX3CL1 is associated with MRI-determined oedema in AS. CX3CL1 may be useful as a biomarker to predict active inflammation in the sacroiliac joint (SIJ) in AS. Key Points • Serum levels of CX3CL1 are associated with MRI-determined oedema in AS. • CX3CL1 may be a useful biomarker to predict active inflammation in the sacroiliac joint in AS.

Progressive Increase in Sacroiliac Joint and Spinal Lesions Detected on Magnetic Resonance Imaging in Healthy Individuals in Relation to Age.

Magnetic resonance imaging (MRI) plays a pivotal role in spondyloarthritis (SpA) diagnosis. However, a detailed description of MRI findings of the sacroiliac (SI) joints and spine in healthy individuals is currently lacking. This study was undertaken to evaluate the occurrence of MRI-detected SI joint and spinal lesions in healthy individuals in relation to age. Ninety-five healthy subjects (ages 20-49 years) underwent MRI of the SI joints and spine. Bone marrow edema (BME) and structural lesions of the SI joints were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Spinal inflammatory and structural lesions were evaluated using the SPARCC MRI spine inflammation index and the Canada-Denmark MRI scoring system, respectively. Fulfillment of the Assessment of SpondyloArthritis international Society definition of a positive MRI for sacroiliitis/spondylitis was reviewed. Findings were compared to MRIs of axial SpA patients from the Belgian Inflammatory Arthritis and Spondylitis cohort. Of the subjects ≥30 years old, 17.2% fulfilled the definition of a positive MRI for sacroiliitis, but this occurred rarely in younger subjects. SI joint erosions (20.0%) and fat metaplasia (13.7%) were detected across all age groups. Erosions were more frequently visualized in subjects ages ≥40 years (39.3%). Spinal BME (35.7%) and fat metaplasia (28.6%) were common in subjects older than 40 years. Nonetheless, only 1 subject had ≥3 corner inflammatory lesions. SI joint and spinal SPARCC scores and total structural lesions scores increased progressively with age. Contrary to what is commonly believed, structural MRI-detected SI joint lesions are frequently seen in healthy individuals. Especially in older subjects, the high occurrence of inflammatory and structural MRI-detected lesions impacts their specificity for SpA, which has important implications for the interpretation of MRIs in patients with a clinical suspicion of SpA.

Evaluation of active inflammation, chronic structural damage, and response to treatment of sacroiliitis in axial spondyloarthritis using the Spondyloarthritis research consortium of Canada scoring system

BackgroundAxial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting the spine and sacroiliac joints. To investigate whether there are differences in inflammatory and chronic structural damages, as assessed by a semiquantitative MRI scoring method, between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) patients with active inflammation at baseline, and to evaluate the treatment response in these patients after 3 months of tumor necrosis factor-alpha (TNF-α) inhibitor treatment.MethodsFifty-eight axSpA patients with active inflammation were included in the study. The patients were divided into nr-axSpA group and AS group. MRI examinations of the sacroiliac joints were performed before and after treatment. Inflammatory and structural damages in these patients were assessed using the established Spondyloarthritis Research Consortium of Canada (SPARCC) inflammation and sacroiliac joint structural (SSS) scoring methods, which are two MRI-based scoring methods. The SPARCC score, SSS score, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were compared between the two groups.ResultsAt baseline, SPARCC scores for patients in the nr-axSpA and AS groups did not differ significantly (P > 0.05); however, SSS scores for fat metaplasia, erosion, and backfill for patients in the AS group were significantly higher (P < 0.001). Compared with baseline, SPARCC scores were significantly decreased in both groups after treatment (P < 0.001); however, after treatment, no statistically significant difference was found regarding SPARCC scores between the AS and nr-axSpA groups. Compared with baseline, a significant increase in the SSS scores for fat metaplasia and backfill (P < 0.001) and a significant decrease in the SSS scores for erosion (P < 0.001) were observed in all axSpA patients. Changes in the SPARCC score was inversely correlated with the changes in the SSS score for fat metaplasia (r = − 0.634, P < 0.001). Changes in the SSS score for backfill were positively correlated with the changes in the SSS score for fat metaplasia (r = 0.277, P < 0.05) and inversely correlated with those for erosion (r = − 0.443, P < 0.001).ConclusionThe SPARCC and SSS scoring systems can be used to assess inflammatory and chronic structural damages as well as treatment responses in patients with axSpA. More severe structural damages were seen in AS patients. TNF-α inhibitor treatment for 3 months could effectively reduce inflammation in axSpA patients.

AB0950 Detection of asymptomatic entheseal involvement in patients with psoriasis: A case-control ultrasound study

BackgroundEnthesopathy is one of the major features of psoriatic arthritis (PsA). The clinical screening for enthesopathies and synovitis in patients with psoriasis is nonspecific during the subclinical phase. Ultrasonography (US) has already demonstrated its ability to study entheses and joints in early stages of PsA.ObjectivesTo evaluate the prevalence of ultrasonographic subclinical synovitis and enthesopathies in psoriasis patients with no clinical evidence of PsA compared with controls.MethodsA cross-sectional study conducted on 40 patients with psoriasis and 40 healthy sex- and age- matched controls. The Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada (SPARCC) were used to evaluate entheseal involvement. US examination of 18 joints (wrists, metacarpophalangeal, and proximal interphalangeal joints) was performed along with 22 entheseal sites (deep flexor of the fingers, lateral epincondyle, triceps, quadriceps, patellar and calcaneal tendons and plantar fascia). Inflammatory-score (thickening, hypoechogenocity, bursitis and Doppler signal) and damage-score (calcifications, enthesophytes and erosions) were calculated (0= absent, 1=present for each abnormality). A total-score was obtained by adding these two scores.ResultsThe mean age of psoriatic patients 51,90±15,90 [19 -76] and the sex ratio of males to females was 3:2. US synovitis were more frequent in psoriatic patients 7/1040 (0,68%) than in controls 3/1040 (0,29%) but this was not significant (p= 0,420). Patients with psoriasis had more US enthesopathies 37 (92,5%) comparing to controls 16 (40%) (p &lt; 0,001). The total number of enthesopathies was higher in the psoriatic group 184/880 (20,90%) comparing to controls 42/880 (4,78%) (p &lt; 0,001). Entheses with more US abnormalities in the psoriasis group comparing to controls were deep flexor tendons of the fingers entheses (p&lt;0,001), distal patellar tendon entheses (p&lt;0,001) and calcaneal tendon entheses (p&lt;0,001). LEI and SPARCC scores were positively correlated to higher number of US enthesopathies (p=0,046, p=0,006). SPARCC was positively correlated to inflammatory-score and damage-score (p=0,009, p=0,024). The mean C-reactive protein level was higher in psoriatic arthritis 5,77±10,10 mg/L than in controls 2,15±3,26mg/L (p=0,037).ConclusionOur results confirm that US enthesopathies and synovitis are more frequent in patients with psoriasis comparing to healthy population. The US screening for subclinical enthesopathies should be the object of longitudinal investigations to define its value in predicting the clinical onset of PsA.Disclosure of InterestsNone declared

OA34 Post-hoc analysis of spinal MRI SPARCC inflammation scores in patients with radiographic axial spondyloarthritis treated with ixekizumab: results from the COAST-V study at week 16

Abstract Background/Aims Ixekizumab, an interleukin-17A inhibitor, has demonstrated efficacy in radiographic axial spondyloarthritis (r-axSpA) irrespective of baseline local inflammation as measured by spinal magnetic resonance imaging (MRI) Spondyloarthritis Research Consortium of Canada (SPARCC) inflammation scores. This post-hoc analysis assessed the efficacy of ixekizumab in patients with r-axSpA categorized by MRI SPARCC score at baseline and 16-week change from baseline (CFB). Methods COAST-V (NCT02696785) was a phase 3, randomized, controlled trial enrolling patients with active r-axSpA naïve to biologic disease-modifying antirheumatic drugs, randomized 1:1:1:1 to 80-mg ixekizumab every 2 weeks, 80-mg ixekizumab every 4 weeks (Q4W), adalimumab, or placebo for the 16-week blinded treatment period. Three categories were defined according to spinal MRI SPARCC inflammation score at baseline and CFB (based on published minimally important change): 1) low baseline (baseline SPARCC score &amp;lt;5.0 points), 2) low responder (baseline SPARCC score ≥5.0 points and CFB &amp;lt;5.0 points), 3) high responder (baseline SPARCC score ≥5.0 points and CFB ≥5.0 points). Proportions of patients achieving Assessment in SpondyloArthritis international Society 40% (ASAS40), Ankylosing Spondylitis Disease Activity Score (ASDAS) &amp;lt;2.1, and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) 50 were determined. Means at baseline and week-16 least squares means of CFBs were calculated for ASDAS, BASDAI, Spinal Pain, Bath Ankylosing Spondylitis Functional Index (BASFI), and 36-item Short Form Health Survey Physical Component Summary (SF-36 PCS). Non-responder imputation and modified baseline observation carried forward were used for missing week-16 data in discrete and continuous variables, respectively. Results Of 78 patients receiving ixekizumab Q4W, 35 (44.9%), 11 (14.1%), and 32 (41.0%), were MRI SPARCC low baseline, low responders, and high responders, respectively. Similar proportions of ixekizumab-treated patients in all categories achieved ASAS40, ASDAS&amp;lt;2.1, and BASDAI50 week-16 responses; week-16 improvements in other efficacy endpoints were broadly similar, with high responders showing greater improvements in ASAS40 and ASDAS CFB (Table). In adalimumab-treated patients, week-16 improvements were less pronounced in the low baseline and low responder categories. Conclusion Patients with r-axSpA receiving ixekizumab Q4W showed broadly similar reduction in the signs and symptoms of r-axSpA irrespective of their spinal MRI SPARCC inflammation score category at week 16. Disclosure H. Marzo-Ortega: Honoraria; Abbvie, Celgene, Eli Lilly and Company, Janssen, Novartis, Pfizer, Takeda, UCB, Biogen. Grants/research support; Janssen, Novartis. W. Tsai: Consultancies; Abbvie, Pfizer, Roche. H. Kameda: Consultancies; Abbvie, Asahikasei Pharma, Bristol-Myers Squibb, Eisai, Eli Lilly and Company, Janssen, Mitsubishi Tanabe Pharma, Novartis, Chugai, Pfizer. Member of speakers’ bureau; Abbvie, Asahikasei Pharma, Bristol-Myers Squibb, Eisai, Eli Lilly and Company, Janssen, Mitsubishi Tanabe Pharma, Novartis, Chugai, Pfizer. A. Konomi: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. A.J. Bradley: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. K. Ng: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. Y. Schymura: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. S. Liu-Leage: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. W.P. Maksymowych: Corporate appointments; CARE Arthritis Limited. Consultancies; Abbvie, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Galapagos, Janssen, Novartis, Pfizer, UCB. Member of speakers’ bureau; Abbvie, Janssen, Novartis, Pfizer, UCB. Grants/research support; Abbvie, Novartis, Pfizer, UCB. M. Østergaard: Consultancies; Abbvie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, UCB. Member of speakers’ bureau; Abbvie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, UCB. Grants/research support; Abbvie, Celgene, Centocor, Merck, Novartis.

Detection of the disease activity with ankylosing spondylitis through intravoxel incoherent motion diffusion-weighted MR imaging of sacroiliac joint.

To explore the value of the quantitative parameter of intravoxel incoherent motion diffusion (IVIM-DWI) at 3.0 T MRI of the sacroiliac joint in differentiating different disease activity statuses of ankylosing spondylitis (AS) and to compare it with traditional diffusion-weighted imaging (DWI) and Spondyloarthritis Research Consortium of Canada (SPARCC) score. 56 AS patients (active group, inactive group) and 24 healthy controls were included. Clinical data, quantitative parameters of IVIM-DWI MR images and the SPARCC scores were collected. The Kruskal-Wallis test was used to compare the differences between the groups. Receiver operating characteristic (ROC) curve analysis of histogram data and the SPARCC scores identified the efficacy of the three groups. The Spearman correlation coefficients were used to analyse the correlation between the quantitative IVIIM-DWI parameters and the SPARCC score. The f (10th percentile) and SPARCC score of the active group were significantly higher than those of the inactive group. The f (10th, 25th, 50th percentiles), Dslow (average, entropy, 10th ~ 90 th percentiles), Dfast (kurtosis, skewness), ADC (average, 10th ~ 90 th percentiles) and the SPARCC score of the active group were significantly higher than the control group (p < 0.05). The AUC of the SPARCC score was the highest (0.799) in the identification between the active and inactive groups, and the sensitivity and specificity were 69.23 and 82.35%, respectively, at the cut-off value of 12. The SPARCC score was positively correlated with each percentile and the average value. Quantitative IVIIM-DWI parameters are helpful for the identification of different AS disease activity levels and are superior to traditional DWI. IVIM-DWI quantitative parameters had a good correlation with the SPARCC score. A new MR technology-quantitative parameters of IVIM-DWI contribute to the identification of AS disease activity. IVIM-DWI quantitative parameters were well correlated with the SPARCC score.

A study of Madrid sonographicenthesis score Index (MASEI) versus spondyloarthritis research consortium of Canada (SPARCC) in the assessment of early enthesopathy among psoriatic skin patient

Abstract Objective To compare between Sonographic Madrid score index (MASEI) versus Spondyloarthritis research consortium of canada (SPARCC) for early assessment of enthesopathy among psoriatic skin patients. Patients and Methods This study included fifty psoriatic skin patients. All underwent history, laboratory investigation, clinical examination using SPARCC score, Psoriasis Area and Severity Index (PASI) and musculoskeletal ultrasound using MASEI score with power Doppler (PD) bilaterally for assessment of enthesitis. Results The mean age of fifty patients was 42.00 ± 10.923 years, disease duration of 11.110 ±7.402 and BMI of 29.356 ± 3.753. The mean PASI was 12.950±8.044. SPARCC score was positive in 10 out of 50 patients (20%).MASEI score was positive in 20 out of 50 patients (40%) with 10 out of 50 patients had power Doppler signals. Highly statistically significant difference between MASEI and SPARCC score( pvalue &amp;lt;0.001). Highly statistically significant positive correlation was observed between PASI score and MASEI(r = 0.498, p-value &amp;lt;0.001). Conclusion musculoskeletal ultrasound is useful for early detection of enthesitis and to be a sensitive tool in detecting of enthesitis and subclinical enthesitis that can be missed during routine clinical examination.

Comparative analysis between ankylosing spondylitis and axial psoriatic arthritis patients

Aim of the workTo compare clinical aspects, disease activity, spinal mobility, and radiographic findings between ankylosing spondylitis (AS) and axial psoriatic arthritis (axPsA) patients Patients and methodsFifty-eight AS and 42 axPsA patients were enrolled. Patients were assessed by clinical examination, spinal mobility measurements, and conventional radiographs of the sacroiliac joints, lumbosacral and cervical spines. Bath.AS Metrology Index (BASMI) and modified Stoke AS Spinal Score (mSASSS) were measured. Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index score and AS Disease Activity Score (ASDAS) were assessed. Results: The mean age of AS and AxPsA patients were comparable (37.2 ± 11.2 years vs 39.6 ± 13.3 years;p = 0.33) and male:female was 2.63 vs 0.24:1 (p < 0.0001). Inflammatory back pain (IBP) was higher in AS (93.1%) than axPsA (76.2%). Peripheral arthritis was higher in axPsA (85.7%) than in AS (39.7%). Dactylitis and nail dystrophy were present only in axPsA (33.3% and 28.6% respectively) while uveitis was more common in AS (60.3%vs 28.6%;p = 0.12). SPARCC score was higher in axPsA (p = 0.12).The median BASMI was higher in AS (2.1) than axPsA (1.2)(p = 0.07). The mSASSS was similar (AS:19.6 ± 4.7;6–40 and axPsA:14.4 ± 2.1;0–32)(p = 0.23). 63.8% of AS patients had grade 3 sacroiliitis while 61.9% of axPsA had grade 2. 75.9% of AS had high ASDAS while 33.3% of axPsA patients had very high activity (p = 0.039). ConclusionsAS patients were more likely to be males, smoked, higher IBP, lower peripheral arthritis, more uveitis, higher limitation in spinal mobility measurements, more spinal deformities, and severe radiographic involvement with nearly equal disease activity as in axPsA patients.

MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis

BackgroundNonradiographic axial spondyloarthropathies (nr-axSpA) are diagnosed by the absence of radiographic sacroiliitis and the presence of bone marrow edema (BME) on magnetic resonance imaging (MRI). According to the classification criteria of the international Assessment of Spondyloarthritis Society (ASAS), structural changes to sacroiliac joints (SIJs) on MRI cannot be used as criteria in the absence of BME. However, less than half the Asian patients with clinically active axSpA show BME. The incidence of human leukocyte antigen (HLA)-B27 is low in Asian populations, which makes it more difficult to identify nr-axSpA. We used MRI to evaluate the structural damage to SIJs in patients with nr-axSpA with and without BME with the aim of identifying the best methodology for accurate diagnosis, especially in populations with less common BME and HLA-B27.MethodsOne hundred three patients with inflammatory back pain were included in this prospective study. No patient’s radiograph met the definition of positive modified New York criteria. BME and structural damage to SIJ including sclerosis and erosion were assessed independently on coronal and axial short-tau inversion recovery and T1-weighted spin echo MRI scans by two well-trained musculoskeletal radiologists using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Demographics of patients were collected. Disease characteristics and structural damage were analyzed in patients with and without BME on SIJ MRI. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of structural damage.ResultsAll individuals in the cohort had at least one abnormal finding on SIJ MRI, including BME or structural damage; 36 of 103 patients had BME. We identified a significant positive correlation between SPARCC scores and severe erosion assessed by focal joint space widening (fJSW) (p = 0.001) in these 36 patients. Fifty-eight of the 103 enrolled patients fulfilled the ASAS criteria for nr-axSpA in the either absence or presence of BME. Of these 58 patients, 57 and 19 had erosions or fJSW, respectively, and the presence of BME was significantly correlated with fJSW (phi score of 0.319 and p = 0.015). We demonstrated a significant positive correlation between fJSW and either the presence or the severity of BME in patients with nr-axSpA who met the ASAS definition. There was a positive correlation between BME and fJSW across the whole study cohort (phi score of 0.389; p < 0.001). The area under the ROC curve (AUC) for fJSW on SIJ MRI was 0.736, p < 0.001. In both HLA-B27-positive and -negative groups, BME was more common in the presence of fJSW (phi scores of 0.370 and 0.377, p = 0.018 and 0.003, respectively) and SPARCC scores were higher in patients with fJSW (p < 0.001 and p = 0.005). We also identified a positive correlation between fJSW and BME in patients with nr-axSpA and normal serum levels of C-reactive protein (phi score of 0.362 and p = 0.001).ConclusionStructural damage detected on SIJ MRI, sclerosis, erosions and fJSW may be present in patients without detectable inflammation on SIJ MRI. However, fJSW is significantly correlated with the severity of inflammation seen on SIJ MRI, which contributes to the accurate diagnosis of nr-axSpA, and it could be used as an alternative diagnostic test for nr-axSpA in the general population, especially for those who do not carry the HLA-B27 gene, Asian patients without BME, or patients with normal serum inflammatory biomarkers.

MRI Changes of the Symphysis Pubis in Patients With Axial Spondyloarthritis and Association With Clinical Factors.

This study aimed to evaluate the magnetic resonance imaging (MRI) changes of the symphysis pubis in patients with axial spondyloarthritis (ax-SpA) and to assess its association with clinical factors. A retrospective analysis of 172 patients with ax-SpA was performed to assess the presence of active inflammatory and structural changes of the symphysis pubis on MRI scans, and their association with clinical factors and the SPARCC (Spondyloarthritis Research Consortium of Canada) scoring of the sacroiliac joint were evaluated. The proportions of active inflammation and structural changes of the symphysis pubis were 69/172 (40.1%) and 54/172 (31.4%), respectively. When comparing the active inflammation and no-active inflammation symphysis pubis groups, the former had higher level C-reactive protein, higher erythrocyte sedimentation rate, and younger median age of patients. Moreover, no significant correlation was noted between the active inflammation of the symphysis pubis and SPARCC score of the sacroiliac joint. When comparing the normal and abnormal symphysis pubis groups, the latter had longer symptom duration. The MRI changes of the symphysis pubis were seen in 55.2% of the patients with ax-SpA and were associated with C-reactive protein, erythrocyte sedimentation rate, and symptom duration.

P193 Clinical features of patients with active ankylosing spondylitis who did not respond to adalimumab but responded to ixekizumab: a post-hoc analysis

Abstract Background/Aims  Biologic treatment in ankylosing spondylitis (AS) are currently limited to TNF and IL-17A inhibitors (IL-17Ai). It is unknown whether there are predictors of AS patients who only respond to 1 of these mechanisms of action or respond to switching from TNF-blocker to IL-17Ai. This post-hoc analysis evaluated whether patients who did not respond to TNF inhibitor adalimumab (ADA) but did subsequently respond to IL-17Ai ixekizumab (IXE) differed from those that responded to both ADA and subsequent IXE. Methods  The analysis included patients from the phase-3 COAST-V trial in bio-naive patients with active AS (BASDAI≥4 and back pain≥4 on VAS of 0-10). There were 341 patients randomized 1/1/1/1 to IXE80mg/2weeks (wks) (Q2W), IXE 80mg/4wks (Q4W), ADA 40mg Q2W (reference arm), and placebo (PBO) for the 16-week blinded-treatment period. Of these, 329 entered the dose double-blind extended treatment period (wks16 to 52). Those who received PBO or ADA were re-randomized to receive IXE 80mg Q4W or Q2W. Patients were stratified as responders or non-responders based on their Assessment of Spondyloarthritis International Society (ASAS) 40 response at wks16 and 52. Data for the 2 IXE dose groups were pooled. Results  Overall, more patients responded to IXE than ADA at wk16. Based on ASAS40 response at wks16 and at wk52, 30.9% of patients responded to both initial ADA and subsequent IXE, 23.5% of patients did not respond to initial ADA but did respond to subsequent IXE, 45.9% of patients responded to IXE at both time points, and 12.3% of patients did not respond to IXE at wk16 but did so at wk52. Across the groups, patients were of similar age and predominantly males, though there were proportionally more women among those who did not respond to either ADA or IXE at wk16. However, ADA non-responders at wk16/IXE responders at wk52 had numerically lower baseline (mean[SD]) C-reactive protein (11.2 [11.2]), lower MRI Spondyloarthritis Research Consortium of Canada (SPARCC) scores of the spine (11.6 [12.1]), and lower MRI SPARCC score of the sacroiliac joints (1.1 [2.2]) than ADA responders at wk16/IXE responders at wk52 patients (16.0 [17.1], 24.6 [32.6], and 5.5 [9.8]), respectively. Conclusion  In this analysis, patients who did not respond to ADA but subsequently responded to IXE exhibited overall lower levels of inflammation, as measured by CRP and MRI of the spine or sacroiliac joints, compared with patients who responded on ADA and also after switching to IXE. Along with comparative findings in patients who continuously received IXE and responded at both wks16 and 52 or wk52 only, these data indicate that IXE is efficacious in patients with active AS irrespective of inflammation level, assessed by CRP and MRI. Alternatively, lower baseline inflammation may be a predictor of delayed response. Disclosure  X. Baraliakos: Consultancies; X. Baraliakos has served as a consultant for AbbVie, Bristol-Myers Squibb, Celgene, Janssen, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche, and UCB Pharma. Grants/research support; X. Baraliakos has received research grants from AbbVie, Bristol-Myers Squibb, Celgene, Janssen, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche, and UCB Pharma. R. Bolce: Shareholder/stock ownership; R. Bolce is a shareholder and employee of Eli Lilly and Company. D. Sandoval Calderon: Shareholder/stock ownership; D. Sandoval Calderon is a shareholder and employee of Eli Lilly and Company. S. Liu Leage: Shareholder/stock ownership; S.L. League is a shareholder and employee of Eli Lilly and Company. V. Geneus: Shareholder/stock ownership; V. Geneus is a shareholder and employee of Eli Lilly and Company. D. Adams: Shareholder/stock ownership; D. Adams is a shareholder and employee of Eli Lilly and Company. A. Deodhar: Consultancies; A. Deodhar has served as a consultant for AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Galapagos NV, GlaxoSmithKline, Janssen, Novartis, Pfizer, and UCB Pharma. Grants/research support; A. Deodhar has received grants from AbbVie, Eli Lilly and Company, GlaxoSmithKline, Novartis, Pfizer, and UCB Pharma. J. Walsh: Consultancies; J. A. Walsh has received consultancy fees from AbbVie, Eli Lilly and Company, Novartis, and UCB Pharma. Grants/research support; J. A. Walsh has received grant/research support from AbbVie and Pfizer. J. Sieper: Consultancies; J. Sieper is a consultant for: AbbVie, Eli Lilly and Company, Novartis, Merck, Janssen, Pfizer. Other; J. Sieper has served as a speaker for: AbbVie, Janssen, Novartis, Merck, Pfizer, and UCB.

Serum calprotectin as a potential biomarker for subclinical enthesitis in psoriatic patients

Aim of the workTo assess serum calprotectin level in psoriatic patients and investigate its potential relation to clinical and ultrasonographic enthesitis. Patients and methodsThe study included 45 psoriatic patients and 20 matched healthy controls. Enthesitis was assessed clinically, by musculoskeletal ultrasound (MSUS) and power Doppler, by Leeds Enthesitis Index (LEI), Maastricht Ankylosing Spondylitis Enthesitis (MASES), Spondyloarthritis Research Consortium of Canada (SPARCC) and Madrid Sonography Enthesitis Index (MASEI) scores. The Psoriasis Area, Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were evaluated. Serum calprotectin was measured using enzyme-linked immunosorbent assay. ResultsThe study included 45 psoriatic patients with a mean age of 49.9 ± 7.8 years and they were 23 males and 22 females with disease duration of 5.2 ± 3 years, (0.5–11 years). Patients were categorized into those with enthesitis (n = 25; 20 clinically and 5 subclinically diagnosed by MSUS) and those without (n = 20). Serum calprotectin was significantly higher among patients with enthesitis (clinical 593.7 ± 192.5 ng/ml and subclinical 692 ± 265.9 ng/ml) compared to those without (381.2 ± 198.5 ng/ml) and to the control (111.1 ± 15 ng/ml) (p = 0.001). The DLQI was significantly severer in patients with clinical enthesitis compared to those subclinically detected or without (p < 0.001). The acute phase reactants (erythrocyte sedimentation rate and C-reactive protein) were comparable between patients and control. Serum calprotectin significantly correlated with MASES, LEI, SPARCC and MASEI score in psoriatic patients (p < 0.001). At cutoff 141 ng/ml, calprotectin yielded specificity 69% and sensitivity 75% to detect enthesitis (p = 0.008). ConclusionCalprotectin may be considered as a potential biomarker for detection of enthesitis in psoriatic patients.

Disease activity in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome: the utility of the SPARCC MRI scoring system for assessment of axial spine involvement.

The aim of this study is to investigate the relationship between spinal MRI findings with disease activity and other clinical and serological parameters, and to determine the importance of MRI scoring system in evaluating disease activity of SAPHO syndrome. Thirty patients with SAPHO syndrome underwent clinical, laboratory and MRI evaluation at baseline, 3 months, 6 months and 1 year. Magnetic resonance images were analysed using modified Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. Correlations between MRI score and clinical and laboratory parameters were analysed using Spearman's rank correlation test. Persistent improvement was observed after 12 months in terms of total modified SPARCC scores (37(12,59) vs. 23(5,45) at baseline and 12 months, p<0.05). Total modified SPARCC scores showed Spearman correlations with hypersensitive C-reaction protein (hs-CRP), ankylosing spondylitis disease activity score (ASDAS) and bath ankylosing spondylitis metroloty index (BASMI) at baseline, 3 months, 6 months and 12 months (p varied from <0.001 to <0.05, and r varied from 0.418 to 0.601). Modified SPARCC scores of spine joint, as the largest contribution to the total scores with the mean score of 12(5,30) after 12 months vs. 26 (12,40) at baseline. The modified SPARCC score proposed in this study exhibits promising potential in the evaluation of extensive radiographic damage in SAPHO and the reflection the disease activity. Our study suggests that MRI could be used together with other parameters of disease activity in the assessment of symptomatic SAPHO patients with spine involvement.

Axial involvement in patients with early peripheral spondyloarthritis: a prospective MRI study of sacroiliac joints and spine

ObjectivesTo assess axial involvement on MRI in early peripheral spondyloarthritis (pSpA) and to evaluate whether axial inflammation predicts relapse on treatment withdrawal.MethodsFifty-six patients with early, active, newly diagnosed pSpA underwent...

OP0110 IS VERY EARLY TREATMENT EFFECTIVE? SIX MONTHS RESULTS OF THE PREVAS STUDY, A PLACEBO-CONTROLLED TRIAL WITH ETANERCEPT IN PATIENTS SUSPECTED OF NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background:Despite the new classification criteria for non-radiographic axial spondyloarthritis (nr-axSpA) patients according to the Assessment of Spondyloarthritis International Society (ASAS), there are limited data on disease progression in nr-axSpA patients.Objectives:First to assess the improvement in disease activity in patients suspected of nr-axSpA after 16 weeks treatment with Etanercept (ETN) or Placebo (PBO). Second, to assess the changes of active inflammation on MRI of the SI-joints (SIJ) between the ETN and PBO group after 16 and 24 weeks without study medication.Methods:The PrevAS study is a randomized, double blind, placebo-controlled trial with ETN performed in the VU University medical center (VUmc) (EudraCT number 2009-015515-40), with a screening period from 2009 until 2014. Patients suspected of nr-axSpA were included if they had chronic back pain for ≥ 3 months, were ≥ 18 years, fulfilled the Calin criteria of inflammatory back pain and had to be either HLA-B27 positive with at least ≥ 1 Spondyloarthritis (SpA)-feature (as defined by the European Spondyloarthropathy Study Group (ESSG), or HLA-B27 negative with at least ≥ 2 SpA-features and had a high disease activity score (Bath Ankylosing Spondylitis Disease Activity Index ≥ 4) plus insufficient response to at least two NSAIDs. Excluded were patients who fulfilled the modified New York criteria for ankylosing spondylitis, or in case of previous biological use. Included patients were randomly assigned (1:1) for 16 weeks treatment with ETN (N=40) or PBO (N=40) and followed after the treatment period for 24 weeks. The primary endpoint was the number of patients achieving the ASAS20 response at week 16. MRI was performed at baseline, 16 and 24 weeks and scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) index for number of active inflammatory lesions.Results:The majority of included patients was female (63.8%). Patient characteristics, like the presence of the HLA-B27 antigen and number of SpA-features at baseline, were comparable between the ETN and PBO group. Mean compliance to the study medication at sixteen weeks was 72.1%. Longitudinal regression analysis over the first 16 weeks showed a trend towards a three times higher chance to achieve the ASAS20 response in the ETN compared to the PBO group (OR = 3.2, 95% CI [0.6;16.7]p=0.18) (Figure 1). No differences were observed in ASAS20 response at 24 weeks. A positive SPARCC score (SPARCC ≥ 2.5) of the SIJ was observed in the ETN and PBO group in 33.3% (13/39 patients) vs. 30.8% (12/39 patients) at baseline, 16.7% (6/36 patients) vs. 17.5% (7/40 patients) at 16 weeks and 21.9% (7/32 patients) vs. 20.0% (7/35 patients) at 24 weeks, respectively. Increased CRP-levels (CRP_UL ≥ 10.0mg/L) nor a positive SPARCC score at baseline, had significant influence on the ASAS20 response at 16 weeks follow-up. The safety profile was consistent with what is known for ETN in AS.Conclusion:Patients suspected of nr-axSpA with high disease activity showed a trend towards a three times higher chance to achieve the ASAS20 response in the ETN group, compared to the PBO group at 16 weeks, regardless of a raised CRP level or positive MRI-SIJ at baseline.Figure:Acknowledgments:We thank Pfizer for financial support of this investigator initiated study. In addition we want to thank H. Hofman and W.A. ter Wee for practical study support.Disclosure of Interests:Tamara Rusman: None declared, Mignon A.C. van der Weijden: None declared, Michael T Nurmohamed Grant/research support from: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp &amp; Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Consultant of: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp &amp; Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Speakers bureau: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp &amp; Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly &amp; Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Janneke J. de Winter: None declared, B.J.H. Boden: None declared, Pierre M. Bet: None declared, Camile M.A. van der Bijl: None declared, Conny J. van der Laken: None declared, Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma