Imaging in Axial Spondyloarthritis: What is Relevant for Diagnosis in Daily Practice?

2021 ◽  
Vol 23 (8) ◽  
Author(s):  
Ulrich Weber ◽  
Anne Grethe Jurik ◽  
Robert G. W. Lambert ◽  
Walter P. Maksymowych
2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1129.1-1129
Author(s):  
A. Baillet ◽  
X. Romand ◽  
A. Pfimlin ◽  
M. Dalecky ◽  
M. Dougados

Background:Standardization of clinical practice has been proven to be effective in management of chronic diseases. This is particularly true at the time where the concept of treat to target is becoming more and more important in the field of axial spondyloarthritis (ax-SpA).Objectives:To propose a list of variables to be collected at the time of the diagnosis and over the follow-up of patients with axial spondyloarthritis (ax-SpA) for an optimal management in daily practice.Methods:The process comprised (1) the evaluation of the interest of 51 variables proposed for the assessment of axSpA via a systematic literature research, (2) a consensus process involving 78 hospital-based or office-based rheumatologists, considering the collection of the variable in a 4 grade scale from ”potentially useful” to “mandatory”, (3) a consensus on optimal timeline for periodic assessment of the selected variables on a 5 grade scale from “at each visit” to “never to be re-collected”.Results:The systematic literature research retrieved a total of 14,133 abstracts, of which 213 were included in the final qualitative synthesis. Concerning the data to be collected at the time of the diagnosis and during follow-up, we proposed to differentiate the results based on a) the way of collection of the variables (e.g. questionnaires by the patient, interview by the physician, physical examination, investigations) b) the usefulness these variables in daily practice based on the opinion of the rheumatologists ” c) the optimal timeline between 2 evaluations of the variable based on the opinion of the rheumatologists. In the initial systematic review, symptoms of heart failure history of inflammatory bowel disease, psoriasis or uveitis, patient global visual analogic scale, spine radiographs, modified Schöber test, coxo-femoral rotations, swollen joint count, urine strip test, BASDAI and ASDAS global scores were considered very useful and nocturnal back pain/morning stiffness, sacro-iliac joints radiographs and CRP were considered mandatory (Figure 1). Timeline between 2 evaluations of variables to collect in the periodic review are summarized inFigure 2.Figure 1.Core sets of items to collect and report in the systematic review in axial spondyloarthritis management in daily practice ASDAS=Ankylosing Spondylitis Disease Activity Score, BASDAI=Bath Ankylosing Spondylitis Disease Activity Index, BASFI=Bath Ankylosing Spondylitis Functionnal Index, BASMI=Bath Ankylosing Spondylitis Metrology Index, CRP=C Reactive Protein, CT=computerized tomography, FIRST=Fibromyalgia Rapid Screening Tool, HLA=Human Leukocyte Antigen, MRI=Magnetic resonance imaging, PET=positron emission tomography.Figure 2.Periodic review timeline of variables to collectASDAS=Ankylosing Spondylitis Disease Activity Score, BASDAI=Bath Ankylosing Spondylitis Disease Activity Index, Spondylitis Metrology Index, CRP=C Reactive Protein, IBD = inflammatory bowel diseases, PRO = Patient Reported OutcomesConclusion:Using an evidence-based and an expert consensus approaches, this initiative defined a core set of variables to be collected and reported at the time of the diagnosis and during follow-up of patients with ax-SpA in daily practice.Acknowledgments:this study has been conducted in two parts: the first one (evidence-based) was conducted thanks to a support from Abbvie France. AbbVie did not review the content or have influence on this manuscript. The second part of this initiative (consensus) has been conducted thanks to a support from the scientific non-profit organization: Association de Recherche Clinique en RhumatologieDisclosure of Interests:Athan Baillet Consultant of: Athan BAILLET has received honorarium fees from Abbvie for his participation as the coordinator of the systematic literature review, Xavier Romand Consultant of: Xavier ROMAND has received honorarium fees from Abbvie, Arnaud Pfimlin Consultant of: Arnaud PFIMLIN has received honorarium fees from Abbvie, Mickael Dalecky Consultant of: Mickael DALECKY has received honorarium fees from Abbvie, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma


Rheumatology ◽  
2018 ◽  
Vol 58 (5) ◽  
pp. 798-802 ◽  
Author(s):  
Alexandre Sepriano ◽  
Sofia Ramiro ◽  
Robert Landewé ◽  
Maxime Dougados ◽  
Désirée van der Heijde ◽  
...  

Abstract Objective To assess any association between bone marrow oedema on MRI of the sacroiliac joints (MRI-SIJ) according to local readings in daily practice and the development of structural damage on radiographs of the SIJ (X-SIJ) in axial spondyloarthritis (axSpA). Methods Patients with axSpA from the Assessment of the SpondyloArthritis international Society (ASAS) and DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR) multicentre cohorts were included. MRI-SIJ and X-SIJ were obtained at baseline, and X-SIJ at follow-up after a mean 4.6 years (ASAS) and 5.1 years (DESIR). All images were scored by local readers. Structural damage in the X-SIJ was defined according to the modified New York criteria. The percentage of structural net progression (number of ‘progressors’ minus the number of ‘regressors’ divided by the total number of patients) was assessed and the effect of bone marrow oedema on MRI-SIJ on X-SIJ damage evaluated by multivariable logistic regression. Results In total, 125 (ASAS-cohort) and 415 (DESIR-cohort) patients had baseline MRI-SIJ and complete X-SIJ data available. According to local readings, progression and ‘improvement’ in X-SIJ was seen in both the ASAS- and DESIR-cohort, yielding a net progression that was higher in the former than in the latter (19.2% and 6.3%). In multivariable analysis, baseline bone marrow oedema on MRI-SIJ was strongly associated with X-SIJ structural progression in both ASAS (odds ratio = 3.2 [95% CI: 1.3; 7.9]), and DESIR (odds ratio = 7.6 [95% CI: 4.3; 13.2]). Conclusion Inflammation on MRI-SIJ is associated with future radiographic progression according to local readings despite an expected increased imprecision invoked by local readings.


2018 ◽  
Vol 14 (3) ◽  
pp. 155-159
Author(s):  
Raquel Almodovar ◽  
Juan C. Torre Alonso ◽  
Enrique Batlle ◽  
Concepción Castillo ◽  
Eduardo Collantes-Estevez ◽  
...  

2020 ◽  
Vol 87 (5) ◽  
pp. 405-411
Author(s):  
Athan Baillet ◽  
Xavier Romand ◽  
Arnaud Pflimlin ◽  
Mickael Dalecky ◽  
Pascal Claudepierrec ◽  
...  

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_4) ◽  
pp. iv6-iv17 ◽  
Author(s):  
Denis Poddubnyy

Abstract In recent years, significant progress has been made in improving the early diagnosis of spondyloarthritides (SpA), including axial SpA. Nonetheless, there are still issues related to the application of classification criteria for making the primary diagnosis of SpA in the daily practice. There are substantial conceptional and operational differences between the diagnostic vs classification approach. Although it is not possible to develop true diagnostic criteria for natural reasons as discussed in this review, the main principles of the diagnostic approach can be clearly defined: consider the pre-test probability of the disease, evaluate positive and negative results of the diagnostic test, exclude other entities, and estimate the probability of the disease at the end. Classification criteria should only be applied to patients with an established diagnosis and aimed at the identification of a rather homogeneous group of patients for the conduction of clinical research.


2017 ◽  
Vol 84 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Anna Molto ◽  
Benjamin Granger ◽  
Daniel Wendling ◽  
Maxime Dougados ◽  
Laure Gossec

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1626-1626
Author(s):  
A. Spoorenberg ◽  
S. Arends ◽  
R. Bruin ◽  
M. De Hair

Background:ASAS-EULAR have developed management recommendations for axial spondyloarthritis (axSpA) to provide guidance to the management of patients with axSpA1. However, there is limited insight into how rheumatologists treat axSpA patients in daily clinical practice and if these recommendations are used.Objectives:To get insight into the management of axSpA patients in daily practice in the Netherlands.Methods:We performed a survey among rheumatologists in the Netherlands with 21 multiple choice questions; 5 general questions on characteristics of their practice and 16 questions addressing treatment and follow-up of axSpA patients in daily practice. The questionnaire was taken during structured face-to-face interviews by employees of the medical department of Novartis NL Rheumatologists in the Netherlands were invited to participate, aiming to get a sample of rheumatologists varying in geographical location and hospital type, as well as a mix of SpA-experts and non-SpA-experts. Rheumatologists gave approval for anonymous use of the data, which were entered in a database and analyzed using descriptive statistics.Results:Between October 15 2019 and January 16 2020, 36 rheumatologists participated; 6 from university hospitals, 27 from general hospitals and 3 from private care centers.81% of the rheumatologists referred most of their axSpA patients (76-100%) after diagnosis for information and education concerning axSpA, exercise and lifestyle to a specialized nurse practitioner. Furthermore, 53% of rheumatologists referred most of their axSpA patients (76-100%) to a physiotherapist for exercise therapy. At diagnosis, approximately 55% of axSpA patients used the daily maximum dose of NSAIDs, compared to 25% for patients on biological treatment.The reported level of importance of different axSpA related aspects for starting a biological was largely similar for AS and nr-axSpA, although some differences could be observed (Figure 1): Most rheumatologists graded insufficient response to 2 NSAIDs during 4 weeks (94% for AS and 92% for nr-AxSpA) and bone marrow edema on MRI (75% and 89%) as important for starting a biological. About 60% of rheumatologists considered active disease using ASDAS/BASDAI important for the decision to start a biological, which was similar to the importance of the level of pain. For nr-axSpA, more rheumatologists graded elevated CRP and bone marrow edema on MRI as important for starting a biological, than for AS.Most rheumatologists (67%) do not base a decision that a biological is ineffective on ASDAS or BASDAI. To assess disease activity in axSpA, 86% of the rheumatologists always measured C-reactive protein (CRP), compared to 42% and 31% for BASDAI and ASDAS, respectively. 77% of rheumatologists reported to follow the 2016 ASAS-EULAR treatment recommendations for axSpA for treatment and follow-up of axSpA patients.Conclusion:This survey among Dutch rheumatologists suggests that ASDAS and BASDAI are as important for starting a biological in axSpA as is the level of pain. Moreover, in contrast to ASAS-EULAR treatment recommendations, most rheumatologists do not use validated disease activity instruments to assess biological ineffectiveness, which may be a topic for increasing awareness and education.References:[1]Van der Heijde D et al, Ann Rheum Dis 2017;76:978-91.Acknowledgments:We would like to thank all participating rheumatologists.Disclosure of Interests:Anneke Spoorenberg: None declared, Suzanne Arends Grant/research support from: Grant/research support from Pfizer, Reindert Bruin Employee of: Current employee of Novartis Pharma B.V., Marjolein de Hair Employee of: Current employee of Novartis Pharma B.V.


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