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4. The natural history of chronic widespread pain in patients with axial spondyloarthritis: a cohort study with clinical and self-tracking data.

Author

Soni, Anushka, Nishtala, Revathi, Ng, Stanley, Barnett, Rosemarie, Chyou, Te-yuan, Cavill, Charlotte, and Sengupta, Raj

Subjects
CHRONIC pain, CONFIDENCE intervals, ANKYLOSIS, MANN Whitney U Test, SPONDYLOARTHROPATHIES, RISK assessment, T-test (Statistics), DESCRIPTIVE statistics, CHI-squared test, QUESTIONNAIRES, DATA analysis software, ODDS ratio, LOGISTIC regression analysis, LONGITUDINAL method, DISEASE risk factors, DISEASE complications
Abstract

Objectives This study investigates longitudinal patterns, predictors and long-term impact of pain in axial spondyloarthritis (axSpA), using clinical and self-tracking data. Methods The presence of multisite pain (MSP), affecting at least six of nine body regions using a Margolis pain drawing, and subsequent chronic widespread pain (CWP), MSP at more than one timepoint, was assessed in a cohort of axSpA patients. Incident MSP (MSP at two consecutive visits or more), intermittent MSP (MSP at two or more non-consecutive visits) and persistent MSP (MSP at each visit) were described. Demographic, clinical and self-tracking measures were compared for the CWP vs non-CWP groups using Students t test, Wilcoxon–Mann–Whitney and χ2 test for normal, non-normal and categorical data, respectively. Predictors of CWP were evaluated using logistic regression modelling. Results A total of 136 patients, mean clinical study duration of 120 weeks (range 27–277 weeks) were included, with sufficient self-tracking data in 97 patients. Sixty-eight (50%) patients reported MSP during at least one clinical visit: eight (6%) incident MSP; 16 (12%) persistent MSP; and 44 (32%) intermittent MSP. Forty-six (34%) of the cohort had CWP. All baseline measures of disease activity, function, quality of life, sleep disturbance, fatigue and overall activity impairment were significant predictors of the development of CWP. BASDAI and BASFI scores were significantly higher in those with CWP and self-tracking data revealed significantly worse pain, fatigue, sleep quality and stress. Conclusions The development of CWP is predicted by higher levels of disease activity and burden at baseline. It also impacts future disease activity and wellbeing. [ABSTRACT FROM AUTHOR]

Published
2023
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5. Radiographic versus non-radiographic axial spondyloarthritis: comparison of daily self-reported flare experience

Author

Barnett, Rosie, Ng, Stanley, Cavill, Charlotte, and Sengupta, Raj

Abstract

Introduction. Axial spondyloarthritis (axSpA) is a chronic, inflammatory condition of the spine; comprised of radiographic (ankylosing spondylitis-AS) and non-radiographic (nr-axSpA) disease. Although nr-axSpA is considered an earlier stage of disease, the natural history of axSpA remains to be elucidated. Daily tracking of subtle changes in symptoms, disease activity and disease flares via smartphone technologies may facilitate further understanding of the axSpA disease spectrum. Methods. At the Royal National Hospital for Rheumatic Diseases, patients with axSpA can log daily self-reported symptoms, behaviour and flare experience between clinic appointments via the Project Nightingale smartphone app. Users with ≥10 days of data entry were included for the analysis. Baseline (date closest to app registration) clinical measures collected at hospital appointments were also assessed. Mean (SD) daily symptom scores, behaviour, flare on/off values and baseline characteristics were reported for AS versus nr-axSpA. Welch’s t-test was used to assess differences between diagnoses.Results. Between 5th April 2018-1st April 2020, 179 patients consented to research and 137 logged ≥10 days of data in the Project Nightingale app. Results are presented in Table 1. Experience of flare was similar in terms of frequency, duration and symptom patterns for patients with AS and nr-axSpA. Although, individuals with nr-axSpA maintained slightly higher levels of recommended exercise during flare (mean 3.7 versus 3.2, p=0.03). Anti-inflammatory use was significantly greater during flare for individuals with AS versus nr-axSpA (58.4% versus 37.9%, p=0.03). While caffeine intake reduced during flare for patients with AS, it increased for patients with nr-axSpA (-0.08 versus 0.13, p=0.003). Baseline disease activity (BASDAI) was greater in nr-axSpA than AS (4.4 versus 3.4), this difference exceeding the minimal clinically important difference for BASDAI, although not statistically significant (p=0.08).Conclusions. Experience of flare is similar in AS and nr-axSpA, including frequency, duration and symptoms. However, exercise and medication behaviour during flare differed. Burden of disease is similar in AS and nr-axSpA.Acknowledgements. UCB supported use of the Project Nightingale smartphone application, hosted by uMotif. The time of R Barnett was funded by the Sir Halley Stewart Trust.

Published
2021

15. Tumor Necrosis Factor Inhibitor Monotherapy Versus Combination Therapy for the Treatment of Psoriatic Arthritis: Combined Analysis of European Biologics Databases

Author

Thomas, Matthew L., primary, Shaddick, Gavin, additional, Charlton, Rachel, additional, Cavill, Charlotte, additional, Holland, Richard, additional, Iannone, Florenzo, additional, Lapadula, Giovanni, additional, Lopriore, Simona, additional, Závada, Jakub, additional, Uher, Michal, additional, Pavelka, Karel, additional, Szczuková, Lenka, additional, Sidiropoulos, Prodromos, additional, Flouri, Irini, additional, Drosos, Alexandros, additional, Möller, Burkhard, additional, Nissen, Michael J., additional, Müller, Rüdiger B., additional, Scherer, Almut, additional, McHugh, Neil, additional, and Nightingale, Alison, additional

Published
2020
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19. Psoriatic Nail Dystrophy Is Associated with Erosive Disease in the Distal Interphalangeal Joints in Psoriatic Arthritis: A Retrospective Cohort Study

Author

Antony, Anna S., primary, Allard, Andrew, additional, Rambojun, Adwaye, additional, Lovell, Christopher R., additional, Shaddick, Gavin, additional, Robinson, Graham, additional, Jadon, Deepak R., additional, Holland, Richard, additional, Cavill, Charlotte, additional, Korendowych, Eleanor, additional, McHugh, Neil J., additional, and Tillett, William, additional

Published
2019
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20. Spondylarthropathies (including psoriatic arthritis): 244. Validity of Colour Doppler and Spectral Doppler Ultrasound of Sacroilicac Joints Againts Physical Examination as Gold Standard

Author

Castillo-Gallego, Concepcion, de Miguel Mendieta, Eugenio, Garcia-Arias, Miriam, Plasencia-Rodriguez, Chamaida, Lojo-Oliveira, Leticia, Martin-Mola, Emilio, Tillett, William, Cavill, Charlotte, Korendowych, Ellie, McHugh, Neil, Coates, Lucy, Bhalla, Ashok K., Creamer, Paul, Packham, Jon, Hailwood, Sarah, Taylor, Gordon, Hamilton, Louise, Brooksby, Alan, Leeder, Jane, Gaffney, Karl, Malipeddi, Aruna S., Neame, Rebecca, Francis, James, Hassan, Waji, Mease, Philip, Olds, Michele, Kary, Sonja, Kupper, Hartmut, Bell, Carolyn, Peffers, Gill, Rees, Frances, Lanyon, Peter, Obrenovic, Karen, Sandhu, Ravinder, Packham, Jonathan, Erb, Nicola, Coates, Laura C., Conaghan, Philip, Emery, Paul, Green, Michael, Ibrahim, Gamal, MakIver, Helen, Helliwell, Philip, Giles, Joanna L., McHugh, Kirsty, DiGleria, Katilin, Shaw, Jackie, Kollnberger, Simon, Maenaka, Katsumi, Marroquin, Osiris, Renner, Christoph, Bowness, Paul, Landewe, Robert, Ritchlin, Christopher, Guérette, Benoit, Lavie, Frederic, Kavanaugh, A., McInnes, I., Krueger, G. G., Gladman, D., Zrubek, J., Goldstein, N., Xu, S., Mudivarthy, S., Mack, M., Prevosto, Claudia, McDonald, Sarah, De Riva, Alessandra, Goodman, Reyna, Key, Tim, Hill Gaston, J S., Deery, Michael J., Busch, Robert, Fischer, Roman, Wright, Cynthia, Kessler, Benedikt, Sheehy, Claire, Jois, Ramesh N., Kerrigan, Nicola, Mills, Karen S., Somerville, Margaret, Scott, David G., van der Heijde, D., Chattopadhyay, Chandra, Mease, P., Xu, W., Rahman, M. U., Baratelle, A., Beutler, A., Stober, Carmel B., Benham, Helen J., Goodall, Jane C., Hill Gaston, J.S., Sanyal, Kaushik, Walker-Bone, Karen, Helliwell, Philip S., Vastesaeger, N., Wang, Y., Inman, R., Deodhar, A., Hsu, B., Dijkmans, B., Braun, J., Geusens, P., Sieper, J., El Miedany, Yasser, Palmer, Deborah, Shaw, Jacqueline, Payeli, Sravan, Utriainen, Lotta, and Milling, Simon

Subjects
musculoskeletal diseases
Abstract

Background: Sacroiliac joints (SJ) involvement is a distinctive and charasteristic feature of Spondyloarthritis (SpA) and x-ray is the test routinely used to make a diagnosis. However, x-ray reveals late structural damage but cannot detect active inflammation. The objective of this study was to assess the validity of Doppler ultrasound in SJ. Methods: Prospective blinded and controlled study of SJ, in which three populations were compared. We studied 106 consecutive cases, who were divided into three groups: a) 53 patients diagnosed with SpA who had inflammatory lumbar and gluteal pain assessed by a rheumatologist; b) 26 patients diagnosed with SpA who didn't have SJ tenderness and had normal physical examination; c) control group of 27 subjects (healthy subjetcs or with mechanical lumbar pain). All patients included that were diagnosed with SpA met almost the European Spondyloarthropathy Study Group (ESSG) classification criteria. Physical examination of the SJ included: sacral sulcus tenderness, iliac gapping, iliac compression, midline sacral thrust test, Gaenslen's test, and Patrick s test were used as gold standard. Both SJ were examined with Doppler ultrasound (General Electric Logiq 9, Wauwatosa WI, USA) fitted with a 9-14 Mhz lineal probe. The ultrasonographer was blinded to clinical data. Doppler in SJ was assessed as positive when both Doppler colour and resistance index (RI)

Published
2017

21. Tumor Necrosis Factor Inhibitor Monotherapy Versus Combination Therapy for the Treatment of Psoriatic Arthritis: Combined Analysis of European Biologics Databases.

Author

Thomas, Matthew L., Shaddick, Gavin, Charlton, Rachel, Cavill, Charlotte, Holland, Richard, Iannone, Florenzo, Lapadula, Giovanni, Lopriore, Simona, Závada, Jakub, Uher, Michal, Pavelka, Karel, Szczuková, Lenka, Sidiropoulos, Prodromos, Flouri, Irini, Drosos, Alexandros, Möller, Burkhard, Nissen, Michael J., Müller, Rüdiger B., Scherer, Almut, and McHugh, Neil

Published
2021
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23. Trajectory of radiographic change over a decade: the effect of transition from conventional synthetic disease-modifying antirheumatic drugs to anti-tumour necrosis factor in patients with psoriatic arthritis

Author

Allard, Andrew, primary, Antony, Anna, additional, Shaddick, Gavin, additional, Jadon, Deepak R, additional, Cavill, Charlotte, additional, Robinson, Graham, additional, Korendowych, Eleanor, additional, McHugh, Neil, additional, and Tillett, William, additional

Published
2018
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25. Comment on: Tumour necrosis factor inhibitor survival and predictors of response in axial spondyloarthritis—findings from a United Kingdom cohort: reply

Author

Yahya, Fariz, primary, Gaffney, Karl, additional, Hamilton, Louise, additional, Lonsdale, Ellie, additional, Leeder, Jane, additional, Brooksby, Alan, additional, Cavill, Charlotte, additional, Berry-Jenkins, Joshua, additional, Boyle, Cathal, additional, Bond, Debbie, additional, and Sengupta, Raj, additional

Published
2018
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27. 115. SURVIVAL ANALYSIS AND REASONS FOR DISCONTINUING OR SWITCHING TUMOUR NECROSIS FACTOR INHIBITORS IN AXIAL SPONDYLOARTHRITIS: FINDINGS FROM A REAL-LIFE UK COHORT

Author

Yahya, Fariz, primary, Gaffney, Karl, additional, Lonsdale, Ellie, additional, Leeder, Jane, additional, Brooksby, Alan, additional, Berry-Jenkins, Joshua, additional, Boyle, Cathal, additional, Bond, Debbie, additional, Cavill, Charlotte, additional, and Sengupta, Raj, additional

Published
2017
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28. Oral abstracts 1: SpondyloarthropathiesO1. Detecting axial spondyloarthritis amongst primary care back pain referrals

Author

Harris, Claire, Remedios, Denis, Aptowitzer, Tanya, Keat, Andrew, Hamilton, Louise, Guile, Geoffrey, Belkhiri, Abdelghani, Newman, David, Toms, Andoni, Macgregor, Alex, Gaffney, Karl, Morton, Linda, Jones, Gareth T., MacDonald, Alan G., Downham, Christina, Macfarlane, Gary J., Tillett, William, Jadon, Deepak, Wallis, Dinny, Costa, Luisa, Waldron, Nicola, Griffith, Nina, Cavill, Charlotte, Korendowych, Eleanor, de Vries, Corinne, McHugh, Neil, Iaremenko, Oleg, Fedkov, Dmytro, Emery, Paul, Baeten, Dominique, Sieper, Joachim, Braun, Jurgen, van der Heijde, D., McInnes, Iain, Van Laar, Jaap, Landewe, R., Wordsworth, Bryan P., Wollenhaupt, Jurgen, Kellner, Herbert, Paramarta, I., Bertolino, Arthur, Wright, Andrew M., Hueber, Wolfgang, Sofat, Nidhi, Smee, Cori, Hermansson, Monika, Wajed, Julekha, Sanyal, Kaushik, Kiely, Patrick, Howard, Matthew, Howe, Franklyn A., Barrick, Thomas R., Abraham, Ajay M., Pearce, Mark S., Mann, Kay D., Francis, Roger M., Birrell, Fraser, Carr, Andrew, Macleod, Iain, Ng, Wan-Fai, Kavanaugh, Arthur, van der Heijde, Desiree, Chattopadhyay, Chandrabhusan, Gladman, Dafna, Mease, Philip, Krueger, Gerald, Xu, Weichun, Goldstein, Neil, Beutler, Anna, Baraliakos, Xenofon, Laurent, Didier D., Wollenhaupt, Jürgen, Gsteiger, Sandro, Conaghan, Philip G., Peterfy, Charles G., DiCarlo, Julie, Olech, Ewa, Alberts, Alan R., Alper, Jeffrey A., Devenport, Jenny, Anisfeld, Andrew M., Troum, Orrin M., Cooper, Philip, Gimpel, Mo, Deakin, Greg, Jameson, Karen, Godtschailk, Malcolm, Gadola, Stephan, Stokes, Maria, Cooper, Cyrus, Gordon, Caroline, Kalunian, K., Petri, M., Strand, V., Kilgallen, B., Barry, A., Wallace, D., Flurey, Caroline A., Morris, Marianne, Pollock, Jon, Hughes, Rod, Richards, Pam, Hewlett, Sarah, Harris, Claire, Remedios, Denis, Aptowitzer, Tanya, Keat, Andrew, Hamilton, Louise, Guile, Geoffrey, Belkhiri, Abdelghani, Newman, David, Toms, Andoni, Macgregor, Alex, Gaffney, Karl, Morton, Linda, Jones, Gareth T., MacDonald, Alan G., Downham, Christina, Macfarlane, Gary J., Tillett, William, Jadon, Deepak, Wallis, Dinny, Costa, Luisa, Waldron, Nicola, Griffith, Nina, Cavill, Charlotte, Korendowych, Eleanor, de Vries, Corinne, McHugh, Neil, Iaremenko, Oleg, Fedkov, Dmytro, Emery, Paul, Baeten, Dominique, Sieper, Joachim, Braun, Jurgen, van der Heijde, D., McInnes, Iain, Van Laar, Jaap, Landewe, R., Wordsworth, Bryan P., Wollenhaupt, Jurgen, Kellner, Herbert, Paramarta, I., Bertolino, Arthur, Wright, Andrew M., Hueber, Wolfgang, Sofat, Nidhi, Smee, Cori, Hermansson, Monika, Wajed, Julekha, Sanyal, Kaushik, Kiely, Patrick, Howard, Matthew, Howe, Franklyn A., Barrick, Thomas R., Abraham, Ajay M., Pearce, Mark S., Mann, Kay D., Francis, Roger M., Birrell, Fraser, Carr, Andrew, Macleod, Iain, Ng, Wan-Fai, Kavanaugh, Arthur, van der Heijde, Desiree, Chattopadhyay, Chandrabhusan, Gladman, Dafna, Mease, Philip, Krueger, Gerald, Xu, Weichun, Goldstein, Neil, Beutler, Anna, Baraliakos, Xenofon, Laurent, Didier D., Wollenhaupt, Jürgen, Gsteiger, Sandro, Conaghan, Philip G., Peterfy, Charles G., DiCarlo, Julie, Olech, Ewa, Alberts, Alan R., Alper, Jeffrey A., Devenport, Jenny, Anisfeld, Andrew M., Troum, Orrin M., Cooper, Philip, Gimpel, Mo, Deakin, Greg, Jameson, Karen, Godtschailk, Malcolm, Gadola, Stephan, Stokes, Maria, Cooper, Cyrus, Gordon, Caroline, Kalunian, K., Petri, M., Strand, V., Kilgallen, B., Barry, A., Wallace, D., Flurey, Caroline A., Morris, Marianne, Pollock, Jon, Hughes, Rod, Richards, Pam, and Hewlett, Sarah

Abstract

Background: Inflammatory back pain (IBP) is an early feature of ankylosing spondylitis (AS) and its detection offers the prospect of early diagnosis of AS. However, since back pain is very common but only a very small minority of back pain sufferers have ASpA or AS, screening of back pain sufferers for AS is problematic. In early disease radiographs are often normal so that fulfilment of diagnostic criteria for AS is impossible though a diagnosis of axial SpA can be made if MRI evidence of sacroiliitis is present. This pilot study was designed to indicate whether a cost-effective pick up rate for ASpA/early AS could be achieved by identifying adults with IBP stratified on the basis of age. Methods: Patients aged between 18 and 45 years who were referred to a hospital physiotherapy service with back pain of more than 3 months duration were assessed for IBP. All were asked to complete a questionnaire based on the Berlin IBP criteria. Those who fulfilled IBP criteria were also asked to complete a second short questionnaire enquiring about SpA comorbidities, to have a blood test for HLA-B27 and CRP level and to undergo an MRI scan of the sacroiliac joints. This was a limited scan, using STIR, diffusion-weighted, T1 and T2 sequences of the sacroiliac joints to minimize time in the scanner and cost. The study was funded by a research grant from Abbott Laboratories Ltd. Results: 50 sequential patients agreed to participate in the study and completed the IBP questionnaire. Of these 27 (54%) fulfilled criteria for IBP. Of these, 2 patients reported a history of an SpA comorbidity - 1 psoriasis; 1 ulcerative colitis - and 3 reported a family history of an SpA comorbidity - 2 psoriasis; 1 Crohn's disease. 4 were HLA-B27 positive, though results were not available for 7. Two patients had marginally raised CRP levels (6, 10 -NR ≤ 5). 19 agreed to undergo MRI scanning of the sacroiliac joints and lumbar spine; 4 scans were abnormal, showing evidence of bilateral sacroiliitis on S

Published
2017

29. Trajectory of radiographic change over a decade: the effect of transition from conventional synthetic disease-modifying antirheumatic drugs to anti-tumour necrosis factor in patients with psoriatic arthritis.

Author

Allard, Andrew, Antony, Anna, Shaddick, Gavin, Jadon, Deepak R, Cavill, Charlotte, Robinson, Graham, Korendowych, Eleanor, McHugh, Neil, and Tillett, William

Subjects
ANTIRHEUMATIC agents, GENERIC drug substitution, PROBABILITY theory, PSORIATIC arthritis, TUMOR necrosis factors, SAMPLE size (Statistics), RETROSPECTIVE studies, DISEASE duration, CHEMICAL inhibitors
Abstract

Objectives To describe the trajectory of radiographic progression among patients with PsA who transitioned from conventional synthetic DMARDs to anti-TNF-α inhibitors in routine care. Methods A retrospective sample of patients with PsA (ClASsification criteria for Psoriatic ARthritis) was taken from the Bath longitudinal cohort. All patients had radiographs of the hands and feet taken: 5 years before (T0), at the time of (T1) and 5 years after (T2) commencing anti-TNF treatment. Radiographs were scored blinded using the PsA-modified Sharp-van der Heijde score (mSvdHS) and for osteoproliferation (Psoriatic Arthritis Ratingen Score) by A.Allard, A.Antony and W.T. This sample size was calculated to ensure 90% power to determine the smallest detectable difference of the mSvdHS to a 5% significance level. Cumulative probability plots were used to determine the probability of radiographic progression pre- (T0–T1) and post- (T1–T2) anti-TNF treatment. Results Eighty-four radiographs from 28 patients were selected for inclusion. The median [interquartile range (IQR)] disease duration at baseline (T0) was 8.5 (0–19.5) years. The interval between T0–T1 and T1–T2 was 4.2 years (3.34–6.65) and 4.9 years (4.25–5.87), respectively. The median mSvdHS at baseline (T0) was 8.5 (IQR 1.75–27.5). The median (IQR) rate of change in mSvdHS per year reduced after commencing anti-TNF, from 2.1 (0.88–3.92) between T0–T1 to 1.0 (IQR 0.05–2.35) between T1–T2 (P = 0.012). Conclusion The trajectory of damage accumulation over a 10-year period in this observational clinical cohort is low overall. The rate of radiographic damage as measured by the mSvdHS slows following commencement of anti-TNF. [ABSTRACT FROM AUTHOR]

Published
2019
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30. Tumour necrosis factor inhibitor survival and predictors of response in axial spondyloarthritis--findings from a United Kingdom cohort.

Author

Yahya, Fariz, Gaffney, Karl, Hamilton, Louise, Lonsdale, Ellie, Leeder, Jane, Brooksby, Alan, Cavill, Charlotte, Berry-Jenkins, Joshua, Boyle, Cathal, and Bond, Debbie

Subjects
ANTIRHEUMATIC agents, TREATMENT effectiveness, FORECASTING, ANKYLOSING spondylitis, CONFIDENCE intervals, LONGITUDINAL method, PROBABILITY theory, SMOKING, TUMOR necrosis factors, DISEASE remission, RETROSPECTIVE studies, DESCRIPTIVE statistics, CHEMICAL inhibitors
Abstract

Objectives. To analyse long-term survival and efficacy of TNFi, reasons for switching or discontinuing, baseline predictors of response and remission in axial spondyloarthritis (axSpA) patients in a UK cohort. Methods. All patients with a physician-verified diagnosis of axSpA attending two specialist centres who fulfilled the eligibility criteria for TNFi were included. Routinely recorded patient data were reviewed retrospectively. Initial TNFi was recorded as the index drug. Results. Six hundred and fifty-one patients (94% AS) were included; adalimumab (n = 332), etanercept (n = 205), infliximab (n = 51), golimumab (n = 40) and certolizumab pegol (n = 23) were index TNFi. The mean (S.D.) duration from symptom onset to time of diagnosis was 8.6 (8.7) years and mean (S.D.) duration from diagnosis to TNFi initiation was 12.6 (11.5) years. A total of 224 (34.4%) stopped index TNFi, and 105/224 switched to a second TNFi. Median drug survival for index and second TNFi were 10.2 years (95% CI: 8.8, 11.6 years) and 5.5 years (95% CI: 2.7, 8.3 years), respectively (P < 0.05). Survival rates were not influenced by choice of TNFi. HLA-B27 predicted BASDAI50 and/or two or more point reduction within 6 months and long-term drug survival (P < 0.05). Low disease activity was predicted by non-smoking and low baseline BASDAI (P < 0.05). Conclusion. We have observed good TNFi survival rates in axSpA patients treated in a real-life setting. This is best for first TNFi and not influenced by drug choice. [ABSTRACT FROM AUTHOR]

Published
2018
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31. Validation of the Psoriatic Arthritis Impact of Disease (PsAID) Questionnaire and its potential as a single-item outcome measure in clinical practice.

Author

Holland, Richard, Tillett, William, Korendowych, Eleanor, Cavill, Charlotte, Waldron, Nicola, Brooke, Melanie, and McHugh, Neil J.

Subjects
PSORIATIC arthritis, COMPARATIVE studies, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, PSYCHOMETRICS, QUESTIONNAIRES, RESEARCH, RESEARCH evaluation, EVALUATION research, SEVERITY of illness index, DIAGNOSIS
Abstract

Objectives: The Psoriatic Arthritis Impact of Disease (PsAID) Questionnaire is a recently developed patient-reported outcome measure (PROM) of disease impact in psoriatic arthritis (PsA). We set out to assess the validity in an independent cohort of patients, estimate the minimally important difference for improvement and explore the potential of individual components of the PsAID in clinical practice.Methods: Data were collected prospectively for a single-centre cohort of patients with PsA. Construct validity was assessed by Spearman correlation with other PROMs and reliability by intraclass correlation coefficient (ICC) at 1 week. Sensitivity to change at 3 months was determined by the standardised response mean (SRM) in those patients with active disease requiring a change in treatment.Results: A total of 129 patients (mean ±SD age 52.1±13.3, 57% women, disease duration 10.2±8 years) completed the baseline questionnaires and assessments. The mean baseline PsAID12 score was 3.92±2.26 with an ICC of 0.91 (95%CI 0.87 to 0.94). The SE of measurement was 0.51 and the minimal detectable change was 1.41. There was strong correlation (r≥0.70) with most of the PROMs studied and moderate correlation with clinical outcomes (r=0.40-0.57). The SRM of the PsAID12 was 0.74 (95%CI 0.45 to 0.97). There was strong correlation with individual PsAID items and their corresponding PROM questionnaires (r≥0.67).Conclusion: The PsAID is a reliable, feasible and discriminative measure in patients with PsA. The good responsiveness of the PsAID and strong correlation of individual items with other PROMS represent an opportunity to reduce questionnaire burden for patients in studies and clinical practice. [ABSTRACT FROM AUTHOR]

Published
2018
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36. Tumor Necrosis Factor Inhibitor Monotherapy Versus Combination Therapy for the Treatment of Psoriatic Arthritis: Combined Analysis of European Biologics Databases

Author

Thomas, Matthew L, Shaddick, Gavin, Charlton, Rachel, Cavill, Charlotte, Holland, Richard, Iannone, Florenzo, Lapadula, Giovanni, Lopriore, Simona, Závada, Jakub, Uher, Michal, Pavelka, Karel, Szczuková, Lenka, Sidiropoulos, Prodromos, Flouri, Irini, Drosos, Alexandros, Möller, Burkhard, Nissen, Michael J, Müller, Rüdiger B, Scherer, Almut, McHugh, Neil, and Nightingale, Alison

Subjects
610 Medicine & health, 3. Good health
Abstract

OBJECTIVE To investigate whether tumor necrosis factor inhibitor (TNFi) combination therapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) is more effective for psoriatic arthritis (PsA) and/or improves TNFi drug survival compared to TNFi monotherapy. METHODS Five PsA biologics cohorts were investigated between 2000 and 2015: the ATTRA registry (Czech Republic); the Swiss Clinical Quality Management PsA registry; the Hellenic Registry of Biologics Therapies (Greece); the University of Bari PsA biologics database (Italy); and the Bath PsA cohort (UK). Drug persistence was analyzed using Kaplan-Meier and equality of survival using log-rank tests. Comparative effectiveness was investigated using logistic regression with propensity scores. Separate analyses were performed on (1) the combined Italian/Swiss cohorts for change in rate of Disease Activity Score in 28 joints (DAS28); and (2) the combined Italian, Swiss, and Bath cohorts for change in rate of Health Assessment Questionnaire (HAQ). RESULTS In total, 2294 patients were eligible for the drug survival analysis. In the Swiss (P = 0.002), Greek (P = 0.021), and Bath (P = 0.014) databases, patients starting TNFi in combination with methotrexate had longer drug survival compared to monotherapy, while in Italy the monotherapy group persisted longer (P = 0.030). In eligible patients from the combined Italian/Swiss dataset (n = 1056), there was no significant difference between treatment arms in rate of change of DAS28. Similarly, when also including the Bath cohort (n = 1205), there was no significant difference in rate of change of HAQ. CONCLUSION Combination therapy of a TNFi with a csDMARD does not appear to affect improvement of disease activity or HAQ versus TNFi monotherapy, but it may improve TNFi drug survival.

37. Spondylarthropathies (including psoriatic arthritis): 244. Validity of Colour Doppler and Spectral Doppler Ultrasound of Sacroilicac Joints Againts Physical Examination as Gold Standard

Author

Castillo-Gallego, Concepcion, de Miguel Mendieta, Eugenio, Garcia-Arias, Miriam, Plasencia-Rodriguez, Chamaida, Lojo-Oliveira, Leticia, Martin-Mola, Emilio, Tillett, William, Cavill, Charlotte, Korendowych, Ellie, McHugh, Neil, Coates, Lucy, Bhalla, Ashok K., Creamer, Paul, Packham, Jon, Hailwood, Sarah, Taylor, Gordon, Hamilton, Louise, Brooksby, Alan, Leeder, Jane, Gaffney, Karl, Malipeddi, Aruna S., Neame, Rebecca, Francis, James, Hassan, Waji, Mease, Philip, Olds, Michele, Kary, Sonja, Kupper, Hartmut, Bell, Carolyn, Peffers, Gill, Rees, Frances, Lanyon, Peter, Obrenovic, Karen, Sandhu, Ravinder, Packham, Jonathan, Erb, Nicola, Coates, Laura C., Conaghan, Philip, Emery, Paul, Green, Michael, Ibrahim, Gamal, MakIver, Helen, Helliwell, Philip, Giles, Joanna L., McHugh, Kirsty, DiGleria, Katilin, Shaw, Jackie, Kollnberger, Simon, Maenaka, Katsumi, Marroquin, Osiris, Renner, Christoph, Bowness, Paul, Landewe, Robert, Ritchlin, Christopher, Guérette, Benoit, Lavie, Frederic, Kavanaugh, A., McInnes, I., Krueger, G. G., Gladman, D., Zrubek, J., Goldstein, N., Xu, S., Mudivarthy, S., Mack, M., Prevosto, Claudia, McDonald, Sarah, De Riva, Alessandra, Goodman, Reyna, Key, Tim, Hill Gaston, J S., Deery, Michael J., Busch, Robert, Fischer, Roman, Wright, Cynthia, Kessler, Benedikt, Sheehy, Claire, Jois, Ramesh N., Kerrigan, Nicola, Mills, Karen S., Somerville, Margaret, Scott, David G., van der Heijde, D., Chattopadhyay, Chandra, Mease, P., Xu, W., Rahman, M. U., Baratelle, A., Beutler, A., Stober, Carmel B., Benham, Helen J., Goodall, Jane C., Hill Gaston, J.S., Sanyal, Kaushik, Walker-Bone, Karen, Helliwell, Philip S., Vastesaeger, N., Wang, Y., Inman, R., Deodhar, A., Hsu, B., Dijkmans, B., Braun, J., Geusens, P., Sieper, J., El Miedany, Yasser, Palmer, Deborah, Shaw, Jacqueline, Payeli, Sravan, Utriainen, Lotta, Milling, Simon, Castillo-Gallego, Concepcion, de Miguel Mendieta, Eugenio, Garcia-Arias, Miriam, Plasencia-Rodriguez, Chamaida, Lojo-Oliveira, Leticia, Martin-Mola, Emilio, Tillett, William, Cavill, Charlotte, Korendowych, Ellie, McHugh, Neil, Coates, Lucy, Bhalla, Ashok K., Creamer, Paul, Packham, Jon, Hailwood, Sarah, Taylor, Gordon, Hamilton, Louise, Brooksby, Alan, Leeder, Jane, Gaffney, Karl, Malipeddi, Aruna S., Neame, Rebecca, Francis, James, Hassan, Waji, Mease, Philip, Olds, Michele, Kary, Sonja, Kupper, Hartmut, Bell, Carolyn, Peffers, Gill, Rees, Frances, Lanyon, Peter, Obrenovic, Karen, Sandhu, Ravinder, Packham, Jonathan, Erb, Nicola, Coates, Laura C., Conaghan, Philip, Emery, Paul, Green, Michael, Ibrahim, Gamal, MakIver, Helen, Helliwell, Philip, Giles, Joanna L., McHugh, Kirsty, DiGleria, Katilin, Shaw, Jackie, Kollnberger, Simon, Maenaka, Katsumi, Marroquin, Osiris, Renner, Christoph, Bowness, Paul, Landewe, Robert, Ritchlin, Christopher, Guérette, Benoit, Lavie, Frederic, Kavanaugh, A., McInnes, I., Krueger, G. G., Gladman, D., Zrubek, J., Goldstein, N., Xu, S., Mudivarthy, S., Mack, M., Prevosto, Claudia, McDonald, Sarah, De Riva, Alessandra, Goodman, Reyna, Key, Tim, Hill Gaston, J S., Deery, Michael J., Busch, Robert, Fischer, Roman, Wright, Cynthia, Kessler, Benedikt, Sheehy, Claire, Jois, Ramesh N., Kerrigan, Nicola, Mills, Karen S., Somerville, Margaret, Scott, David G., van der Heijde, D., Chattopadhyay, Chandra, Mease, P., Xu, W., Rahman, M. U., Baratelle, A., Beutler, A., Stober, Carmel B., Benham, Helen J., Goodall, Jane C., Hill Gaston, J.S., Sanyal, Kaushik, Walker-Bone, Karen, Helliwell, Philip S., Vastesaeger, N., Wang, Y., Inman, R., Deodhar, A., Hsu, B., Dijkmans, B., Braun, J., Geusens, P., Sieper, J., El Miedany, Yasser, Palmer, Deborah, Shaw, Jacqueline, Payeli, Sravan, Utriainen, Lotta, and Milling, Simon

Abstract

Background: Sacroiliac joints (SJ) involvement is a distinctive and charasteristic feature of Spondyloarthritis (SpA) and x-ray is the test routinely used to make a diagnosis. However, x-ray reveals late structural damage but cannot detect active inflammation. The objective of this study was to assess the validity of Doppler ultrasound in SJ. Methods: Prospective blinded and controlled study of SJ, in which three populations were compared. We studied 106 consecutive cases, who were divided into three groups: a) 53 patients diagnosed with SpA who had inflammatory lumbar and gluteal pain assessed by a rheumatologist; b) 26 patients diagnosed with SpA who didn't have SJ tenderness and had normal physical examination; c) control group of 27 subjects (healthy subjetcs or with mechanical lumbar pain). All patients included that were diagnosed with SpA met almost the European Spondyloarthropathy Study Group (ESSG) classification criteria. Physical examination of the SJ included: sacral sulcus tenderness, iliac gapping, iliac compression, midline sacral thrust test, Gaenslen's test, and Patrick s test were used as gold standard. Both SJ were examined with Doppler ultrasound (General Electric Logiq 9, Wauwatosa WI, USA) fitted with a 9-14 Mhz lineal probe. The ultrasonographer was blinded to clinical data. Doppler in SJ was assessed as positive when both Doppler colour and resistance index (RI) < 0.75 within the SJ area were present. Statistical analysis was performed estimating sensitivity and specificity against gold standard. The Kappa correlation coefficient was used for reliability study. Results: 106 cases (53 female, 55 male; mean age 36 10 years) were studied. There were no statistical differences between groups related to age or sex. Physical examination of SJ was positive in 38 patients (59 sacroiliac joints). US detected Doppler signal within SJ in 37 patients (58 SJ): 33 of them were symptomatic SpA (52 SJ), one of them were asymptomatic SpA (1 SJ) and one was a

38. Oral abstracts 1: SpondyloarthropathiesO1. Detecting axial spondyloarthritis amongst primary care back pain referrals

Author

Harris, Claire, Remedios, Denis, Aptowitzer, Tanya, Keat, Andrew, Hamilton, Louise, Guile, Geoffrey, Belkhiri, Abdelghani, Newman, David, Toms, Andoni, Macgregor, Alex, Gaffney, Karl, Morton, Linda, Jones, Gareth T., MacDonald, Alan G., Downham, Christina, Macfarlane, Gary J., Tillett, William, Jadon, Deepak, Wallis, Dinny, Costa, Luisa, Waldron, Nicola, Griffith, Nina, Cavill, Charlotte, Korendowych, Eleanor, de Vries, Corinne, McHugh, Neil, Iaremenko, Oleg, Fedkov, Dmytro, Emery, Paul, Baeten, Dominique, Sieper, Joachim, Braun, Jurgen, van der Heijde, D., McInnes, Iain, Van Laar, Jaap, Landewe, R., Wordsworth, Bryan P., Wollenhaupt, Jurgen, Kellner, Herbert, Paramarta, I., Bertolino, Arthur, Wright, Andrew M., Hueber, Wolfgang, Sofat, Nidhi, Smee, Cori, Hermansson, Monika, Wajed, Julekha, Sanyal, Kaushik, Kiely, Patrick, Howard, Matthew, Howe, Franklyn A., Barrick, Thomas R., Abraham, Ajay M., Pearce, Mark S., Mann, Kay D., Francis, Roger M., Birrell, Fraser, Carr, Andrew, Macleod, Iain, Ng, Wan-Fai, Kavanaugh, Arthur, van der Heijde, Desiree, Chattopadhyay, Chandrabhusan, Gladman, Dafna, Mease, Philip, Krueger, Gerald, Xu, Weichun, Goldstein, Neil, Beutler, Anna, Baraliakos, Xenofon, Laurent, Didier D., Wollenhaupt, Jürgen, Gsteiger, Sandro, Conaghan, Philip G., Peterfy, Charles G., DiCarlo, Julie, Olech, Ewa, Alberts, Alan R., Alper, Jeffrey A., Devenport, Jenny, Anisfeld, Andrew M., Troum, Orrin M., Cooper, Philip, Gimpel, Mo, Deakin, Greg, Jameson, Karen, Godtschailk, Malcolm, Gadola, Stephan, Stokes, Maria, Cooper, Cyrus, Gordon, Caroline, Kalunian, K., Petri, M., Strand, V., Kilgallen, B., Barry, A., Wallace, D., Flurey, Caroline A., Morris, Marianne, Pollock, Jon, Hughes, Rod, Richards, Pam, Hewlett, Sarah, Harris, Claire, Remedios, Denis, Aptowitzer, Tanya, Keat, Andrew, Hamilton, Louise, Guile, Geoffrey, Belkhiri, Abdelghani, Newman, David, Toms, Andoni, Macgregor, Alex, Gaffney, Karl, Morton, Linda, Jones, Gareth T., MacDonald, Alan G., Downham, Christina, Macfarlane, Gary J., Tillett, William, Jadon, Deepak, Wallis, Dinny, Costa, Luisa, Waldron, Nicola, Griffith, Nina, Cavill, Charlotte, Korendowych, Eleanor, de Vries, Corinne, McHugh, Neil, Iaremenko, Oleg, Fedkov, Dmytro, Emery, Paul, Baeten, Dominique, Sieper, Joachim, Braun, Jurgen, van der Heijde, D., McInnes, Iain, Van Laar, Jaap, Landewe, R., Wordsworth, Bryan P., Wollenhaupt, Jurgen, Kellner, Herbert, Paramarta, I., Bertolino, Arthur, Wright, Andrew M., Hueber, Wolfgang, Sofat, Nidhi, Smee, Cori, Hermansson, Monika, Wajed, Julekha, Sanyal, Kaushik, Kiely, Patrick, Howard, Matthew, Howe, Franklyn A., Barrick, Thomas R., Abraham, Ajay M., Pearce, Mark S., Mann, Kay D., Francis, Roger M., Birrell, Fraser, Carr, Andrew, Macleod, Iain, Ng, Wan-Fai, Kavanaugh, Arthur, van der Heijde, Desiree, Chattopadhyay, Chandrabhusan, Gladman, Dafna, Mease, Philip, Krueger, Gerald, Xu, Weichun, Goldstein, Neil, Beutler, Anna, Baraliakos, Xenofon, Laurent, Didier D., Wollenhaupt, Jürgen, Gsteiger, Sandro, Conaghan, Philip G., Peterfy, Charles G., DiCarlo, Julie, Olech, Ewa, Alberts, Alan R., Alper, Jeffrey A., Devenport, Jenny, Anisfeld, Andrew M., Troum, Orrin M., Cooper, Philip, Gimpel, Mo, Deakin, Greg, Jameson, Karen, Godtschailk, Malcolm, Gadola, Stephan, Stokes, Maria, Cooper, Cyrus, Gordon, Caroline, Kalunian, K., Petri, M., Strand, V., Kilgallen, B., Barry, A., Wallace, D., Flurey, Caroline A., Morris, Marianne, Pollock, Jon, Hughes, Rod, Richards, Pam, and Hewlett, Sarah

Abstract

Background: Inflammatory back pain (IBP) is an early feature of ankylosing spondylitis (AS) and its detection offers the prospect of early diagnosis of AS. However, since back pain is very common but only a very small minority of back pain sufferers have ASpA or AS, screening of back pain sufferers for AS is problematic. In early disease radiographs are often normal so that fulfilment of diagnostic criteria for AS is impossible though a diagnosis of axial SpA can be made if MRI evidence of sacroiliitis is present. This pilot study was designed to indicate whether a cost-effective pick up rate for ASpA/early AS could be achieved by identifying adults with IBP stratified on the basis of age. Methods: Patients aged between 18 and 45 years who were referred to a hospital physiotherapy service with back pain of more than 3 months duration were assessed for IBP. All were asked to complete a questionnaire based on the Berlin IBP criteria. Those who fulfilled IBP criteria were also asked to complete a second short questionnaire enquiring about SpA comorbidities, to have a blood test for HLA-B27 and CRP level and to undergo an MRI scan of the sacroiliac joints. This was a limited scan, using STIR, diffusion-weighted, T1 and T2 sequences of the sacroiliac joints to minimize time in the scanner and cost. The study was funded by a research grant from Abbott Laboratories Ltd. Results: 50 sequential patients agreed to participate in the study and completed the IBP questionnaire. Of these 27 (54%) fulfilled criteria for IBP. Of these, 2 patients reported a history of an SpA comorbidity - 1 psoriasis; 1 ulcerative colitis - and 3 reported a family history of an SpA comorbidity - 2 psoriasis; 1 Crohn's disease. 4 were HLA-B27 positive, though results were not available for 7. Two patients had marginally raised CRP levels (6, 10 -NR ≤ 5). 19 agreed to undergo MRI scanning of the sacroiliac joints and lumbar spine; 4 scans were abnormal, showing evidence of bilateral sacroiliitis on S

39. Fatigue contributes to work productivity impairment in patients with axial spondyloarthritis: a cross-sectional UK study.

Author

Espahbodi S, Bassett P, Cavill C, Freeth M, Hole J, and Sengupta R

Subjects
Adult, Aged, Anxiety epidemiology, Cross-Sectional Studies, Depression epidemiology, Fatigue etiology, Female, Humans, Linear Models, Logistic Models, Male, Middle Aged, Multivariate Analysis, Quality of Life, Severity of Illness Index, Smoking epidemiology, Spondylarthropathies complications, Spondylarthropathies epidemiology, Spondylarthropathies physiopathology, Spondylitis, Ankylosing complications, Spondylitis, Ankylosing epidemiology, Surveys and Questionnaires, United Kingdom, Absenteeism, Activities of Daily Living, Efficiency, Fatigue physiopathology, Presenteeism, Spondylitis, Ankylosing physiopathology, Work
Abstract

Objectives: To determine factors associated with absenteeism, presenteeism, work productivity loss (WPL), and daily activity impairment in UK patients with AxSpA using standardised measures., Methods: 490 patients with AxSpA completed (1) Work Productivity and Impairment questionnaire (WPAI), providing measures for absenteeism, presenteeism, WPL and daily activity impairment, and (2) BASDAI, BASFI, BASMI, Jenkins Sleep scale, Patient Global Assessment disease activity (PGA), back pain night and anytime, EQ-5D for mobility, self-care, daily activities, pain/discomfort, anxiety/depression, EQ-VAS Health State Today, FACIT fatigue, for health-related disease factors. Multivariate linear and logistic regression determined associations between WPAI measures and health-related factors., Results: 301(61%) patients provided WPAI measurements, 76% were male, 87% HLA-B27+. Mean (SD) WPAI scores for absenteeism were 5.1%(19.2), presenteeism 22%(24.3), WPL 23.2%(25.7), activity impairment 34.8%(27.3). Absenteeism was associated with higher fatigue levels and more likely in patients with nrAxSpA. Presenteeism and WPL were both associated higher fatigue levels, BASDAI, and BASFI respectively. Daily activity impairment was associated with higher fatigue levels, BASFI, PGA, EQ-VAS, and smoking., Conclusions: Work productivity and impairment are associated with fatigue, disease activity, and functional ability in UK patients with AxSpA. The strong association of fatigue with all work measures as well as with daily activity impairment emphasises the need to better understand the impact of fatigue on patients' quality of life. Improving fatigue may help to optimise work status.

Published
2017

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