FRI0525 Early Sacroiliitis and Progression to Ankylosing Spondylitis is Associated to Positive HLA-B27 in Juvenile Spondyloarthritis:
Manuel Orozco PérezNádia Emi AikawaSolange CarrascoCarla Gonçalves Schahin SaadPercival D. Sampaio‐BarrosCélio Roberto GonçalvesJúlio César Bertacini de MoraesCláudia Goldenstein‐Schainberg
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Abstract:
Background
Axial and peripheral involvement, enthesitis and positive HLAB27 in 60-90% children are main features of juvenile spondyloarthritis (JSpA). Radiological sacroiliitis represents an important prognostic factor that may occur within 10 years from onset.Objectives
To determine initial and long term clinical profiles of Brazilian patients with JSpA from a single tertiary university center; the prevalence of HLAB27 and correlation with disease progression to ankylosing spondylitis (AS), according to ASAS criteria.Methods
Descriptive cross-sectional study of a cohort of JSpA patients. All clinical demographic and radiological data were collected from chart review and HLA-B27 was analysed by flow cytometry (Becton Dickinson). Fisher and McNemar9s tests were used for statistical analyses and p<0.05 considered significant.Results
Fifty patients with JSpA were assessed, with mean age=31.5±11.1yrs (15-60), mean age at.2±2.73yrs (7-16), mean age at diagnosis=19.8±9.0yrs (7-44) and mean disease duration=18.9±11.4yrs (3-44). The majority were males (44M:6F,88%) and whites (n=42,84%). Eleven (22%) subjects had a 1st-degree relative with SpA and 87% (34/39) were HLAB27+. At diagnosis (Table), peripheral manifestations was predominant, particularly asymmetric oligoarthritis while axial involvement was mainly inflammatory back and buttocks pain; 21 (42%) had enthesitis, all at the Achilles insertion; anterior uveitis was the major extra-articular manifestation. After a mean follow up period of 12.8±9.13yrs (1-45), 5 patients were lost, axial involvement prevailed, enthesitis remained in 13/21 and none had uveitis (Table). Radiological sacroiliitis developed in 96% (n=48) patients: 42% (n=20) ≤5yrs, 17% (n=8) within 6-10yrs and 42% (n=20) >10yrs of initial symptoms. Of note, HLA-B27+ children had earlier sacroiliitis ≤5yrs from diagnosis (p=0.02), high ESR at diagnosis (p=0.04) and developed AS (p=0.02). Regardless of daily NSAIDs therapy intake by all patients, sacroiliitis progression was not prevented (p>0.05). Sulfasalazine was used by 86% and MTX by 72%, and currently 49% patients are on anti-TNF drugs.Conclusions
Brazilian JSpA patients are characteristically white males with initial peripheral joint and enthesitic manifestations that develop axial disease. The high prevalence of HLAB27+ in JSpA associated to early sacroiliitis, elevated ESR at diagnosis and progression to AS strengthen its role as a genetic marker of disease severity in children.Disclosure of Interest
None declaredKeywords:
BASFI
HLA-B27
Oligoarthritis
Background
Peripheral manifestations (arthritis, enthesitis and dactylitis) are frequent in patients with Spondyloarthritis (SpA)1. However, little is known regarding the impact of these manifestations on patients' disease perception and treatments.Objectives
To evaluate the impact of the presence of peripheral manifestations on patient-reported outcomes (PROs) and treatment.Methods
Data from the ASAS-COMOSPA study were analysed. Patients who reported peripheral arthritis were divided into three groups: current, past history and no history. The impact of the presence of peripheral arthritis on VAS-G (Global Visual Analogue Scale), BASDAI (Bath Ankylosing Spondylitis Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), work and activity impairment was evaluated through the use of the ANOVA one factor test. Finally, NSAIDs, corticosteroids and DMARDs intake were compared among patients with and without peripheral articular involvement. A similar statistical analysis was performed for enthesitis and dactylitis.Results
Among the 3984 patients included in the ASAS-COMOSPA study, 1333 (33.5%), 718 (18%) and 1933 (48.5%) patients had current, past history and no history of peripheral arthritis, respectively. Patients with current peripheral arthritis showed higher levels in VAS-G, BASDAI, BASFI, as well as in work and activity impairment, in comparison to the other two groups, being these differences statistically significant (p<0.01). Patients with peripheral articular involvement at the time of the visit showed higher mean scores in all questions of the BASDAI questionnaire, in contrast to those with past history and/or no history (p<0.001). Impact on treatment is shown in table 1. Regarding enthesitis, 642 (16.1%), 864 (21.7%) and 2478 (62.2%) patients had current, past history and no history of enthesitis, respectively. Patients with current enthesitis showed significant higher levels in all PROs against the other two groups of patients (p<0.05), as well as higher scores in all the BASDAI questions (p<0.001). Finally, 171 (4.3%), 447 (11.2%) and 3366 (84.5%) patients had current, past history and no history of dacylitis, respectively. The same results as the other two peripheral manifestations were obtained regarding impact on PROs and BASDAI questions.Conclusions
The presence of any of the three peripheral manifestations at the time of the visit was associated to higher scores in all PROs. Patients with peripheral involvement showed greater use of NSAIDs, corticosteroids and DMARDs than those without peripheral manifestations.Reference
[1] Dougados M, d'Agostino MA, Banessiano J, et al. Joint Bone Spine2011Dec;78(6):589–603. doi:10.1016/j.jbspin.2011.01.013Disclosure of Interest
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The aim of this study was to investigate the relationship between Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index and disease activity and health-related quality of life in patients with ankylosing spondylitis (AS).Eighty-six AS patients not receiving antitumour necrosis factor (TNF) therapy were included in the study. Spinal pain by visual analogue scale (pain VAS rest and activity), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis severity by SPARCC index, quality of life by Short Form-36 (SF-36), and Bath Ankylosing Spondylitis Metrology Index (BASMI) were assessed in patients. In the laboratory evaluations, the erythrocyte sedimentation rates and serum C-reactive protein levels of the patients were determined.All participants were aged between 18 and 65 years, with a mean age of 36.9 ± 11.13 years. The most frequent region of enthesitis was Achilles tendon insertion into calcaneum (55.8%). Pain VAS rest and activity, BASFI and all parameters of SF-36 were significantly different in AS patients with and without enthesitis. SPARCC index was significantly correlated with pain VAS activity (P < 0.05), pain VAS rest, BASDAI, BASFI and all parameters of SF-36 (P < 0.001). There were no correlations between SPARCC index and BASMI, disease duration and laboratory parameters (P > 0.05).The clinical assessment of enthesitis in AS is an important outcome measure, and enthesitis indexes such as SPARCC enthesitis index can be valuable tools in the evaluation of disease activity in AS patients not receiving anti-TNF therapy.
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Spondylitis
Oswestry Disability Index
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To assess serum level of bone morphogenetic protein-7 (BMP-7) and to study its relation to clinical and sonographic assessment of peripheral enthesitis in ankylosing spondylitis (AS) patients. This study involved 49 AS patients and 40 matched controls. The serum BMP-7 level was determined by enzyme linked immunosorbant assay (ELISA). Entheses were assessed by musculoskeletal ultrasound (MSUS) and scored using Madrid Sonographic Enthesitis Index (MASEI). The AS disease activity score-C-reactive protein (ASDAS-CRP), Bath AS disease activity index (BASDAI) and Bath AS Functional Index (BASFI) were assessed. Patients were 45 males and 4 females with a mean age of 35.57 ± 9.71 years and median disease duration of 10 (2–28) years. US lesions were frequently found at the insertions of Achilles (76.5%), quadriceps (57.1%), plantar fascia (51%) and triceps (43.8%) tendons. Serum level of BMP-7 was significantly increased in patients (41.8 ng/ml) compared to controls (38.5 ng/ml) (p = 0.031). BMP-7 serum level significantly correlated with age (p = 0.03), disease duration (p < 0.001) and BASFI (p = 0.02) but did not correlate with ASDAS CRP, BASDAI, clinical enthesitis or total MASEI. Total MASEI correlated significantly with age, disease duration, ASDAS-CRP, BASDAI and BASFI. MASEI is a good predictor of activity in AS patients at a cut-off score of 9. AS patients have a significant higher level of serum BMP-7 compared to control which indicates that it may play an important pathogenetic role in AS. However, this level did not correlate with either clinical or sonographic assessment of peripheral enthesitis.
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Enthesis
Spondylitis
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BASFI
Enthesis
Erythrocyte sedimentation rate
Spondylitis
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Citations (26)
Background
Enthesitis is one of the assessment parameters of the patients with Ankylosing spondylitis (AS). Many indexes are used in the evaluation of the severity of enthesitis and there are several studies investigating the relationship between severity of enthesitis and clinical and laboratory parameters. Spondyloarthritis Research Consortium of Canada Enthesitis (SPARCC) index is feasible and reliable for measurement of enthesitis severity.Objectives
The aim of this study was to investigate the relationship between SPARCC index and disease activity and health related quality of life (QoL) in patients with AS.Methods
Eighty six AS patients were included in the study. Pain by visual analogue scale (pain VAS-rest and activity), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis severity by SPARCC index, QoL by short form-36 (SF-36), and Bath Ankylosing Spondylitis Metrology Index (BASMI) were assessed in patients. In the laboratory evaluations, the erythrocyte sedimentation rates (ESR) and serum C-reactive protein levels of the patients were determined. Descriptive statistics and Spearman tests were used for statistical analysis.Results
All participants were aged between 18 and 65 years, with a mean age of 36.9±11.13 years. The most frequent region of enthesopaties was Achilles tendon insertion into calcaneum (55.8%). SPARCC index was significantly correlated with pain VAS-rest, BASDAI, and BASFI (p<0.001). There was also positive correlation between SPARCC index and pain VAS-activity (p<0.05). There was no relation between SPARCC index and BASMI or laboratory parameters (p>0.05).Conclusions
The clinical assessment of enthesitis in AS is an important outcome measure, and enthesitis indexes such as SPARCC enthesitis index can be valuable tool in the evaluation of disease activity in patients with AS.References
WP Maksymowych, C Mallon, S Morrow, et al. Development and validation of the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index. Ann Rheum Dis 2009 68: 948-53. Turan Y, Duruöz MT, Cerrahoglu L. Relationship between enthesitis, clinical parameters and quality of life in spondyloarthritis. Joint Bone Spine 2009; 76: 642–7. Laatiris A, Amine B, Ibn Yacoub Y. Enthesitis and its relationships with disease parameters in Moroccan patients with ankylosing spondylitis. Rheumatol Int 2010; 10.1007/s00296-010-1658-0.Disclosure of Interest
None DeclaredBASFI
Erythrocyte sedimentation rate
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MAY WE USE ENTHESITIS INDICES IN EVALUATING DISEASE ACTIVITY IN PATIENTS WITH ANKYLOSING SPONDYLITIS
Aims: The objective of the present study was to investigate the parameters related to disease activity in patients with Ankylosing Spondylitis (AS). Materials and methods: Fifty-three patients with AS who fulfilled the modified New York criteria were included in this study. The demographic data of the patients were recorded. Laboratory evaluation of the patients comprised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional disability was evaluated using The Bath Ankylosing Spondylitis Functional Index (BASFI) and Dougados Functional Index (DFI). Clinical status was evaluated with Bath Ankylosing Spondylitis Metrology Index (BASMI) and quality of life was assessed with Ankylosing Spondylitis Quality of Life Scale (ASQoL). We assessed enthesitis by two indices: Mander Enthesitis Index (MEI) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES). Results: The patients were divided into two groups: patients having BASDAI scores of less than four (BASDAI<4) with mild disease activity (N=42) and patients having BASDAI scores of four or higher (BASDAI≥4) with moderate to severe disease activity (N=11). MEI, MASES and BASFI scores were significantly higher in patients with moderate to severe disease activity. No significant difference was found in terms of CRP, BASMI and ASQoL between the two groups. A significant correlation was found between the BASDAI scores and MEI, MASES, CRP, DFI and BASFI in patients with AS (the correlation coefficients were 0.538, 0.544, 0.328, 0.407 and 0.466 respectively. P values were <0.05 for all). Conclusions: Laboratory findings are not enough to evaluate disease activity in AS. However CRP seems to have better correlation with disease activity than ESR does and MASES and MEI seem to be an appropriate surrogate for disease activity in AS patients.
BASFI
Enthesis
Erythrocyte sedimentation rate
Spondylitis
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BASFI
Erythrocyte sedimentation rate
Spondylitis
Enthesis
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Spondylitis
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Objectives
To evaluate the clinical features and course of ankylosing spondylitis (AS) in women according to the City rheumatological center in Kazan.Methods
The study involved two groups of patients with AS: 23 women and 25 men, respectively, matched by age (average - 33,1±9,6 years), established diagnosis (average - 3,4±1,6 years). The presence of inflammatory back pain (IBP), BASDAI, ASDAS, BASFI indexes, presence of HLA B27, the results of X-ray of the sacroiliac joint were evaluated.Results
In women, the disease duration from first symptoms to diagnosis was 4,6±1,8 years, age at onset 26,3±4,9 years, in men these figures were 5,7±2,1 years and 25.6±3,8 years respectively. According to a survey of patients, disease onset in women was characterized by the presence of IBP (at 69.6%), occurring periodically (38.5%), peripheral arthritis clinic (60.9%), enthesitis (21, 7%), uveitis (4.3%). Among men IBP occurred in 60%, less recurring (14%), arthritis occurred in 40%, enthesitis - 75%, uveitis - 8%. At the time of examination in women peripheral arthritis was significantly (at 69.6%, p<0.01) more common than in men (30.4%). Disease activity (BASDAI, ASDAS) were comparable in two groups. Functional impairment was higher in men (BASFI=5,6±1,2) than in women group (BASFI=4,5±1,0). According to the results of X-ray stage 0-1 sacroiliitis detected in 17.4% of women and 12% of men, the second stage - in 47.8% of women and 44% of men, the third stage - in 34.8% and 36% respectively, the fourth stage - 8% of men.Conclusions
AS in women has several significant features: IBP at onset of the disease is less common and is less permanent, more often peripheral joints are involved, enthesitis and uveitis are rarely diagnosed. AS in women is characterized by slower radiological progression.Disclosure of Interest
None declaredDOI
10.1136/annrheumdis-2014-eular.3759BASFI
HLA-B27
Spondylitis
Reactive arthritis
Sacroiliac joint
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Abstract Background Sonoelastography (SE) is a new ultrasound (US)-based technique able to assess tissue elasticity. Using conventional US, it is sometimes difficult or even impossible to distinguish pathologic tissue because it often presents with the same echogenicity as the surrounding healthy tissue. This study aimed to evaluate SE findings in Achilles tendons of patients with axial spondyloarthritis (axSpA) and to assess how these findings are associated with disease-related parameters. Material and Methods Sixty-four consecutive patients (37 men, 27 women; mean age 39.7 years; range 20–65 years) with axSpA and 30 sex and age-matched healthy controls were enrolled in the study. Disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), whereas functional capacity was evaluated using the Bath Ankylosing Spondylitis Functional Index (BASFI). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and the Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index were recorded. All participants underwent an SE examination of the Achilles tendon and measurement of the strain index (SI). Results The mean right and left SI were significantly higher in axSpA patients than in controls (2.96±0.94 vs. 1.90±0.45; p<0.001; 2.95±0.95 vs. 1.92±0.48, p<0.001, respectively). In axSpA patients, both right and left SI were significantly correlated with the BASDAI, BASFI and SPARCC enthesitis indices, but not with ESR or CRP. Conclusion AxSpA patients had an increased SI compared with healthy subjects and these values were associated with disease activity, functional capacity and the enthesitis index. SE may be a useful tool for the evaluation of Achilles tendons in patients with axSpA.
BASFI
Enthesis
Erythrocyte sedimentation rate
Spondylitis
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