Axial spondyloarthritis: time to stop the split 10 years on

Michelena, Xabier; Marzo‐Ortega, Helena

doi:10.1038/s41584-019-0331-6

Cited by 4 publications

(6 citation statements)

References 13 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Following the introduction of the Assessment of Spondyloarthritis international Society (ASAS) classification criteria [ 2 ], the rheumatology community has an increased awareness of the diagnostic issues in axSpA if such criteria are misused, particularly in the non-radiographic patient subgroup. Yet, despite growing evidence that nr-axSpA and r-axSpA show a comparable burden of disease [ 3 ], different treatment strategies are still suggested [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Similar biologic drug response regardless of radiographic status in axial spondyloarthritis: data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis registry

et al. 2021

Self Cite

View full text Add to dashboard Cite

Objectives To describe the baseline characteristics, bDMARD response and drug survival of axSpA patients in the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) according to radiographic status. Methods BSRBR-AS is a national prospective cohort including axSpA participants classified according to the ASAS criteria. In this analysis, baseline data of patients starting bDMARDs were compared. Ankylosing Spondylitis Disease Activity Scores (ASDAS) for low disease status, clinically important improvement (CII) and major improvement (MI) at one year were used to assess treatment response. Cox proportional hazard analysis was performed after adjusting for clinically relevant cofounders. Results 1,145 axSpA patients were included. Higher male prevalence, older age and longer disease duration was seen in the r-axSpA subgroup. Based on a complete case analysis (290 patients), two thirds of patients achieved ASDAS low disease state at one year regardless of radiographic status (nr-axSpA: 64.2% vs r-axSpA: 66.1). No statistically significant differences were seen between the subgroups in attaining ASDAS CII (nr-axSpA: 50.7% vs r-axSpA: 44.7%) or MI (nr-axSpA: 20% vs r-axSpA: 18.7%). Drug survival probability curves were similar for both subgroups and hazard ratio for nr-axSpA/axSpA was 0.94 (95% CI 0.69-1.28) when adjusted for sex, age, baseline ASDAS-CRP, smoking status, disease duration, HLA-B27 and prescribed biologic. Conclusions Although there appeared to be some differences in the baseline characteristics when exploring this cohort according to radiographic status which are likely related to the natural history of the disease, the level of biologic response and drug survival was comparable between nr-axSpA and r-axSpA.

show abstract

Section: Introductionmentioning

confidence: 99%

Similar biologic drug response regardless of radiographic status in axial spondyloarthritis: data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis registry

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…We demonstrate here that patients with r22axSpA—a subgroup of r-axSpA -perform similarly to patients with nr-axSpA and not like the remainder of patients with r-axSpA with regard to treatment effectiveness and spinal radiographic progression, emphasising the arbitrariness of the current differentiation between the two disease states 15…”

Section: Discussionmentioning

confidence: 75%

“…19 We demonstrate here that patients with r22axSpA-a subgroup of r-axSpA -perform similarly to patients with nr-axSpA and not like the remainder of patients with r-axSpA with regard to treatment effectiveness and spinal radiographic progression, emphasising the arbitrariness of the current differentiation between the two disease states. 15 It is not our intention to suggest that shifting the cutoff between disease states to at least a moderate to severe (grade 3) radiographic sacroiliitis unilaterally would solve the issue, as it would further delay its diagnostic and predictive capacity. A more promising approach for RCTs as well as for day-to-day clinical practice would be to consider the important progress made in the assessment of MRI for diagnostic purposes, which entails simultaneous contextual evaluation of both active and structural SIJ lesions.…”

Section: Discussionmentioning

confidence: 99%

“…14 Consequently, it has been suggested to abandon the distinction between nr-axSpA and r-axSpA and that RCTs should be performed across the whole spectrum of axSpA. 15 The latter seems of particular relevance as patients with nr-axSpA and r-axSpA have been shown to present with a comparable disease burden 16 and to respond similarly well to treatment with biologics when objective signs of inflammation are taken into consideration. [17][18][19][20][21][22][23] Moreover, significant progress has been made over the past decade to improve identification of both inflammatory and structural SIJ changes on MRI, allowing not only for earlier diagnosis, but also for improved differentiation from alternative reasons of back pain.…”

Section: Key Messagesmentioning

confidence: 99%

“…This leads to an important inter-rater and intrarater variability of SIJ scoring,12 13 which cannot be significantly improved with training 14. Consequently, it has been suggested to abandon the distinction between nr-axSpA and r-axSpA and that RCTs should be performed across the whole spectrum of axSpA 15. The latter seems of particular relevance as patients with nr-axSpA and r-axSpA have been shown to present with a comparable disease burden16 and to respond similarly well to treatment with biologics when objective signs of inflammation are taken into consideration 17–23.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Current differentiation between radiographic and non-radiographic axial spondyloarthritis is of limited benefit for prediction of important clinical outcomes: data from a large, prospective, observational cohort

et al. 2022

View full text Add to dashboard Cite

ObjectiveTo compare disease characteristics and outcomes between patients with axial spondyloarthritis with non-radiographic disease (nr-axSpA), bilateral grade 2 sacroiliitis (r22axSpA) and unilateral/bilateral grade 3–4 sacroiliitis (r3+axSpA) according to the modified New York criteria.MethodsWe included patients with axial spondyloarthritis with available pelvic radiographs from the Swiss Clinical Quality Management Cohort. Retention of a first tumour necrosis factor inhibitor (TNFi) was investigated with multiple adjusted Cox proportional hazards models. The proportion of patients reaching 50% reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50) at 1 year was assessed with multiple adjusted logistic regression analyses. Spinal radiographic progression, defined as an increase in ≥2 mSASSS units in 2 years, was assessed in generalised estimating equation models.ResultsFrom 2080 patients, those with nr-axSpA (n=485) and r22axSpA (n=443) presented with lower C reactive protein levels and less severe clinical spinal involvement compared with patients with r3+axSpA (n=1152). While TNFi retention was similar in r22axSpA and nr-axSpA, the risk of discontinuation was significantly lower in r3+axSpA (HR 0.60, 95% CI 0.44 to 0.82 vs nr-axSpA). BASDAI50 responses at 1 year were comparable in r22axSpA and nr-axSpA, with a better response associated with r3+axSpA (OR 2.05, 95% CI 1.09 to 3.91 vs nr-axSpA). Spinal radiographic progression was similar in r22axSpA and nr-axSpA and significantly higher in r3 +axSpA.ConclusionPatients with r22axSpA are comparable to nr-axSpA patients but differ from patients with more severe sacroiliac damage with regard to treatment effectiveness and spinal radiographic progression. Therefore, current differentiation between nr-axSpA and radiographic disease seems of limited use for outcome prediction.

show abstract

Exploring the unifying concept of spondyloarthritis: a latent class analysis of the REGISPONSER registry

Michelena,

Sepriano,

Zhao

et al. 2024

Rheumatology

View full text Add to dashboard Cite

Objectives The aim of our study is to identify the potential distinct phenotypes within a broad Spondyloarthritis (SpA) population. Methods We conducted a cross-sectional study using the REGISPONSER registry with data from 31 specialist centres in Spain including patients with SpA who fulfilled the European Spondyloarthropathy Study Group (ESSG) criteria. A latent class analysis (LCA) was performed to identify the latent classes underlying SpA according to a set of predefined clinical and radiographic features, independently of expert opinion. Results In a population of 2319 SpA patients, a 5 classes LCA model yielded the best fit. Classes named ‘axial with spine involvement’ and ‘axial with isolated SIJ involvement” show a primarily axial SpA phenotype defined by inflammatory back pain and high HLA-B27 prevalence. Patients in class ‘axial + peripheral’ show similar distribution of manifest variables to previous classes but also have a higher likelihood of peripheral involvement (peripheral arthritis/dactylitis) and enthesitis, therefore representing a mixed (axial and peripheral) subtype. Classes ‘Peripheral + psoriasis’ and ‘Axial + peripheral + psoriasis’ are indicative of peripheral SpA (and/or PsA) with high likelihood of psoriasis, peripheral involvement, dactylitis, nail disease, and low HLA-B27 prevalence, while class ‘Axial + peripheral + psoriasis’ also exhibits increased probability of axial involvement both clinically and radiologically. Conclusion The identification of 5 latent classes in the REGISPONSER registry with significant overlap between axial and peripheral phenotypes is concordant with a unifying concept of SpA. Psoriasis and related features (nail disease and dactylitis) influence the phenotype of both axial and peripheral manifestations.

show abstract

Axial spondyloarthritis: time to stop the split 10 years on

Cited by 4 publications

References 13 publications

Similar biologic drug response regardless of radiographic status in axial spondyloarthritis: data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis registry

Similar biologic drug response regardless of radiographic status in axial spondyloarthritis: data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis registry

Current differentiation between radiographic and non-radiographic axial spondyloarthritis is of limited benefit for prediction of important clinical outcomes: data from a large, prospective, observational cohort

Exploring the unifying concept of spondyloarthritis: a latent class analysis of the REGISPONSER registry

Contact Info

Product

Resources

About