juillet 29, 2016 | Posted by admin
Un nouvel article scientifique intitulé «Responsiveness of a simple RAPID-3-like index compared to disease-specific BASDAI and ASDAS indices in patients with axial spondyloarthritis» a été publié dans le journal RDM Open.
Castrejón I, Pincus T, Wendling D, Dougados M.
OBJECTIVE:
To evaluate the responsiveness of a simple routine assessment of patient index data (RAPID3)-like index that includes only 3 patient self-report measures (physical function, pain and patient global estimate) compared to that of traditional composite indices to assess change in patients with axial spondyloarthritis (Ax-SpA).
METHODS:
Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR) is a prospective cohort of patients with inflammatory back pain suggestive of Ax-SpA. The study included 461 patients, who met the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for Ax-SpA. A simple RAPID3-like index was compared with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the AS Disease Activity Score (ASDAS) scores for responsiveness over 6 months. Construct validity was also evaluated through Pearson correlations and discrimination of disease activity through standardised mean differences for the 3 indices.
RESULTS:
The RAPID3-like index was correlated significantly with BASDAI (r=0.84, p<0.005) and ASDAS-C-reactive protein (CRP) (r=0.74, p<0.005), similar to correlations of BASDAI with ASDAS-CRP (r=0.76, p<0.005). The percentage of patients with inactive disease ranged from 9% to 25% and with high activity from 10% to 45%, according to various measures. The capacity to discriminate between high and low disease activity was similar for the 3 indices. The strength of agreement of RAPID3 with ASDAS-CRP was moderate (0.44) and lower with BASDAI (0.37). Responsiveness over 6 months was slightly higher for ASDAS-CRP and the RAPID3-like index than that for BASDAI.
CONCLUSIONS:
The RAPID3-like index provides similar information to BASDAI and ASDAS-CRP concerning responsiveness over 6 months. RAPID3 appears feasible to assess patients with Ax-SpA quantitatively over time in busy clinical settings.
KEYWORDS:
Disease Activity; Outcomes research; Patient perspective; Spondyloarthritis
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juillet 7, 2016 | Posted by admin
Un nouvel article scientifique intitulé «Two Phenotypes are Identified by Cluster Analysis in Early Inflammatory Back Pain Suggestive of Spondyloarthritis. Results from the Desir Cohort.» a été publié dans le journal Arthritis Rheumatol.
Costantino F, Aegerter P, Dougados M, Breban M, D’Agostino MA
Arthritis Rheumatol. 2016 Feb 11. doi: 10.1002/art.39628.
Abstract
OBJECTIVE:
To examine whether in patients with early inflammatory back pain (IBP) suggestive of spondyloarthritis (SpA), disease manifestations at baseline would combine according to distinguishable ordered phenotypes.
METHODS:
Baseline clinical and demographic characteristics, as well as imaging and biological data of patients included in the French multicenter DESIR cohort were analyzed by multiple correspondence analysis and cluster analysis to identify subgroups of patients, based on shared characteristics.
RESULTS:
Cluster analysis allowed us to classify the 679 patients of the cohort with no missing data into 2 major groups: one with a predominance of isolated axial manifestations and the other with associated peripheral symptoms. The application of the same analysis to selected subsets of the cohort such as HLA-B27 positive and negative patients, and patients fulfilling the Assessment of SpondyloArthritis international Society classification criteria for axial SpA, resulted again in an optimal division of the samples into 2 recurrent clusters of patients, similar to those observed in the whole cohort.
CONCLUSION:
Cluster analysis of SpA manifestations among patients with early IBP highly suggestive of SpA, allowed us to clearly identify at baseline 2 different clinical phenotypes, one with predominant axial, and the other with predominant peripheral manifestations. Ongoing follow up will allow determining whether these clusters may correspond to different severity patterns. This article is protected by copyright. All rights reserved.
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juillet 4, 2016 | Posted by admin
Un nouvel article scientifique intitulé « Fatigue in early axial spondyloarthritis. Results from the French DESIR cohort» a été publié dans le journal Joint Bone Spine.
Gossec L, Dougados M, D’Agostino MA, Fautrel B.
Joint Bone Spine. 2015 Dec 18. pii: S1297-319X(15)00289-4. doi: 10.1016/j.jbspin.2015.07.012
Abstract
INTRODUCTION:
Fatigue is frequent in long-standing axial spondyloarthritis (axSpA); its frequency in early axSpA and its causes are unclear. The objective was to evaluate the magnitude of fatigue in early axSpA and to assess if fatigue appeared more strongly associated with patient- or with disease-related characteristics.
METHODS:
Patients were assessed in DESIR, a national observational cohort of patients with recent (<3 years duration) inflammatory back pain suggestive of axSpA. Magnitude of fatigue was assessed by a numeric rating scale (0-10) over one year. Factors associated with high fatigue(≥5/10) at 12 months were assessed by univariate and multivariate logistic regression, for patients fulfilling the ASAS axSpA criteria.
RESULTS:
Of the 708 patients, 486 fulfilled the ASAS criteria for axSpA: mean age 33±9 years; 244 (50%) males. Magnitude of fatigue was high at baseline (mean fatigue: 5.7±2.3) and decreased only slightly over the first year, and was overlapping in patients fulfilling the ASAS criteria or not. High fatigue at 12 months was well explained (variance explained: 0.84) by a higher ASDAS-CRP (odds ratio [OR]: 3.05 [95% confidence interval (CI) 2.27-4.12], P<0.0001), higher Bath Anylosing Spondylitis Patient Global (BAS-G) (OR: 3.51 [95% CI, 2.08-6.02], P<0.0001) and with borderline significance, female gender (OR: 1.65 [95% CI, 1.00-2.71], P=0.049).
CONCLUSION:
Fatigue levels were high in this population, both for patients fulfilling or not, the ASAS criteria for axSpA. High fatigue was closely related to disease-related variables, indicating fatigue may be an integral part of the disease process in axSpA.
Categories: Publication de travaux dans des journaux médicaux | Tags: cohorte DESIR, DESIR, fatigue, laure gossec | No Comments »
juin 28, 2016 | Posted by admin
De nouveaux travaux ont été présentés lors du congrès de la Société Française de Rhumatologie (SFR) qui s’est déroulé du 11 au 13 décembre 2016 au Parc des Expositions à Paris :
▫ Association entre les polymorphismes des gènes ERAP1, IL23R et TRAILR1 et la présence d’une sacroiliite magnétique chez les patients atteints de spondyloarthrite axiale récente : données issues de la cohorte française DESIR. C. Luxembourger
▫ Intérêt de l’échographie des enthèses dans l’évaluation des activités et association avec la sévérité de la spondyloarthrite : donnée de la cohorte française DESIR. A. Ruyssen-Witrand
▫ Validité de la mesure d’utilité SF-SD dans la spondyloarthrite axiale débutante: résultats de la cohorte cohorte DESIR. C. Gaujoux-Viala
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juin 28, 2016 | Posted by admin
Des nouveaux travaux ont été présentés lors du congrès du collège américain (ACR) de rhumatologie qui s’est déroulé du 11 au 16 novembre 2016 à Washington :
▫ Polymorphisms of ERAP1, IL23R and TRAILR1 Are Associated with MRI-Sacroiliitis in Early Axial Spondyloarthritis: Data from the French DESIR Cohort : Cécile Luxembourger
▫ 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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juin 27, 2016 | Posted by admin
Lors du congrès de l’EULAR 2016 qui s’est déroulé à Londres du 8 au 11 juin 2016, 6 abstracts ont été acceptés pour une présentation orale ou par poster :
▫ Inflammation On Mri Of The Spine Is Longitudinally Related To Disease Activity In Smokers But Not In Non-smokers In Axial Spondyloarthritis: 2-year Data From The Desir Cohort : V. Navarro-Compán et al.
▫ Asdas-based Remission Was Less Frequent Than Basdai-based Remission, And Both Were Related To Crp And Smoking In Early Axial Spondyloarthritis. The Desir Cohort : D. Wendling et al.
▫ Visceral Adipose Tissue And Cardiovascular Risk In Spondyloarthritis: Results From The Desir And Comospa Cohorts : H. Che et al.
▫ Increase In Il-31 Serum Level In Recent Spondyloarthritis: Data From The Desir Cohort : N. Rosine et al.
▫ Factors Associated With Elevated Acute Phase Reactants In Patients With Recent Inflammatory Back Pain: Impact Of C Reactive Protein On The Phenotype Of Patients. Data From The Prospective Multicenter French Cohort Desir : P. Manicki et al.
▫ Validity Of The Short Form 6d Utility Measure In Early Axial Spondyloarthritis: Results From The Desir Cohort : C. Gaujoux-Viala et al.
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mai 29, 2016 | Posted by admin
Un nouvel article scientifique intitulé «Vitamin D, disease activity and comorbidities in early spondyloarthritis» a été publié dans le journal Clin Exp Rheumatol.
Hmamouchi I, Paternotte S, Molto A, Etcheto A, Borderie D, Combe B, Dougados M.
OBJECTIVES:
To assess the vitamin D status in patients presenting inflammatory back pain suggestive of axial spondyloarthritis and to assess the relationship between vitamin D status and disease activity/severity; comorbidities at baseline and during the first two years of follow-up.
METHODS:
DESIR is a prospective, multicentre, observational study. Vitamin D deficiency was defined as <50 nmol/L and severe deficiency less than 25 nmol/L. Clinical variables were collected at each six month interval visits during the two-year follow-up.
RESULTS:
A total of 700 patients were analysed. The mean vitamin D was 54.2±28.7 nmol/L. Severe deficiency were observed in 11.7% versus 5% in the DESIR cohort versus the French population respectively. In the DESIR cohort, after adjusting for season and ethnicity, vitamin D deficiency remained significantly associated with presence of radiological sacroiliitis, higher ASDAS score and elevated BASDAI. Such association was also found between vitamin D deficiency and the mean value of disease activity/severity parameters during the two-year follow-up. Otherwise, vitamin D deficiency was significantly associated with the presence of baseline abdominal obesity (OR=1.65 [1.05-2.61], p=0.03), low HDL (OR=1.71 [1.14-2.55], p=0.01) and presence of metabolic syndrome (OR=2.20 [1.04-4.64], p=0.03) at baseline.
CONCLUSIONS:
We found a higher percentage of patients with severe vitamin D deficiency in early axial spondyloarthritis. Vitamin D deficiency was associated with higher disease activity and severity and presence of metabolic syndrome. Further longitudinal studies are required to evaluate the interest of vitamin D supplementation on the long-term outcome of the disease.
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mai 4, 2016 | Posted by admin
Un nouvel article scientifique intitulé « Disease Activity is Longitudinally Related to Sacroiliac Inflammation on MRI in Male Patients with Axial Spondyloarthritis: 2-year of the DESIR cohort» a été publié dans le journal Ann Rheum Dis.
Navarro-Compán V, Ramiro S, Landewé R, Dougados M, Miceli-Richard C, Richette P, van der Heijde D.
Ann Rheum Dis. 2015 Sep 24. pii: annrheumdis-2015-207786. doi: 10.1136/annrheumdis-2015-207786
ABSRACT
Objectives
To investigate the longitudinal relationship between inflammatory lesions in sacroiliac joints on MRI (MRI-SI) and clinical disease activity measures (DA) in patients with axial spondyloarthritis (axSpA).
Methods
Two-year follow-up data from 167 patients (50% males, mean (SD) age 33 (9) years) fulfilling the Assessment of SpondyloArthritis international Society axSpA criteria in the DEvenir des Spondylarthopathies Indifférenciées Récentes cohort with MRI-SI at baseline, 1 year and 2 years were analysed. The relationship between MRI-SI (as dependent variable) and DA (Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), patient’s global DA, night pain, C reactive protein and erythrocyte sedimentation rate, as independent variables) was investigated using two types of generalised estimating equations (GEE) models: model of absolute scores and model of change scores.
Results
In the model of absolute scores, the relationship between DA and MRI-SI was different for males and females: in males, but not in females, a statistically significant relationship with MRI-SI was found for all DA except BASDAI. In the model of changes, only ASDAS (beta (95% CI): 2.79 (0.85 to 4.73) and pain at night (0.97 (0.04 to 1.90)) were significantly associated in males while again in females no significant relationship was found. ASDAS fitted the data best.
Conclusions
In male patients, but not in female patients, with axSpA, clinical DA, especially if measured by ASDAS, is longitudinally associated with MRI-SI inflammatory lesions.
Categories: Publication de travaux dans des journaux médicaux | Tags: axial SPA, cohorte DESIR, Victoria Navarro-Compan | No Comments »
avril 29, 2016 | Posted by admin
Un nouvel article scientifique intitulé «Costs of early spondyloarthritis: estimates from the first 3 years of the DESIR cohort» a été publié dans le journal RMD Open.
Harvard S, Guh D, Bansback N, Richette P, Dougados M, Anis A, Fautrel B.
OBJECTIVES:
To value health resource utilisation and productivity losses in DESIR, a longitudinal French cohort of 708 patients with early spondyloarthritis (SpA) enrolled between 2007 and 2010, and identify factors associated with costs in the first 3 years of follow-up.
METHODS:
Self-reported clinical data from DESIR and French public data were used to value health resource utilisation and productivity losses in 2013 Euros. Factors associated with costs, including and excluding biological drugs, were identified in generalised linear models using the generalised estimating equations algorithm to account for repeated observations over participants.
RESULTS:
The mean (±SD) annual cost per patient was €5004±6870 in year 1, decreasing to €4961±7457 in year 3. Patients who never received a biologic had mean 3-year total costs of €4789±6022 compared to €38 206±19 829 among those who received a biologic. Factors associated with increased total costs were peripheral arthritis (rate ratio (RR) 1.19; 95% CI 1.04 to 1.37; p<0.0001), time on biologics (RR 1.23 per month; 1.21, 1.24; p<0.0001), and average BASFI score (RR 1.18/10 point increase; 1.15, 1.25; p<0.0001). Factors associated with increased costs excluding biologics were baseline age (RR 1.10 per 5 year increase; 1.05, 1.16; p<0.0001), peripheral arthritis (RR 1.20; 1.02, 1.40; p<0.0133), time on biologics (RR 1.04 per month; 1.02, 1.05; p<0.0001), and average BASDAI score (RR 1.21 per 10 point increase; 1.16, 1.25; p<0.0001).
CONCLUSIONS:
In addition to biologics, factors like age, peripheral arthritis and disease activity independently increase SpA-related costs. This study may serve as a benchmark for cost of illness among patients with early SpA in the biologic era.
KEYWORDS:
Ankylosing Spondylitis; Anti-TNF; Spondyloarthritis
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mars 6, 2016 | Posted by admin
Un nouvel article scientifique intitulé « Evaluation of physiotherapy in a prospective cohort of early axial spondyloarthritis. Data from the DESIR cohort» a été publié dans le journal Joint Bone Spine.
Escalas C, Dalichampt M, Dougados M, Poiraudeau S.
Joint Bone Spine. 2015 Dec 8. pii: S1297-319X(15)00244-4. doi: 10.1016/j.jbspin.2015.05.008.
Abstract
OBJECTIVE:
To evaluate the effect of physiotherapy on functional limitation in an observational cohort of early axial spondyloarthritis.
METHODS:
Design: prospective population-based cohort study.
PATIENTS:
708 patients with early axial spondyloarthritis between 2007 and 2010 naive of TNF blockers.
INTERVENTION:
early physiotherapy defined by at least eight supervised sessions of physical therapy during the first six months.
MEASUREMENTS:
the primary outcome was functional improvement defined by a relative improvement of at least 20% in BASFI at six months. Secondary outcomes were improvement in BASFI at one and two years and ASAS20 response criteria at six months.
STATISTICAL ANALYSIS:
a propensity score of having physiotherapy was developed and multivariate analysis using propensity score weighting were used to assess the effect of physiotherapy on outcome.
RESULTS:
Overall, 166 (24%) patients had physiotherapy during the first six months. After using propensity score weighting, there was no functional improvement on the primary outcome in patients treated with early physical therapy (relative risk [IC95%]: 1.15 [0.91-1.45]). No differences were observed on secondary outcomes (relative risk [IC95%]: 0.94 [0.80-1.11]).
CONCLUSIONS:
It seems there is no functional benefit for patients with early spondyloarthritis to be treated early by physiotherapy in daily practice, even though the efficacy of physiotherapy has been shown in several randomized controlled studies.
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