FRI0324 NO RADIOGRAPHIC SACROILIITIS PROGRESSION OVER 6 YEARS IN PATIENTS WITH EARLY SPONDYLOARTHRITIS FROM THE ESPERANZA COHORT

Background:Longitudinal studies about the change from non-radiographic axial Spondyloarthritis (nr-axSpA) to r-axSpA (radiographic axial Spondyloarthritis) are scarce but show a 9-10% progression rate over 2 years (1-2) and a 24% progression rate over 10 years in another study (3). However, in early cohorts such as DESIR, this only represents a 5% over 5 years (4).Objectives:The aim of this study was to know the rate of progression from nr-axSpA to r-axSpA over 6 years in the early Esperanza cohort.Methods:This study included 94 patients of the Spanish early spondyloarthritis (SpA) Esperanza cohort, 60 fulfilled the ASAS classification criteria for SpA. Every patient had a baseline and a six years sacroiliac X-ray. Nine readers, blinded for the diagnosis, participated in the reliability exercise, all of them experienced rheumatologists and members of the Spanish spondyloarthritis working group (GRESSER). Patients with SpA were classified as having r-axSpA, at baseline or after 6 years of follow-up, if they fulfilled the radiographic item of the modified New York criteria (mNY) (presence of radiographic changes in the sacroiliac joints -SIJ- of at least grade II bilaterally or grade III or IV unilaterally). The gold standard of SIJ X-Ray was the categorical opinion of at least five of the expert readers. For the statistical analysis, the Chi-square and Kappa tests were performed.Results:Demographic data of the SpA patients were: mean age 33.4±7.5 years; 37 (61.7%) male; mean CRP 6.4±6.5 mg/dl and ESR 10.3±10.6. Present smokers 30.6%; and past smokers 16.3%. HLA-B27 (+) 56.7%. Regarding the presence of X-Ray sacroilitis: 20 patients had baseline sacroilitis and 18 at the final visit; 11 had sacroiliitis at both baseline and final visits; 9 patients changed from baseline sacroiliitis to no-sacroiliitis and 7 changed from baseline no-sacroiliitis to sacroiliitis at the 6 year visit. The reliability of the readers was fair with a mean inter-reader kappa test of 0.375 (range 0.146 - 0.652) and a mean agreement of 73.7% (range 58.7% - 90%).Conclusion:In this group of patients with early SpA no progression from nr-axSpA to r-axSpA over 6 years was observed. It appears that early diagnosis and standard treatment seem to reduce SIJ radiographic progression.References:[1]Poddubnyy D, Rudwaleit M, Haibel H, et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 2011;70:1369–74.[2]Sampaio-Barros PD, Conde RA, Donadi EA, et al. Undifferentiated spondyloarthropathies in Brazilians: importance of HLA-B27 and the B7-CREG alleles in characterization and disease progression. J Rheumatol 2003;30:2632–7.[3]Sampaio-Barros PD, Bortoluzzo AB, Conde RA, et al. Undifferentiated spondyloarthritis: a longterm followup. J Rheumatol 2010;37:1195–9.[4]Dougados M, et al. Ann Rheum Dis 2017;76:1823–1828.Disclosure of Interests:Carolina Tornero: None declared, María del Carmen Castro Villegas: None declared, Xavier Juanola-Roura: None declared, Maria Luz García-Vivar: None declared, Cristina Fernández-Carballido Consultant of: Yes, I have received fees for scientific advice (Abbvie, Celgene, Janssen, Lilly and Novartis), Speakers bureau: Yes, I have received fees as a speaker (Abbvie, Celgene, Janssen, Lilly, MSD, Novartis), Jose Francisco Garcia LLorente: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, E. Galindez: None declared, Claudia Urrego-Laurín: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi)

Download Full-text

Evaluation of the change in structural radiographic sacroiliac joint damage after 2 years of etanercept therapy (EMBARK trial) in comparison to a contemporary control cohort (DESIR cohort) in recent onset axial spondyloarthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-212008 ◽

2017 ◽

Vol 77 (2) ◽

pp. 221-227 ◽

Cited By ~ 13

Author(s):

Maxime Dougados ◽

Walter P Maksymowych ◽

Robert B M Landewé ◽

Anna Moltó ◽

Pascal Claudepierre ◽

...

Keyword(s):

New York ◽

Sacroiliac Joint ◽

Axial Spondyloarthritis ◽

Joint Damage ◽

Control Group ◽

Progression Rate ◽

Recent Onset ◽

Link Type ◽

Factor Therapy ◽

Adjusted Least Squares

ObjectiveTo compare 2 years of radiographic sacroiliac joint (SIJ) changes in patients with recent onset axial spondyloarthritis (axSpA) receiving etanercept in a clinical trial (EMBARK) to similar patients not receiving biologics in a cohort study (DESIR).MethodsEndpoints were changes at week 104 per the modified New York (mNY) grading system in total SIJ score (primary endpoint) and net percentage of patients with progression defined three ways. Treatment effect was analysed with and without adjustment for baseline covariates.ResultsAt 104 weeks, total SIJ score improved in the etanercept group (n=154, adjusted least-squares mean change: –0.14) and worsened in the control group (n=182, change: 0.08). The adjusted difference between groups (etanercept minus control) was –0.22 (95% CI –0.38 to –0.06), p=0.008. The net percentage of patients with progression was significantly lower in the etanercept versus the control group for two of three binary endpoints: –1.9% versus 1.6% (adjusted difference for etanercept minus control: –4.7%,95% CI –9.9 to 0.5, p=0.07) for change in mNY criteria; –1.9% versus 7.8% (adjusted difference: –18.2%,95% CI –30.9 to –5.6, p=0.005) for change ≥1 grade in ≥1 SIJ; and –0.6% versus 6.7% (adjusted difference: –16.4%,95% CI –27.9 to –5.0, p=0.005) for change ≥1 grade in ≥1 SIJ, with shift from 0 to 1 or 1 to 0 considered no change.ConclusionDespite the slow radiographic SIJ progression rate over 2 years in axSpA, this study suggests a lower rate of progression in the SIJ with etanercept than without anti-tumour necrosis factor therapy.Trial registration numbersNCT01258738, NCT01648907; Post-results.

Download Full-text

Imaging in axial spondyloarthritis

10.1093/med/9780198755296.003.0011 ◽

2016 ◽

Author(s):

Stefan Siebert ◽

Sengupta Raj ◽

Alexander Tsoukas

Keyword(s):

New York ◽

Structural Damage ◽

Axial Spondyloarthritis ◽

Imaging Modalities ◽

X Rays ◽

Mri Imaging ◽

Sacroiliac Joints ◽

X Ray ◽

X Ray Imaging ◽

Imaging Results

Imaging has always been a key component in the diagnosis of ankylosing spondylitis as part of the modified New York criteria. With the increased availability of MRI and the development of the ASAS axial spondyloarthritis (axSpA) criteria, there has been a shift from x-ray imaging of structural damage to MRI imaging of inflammation. This information can help in both the diagnosis of axSpA and in guiding treatment decisions in patients with this diagnosis. However, imaging results must be evaluated in the context of the clinical picture and should not be acted on in isolation. Here we review the key imaging modalities used in axSpA, with the main focus on x-rays and MRI of the sacroiliac joints, spine, and peripheral structures. Advances in technology are also likely to lead to the development of even better imaging modalities for axSpA in future.

Download Full-text

What is axial spondyloarthritis? A latent class and transition analysis in the SPACE and DESIR cohorts

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2019-216516 ◽

2020 ◽

Vol 79 (3) ◽

pp. 324-331 ◽

Cited By ~ 10

Author(s):

Alexandre Sepriano ◽

Sofia Ramiro ◽

Désirée van der Heijde ◽

Floris van Gaalen ◽

Pierre Hoonhout ◽

...

Keyword(s):

At Risk ◽

Back Pain ◽

Latent Class ◽

Axial Spondyloarthritis ◽

Positive Family History ◽

Classification Criteria ◽

Hla B27 ◽

Transition Analysis ◽

Latent Constructs ◽

Asas Classification Criteria

ObjectivesTo gain expert-judgement-free insight into the Gestalt of axial spondyloarthritis (axSpA), by investigating its ‘latent constructs’ and to test how well these latent constructs fit the Assessment of SpondyloArthritis international Society (ASAS) classification criteria.MethodsTwo independent cohorts of patients with early onset chronic back pain (SPondyloArthritis Caught Early (SPACE)) or inflammatory back pain (IBP) (DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR)) were analysed. Latent class analysis (LCA) was used to estimate the (unobserved) potential classes underlying axSpA. The best LCA model groups patients into clinically meaningful classes with best fit. Each class was labelled based on most prominent features. Percentage fulfilment of ASAS axSpA, peripheral SpA (pSpA) (ignoring IBP) or both classification criteria was calculated. Five-year data from DESIR were used to perform latent transition analysis (LTA) to examine if patients change classes over time.ResultsSPACE (n=465) yielded four discernible classes: ‘axial’ with highest likelihood of abnormal imaging and HLA-B27 positivity; ‘IBP+peripheral’ with 100% IBP and dominant peripheral symptoms; ‘at risk’ with positive family history and HLA-B27 and ‘no SpA’ with low likelihood for each SpA feature. LCA in DESIR (n=576) yielded similar classes, except for the ‘no-SpA’. The ASAS axSpA criteria captured almost all (SPACE: 98%; DESIR: 93%) ‘axial’ patients, but the ‘IBP+peripheral’ class was only captured well by combining the axSpA and pSpA criteria (SPACE: 78%; DESIR: 89%). Only 4% of ‘no SpA’ patients fulfilled the axSpA criteria in SPACE. LTA suggested that 5-year transitions across classes were unlikely (11%).ConclusionThe Gestalt of axSpA comprises three discernible entities, only appropriately captured by combining the ASAS axSpA and pSpA classification criteria. It is questionable whether some patients with ‘axSpA at risk’ will ever develop axSpA.

Download Full-text

Development and Validation of Three Preliminary MRI Sacroiliac Joint Composite Structural Damage Scores in a 5-year Longitudinal Axial Spondyloarthritis Study

The Journal of Rheumatology ◽

10.3899/jrheum.201075 ◽

2021 ◽

pp. jrheum.201075

Author(s):

Marie Wetterslev ◽

Mikkel Østergaard ◽

Inge Juul Sørensen ◽

Ulrich Weber ◽

Anne Gitte Loft ◽

...

Keyword(s):

New York ◽

Sacroiliac Joint ◽

Structural Damage ◽

Axial Spondyloarthritis ◽

Joint Damage ◽

Tumor Necrosis Factor Inhibitor ◽

Symptom Duration ◽

Progression Rate ◽

Advanced Stages ◽

Research Consortium

Objective In axial spondyloarthritis (axSpA), sacroiliac joint (SIJ) erosion is often followed by fat metaplasia in an erosion cavity (backfill), and subsequently ankylosis. We aimed to combine Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ Structural score for Erosion, Backfill and Ankylosis into 3 versions of a novel preliminary Composite axSpA MRI SIJ Structural Damage Score (CSDS) and test these. Methods Thirty-three axSpA patients followed for 5 years after initiation of tumor necrosis factor inhibitor had MRI of SIJs at baseline, and yearly thereafter. Three versions of CSDSs were calculated based on different weightings of erosion, backfill and ankylosis: Equal weighting: CSDSequal=(erosion x0.5)+backfill+ankylosis; Advanced stages weighting more: CSDSstepwise=(erosion x1)+(backfill x4)+(ankylosis x6); Advanced stages overruling earlier stages (“hierarchical”) with “<” meaning “overruled by”: CSDShierarchical=(erosion x1)<(backfill x4)<(ankylosis x6). Results At baseline all CSDSs correlated positively with SPARCC Fat and Ankylosis, modified New Yorkradiography grading and negatively with BASDAI and SPARCC SIJ Inflammation. CSDSstepwise and CSDShierarchical (not CSDSequal) correlated positively with symptom duration and BASMI, and closer with SPARCC ankylosis and Modified New York-radiography grading than CSDSequal. The adjusted annual progression rate for CSDSstepwise and CSDShierarchical (not CSDSequal) was higher the first year compared with fourth year (p=0.04 and p=0.01). Standardized response mean (baselineweek 46) was moderate for CSDShierarchical (0.64) and CSDSstepwise (0.59) and small for CSDSequal (0.25). Conclusion Particularly CSDSstepwise and CSDShierarchical showed construct validity and responsiveness, encouraging further validation in larger clinical trials. The potential clinical implication is assessment of sacroiliac joint damage progression by one composite score.

Download Full-text

Predictors of remission in patients with non-radiographic axial spondyloarthritis receiving open-label adalimumab in the ABILITY-3 study

RMD Open ◽

10.1136/rmdopen-2019-000917 ◽

2019 ◽

Vol 5 (1) ◽

pp. e000917 ◽

Cited By ~ 6

Author(s):

Joachim Sieper ◽

Robert Landewé ◽

Marina Magrey ◽

Jaclyn K Anderson ◽

Sheng Zhong ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Sacroiliac Joint ◽

Axial Spondyloarthritis ◽

Inactive Disease ◽

Final Visit ◽

Hla B27 ◽

Open Label ◽

Younger Age ◽

Adalimumab Therapy ◽

Male Sex

BackgroundThis analysis assessed baseline predictors of remission in patients with non-radiographic axial spondyloarthritis (nr-axSpA) who received open-label adalimumab therapy.MethodsABILITY-3 enrolled 673 adult patients with nr-axSpA who had objective evidence of inflammation by MRI or elevated high-sensitivity C reactive protein at screening, active disease and an inadequate response to two or more non-steroidal anti-inflammatory drugs. Patients received adalimumab 40 mg every other week during a 28-week open-label lead-in period. Clinical remission was defined as Ankylosing Spondylitis Disease Activity Score inactive disease (ASDAS ID; score <1.3) and Assessment of SpondyloArthritis international Society partial remission (ASAS PR; score <2/10 in each of the four ASAS domains). Stepwise logistic regression was used to identify baseline predictors of remission at week 12 and at final visit (last postbaseline visit up to week 28). Only patients without missing data were included.ResultsOverall, 593 patients were included in the ASDAS ID and 596 in the ASAS PR analysis at week 12. Younger age (≤45 years), male sex, positive human leucocyte antigen (HLA)-B27 and higher Spondyloarthritis Research Consortium of Canada (SPARCC) MRI sacroiliac joint score were consistent predictors of remission by both ASAS ID and ASDAS PR at week 12. Results were generally similar in the final visit analysis. Other variables did not consistently predict remission.ConclusionsIn ABILITY-3, consistent and strong baseline predictors of remission included younger age, male sex, HLA-B27 positivity and higher SPARCC MRI sacroiliac joint score among patients with active nr-axSpA receiving adalimumab therapy, similar to previous findings in ankylosing spondylitis.

Download Full-text

HLA-B27 is associated with reduced disease activity in axial spondyloarthritis

Scientific Reports ◽

10.1038/s41598-021-91829-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

James T. Rosenbaum ◽

Michael H. Weisman ◽

Hedley Hamilton ◽

Cassie Shafer ◽

Elin Aslanyan ◽

...

Keyword(s):

Back Pain ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Activity Index ◽

Disease Activity Index ◽

Medical Decision ◽

Hla B27 ◽

Chi Square ◽

The Difference

AbstractHLA-B27 is associated with increased susceptibility and disease activity of ankylosing spondylitis, but the effect of HLA-B27 on the activity of the broader category now called axial spondyloarthritis (AxSpA) is apparently the opposite. A modified Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess disease activity among 3435 patients with spondyloarthritis (SpA) who participated in a survey designed to assess the effect of their disease and its treatment on the susceptibility and severity of Covid-19. Chi square testing was used to compare BASDAI scores between HLA-B27 positive and negative subjects. 2836 survey respondents were HLA B27 positive. The average BASDAI for the HLA-B27 negative cohort was 4.92 compared to 4.34 for the HLA-B27 positive subjects. Based on linear regression, a subject’s sex could not fully account for the differing BASDAI score in HLA-B27 negative subjects compared to those who are HLA-B27 positive. The difference between B27 positive and negative subjects was skewed by those with a BASDAI score of one or two. HLA-B27 positive subjects were more than twice as likely to have a BASDAI score of 1 compared to HLA B27 negative subjects and about 60% more likely to have a BASDAI score of 2 (p < 0.0001). HLA-B27 positive subjects have less active spondyloarthritis compared to HLA-B27 negative subjects as measured by a BASDAI score. Our data indicate that patients with mild back pain and a diagnosis of AxSpA are disproportionately HLA-B27 positive. The HLA-B27 test facilitates the diagnosis of axial spondyloarthritis such that patients from a community survey with mild back pain may be disproportionately diagnosed as having AxSpA if they are HLA-B27 positive. The test result likely introduces a cognitive bias into medical decision making and could explain our observations.

Download Full-text

The role of lymphocyte-monocyte ratio on axial spondyloarthritis diagnosis and sacroiliitis staging

10.21203/rs.2.21180/v4 ◽

2020 ◽

Author(s):

Jing Wang ◽

Jinyu Su ◽

Yuan Yuan ◽

Xiaxia Jin ◽

Bo Shen ◽

...

Keyword(s):

Blood Cell ◽

Disease Activity ◽

Sensitivity And Specificity ◽

Red Blood Cell ◽

Axial Spondyloarthritis ◽

Roc Curves ◽

X Ray ◽

Lymphocyte Ratio ◽

Asas Classification Criteria

Abstract Background: Axial spondyloarthritis (axial SpA)is a chronic inflammatory disorder involving the sacroiliac joints, that could lead to disability due to the failure of timely treatment. The lymphocyte-to-monocyte ratio (LMR) is an indicator of disease progression. However, its role in axial SpA remains unclear. The aim of this study was to investigate the role of LMR in axial SpA diagnosis, disease activity classification and sacroiliitis staging. Methods: Seventy-eight axial SpA patients and 78 healthy controls (HCs) were enrolled in this study. The diagnosis of axial SpA was performed according to the New York criteria or the Assessment of Spondyloarthritis international Society (ASAS) classification criteria, whereas the staging of sacroiliitis in axial SpA patients was determined by X-ray examination. Comparisons of LMR levels between groups were performed using t test. Pearson or Spearman correlation analysis were used to assess correlations between LMR and other indicators. Receiver operating characteristic (ROC) curves were used to determine the role of LMR in the diagnosis of axial SpA.Results: Higher neutrophil-to-lymphocyte ratio(NLR), red blood cell distribution width(RDW), platelet-to-lymphocyte ratio(PLR), mean platelet volume(MPV), erythrocyte sedimentation rate (ESR), and C-reactive protein(CRP) levels and lower red blood cell (RBC), hemoglobin (Hb), Hematocrit (Hct), LMR, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin/globulin (A/G) levels were noted in axial SpA patients compared to HCs. Positive correlations were observed between LMR and RBC, Hb, Hct and A/G, whereas negative correlations were found between LMR and NLR, PLR, AST, and TBIL (P< 0.05). ROC curves showed that the area under the curve(AUC) for LMR in the diagnosis of ankylosing spondylitis was 0.803 (95% CI =0.734-0.872) with a sensitivity and specificity of 62.8% and 87.2%, respectively, and the AUC (95% CI) for the combination of ESR, CRP and LMR was 0.975 (0.948-1.000) with a sensitivity and specificity of 94.9% and 97.4%, respectively. LMR levels were lower (P<0.05) and significant differences in LMR values were observed among different stages (P<0.05). Conclusions: Our study suggested that LMR might be an important inflammatory marker to identify axial SpA and assess disease activity and X-ray stage of sacroiliitis.

Download Full-text

POS1387 QUANTIFICATION OF BONE MARROW EDEMA BY MRI OF THE SACROILIAC JOINTS IN PATIENTS DIAGNOSED WITH AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE ESPERANZA COHORT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.315 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 976.2-976

Author(s):

R. Almodovar ◽

P. Zarco-Montejo ◽

A. Bueno ◽

C. Garcia-Monco ◽

E. De Miguel ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Edema ◽

Axial Spondyloarthritis ◽

Area Under The Curve ◽

Added Value ◽

Hla B27 ◽

Predictive Capacity ◽

Asas Criteria ◽

Asas Classification Criteria ◽

Marrow Edema

Background:The present study analyzes the added value of quantification by MRI of SI joints by comparing it to the standard interpretation with ASAS criteria for the classification of patients with axSpA of recent onset and a six-year follow-up.Objectives:To evaluate if the quantification of bone marrow edema (BME) of the sacroiliac (SI) joints by magnetic resonance imaging (MRI) improves capacity for axial spondyloarthritis (axSpA) classification in comparison to the assessment of sacroiliitis by means of ASAS classification criteria.Methods:Prospective study from the ESPeranza cohort involving 66 subjects with an available MRI of the SI joints at baseline. This subgroup includes patients with axSpA (n=28), peripheral spondyloarthritis (n=10) and a group with other diagnoses that were not spondyloarthritis (n=28). Measures of diagnostic usefulness (area under the curve (AUC), sensitivity, specificity, Youden’s J statistic, LR+ and LR-) were calculated for MRI of the SI joints according to ASAS criteria and for MRI quantified by means of SCAISS (Spanish tool for semi-automatic quantification of sacroiliac inflammation by MRI in spondyloarthritis). This analysis was stratified in patients who were HLA-B27 positive and negative.Results:Out of a total of 66 MRI of the SI joints, 20 (30.3%) were positive according to ASAS criteria. Out of these 20 subjects, 18 patients with final diagnosis of axSpA had a positive MRI, and 2 patients did not have axSpA. Out of the 66 patients of the cohort, 23 (34.8%) patients were HLA-B27 positive and 42 (63,6%) were negative. AUC value with bone marrow edema (BME) quantification was 0.919 (CI95% 0.799-1) for HLA-B27 positive patients and 0.884 (CI95% 0.764-1) for HLA-B27 negative patients. A SCAISS cutoff point of 80 units obtained a specificity of 94.4% and LR+ 7.5, while assessment by ASAS criteria showed a specificity value of 90% and LR+ 6.4.Conclusion:For patients with suspected axSpA, quantification of BME improves the predictive capacity of MRI of the SI joints, for both HLA-B27 positive and negative patients.Disclosure of Interests:None declared

Download Full-text

Presence of multiple spondyloarthritis (SpA) features is important but not sufficient for a diagnosis of axial spondyloarthritis: data from the SPondyloArthritis Caught Early (SPACE) cohort

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-210119 ◽

2017 ◽

Vol 76 (6) ◽

pp. 1086-1092 ◽

Cited By ~ 14

Author(s):

Z Ez-Zaitouni ◽

P A C Bakker ◽

M van Lunteren ◽

I J Berg ◽

R Landewé ◽

...

Keyword(s):

Back Pain ◽

Human Leucocyte Antigen ◽

Chronic Back Pain ◽

Axial Spondyloarthritis ◽

Classification Criteria ◽

Hla B27 ◽

Sacroiliac Joints ◽

Asas Classification Criteria ◽

Early Cohort ◽

Made In

ObjectivesConcerns have been raised about overdiagnosis of axial spondyloarthritis (axSpA). We investigated whether patients with chronic back pain (CBP) of short duration and multiple SpA features are always diagnosed with axSpA by the rheumatologist, and to what extent fulfilment of the Assessment of SpondyloArthritis International Society (ASAS) axSpA criteria is associated with an axSpA diagnosis.MethodsBaseline data from 500 patients from the SPondyloArthritis Caught Early cohort which includes patients with CBP (≥3 months, ≤2 years, onset <45 years) were analysed. All patients underwent full diagnostic workup including MRI of the sacroiliac joints (MRI-SI) and radiograph of sacroiliac joints (X-SI). For each patient, the total number of SpA features excluding sacroiliac imaging and human leucocyte antigen B27 (HLA-B27) status was calculated.ResultsBefore sacroiliac imaging and HLA-B27 testing, 32% of patients had ≤1 SpA feature, 29% had 2 SpA features, 16% had 3 SpA features and 24% had ≥4 SpA features. A diagnosis of axSpA was made in 250 (50%) of the patients: 24% with ≤1 SpA feature, 43% with 2 SpA features, 62% with 3 SpA features and 85% with ≥4 SpA features. Of the 230 patients with a positive ASAS classification 40 (17.4%) did not have a diagnosis of axSpA. HLA-B27 positivity (OR 5.6; 95% CI 3.7 to 8.3) and any (MRI-SI and/or X-SI) positive imaging (OR 34.3; 95% CI 17.3 to 67.7) were strong determinants of an axSpA diagnosis.ConclusionsIn this cohort of patients with CBP, neither the presence of numerous SpA features nor fulfilment of the ASAS classification criteria did automatically lead to a diagnosis axSpA. Positive imaging was considered particularly important in making a diagnosis of axSpA.

Download Full-text

The role of lymphocyte-monocyte ratio on axial spondyloarthritis diagnosis and sacroiliitis staging

10.21203/rs.2.21180/v3 ◽

2020 ◽

Author(s):

Jing Wang ◽

Jinyu Su ◽

Yuan Yuan ◽

Xiaxia Jin ◽

Bo Shen ◽

...

Keyword(s):

Blood Cell ◽

Disease Activity ◽

Sensitivity And Specificity ◽

Red Blood Cell ◽

Axial Spondyloarthritis ◽

Roc Curves ◽

X Ray ◽

Lymphocyte Ratio ◽

Asas Classification Criteria

Abstract Background: Axial spondyloarthritis (axial SpA)is a chronic inflammatory disorder involving the sacroiliac joints, that could lead to disability due to the failure of timely treatment. The lymphocyte-to-monocyte ratio (LMR) is an indicator of disease progression. However, its role in axial SpA remains unclear. The aim of this study was to investigate the role of LMR in axial SpA diagnosis, disease activity classification and sacroiliitis staging.Methods: Seventy-eight axial SpA patients and 78 healthy controls (HCs) were enrolled in this study. The diagnosis of axial SpA was performed according to the New York criteria or the Assessment of Spondyloarthritis international Society (ASAS) classification criteria, whereas the staging of sacroiliitis in axial SpA patients was determined by X-ray examination. Comparisons of LMR levels between groups were performed using t test. Pearson or Spearman correlation analysis were used to assess correlations between LMR and other indicators. Receiver operating characteristic (ROC) curves were used to determine the role of LMR in the diagnosis of axial SpA.Results: Higher neutrophil-to-lymphocyte ratio(NLR), red blood cell distribution width(RDW), platelet-to-lymphocyte ratio(PLR), mean platelet volume(MPV), erythrocyte sedimentation rate (ESR), and C-reactive protein(CRP) levels and lower red blood cell (RBC), hemoglobin (Hb), Hematocrit (Hct), LMR, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin/globulin (A/G) levels were noted in axial SpA patients compared to HCs. Positive correlations were observed between LMR and RBC, Hb, Hct and A/G, whereas negative correlations were found between LMR and NLR, PLR, AST, and TBIL (P< 0.05). ROC curves showed that the area under the curve(AUC) for LMR in the diagnosis of ankylosing spondylitis was 0.803 (95% CI =0.734-0.872) with a sensitivity and specificity of 62.8% and 87.2%, respectively, and the AUC (95% CI) for the combination of ESR, CRP and LMR was 0.975 (0.948-1.000) with a sensitivity and specificity of 94.9% and 97.4%, respectively. LMR levels were lower (P<0.05) and significant differences in LMR values were observed among different stages (P<0.05).Conclusions: Our study suggested that LMR might be an important inflammatory marker to identify axial SpA and assess disease activity and X-ray stage of sacroiliitis.

Download Full-text