janvier 27, 2018 | Posted by admin
Un nouvel article scientifique intitulé «Classification criteria versus physician’s opinion for considering a patient with inflammatory back pain as suffering from spondyloarthritis.» a été publié dans le journal Joint Bone Spine.
Gazeau P, Cornec D, Timsit MA, Dougados M, Saraux A.
Abstract
OBJECTIVE:
To assess agreement among methods for classifying patients with inflammatory back pain (IBP) after a 2-year follow-up.
METHODS:
Patients with IBP in the French nationwide, longitudinal, prospective cohort DESIR were classified after 2years based on imaging findings, rheumatologist’s confidence in a diagnosis of spondyloarthritis, three classification criteria sets (axial Assessment of Spondyloarthritis international Society [ASAS], European Spondylarthropathy Study Group [ESSG], and Amor) and treatment (TNFα antagonists). Agreement among these methods was assessed by computing the percentage of concordant classifications and Cohen’s kappa coefficient. Using logistic regression, we identified the items most strongly associated with rheumatologist’s confidence.
RESULTS:
Agreement among criteria sets was poor (kappa<0.6), even in the group with inflammation by magnetic resonance imaging. Of 708 patients, 541 had all available data including rheumatologist’s confidence after 2years, which was 0/10 for 31 (5.7%) patients, 1/10 to 7/10 for 158 (29.2%) patients, 8/10 or 9/10 for 167 (30.9%) patients, and 10/10 for 185 (34.2%) patients. TNFα antagonists were used in 156/356 (43.8%) patients in the two highest confidence groups versus 53/188 (28.2%) patients in the two lowest confidence groups. Factors independently associated with confidence ≥8/10 were fulfilment of ASAS, ESSG, and Amor criteria.
CONCLUSION:
Confidence of rheumatologists in the diagnosis of spondyloarthritis in patients with recent-onset IBP shows limited agreement with classification criteria. The best way to currently classify spondyloarthritis should be the association of both at least one classification criteria and a diagnosis of spondyloarthritis according to the rheumatologist.
KEYWORDS:
Ankylosing spondylitis; Axial spondyloarthritis; Sacro-iliitis
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novembre 11, 2017 | Posted by admin
Un nouvel article scientifique intitulé «Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort.» a été publié dans le journal Ann Rheum Dis.
Dougados M, Sepriano A, Molto A, van Lunteren M, Ramiro S, de Hooge M, van den Berg R, Navarro Compan V, Demattei C, Landewé R, van der Heijde D.
Ann Rheum Dis. 2017 Jul 6. pii: annrheumdis-2017-211596. doi: 10.1136/annrheumdis-2017-211596. [Epub ahead of print]
Abstract
OBJECTIVE:
To estimate sacroiliac joint radiographic (X-SIJ) progression in patients with axial spondyloarthritis (axSpA) and to evaluate the effects of inflammation on MRI (MRI-SIJ) on X-SIJ progression.
METHODS:
X-SIJ and MRI-SIJ at baseline and after 2 and 5 years in patients with recent onset axSpA from the DESIR cohort were scored by three central readers. Progression was defined as (1) the shift from non-radiographic (nr) to radiographic (r) sacroiliitis (by modified New York (mNY) criteria) or alternative criteria, (2) a change of at least one grade or (3) a change of at least one grade but ignoring a change from grade 0 to 1. The effects of baseline inflammation on MRI-SIJ on 5-year X-SIJ damage (mNY) were tested by generalised estimating equations.
RESULTS:
In 416 patients with pairs of baseline and 5-year X-SIJ present, net progression occurred in 5.1% (1), 13.0% (2) and 10.3% (3) respectively, regarding a shift from nr-axSpA to r-axSpA (1), a change of at least one grade (2) or a change of at least one grade but ignoring a change from grade 0 to 1 (3). Baseline MRI-SIJ predicted structural damage after 5 years in human leukocyte antigen-B27 (HLA-B27) positive (OR 5.39 (95% CI 3.25 to 8.94)) and in HLA-B27 negative (OR 2.16 (95% CI 1.04 to 4.51)) patients.
CONCLUSIONS:
Five-year progression of X-SIJ damage in patients with recent onset axSpA is limited but present beyond measurement error. Baseline MRI-SIJ inflammation drives 5-year radiographic changes.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
KEYWORDS:
epidemiology; magnetic resonance imaging; outcomes research; spondyloarthritis
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octobre 29, 2017 | Posted by admin
Un nouvel article scientifique intitulé «The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts» a été publié dans le journal Ann Rheum Dis.
Ez-Zaitouni Z, Bakker PA, van Lunteren M, de Hooge M, van den Berg R, Reijnierse M, Fagerli KM, Landewé RB, Ramonda R, Jacobsson LT, Saraux A, Lenczner G, Feydy A, Pialat JB, Thévenin F, van Gaalen FA, van der Heijde D.
OBJECTIVES:
To assess the prevalence of spinal inflammation on MRI in patients with chronic back pain (CBP) of maximally 3 years duration and to evaluate the yield of adding a positive MRI-spine as imaging criterion to the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA).
METHODS:
Baseline imaging of the sacroiliac joints (X-SI), MRI of the sacroiliac joints (MRI-SI) and MRI-spine were scored by ≥2 experienced central readers per modality in the SPondyloArthritis Caught Early (SPACE) and DEvenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohorts. Inflammation suggestive of axSpA was assessed in the entire spine. A positive MRI-spine was defined by the presence of ≥5 inflammatory lesions. Alternative less strict definitions were also tested.
RESULTS:
In this study, 541 and 650 patients with CBP from the SPACE and DESIR cohorts were included. Sacroiliitis on X-SI and MRI-SI was found in 40/541 (7%) and 76/541 (14%) patients in SPACE, and in DESIR in 134/650 (21%) and 231/650 (36%) patients, respectively. In SPACE and DESIR, a positive MRI-spine was seen in 4/541 (1%) and 48/650 (7%) patients. Of the patients without sacroiliitis on imaging, 3/447 (1%) (SPACE) and 8/382 (2%) (DESIR) patients had a positive MRI-spine. Adding positive MRI-spine as imaging criterion led to new classification in only one patient in each cohort, as the other patients already fulfilled the clinical arm. Other definitions of a positive MRI-spine yielded similar results.
CONCLUSION:
In two cohorts of patients with CBP with a maximum symptom duration of 3 years, a positive MRI-spine was rare in patients without sacroiliitis on MRI-SI and X-SI. Addition of MRI-spine as imaging criterion to the ASAS axSpA criteria had a low yield of newly classified patients and is therefore not recommended.
KEYWORDS:
ankylosing spondylitis; axial spondyloarthritis; classification criteria; magnetic resonance imaging
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octobre 11, 2017 | Posted by admin
Un nouvel article scientifique intitulé «Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort.» a été publié dans le journal J Rheumatol.
Harvard S, Guh D, Bansback N, Richette P, Saraux A, Fautrel B, Anis AH.
Abstract
OBJECTIVE:
To evaluate a classification system to define adherence to axial spondyloarthritis (axSpA) anti-tumor necrosis factor (anti-TNF) use recommendations and examine the effect of adherence on outcomes in the DESIR cohort (Devenir des Spondylarthropathies Indifférenciées Récentes).
METHODS:
Using alternate definitions of adherence, patients were classified as adherent « timely » anti-TNF users, nonadherent « late » anti-TNF users, adherent nonusers ( »no anti-TNF need »), non-adherent nonusers ( »unmet anti-TNF need »). Multivariate models were fitted to examine the effect of adherence on quality-adjusted life-years (QALY), total costs, and nonbiologic costs 1 year following an index date. Generalized linear regression models assuming a γ-distribution with log link were used for costs outcomes and linear regression models for QALY outcomes.
RESULTS:
Using the main definition of adherence, there were no significant differences between late anti-TNF users and timely anti-TNF users in total costs (RR 0.86, 95% CI 0.54-1.36, p = 0.516) or nonbiologic costs (RR 0.72, 95% CI 0.44-1.18, p = 0.187). However, in the sensitivity analysis, late anti-TNF users had significantly increased nonbiologic costs compared with timely users (RR 1.58, 95% CI 1.06-2.36, p = 0.026). In the main analysis, there were no significant differences in QALY between timely anti-TNF users and late anti-TNF users, or between timely users and patients with unmet anti-TNF need. In the sensitivity analysis, patients with unmet anti-TNF need had significantly lower QALY than timely anti-TNF users (-0.04, 95% CI -0.07 to -0.01, p = 0.016).
CONCLUSION:
The effect of adherence to anti-TNF recommendations on outcomes was sensitive to the definition of adherence used, highlighting the need to validate methods to measure adherence.
KEYWORDS:
ADHERENCE; ANKYLOSING SPONDYLITIS; ANTI-TNF; ECONOMIC; QUALITY OF LIFE; SPONDYLOARTHRITIS
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septembre 5, 2017 | Posted by admin
Un nouvel article scientifique intitulé «Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates.» a été publié dans le journal Cost Eff Resour Alloc.
Harvard S, Guh D, Bansback N, Richette P, Saraux A, Fautrel B, Anis A.
Abstract
BACKGROUND:
Anti-tumor necrosis factor (anti-TNF) agents are an effective, but costly, treatment for spondyloarthritis (SpA). Worldwide, multiple sets of access criteria aim to restrict anti-TNF therapy to patients with specific clinical characteristics, yet the influence of access criteria on anti-TNF cost-effectiveness is unknown. Our objective was to use data from the DESIR cohort, a prospective study of early SpA patients in France, to determine whether the French anti-TNF access criteria are the most cost-effective in that setting relative to other potential restrictions.
METHODS:
We used data from the DESIR cohort to create five study populations of patients meeting anti-TNF access criteria from Canada, France, Germany, United Kingdom, and Hong Kong, respectively. For each study population, we calculated the costs and quality-adjusted life years (QALYs) over 1 year of patients treated and not treated with anti-TNF therapy. To control for differences between anti-TNF users and non-users, we used linear regression models to derive adjusted mean costs and QALYs. We calculated incremental cost-effectiveness ratios (ICERs) representing the incremental cost per additional QALY gained by treating with an anti-TNF within each of the five study populations, using bootstrapping to explore the range of uncertainty in costs and QALYs. A series of sensitivity analyses was conducted, including one to simulate the effect of a 24-week stopping rule for anti-TNF non-responders.
RESULTS:
Anti-TNF access criteria from France were satisfied by the largest proportion of DESIR patients (27.8%), followed by Germany (25.1%), Canada (23.8%), the UK (12.1%) and Hong Kong (8.6%). Confidence intervals around incremental costs and QALYs in the basecase analysis were overlapping, indicating that anti-TNF cost-effectiveness estimates derived from each subset were similar. In the sensitivity analysis that examined the effect of excluding costs accumulated past 24 weeks by anti-TNF non-responders, the incremental cost per QALY was reduced by approximately 25% relative to the basecase analysis (France: €857,992 vs. €1,105,859; Canada: € 626,459 vs. €818,186; Germany: € 422,568 vs. €545,808); UK €578,899 vs. €766,217; Hong Kong €335,418 vs. €456,850).
CONCLUSIONS:
Anti-TNF cost-effectiveness is strongly affected by treatment continuation among non-responders. Access criteria could improve anti-TNF cost-effectiveness by defining patients likely to respond.
KEYWORDS:
Anti-TNF; Biologics; Cost-effectiveness; Pharmaceutical policy; Spondyloarthritis
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septembre 5, 2017 | Posted by admin
Un nouvel article scientifique intitulé «Relationships between ultrasound enthesitis, disease activity and axial radiographic structural changes in patients with early spondyloarthritis: data from DESIR cohort.» a été publié dans le journal RMD Open.
Ruyssen-Witrand A, Jamard B, Cantagrel A, Nigon D, Loeuille D, Degboe Y, Constantin A.
Abstract
BACKGROUND:
To search for association between ultrasound (US) enthesis abnormalities and disease activity, spine and sacro-iliac joints (SIJ) MRI inflammatory lesions and spine structural changes in a cohort of patients suspected for axial spondyloarthritis (SpA).
METHODS:
Patients: Of 708 patients included in the DESIR(Devenir des Spondyloarthrites Indifférenciées Récentes) cohort, 402 had an US enthesis assessment and were selected for this study. Imaging: Achilles, lateral epicondyles, superior patellar ligament, inferior patellar ligament entheses were systematically US scanned and abnormalities were summed in US structural and power Doppler (PDUS) scores. Spine radiographs, SIJ and spine MRI scans were centrally scored modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), presence of MRI sacro-iliitis, Spondyloarthritis Research Consortium of Canada and Berlin scores. Analysis: The associations between the US structural/PDUS scores and disease activity, C reactive protein (CRP), MRI SIJ and spine inflammatory lesions and mSASSS were tested by Spearman’s correlation tests.
RESULTS:
Among the 402 patients included (median age: 33.5 years, males: 48.5%), 55% had US enthesis structural abnormalities while 14% had PDUS abnormalities. There was no association between US scores and Bath Ankylosing Spondylitis Disease Activity Index, CRP or inflammatory lesions on SIJ and spine MRI. There was a correlation between US structural and PDUS scores and the mSASSS (respectively, r=0.151, p=0.005; r=0.143, p=0.007). The proportion of patients with syndesmophytes was higher in the case of US enthesophytes (26% of syndesmophytes vs 6% in the absence of US enthesophytes, p<0.0001).
CONCLUSION:
While the US abnormalities do not seem to be a helpful tool for monitoring disease activity in axial SpA, US enthesophytes, strongly associated with axial syndesmophytes, might be a marker of interest for disease severity.
TRIAL REGISTRATION NUMBER:
NCT01648907, date of registration : 20 July 2012.
KEYWORDS:
sacro-iliitis; spondyloarthritis; syndesmophytis; ultrasound
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juillet 19, 2017 | Posted by admin
Un nouvel article scientifique intitulé «Assessment of typical SpA lesions on MRI of the spine: do local readers and central readers agree in the DESIR-cohort at baseline » a été publié dans le journal Clin Rheumatol.
de Hooge M, Pialat JB, Reijnierse M, van der Heijde D, Claudepierre P, Saraux A, Dougados M, Feydy A.
Clin Rheumatol. 2017 Jul;36(7):1551-1559. doi: 10.1007/s10067-017-3643-4. Epub 2017 May 23.
Abstract
Comparing local reading (LocR) with central reading (CentR) of typical spondyloarhritis lesions including bone marrow edema (BME) and structural lesions on magnetic resonance imaging of the spine (MRI-spine), in patients with inflammatory back pain (IBP; ≥3 months, <3 years). Baseline data of 667 patients, age 18-50 years, from the Devenir des Spondylarthopathies Indifferenciees Recentes (DESIR)-cohort were used. Two trained central readers scored anterior and posterior corner BME, fatty lesions, erosions and syndesmophytes on MRI-spine. Presences of lesions, based on average scores, were used for CentR. A local radiologist and/or rheumatologist scored MRI-spine on presence/doubt/absence of ‘inflammation’ and ’structural lesions’. Agreement between central readers and readings was calculated (Cohen’s kappa: κ). Agreement between central readers was moderate (BME κ = 0.55, fatty lesions κ = 0.50) to slight (erosions κ = 0.12, syndesmophytes κ = 0.19). Agreement between LocR and CentR was κ = 0.32 (BME) and κ = 0.13 (structural lesions). In 78/160 patients (48.8%) LocR were in doubt while CentR scored BME lesions, for structural lesions this was 17.8% (28/157 patients). Agreement between 2 central readers for scoring spondyloarhritis-like lesions on MRI-spine was moderate but better compared to LocR and CentR agreement. LocR often doubt about the presence of MRI-spine lesions while central trained readers score lesions.
KEYWORDS:
Inflammation; Magnetic resonance imaging; Spondyloarthritis
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juillet 17, 2017 | Posted by admin
Un nouvel article scientifique intitulé «Remission is related to CRP and smoking in early axial spondyloarthritis. The DESIR cohort.» a été publié dans le journal Joint Bone Spine.
Wendling D, Guillot X, Gossec L, Prati C, Saraux A, Dougados M
Joint Bone Spine. 2016 Jul 20. doi: 10.1016/j.jbspin.2016.06.004
Abstract
INTRODUCTION:
No evaluation of factors associated with remission has been performed in early SpA. The aim of the study was to evaluate percentage of patients in remission using and comparing different definitions of remission, and to evaluate factors associated with remission at inclusion in the prospective DESIR cohort, and after 24 months.
METHODS:
Performance of three definitions (ASAS partial remission [PR], ASDAS-CRP less than 1.3 [ASDAS-R], BASDAI less than 3.6 [BASDAI-R]) were assessed using sensibility, specificity and Youden Index. Data at M0 and M24 were analyzed in uni- and multivariate analysis.
RESULTS:
Seven hundred and six patients were evaluated at M0 and 577 at M24. At M0, percentage of patients in remission was 4% (PR), 8% (ASDAS), 34% (BASDAI), and at M24: 15%, 24% and 54% respectively, in the whole population and similar in Amor, ESSG and ASAS classified patients. BASDAI less than 3.6 had the best sensitivity, and ASDAS-R the best Youden index when using each of the two other definitions of remission as a gold standard. At M24 in multivariate analysis, remission was associated with less smoking, less analgesics, ASAS clinical arm fulfilling, less NSAIDs (ASDAS-R), low CRP (ASDAS-R), low BMI (BASDAI-R). However, over the two years, this study did not allow to demonstrate a relation between remission and structural progression or morbidity.
CONCLUSION:
In this population suggestive of early SpA, smoking and CRP appear as major markers of disease activity in early SpA, and associated with absence of remission.
Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.
KEYWORDS:
Early disease; Remission; Spondyloarthritis
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juillet 1, 2017 | Posted by admin
Une nouvelle review scientifique intitulé «Biomarkers for outcomes of spondyloarthritis» a été publié dans le journal Joint Bone Spine.
Xavier Romand, Claire Douillard, Athan Baillet.
No abstract available Keywords: Adipokines; Anti-Saccharomyces cerevisiæ antibodies; Biomarkers; Calprotectin; Cytokines; Spondyloarthritis.
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juin 28, 2017 | Posted by admin
Des nouveaux travaux ont été présentés lors du congrès du collège américain (ACR) de rhumatologie qui s’est déroulé du 3 au 8 novembre 2017 à San Diego (Etats-Unis) :
▫ Inflammation on MRI of Spine and Sacroiliac Joints Is Highly Predictive of Structural Damage in Axial Spondyloarthrisis: The 5 Years Data of the DESIR Cohort. Alexandre Sepriano
▫ Which Imaging Outcomes for AxSpA Are Most Sensitive to Change? a 5-Year Analysis of the DESIR Cohort : Alexandre Sepriano
▫ Progression of Structural Damage on MRI in Patients with Axial Spondyloarthritis Is Limited: The 5 –Year Results in the DESIR Cohort : Alexandre Sepriano
▫ Evaluation of the Adherence to Recommendations for Tnfα Blockers Use and Its Impact over 5 Years of Follow-up in Early Axial Spondyloarthritis. Data from the DESIR Cohort : Clementina López-Medina
▫ Integrated Longitudinal Analysis Increases Precision and Reduces Bias: A Comparative 5-Year Analysis in the DESIR Cohort : Alexandre Sepriano
▫ Detection of Structural Lesions on T1 Weighted MRI Versus Radiography of the Sacroiliac Joints in Early Axial Spa: 2-Year Data Walter : P. Maksymowych
▫ Inflammatory Lesions of the Sacroiliac Joints, but Not of the Spine, Are of High Utility for Recent Onset Axial Spondyloarthritis Recognition : Anna Molto
▫ Erosions at the Sacroiliac Joints and Fatty Lesions at the Spine Are the Most Discriminant Lesions for Recent Onset Axial Spondyloarthritis Recognition : Anna Molto
▫ Sustained Remission of Inflammation Is Associated with Reduced Structural Damage on SI Joint MRI in Patients with Early Axial Spa: Evidence to Support the Concept of Treat-to-Target Walter : P. Maksymowych
▫ X-Ray Spine Lesions Are Rare and Not Discriminant for Axial Spondyloarthritis Recognition in Patients with Recent Onset Chronic Back Pain : Anna Molto
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