scholarly journals Can power Doppler ultrasound of the entheses help in classifying recent axial spondyloarthritis? Data from the DESIR cohort

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000686 ◽  
Author(s):  
Cecile Poulain ◽  
Maria Antonietta D'Agostino ◽  
Severine Thibault ◽  
Jean Pierre Daures ◽  
Salah Ferkal ◽  
...  
Keyword(s):  
Predictive Value ◽  
Axial Spondyloarthritis ◽  
Clinical Symptoms ◽  
Power Doppler ◽  
Inflammatory Back Pain ◽  
Power Doppler Ultrasonography ◽  
Asas Criteria ◽  
Asas Classification Criteria ◽  
Diagnostic Management ◽  
Additional Value

Early diagnosis of axial spondyloarthritis (axSpA) remains a challenge due to the lack of specificity of clinical symptoms and variable prevalence of axial imaging findings permitting a definite diagnosis. Power Doppler ultrasonography (PDUS) of the entheses has demonstrated to be a potential useful tool for the classification and diagnostic management of early SpA independently of the phenotype.Objectives To assess the classification value (sensitivity and specificity) of PDUS-defined enthesitis for identifying patients fulfilling Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA (ASAS+) in patients with recent inflammatory back pain (IBP) (the DESIR (DEvenir des Spondylarthropathies Indifférenciées Récentes) cohort).Methods Baseline PDUS was performed at eight entheseal sites, and PDUS enthesitis was defined by the presence of vascularisation at entheseal insertion.Results 402 patients from the DESIR cohort underwent a PDUS evaluation. PDUS enthesitis was detected in 58 (14.4%) patients of whom 40 (14.2%) belonged to the ASAS+ patients and 18 (17%) to the ASAS- patients. The sensitivity of PDUS enthesitis was 13.9% and the specificity was 83.5%, with a positive predictive value of 69% and 26.8% of negative predictive value for meeting ASAS criteria for axSpA. Of the 18 ASAS- patients with positive PDUS, 59% fulfilled Amor’s criteria, 88% European Spondyloarthropathy Study Group criteria and 59% both.ConclusionsIn a cohort of patients with recent IBP, the prevalence of PDUS enthesitis was low (14.4%); however, its specificity for classifying patients as axSpA according to ASAS criteria was high (83.5%). PDUS enthesitis might be of additional value for classifying as patients with axSpA IBP who do not fulfil ASAS criteria.

Prevalence of Inflammatory Back Pain and Axial Spondyloarthritis Among University Employees in Izmir, Turkey

2015 ◽  
Vol 42 (9) ◽  
pp. 1647-1651 ◽  
Author(s):  
Fatos Onen ◽  
Dilek Solmaz ◽  
Pinar Cetin ◽  
Ismail Sari ◽  
Ali Balci ◽  
...  
Keyword(s):  
Back Pain ◽  
Axial Spondyloarthritis ◽  
Age At Onset ◽  
Turkish Population ◽  
The United States ◽  
Classification Criteria ◽  
Inflammatory Back Pain ◽  
Face To Face ◽  
Asas Criteria ◽  
Asas Classification Criteria

Objective.To estimate the prevalence of inflammatory back pain (IBP) and axial spondyloarthritis (axSpA) using the Assessment of SpondyloArthritis International Society (ASAS) classification criteria among employees in a university.Methods.In the first stage of the study, a face-to-face interview was done using a standard questionnaire to investigate IBP in 381 subjects randomly selected from 2894 employees at Dokuz Eylul University in Izmir, Turkey. In the second stage, subjects with back pain for ≥ 3 months and age at onset < 45 years were evaluated for axSpA using the ASAS criteria. Both the European Spondyloarthropathy Study Group (ESSG) criteria and Amor criteria were used for the classification of the whole group of spondyloarthritis (SpA).Results.There were 131 male and 250 female subjects (mean age: 38.0 yrs). Twenty-five subjects (6.6%) were classified as having IBP according to the ASAS criteria. The prevalence of IBP according to the Berlin and Calin criteria was 7.1% and 21.5%, respectively. The prevalence of axSpA was estimated at 1.3% according to the ASAS classification criteria (0.5% for radiographic axSpA and 0.8% for nonradiographic axSpA). A total of 7 patients (1.8%) fulfilled both the Amor and ESSG criteria for the whole group of SpA.Conclusion.This is the first prevalence study of IBP and axSpA using ASAS classification criteria in the Turkish population. The prevalence estimates of IBP and axSpA reported here are within the upper range of other studies in European countries and the United States.

scholarly journals SAT0380 ENHANCING RHEUMATOLOGY REFERRALS AMONG INFLAMMATORY BOWEL DISEASE PATIENTS WITH SUSPECTED AXIAL SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1138.2-1138
Author(s):  
C. S. E. Lim ◽  
M. Tremelling ◽  
L. Hamilton ◽  
A. Macgregor ◽  
K. Gaffney
Keyword(s):  
Back Pain ◽  
Musculoskeletal Pain ◽  
Chronic Back Pain ◽  
Axial Spondyloarthritis ◽  
Inflammatory Back Pain ◽  
Aminosalicylic Acid ◽  
Research Support ◽  
Clinical Probability ◽  
Asas Criteria ◽  
History Of

Background:Axial spondyloarthritis (axSpA) is associated with inflammatory bowel disease (IBD). In IBD patients, the clinical probability of axSpA increases in those with chronic back pain (CBP) whose symptoms started before the age of forty-five years old. In practice, this should trigger a rheumatology review especially if accompanied by other symptoms suspicious of inflammatory disease. However, in any health system, the goal of identifying all possible cases need to be balanced with the practical realisation of the finite resources available.Objectives:The study aimed to define the clinical characteristics of a subgroup of IBD patients who are routinely managed in secondary care who have an increased clinical probability for axSpA. Identification of these characteristics may help improve the quality and specificity of referrals to Rheumatology from Gastroenterology clinics.Methods:An analytical cross-sectional study was undertaken. Consecutive IBD patients attending routine Gastroenterology clinics were sent a modified validated back pain questionnaire. The questionnaire included the presence or absence of a previous diagnosis of axSpA; components of validated inflammatory back pain criteria; diagrams to indicate the location of back pain and other musculoskeletal pain; personal and family history of known axSpA manifestations; and details of their IBD course, activity and treatment.IBD patients, with back pain duration > 3 months with onset before 45 years were considered to have a medium diagnostic probability (MDP) for axSpA. MDP-positive IBD patients were compared with MDP-negative IBD patients and logistic regression was used to model the association with clinical features.Results:Four hundred and seventy consecutive IBD patients (mean age 54 years; 46% male) were surveyed. Two hundred and nine patients (59%) replied, of whom 191 patients (69%) consented to participate. One hundred and seventy-three (91%) of those who consented had a valid completed questionnaire and were included for data analysis. Of these, 74% had Ulcerative Colitis and 26% had Crohn’s disease. Their mean age was 58 years, 39% male. Mean age at IBD diagnosis was 39 years, mean IBD disease duration 19 yrs. CBP (back pain greater than three months) was reported by 76%. Inflammatory back pain fulfilling Calin, Berlin, ASAS criteria was seen in 23%, 29%, and 15% respectively. In addition, 80% reported peripheral musculoskeletal pain. Self-reported personal history of enthesitis, reactive arthritis (ReA), acute anterior uveitis (AAU), skin psoriasis (PSO) and dactylitis were 50%, 30%, 24%, 15% and 0% respectively. Self-reported family history of IBD, ReA, PSO, axSpA and AAU were 60%, 36%, 22%, 11%, and 1% respectively.Ninety-one (53%) patients were MDP-positive and 82 (47%) patients were MDP-negative. The clinical characteristics associated with MDP (adjusted for age at invitation) were: the presence of inflammatory back pain using ASAS criteria [OR 8.84 (1.61,48.67); p=0.01], longer interval between symptom onset and gastroenterologist diagnosis of IBD [OR 1.09 (1.03,1.16); p=0.005], and use of rectal topical 5-aminosalicylic acid [OR 3.27 (1.11,9.68); p=0.03].Conclusion:Chronic back pain and peripheral musculoskeletal pain are common in a secondary care IBD population. In IBD patients, with back pain duration > 3 months and onset before 45 years, the presence of inflammatory back pain, longer diagnostic delay of IBD and the use of rectal topical 5-aminosalicylic acid were associated with a higher clinical probability of axSpA. The identification of these clinical features may not only improve the quality and specificity of Rheumatology referrals from Gastroenterology in this subgroup of patients but also lends real world evidence to current ASAS-endorsed recommendations for early referral of patients with a suspicion of axial spondyloarthritis.Disclosure of Interests:Chong Seng Edwin Lim Grant/research support from: AbbVie - Research support/grant but NOT for this study., Mark Tremelling: None declared, Louise Hamilton: None declared, Alexander Macgregor: None declared, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma

scholarly journals P240 Can ultrasound alone predict the need to treat ACPA positive individuals without synovitis?

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Laurence M Duquenne ◽  
Kulveer Mankia ◽  
Leticia Garcia Montoya ◽  
Andrea Di Matteo ◽  
Jacqueline Nam ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Value ◽  
Cox Regression ◽  
Clinical Symptoms ◽  
Power Doppler ◽  
Musculoskeletal Symptoms ◽  
Features Selection ◽  
Moderate Sensitivity ◽  
Us Scan ◽  
Selection Of

Abstract Background In anti-cyclic citrullinated peptide antibody-positive (ACPA+) individuals without clinical synovitis (at-risk), to define the critical ultrasound (US) features sufficiently predictive for inflammatory arthritis (IA) to enable logical initiation of therapy. Methods In a single centre prospective cohort, at risk ACPA+ individuals with a new musculoskeletal symptoms underwent an US scan of 38 joints and 18 tendons at first visit. The predictive value of US abnormalities (Power Doppler (PD), Grey Scale (GS), erosion or tenosynovitis (TSV)) for progression to IA was analysed and the best predictive joints determined by Multivariable Cox Regression, adjusted for confounders. The US results were combined with clinical symptoms/findings to produce predictive models. Results Consecutive at-risk ACPA+ individuals (n = 457, mean age 50.3 years old, 74.2% women) were followed up for median of 15.4 months (range 0.1-127.4), a complete dataset with follow-up of at least 6 months was available for 319 of them. 135 (29.5%) developed IA after a median of 11.3 months (range 0.1-111.7). The negative predictive value of a US scan without any abnormality was 82%. In multivariable Cox regression, both PD and TSV were predictive of progression, with respectively hazard ratios of 1.2 (9=0.026) and 1.13 (p = 0.025). All US abnormalities had a high specificity (spec) but only moderate sensitivity (sens), PD was the most specific with a spec/sens of 0.94/0.23, followed by TSV with a spec/sens of 0.91/0.26 but the best area under the curve (AUC) of 0.599 (P = 0.0015). The addition ACPA titre (high compared to low), but not GS, improved spec/sens up to 0.92/0.34 and AUC to 0.964 (p &lt; 0.001). A selection of US and clinical data of 14 joints also improved prediction, with an AUC of 0.670 (p &lt; 0.001) and a spec/sens of 0.65/0.62. A selection of the 34 most predictive features reached the same sens/spec as the ACR/EULAR 2010 classification criteria for RA, showing a spec/sens of 0.80/0.56. Conclusion In at-risk ACPA+ individuals, the presence of sub-clinical US abnormalities are highly specific for progression to IA. The only moderate sensitivity can be improved by using joints or features selection in combination with clinical examination. These results are the first step in providing guidance for which at-risk ACPA+ individuals to treat. Disclosures L.M. Duquenne None. K. Mankia None. L. Garcia Montoya None. A. Di Matteo None. J. Nam None. P. Emery None.

scholarly journals P271 An analysis of short-term repeat MRI scans of vertebral corner lesions in suspected early axSpA: defining the prevalence and evolution of clinically significant spinal lesions without concurrent SIJ changes on imaging

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Saion Chatterjee ◽  
Helena Marzo-Ortega ◽  
Dennis McGonagle ◽  
Alexander N Bennett ◽  
Raj Sengupta
Keyword(s):  
Back Pain ◽  
Axial Spondyloarthritis ◽  
De Novo ◽  
Current Evidence ◽  
Inflammatory Back Pain ◽  
Short Term ◽  
Spinal Imaging ◽  
Asas Criteria ◽  
Mri Scans

Abstract Background MRI offers an enhanced opportunity to detect early spinal changes of axial spondyloarthritis (axSpA), by identifying characteristic inflammatory and structural lesions, so called Romanus lesions. These include bone marrow oedema lesions on the vertebral corners and fatty replacement of these lesions, both highly suggestive features of axSpA. Current evidence suggests that treatment of these lesions requires early biologic therapy, hence early identification is imperative. We evaluate the prevalence and variation of vertebral corner lesions on short-term repeat MRI scans in patients with suspected early axSpA. Methods 109 MRI scans were performed at baseline and at 4, 8 and 12-weeks on 30 patients with suspected axial spondyloarthritis, who fulfilled the ASAS inflammatory back pain criteria, and had normal sacroiliac joints (SIJs) on antero-posterior pelvis radiographs. The protocol included sagittal T1 and short-tau inversion recovery of the cervico-thoracic spine and thoracolumbar spine. Results 29 patients completed the study (66% were male, 72% HLA-B2-positive). All patients had ≥1 clinical spondyloarthritis (SpA) feature and 86% had ≥2. 13 patients used NSAIDs regularly over the 12-week study period. Overall, 40 corner lesions were present in participants at baseline scanning. 67 new vertebral corner lesion changes occurred at different time points over the follow-up period compared to baseline. 43 changes were new or worsening lesions, while 24 changes were an improvement or resolution of a lesion. 48.6% (14/29) of patients had a minimum of 1 corner lesion present at baseline. 78.5% (11/14) of patients with baseline corner lesions experienced either a decrease/improvement or increase/progression of spinal corner lesions. 20.7% (6/29) of patients demonstrated transient corner lesions at baseline or follow-up with resolution by the 12-week scan (likely artefact). 5/29 patients met spinal imaging criteria suggestive of AS (3 at baseline, 1 only transiently at 1 month, and 1 which persisted from interval scanning). At 12-weeks, 13.8% of patients had at least 3 concomitant baseline or de-novo vertebral corner lesions present (minimum number needed for diagnostic significance). 75% of these patients did not have evidence of concomitant SIJ changes (10.3% of all patients). HLA-B27 status, gender, NSAID use, and number of SpA features were not associated with corner lesion development or improvement. Conclusion Approximately half of all patients who meet ASAS criteria for inflammatory back pain, but do not meet ASAS criteria for axSpA, demonstrated at least 1 vertebral corner lesion on MRI scan at baseline, which may represent artefact or a prelude to future disease progression. 13.8% of patients had at least 3 concomitant baseline or de-novo vertebral corner lesions present on MRI at the conclusion of 12-weeks of follow-up. In cases of suspected axSpA with negative SIJ MRI imaging, 10.3% of patients had significant spinal evidence of axSpA on MRI, highlighting the importance of spinal imaging and monitoring as part of the diagnostic work-up for axSpA. Disclosures S. Chatterjee None. H. Marzo-Ortega None. D. McGonagle None. A. Bennett None. R. Sengupta None.

scholarly journals ASAS criteria for inflammatory back pain: diagnostic significance in patients with inflammatory bowel disease

2019 ◽  
Vol 57 (2) ◽  
pp. 175-179
Author(s):  
E. N. Belousova ◽  
A. Kh. Odintsova ◽  
M. S. Protopopov ◽  
D. I. Abdulganieva
Keyword(s):  
Back Pain ◽  
Likelihood Ratio ◽  
International Society ◽  
Predictive Value ◽  
Chronic Back Pain ◽  
Inflammatory Back Pain ◽  
Diagnostic Significance ◽  
Asas Criteria ◽  
Diagnostic Characteristics ◽  
Inflammatory Bowel

Damage of peripheral joints and spine is a frequent manifestation of spondyloarthritis associated with inflammatory bowel diseases (IBD). One of the most frequent and typical manifestations of axial spondyloarthritis (axSpA) is inflammatory back pain (IBP), which is determined according to the IBP criteria of the International society for the study of spondyloarthritis (The Assessment of SpondyloArthritis international Society – ASAS) 2009. The diagnosis of axSpA is based on the identification of combination of typical changes in the sacroiliac joints (presence of sacroiliitis according to MRI or radiography) with a characteristic clinical picture. However, the diagnostic significance of these criteria and the possibility of use in patients with IBD and chronic back pain have not been studied.Subjects and methods. The study included 84 patients with IBD and back pain. The mean age of patients was 40.5±11.9 years, the duration of IBD symptoms – 8.11±7.67 years.Results and discussion. In our study, the sensitivity of the ASAS criteria for IBD was 76.9% and specificity – 67.2%, positive predictive value was 0.51, a negative predictive value – 0.87. The likelihood ratio of a positive result is 2.3, the likelihood ratio of a negative result is 0.3.Conclusion. The main diagnostic characteristics of ASAS IBD criteria (2009) for patients with IBD were comparable with those in the population of patients with chronic back pain (sensitivity – 79.6% and specificity – 72.4%).

AB0697 PERFORMANCE OF DIFFERENT CRITERIA SETS FOR INFLAMMATORY BACK PAIN IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS IN DEMOCRATIC REPUBLIC OF CONGO

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1644-1645
Author(s):  
P. Lebughe ◽  
K. De Vlam ◽  
R. Westhovens ◽  
J. M. Mbuyi-Muamba ◽  
J. J. Malemba
Keyword(s):  
Back Pain ◽  
Clinical Judgment ◽  
Democratic Republic ◽  
Axial Spondyloarthritis ◽  
Democratic Republic Of Congo ◽  
University Hospital ◽  
Inflammatory Back Pain ◽  
Research Support ◽  
Asas Criteria ◽  
The University

Background:Inflammatory back pain (IBP) is the most prominent clinical feature for an early diagnosis of axial spondyloarthritis. The performance of the criteria sets for IBP has not yet been assessed in clinical practice in the Democratic Republic of Congo (DRC).Objectives:To assess and to compare the performance of different IBP criteria sets in axial spondyloarthritis (SpA) outpatients attending the rheumatology unit of the University Hospital of Kinshasa, DRC.Methods:One hundred and eight Congolese outpatients with axial SpA defined by rheumatologist’s clinical judgment were included in the spondyloarthritis cohort of the University Hospital of Kinshasa from March 1st2015 to February 28, 2017. Calin criteria, Berlin criteria and ASAS criteria sets for IBP were performed to assess their performance against clinical judgment. Detailed history, clinical examination and imaging of sacroiliac joints by plain radiography were obtained. Sacroiliac joint radiographic lesions were scored with the modified New York criteria. Magnetic resonance imaging and HLA B27 were not performed. Fifty additional patients with a diagnosis of chronic (>3 months) mechanical low back pain (MLBP) were included as control group. The performance of each item and different criterias was evaluated using sensitivity, specificity, and likelihood ratio (LR). Baseline characteristics of the mechanical and inflammatory back pain cohorts were compared with chi-square or Student t tests as appropriate.Results:The mean age was 43.8±15.1 years in SpA patients versus 62.4±9.1 years in controls (MLBP patients) with respective sex ratio (M/F) of 1/0.8 and 1/2.1. There were significantly more male patients in the ankylosing spondylitis (AS) group than in the non-radiographic axial spondyloarthritis group (p<0.01). Among the criteria sets, Calin criteria showed the best sensitivity (92.6%) while the Berlin criteria showed the best specificity (97.6%) in the detection of IBP patients. The new ASAS criteria for IBP compared to the two previous criteria sets did not show good sensitivity nor specificity (sensivity 80%, specificity 62%, LR+ 1.05 (0.90 – 1.22), LR- 0.52 (0.39 – 0.69), 95%CI).Conclusion:The Calin criteria set would be useful for epidemiological and clinical studies in DRC. The ASAS criteria set for IBP is not better than other criteria sets in the screening of IBP for Congolese patients with axSpA.References:[1]Heuft-Dorenbosch L, Landewe R, Weijers R et al.Performance of various criteria sets in patients with inflammatory back pain of short duration; the Maastricht early spondyloarthritis clinic Ann Rheum Dis 2007;66:92–98. doi: 10.1136/ard.2006.053918[2]Michele C. Battié M, LINDA J. CARROLL et al. Preliminary Validation of a Self-reported Screening Questionnaire for Inflammatory Back Pain. J Rheumatol 2012;39;822-829[3]Poddubnyy D, Callhoff J, Spiller I, et al. Diagnostic accuracy of inflammatory back pain for axial spondyloarthritis in rheumatological care.RMD Open. 2018;4(2):e000825. Published 2018 Dec 5. doi:10.1136/rmdopen-2018-000825[4]Wang R, Crowson CS, Wright K, Ward MM. Clinical Evolution in Patients With New-Onset Inflammatory Back Pain: A Population-Based Cohort Study.Arthritis Rheumatol. 2018;70(7):1049–1055. doi:10.1002/art.40460Disclosure of Interests:Pierrot Lebughe: None declared, Kurt de Vlam Grant/research support from: Celgene, Eli Lilly, Pfizer Inc, Consultant of: AbbVie, Eli Lilly, Galapagos, Johnson & Johnson, Novartis, Pfizer Inc, UCB, Rene Westhovens Grant/research support from: Celltrion Inc, Galapagos, Gilead, Consultant of: Celltrion Inc, Galapagos, Gilead, Speakers bureau: Celltrion Inc, Galapagos, Gilead, Jean-Marie Mbuyi-Muamba: None declared, Jean-Jacques Malemba: None declared

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