janvier 12, 2021 | Posted by admin Un nouveau bilan du nombre de projets soumis et acceptés par le comité scientifique depuis le début de l’étude est accessible cliquer ici .
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décembre 13, 2020 | Posted by admin De nouveaux travaux ont été présentés lors du congrès de la Société Française de Rhumatologie (SFR) qui s’est déroulé du 13 au 16 décembre 2020 en visioconférence :
• Déterminants sociodémographiques de l’évolution de la douleur au cours des rhumatismes inflammatoires chroniques : résultats des cohortes ESPOIR et DESIR. S. Kumaradev (Paris, France)
• Uvéite dans la spondyloarthrite récente : données à 5 ans de la cohorte nationale DESIR. D. Wendling (Besançon, France)
• Facteurs initiaux associés à la rémission à 5 ans dans la spondyloarthrite axiale précoce : données issues de la cohorte DESIR. L. Pina Vegas (Créteil, France)
• Facteurs associés à la rémission sans traitement à 5 ans dans la spondyloarthrite axiale : données de la cohorte DESIR. A. Ruyssen-Witrand (Toulouse, France)
• Identification de trajectoires d’activité dans la spondyloarthrite axiale récente: Résultats de la cohort DESIR. L. Benattar (Paris, France)
• Absence de différence des sérologies des germes dentaires entre les phénotypes des spondyloarthrites au sein de la cohorte DESIR. T. Neel (Saint-Étienne, France)
• Appariement probabiliste au système national des données de santé (SNDS) d’une cohorte de patients ayant des symptômes évocateurs d’une spondyloarthrite axiale récente : la cohorte DESIR. A. Ajrouche (Paris, France)
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novembre 18, 2020 | Posted by admin Un nouvel article scientifique intitulé «Long-term association between disease activity and disability in early axial spondyloarthritis: results from the DESIR cohort» a été publié dans le journal Arthritis Care Res (Hoboken).
Pedro D Carvalho, Adeline Ruyssen-Witrand, Ana Marreiros, Pedro M Machado.
Objectives:
Our primary objective was to study the long-term association between disease activity and disability in axial spondyloarthritis (axSpA). Our secondary objective was to define patient profiles according to their level of disability.
Methods:
We analysed data collected during the first five years of follow-up of a large early axSpA cohort – the Devenir des Spondylarthropathies Indifferénciées Récentes (DESIR) cohort. Multivariable models were built to study the association between Ankylosing Spondylitis Health Assessment Questionnaire (HAQ-AS) and Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), adjusting for potential confounders. Hierarchical multivariable analysis was conducted using the Chi-square Automatic Interaction Detector (CHAID) method, to help determine how variables best cluster to explain HAQ-AS.
Results:
Data from 644 patients and 5152 visits were analysed. HAQ-AS was longitudinally, independently and positively associated with ASDAS-CRP [adjusted (adj) B=0.205, (95% confidence interval (CI)= 0.187 to 0.222], enthesitis score (adjB=0.011, CI=0.008 to 0.015), Bath Ankylosing Spondylitis Metrology Index (BASMI) (adjB=0.087, CI=0.069 to 0.105) and female gender (adjB=0.172, CI=0.120 to 0.225). The CHAID decision tree revealed ASDAS-CRP as the first variable with discriminative power on HAQ-AS. The cut-offs that separated different patient disability profiles were obtained.
Conclusion:
Disease activity contributes longitudinally to disability and is hierarchically superior to any other variable in explaining this health domain. Enthesitis and spinal mobility are also key drivers of disability in early axSpA. ASDAS-CRP cut-offs that separated different patient disability profiles largely mimicked the cut-offs previously defined for ASDAS-CRP disease activity states.
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novembre 6, 2020 | Posted by admin Un nouvel article scientifique intitulé «Uveitis occurrence in early inflammatory back pain. Five years data from the prospective French nationwide DESIR cohort» a été publié dans le journal Joint Bone Spine.
Daniel Wendling, Clément Prati, Thierry Lequerré, Corinne Miceli, Maxime Dougados, Anna Molto, Xavier Guillot.
Objective:
Uveitis is a frequent extra rheumatological manifestation in axial Spondyloarthritis (SpA). The aim of study was to evaluate the prevalence and incidence of uveitis over the first five years of a prospective nationwide cohort of patients with high suspicion of early axial SpA, and to evaluate its associated factors.
Methods:
DESIR is a prospective observational cohort of patients with recent onset inflammatory back pain (more than 3 months, less than 3 years), suggestive of axial SpA, All available factors in the database were compared between patients with and without uveitis at 5 years, by uni and then multivariate analysis. Baseline factors associated with new cases of uveitis occurrence over the 5 years were also analyzed.
Significance: p less than 0.05.
Results:
After 5 years, 91 patients (out of 480 with complete follow-up) had at least one uveitis episode, giving an estimated prevalence of 18.9% [95% CI : 15.4-22.4]. In multivariate analysis, uveitis was significantly associated with dactylitis, and elevated ESR. New incident uveitis occurred in 31 cases over 5 years, giving an estimated incidence rate of 1.29 [0.84 - 1.74] / 100 patient-years. Incidence of new uveitis was associated in multivariate analysis with baseline factors: diagnosis of SpA, sacro iliac MRI inflammatory SPARCC score, dactylitis, syndesmophyte score. No significant association was found with HLA-B27, DMARDs, BASDAI, ASDAS, BASFI.
Conclusion:
Five-years data of the DESIR cohort allowed an estimation of incidence rate of uveitis of 1.3/100p-y; over five years, uveitis was associated with dactylitis, biologic and sacro iliac MRI inflammation.
Keywords:
Uveitis; cohort; dactylitis; spondyloarthritis.
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novembre 5, 2020 | Posted by admin Lors du congrès de l’ACR 2020 qui s’est déroulé du 5 au 9 novembre 2020 en visioconférence, 1 abstract a été accepté :
▫ Different Disease Activity Trajectories in Early Axial Spondyloarthritis Lead to Significantly Different Long-term Outcomes : A Cluster-based Analysis of the DESIR Cohort. Benattar Leslie, Anna Molto, Laure Gossec and Resche Rigon Matthieu
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octobre 6, 2020 | Posted by admin Un nouvel article scientifique intitulé «Determining factors related to impaired spinal and hip mobility in patients with axial spondyloarthritis: longitudinal results from the DESIR cohort» a été publié dans le journal RMD Open.
Pedro D Carvalho, Adeline Ruyssen-Witrand, Joao Fonseca, Ana Marreiros, Pedro M Machado.
Objective:
To investigate the determinants of impaired spinal and hip mobility in patients with early axial spondyloarthritis (axSpA).
Methods:
Five-year longitudinal data from the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort were analysed. Associations were investigated using generalised estimating equations, using Bath Ankylosing Spondylitis Metrology Index (BASMI) linear or each of the five components of BASMI as dependent variables, and clinical and demographic variables as independent variables in univariable models. Multivariable analyses were performed, adjusting for potential confounders.
Results:
Data from 644 patients and 5152 visits were analysed. Higher BASMI values were independently and positively associated with Ankylosing Spondylitis Disease Activity Score C reactive protein (ASDAS-CRP) (adjusted B (adjB)=0.21; 95% CI=0.15 to 0.28), MRI spinal inflammation score (adjB=0.11; 95% CI=0.04 to 0.19), enthesitis score (adjB=0.02; 95% CI=0.01 to 0.04) and age (adjB=0.02; 95% CI=0.01 to 0.03). All BASMI components were independently associated with ASDAS-CRP and MRI spinal inflammation, except for maximal intermalleolar distance (reflecting hip mobility), which was not associated with MRI spinal inflammation.
Conclusion:
In early axSpA, spinal mobility impairment is independently determined by clinical disease activity, MRI spinal inflammation, enthesitis and age. The influence of spinal inflammation prevails in early axSpA, as opposed to spinal structural damage, which may become more relevant in later disease stages.
Keywords:
Ankylosing; MRI; Patient Reported Outcome Measures; Spondylitis.
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septembre 28, 2020 | Posted by admin Un nouvel article scientifique intitulé «Determinants of the physician global assessment of disease activity and influence of contextual factors in early axial spondyloarthritis» a été publié dans le journal Arthritis Care Res (Hoboken).
Fumio Hirano, Robert B M Landewé, Floris A van Gaalen, Désirée van der Heijde, Cécile Gaujoux-Viala, Sofia Ramiro.
Objectives:
To investigate determinants of the physician global assessment of disease activity (PhGA) and the influence of the contextual factors on this relationship in patients with early axial spondyloarthritis (axSpA).
Method:
Five-year data of DESIR, a cohort of early axSpA, were analyzed. Univariable generalized estimating equations (GEE) were used to investigate contributory explanatory effects of various potential determinants of PhGA. Effect modification by contextual factors (age, gender and educational level) was tested and, if significant, models were stratified. Autoregressive GEE models (i.e., models adjusted for PhGA at the previous time point) were used to confirm a longitudinal relationship.
Results:
A total of 708 patients were included. Higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) individual questions, swollen joint count in 28 joints (SJC28), tender joint count in 53 joints, Maastricht Ankylosing Spondylitis Enthesitis Score, C-reactive protein (CRP) and Bath Ankylosing Spondylitis Metrology Index were associated with a higher PhGA. Gender and age were effect modifiers of SJC28; the contributory effect of SJC28 was largest in the younger male stratum (β [95% CI]; 1.07 [0.71-1.43]), and the smallest in the older female stratum (0.13 [0.04-0.22]). Autoregressive GEE models revealed the same determinants as having a longitudinal association with PhGA and the same pattern of effect modification.
Conclusions:
Patient’s subjective symptoms, peripheral arthritis and enthesitis, higher CRP and impaired spinal mobility contribute to explaining PhGA in patients with early axSpA irrespective of gender and age. Intriguingly, physicians consider the presence of swollen joints as more important in males than in females.
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septembre 25, 2020 | Posted by admin Un nouvel article scientifique intitulé «Which imaging outcomes for axSpA are most sensitive to change? A 5-Year analysis of The DESIR Cohort» a été publié dans le journal Arthritis Care Res (Hoboken).
Alexandre Sepriano, Sofia Ramiro, Désirée van der Heijde, Maxime Dougados, Pascal Claudepierre, Antoine Feydy, Monique Reijnierse, Damien Loeuille, Robert Landewé.
Objective:
To compare the sensitivity to change of different imaging scoring methods in patients with early axial spondyloarthritis (axSpA).
Methods:
Patients from the DESIR cohort fulfilling the ASAS axSpA criteria were included. Radiographs and MRI of the sacroiliac joints (SIJ) and spine were obtained at baseline, 1, 2 and 5 years. Each image was scored by 2 or 3 readers in 3 separate ‘reading-waves’. The rate of change of outcomes measuring spinal and SIJ inflammation (e.g. SPARCC score) and structural damage on MRI (e.g. ≥3 fatty lesions) and radiographs (e.g. mNY grading) was assessed using multilevel generalized estimating equations (GEE) models (taking all readers and waves into account). To allow comparisons across outcomes, rates were standardized (difference between the individual’s value and the population mean divided by the standard deviation).
Results:
In total, 345 patients were included. Inflammation on MRI-SIJ (standardized rate range: -0.278; -0.441) was more sensitive to change compared to spinal inflammation (range: -0.030; -0.055). Structural damage in the SIJ showed a higher standardized rate of change on MRI-SIJ (range: 0.015-0.274) compared to X-SIJ (range: 0.043-0.126). MRI-SIJ damage defined by ≥3 fatty lesions showed the highest sensitivity to change (0.274). Spinal structural damage slowly progressed over time with no meaningful difference between radiographic (range: 0.037-0.043) and MRI structural outcomes (range: 0.008-0.027).
Conclusion:
Structural damage assessed in pelvic radiographs has low sensitivity to change, while fatty lesions detected on MRI-SIJ are a promising alternative. In contrast, MRI-spine is not better than X-spine in detecting structural changes in early axSpA patients.
Keywords: Axial spondyloarthritis; imaging; sensitivity to change.
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septembre 16, 2020 | Posted by admin Un nouvel article scientifique intitulé «Inflammation of the sacroiliac joints and spine on MRI predicts structural changes on MRI in axial spondyloarthritis: 5-year data from DESIR » a été publié dans le journal Arthritis Care Res (Hoboken).
Alexandre Sepriano, Sofia Ramiro, Robert Landewé, Anna Moltó, Pascal Claudepierre, Daniel Wendling, Maxime Dougados, Désirée van der Heijde.
Objective:
To test the impact of inflammation on MRI-structural changes occurring in the sacroiliac joints (SIJ) and the spine.
Methods:
Patients with early axSpA from the DESIR cohort were included. MRIs of the SIJ (MRI-SIJ) and spine (MRI-spine), obtained at baseline, 2 and 5 years, were scored by 3 central readers. Inflammation and structural damage on MRI-SIJ/MRI-spine were defined by the agreement of ≥2 of 3 readers (binary outcomes), and by the average of 3 readers (continuous outcomes). The effect of inflammation (MRI-SIJ/MRI-spine) on damage (MRI-SIJ/MRI-spine, respectively) was evaluated in two models: i. Baseline prediction model: effect of baseline inflammation on damage assessed at 5-year; and ii. Longitudinal model: effect of inflammation on structural damage assessed during 5 years.
Results:
202 patients were included. Both the presence of bone marrow edema (BME) on MRI-SIJ and on MRI-spine at baseline were predictive of 5-year damage (≥3 fatty lesions) on MRI-SIJ [OR=4.2 (95% CI: 2.4; 7.3)] and MRI-spine [OR=10.7 (95% CI: 2.4; 49.0)], respectively, when adjusted for CRP. The association was also confirmed in longitudinal models (when adjusted for ASDAS) both in the SIJ [OR=5.1 (95% CI: 2.7; 9.6)] and spine [OR=15.6 (95% CI: 4.8; 50.3)]. Analysis of other structural outcomes (i.e. erosions) on MRI-SIJ yielded similar results. In the spine, a significant association was found for fatty lesions but not for erosions and bone spurs, which occurred infrequently over time.
Conclusion:
We found a predictive and longitudinal association between MRI-inflammation and several types of MRI-structural damage in patients with early axSpA which adds to the proof for a causal relationship.
Keywords:
Axial spondyloarthritis; Inflammation; magnetic resonance imaging; structural damage.
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septembre 15, 2020 | Posted by admin Un nouvel article scientifique intitulé «Pregnancy rates and outcomes in early axial spondyloarthritis: an analysis of the DESIR cohort» a été publié dans le journal Joint Bone Spine.
Marion Pons, Maxime Dougados, Nathalie Costedoat-Chalumeau, Karine Briot, Philippe Goupille, Christian Roux, Anna Molto.
Objectives:
Only scarce data is available regarding pregnancy outcomes in early axSpA, particularly little is known about the impact of disease activity. The objective is to identify a) the factors associated with the occurrence of a clinical pregnancy during follow-up and b) the risk factors for an unfavorable pregnancy outcome (e.g. miscarriage, medical termination or pre-term delivery) in an early axSpA population.
Methods:
Observational prospective French cohort (DESIR) with 6 years of follow-up including 381 TNFi-naïve women with early axSpA. Factors associated with a clinical pregnancy occurring over follow-up and risk factors for an unfavorable pregnancy outcome were estimated by multivariable multilevel models (i.e. Frailty Shared Models and Mixed Models).
Results:
During follow-up, 124 pregnancies occurred. Patients who got pregnant during follow-up were more likely to have discontinued their TNFi treatment in the 6 months preceding the pregnancy (HR=2.0 [95%IC 1.1-3.3], p=0.01) and to have an increased CRP at the previous visit (HR=1.7 [95%IC 1.2-2.5], p= 0.01). Full-term delivery was by far the most frequent pregnancy outcome (75% of all pregnancies), and only NSAID use in the 6 months prior to the outcome was associated with an unfavorable outcome (OR=2.5 [95%IC 1.1-5.0], p=0.02). No association was found between TNFi use and an unfavorable pregnancy outcome.
Conclusion:
Full-term delivery was the most frequent pregnancy outcome. NSAID use within 6 months of outcome, but not TNFi use, was associated with an unfavorable pregnancy outcome in this early axSpA cohort.
Keywords: Epidemiology; Pregnancy; Spondyloarthritis.
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