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7. Open-label, pilot protocol of patients with rheumatoid arthritis who switch to infliximab after an incomplete response to etanercept: the opposite study

Author

Furst, Daniel E, Gaylis, Norman, Bray, Vance, Olech, Ewa, Yocum, David, Ritter, Jeffrey, Weisman, Michael, Wallace, Daniel J, Crues, John, Khanna, Dinesh, Eckel, Gregory, Yeilding, Newman, Callegari, Peter, Visvanathan, Sudha, Rojas, Jeannie, Hegedus, Ronald, George, Laura, Mamun, Khalid, Gilmer, Keith, and Troum, Orrin

Published
2007

9. Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Author

McErlane, Flora, Beresford, Michael W., Baildam, Eileen M., Thomson, Wendy, Hyrich, Kimme, Chieng, Alice, Davidson, Joyce, Foster, Helen E., Gardner-Medwin, Janet, Lunt, Mark, Wedderburn, Lucy, Nikiphorou, Elena, Carpenter, Lewis, Kiely, Patrick, Walsh, David, Dixey, Josh, Young, Adam, Kapoor, Sabrina R., Filer, Andrew, Fitzpatrick, Martin, Fisher, Benjamin A., Taylor, Peter C., Buckley, Christopher, McInnes, Iain, Raza, Karim, Young, Stephen P., Dougados, Maxime, Kissel, Karsten, Amital, Howard, Conaghan, Philip, Martin-Mola, Emilio, Nasonov, Evgeny, Schett, Georg, Troum, Orrin, Veldi, Tiina, Bernasconi, Corrado, Huizinga, Tom, Durez, Patrick, Genovese, Mark C., Richards, Hanno B., Supronik, Jerzy, Dokoupilova, Eva, Aelion, Jacob A., Lee, Sang-Heon, Codding, Christine E., Kellner, Herbert, Ikawa, Takashi, Hugot, Sophie, Ligozio, Gregory, Mpofu, Shephard, Kavanaugh, Arthur, Emery, Paul, Fleischmann, Roy, Van Vollenhoven, Ronald, Pavelka, Karel, Guérette, Benoît, Santra, Sourav, Redden, Laura, Kupper, Hartmut, Smolen, Josef S., Wilkie, Ross, Tajar, Abdelouahid, McBeth, John, Hooper, Lindsey S., Bowen, Catherine J., Gates, Lucy, Culliford, David, Edwards, Christopher J., Arden, Nigel K., Adams, Jo, Ryan, Sarah, Haywood, Hannah, Pain, Helen, Siddle, Heidi J., Redmond, Anthony C., Waxman, Robin, Dagg, Abigail R., Alcacer-Pitarch, Begonya, Wilkins, Richard A., Helliwell, Philip S., Norton, Sam, Williams, Richard, Halls, Serena, Law, Rebecca-Jane, Jones, Jeremy, Markland, David, Maddison, Peter, Thom, Jeanette, Parker, Ben, Urowitz, Murray B., Gladman, Dafna D., Bruce, Ian, Croca, Sara C., Pericleous, Charis, Yong, Harry, Isenberg, David, Giles, Ian, Rahman, Anisur, Ioannou, Yiannis, Warrell, Clare E., Dobarro, David, Handler, Clive, Denton, Christopher P., Schreiber, Benjamin E., Coghlan, John G., Betteridge, Zoe E., Woodhead, Felix, Bunn, Christopher, Abraham, David, Desai, Sujal, du Bois, Roland, Wells, Athol, McHugh, Neil, Abignano, Giuseppina, Aydin, Sibel, Castillo-Gallego, Conception, Woods, Daniel, Meekings, Adam, McGonagle, Dennis, Del Galdo, Francesco, Vila, Josephine, Mitchell, Sheryl, Bowman, Simon, Price, Elizabeth, Pease, Colin T., Andrews, Jacqueline, Bombardieri, Michele, Sutcliffe, Nurhan, Pitzalis, Constantino, Lanyon, Peter, Hunter, John, Gupta, Monica, McLaren, John, Regan, Marian, Cooper, Annie, Vadivelu, Saravanan, Coady, David, Griffiths, Bridget, Lendrem, Dennis, Foggo, Heather, Tarn, Jessica, Ng, Wan-Fai, Goodhead, Charlotte, Shekar, Priya, Kelly, Clive, Francis, Gail, Bailey, Ann-Marie, Thompson, Lynsey, Hamilton, Jennifer, Salisbury, Chris, Foster, Nadine E., Bishop, Annette, Coast, Jo, Franchini, Angelo, Hall, Jeanette, Hollinghurst, Sandra, Hopper, Cherida, Grove, Sean, Kaur, Surinder, Montgomery, Alan, Paskins, Zoe, Sanders, Tom, Croft, Peter R., Hassell, Andy B., Coxon, Domenica E., Frisher, Martin, Jordan, Kelvin P., Jinks, Clare, Peat, George, Monk, Helen L., Muller, Sara, Mallen, Christian, Hider, Samantha L., Roddy, Edward, and Hayward, Richard

Abstract

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JADAS without inclusion of the ESR. Disclosure statement: All authors have declared no conflicts of interest. Table 1Spearman's correlation between JADAS 71 and single markers DA by ILAR subtype ILAR Subtype Systemic onset JIA Persistent oligo JIA Extended oligo JIA Rheumatoid factor neg JIA Rheumatoid factor pos JIA Enthesitis related JIA Psoriatic JIA Undifferentiated JIA Unknown subtype Total cohort Number of children 23 111 12 57 7 9 19 7 17 262 AJC 0.54 0.67 0.53 0.75 0.53 0.34 0.59 0.81 0.37 0.59 PGA 0.63 0.69 0.25 0.73 0.14 0.05 0.50 0.83 0.56 0.64 PGE 0.51 0.68 0.83 0.61 0.41 0.69 0.71 0.9 0.48 0.61 ESR 0.28 0.31 0.35 0.4 0.6 0.85 0.43 0.7 0.5 0.53 Limited 71 JC 0.29 0.51 0.23 0.37 0.14 -0.12 0.4 0.81 0.45 0.41 Parental pain 0.23 0.62 0.03 0.57 0.41 0.69 0.7 0.79 0.42 0.53 Childhood health assessment questionnaire 0.25 0.57 -0.07 0.36 -0.47 0.84 0.37 0.8 0.66 0.47

Published
2017

10. Short-Term changes on MRI predict long-Term changes on radiography in rheumatoid arthritis:An analysis by an OMERACT Task Force of pooled data from four randomised controlled trials

Author

Peterfy, Charles, Strand, Vibeke, Tian, Lu, Østergaard, Mikkel, Lu, Ying, DiCarlo, Julie, Countryman, Peter, Deodhar, Atul, Landewé, Robert, Ranganath, Veena K., Troum, Orrin, Conaghan, Philip G., Peterfy, Charles, Strand, Vibeke, Tian, Lu, Østergaard, Mikkel, Lu, Ying, DiCarlo, Julie, Countryman, Peter, Deodhar, Atul, Landewé, Robert, Ranganath, Veena K., Troum, Orrin, and Conaghan, Philip G.

Abstract

Objective In rheumatoid arthritis (RA), MRI provides earlier detection of structural damage than radiography (X-ray) and more sensitive detection of intra-Articular inflammation than clinical examination. This analysis was designed to evaluate the ability of early MRI findings to predict subsequent structural damage by X-ray. Methods Pooled data from four randomised controlled trials (RCTs) involving 1022 RA hands and wrists in early and established RA were analysed. X-rays were scored using van der Heijde-modified or Genant-modified Sharp methods. MRIs were scored using Outcome Measures in Rheumatology (OMERACT) RA MRI Score (RAMRIS). Data were analysed at the patient level using multivariable logistic regression and receiver operating characteristic curve analyses. Results Progression of MRI erosion scores at Weeks 12 and 24 predicted progression of X-ray erosions at Weeks 24 and 52, with areas under the curve (AUCs) of 0.64 and 0.74, respectively. 12-week and 24-week changes in MRI osteitis scores were similarly predictive of 24-week and 52-week X-ray erosion progressions; pooled AUCs were 0.78 and 0.77, respectively. MRI changes in synovitis at Weeks 12 and 24 also predicted progression of X-ray joint damage (erosion and joint-space narrowing) at Weeks 24 and 52 (AUCs=0.72 and 0.65, respectively). Conclusions Early changes in joint damage and inflammation detected with MRI predict changes in joint damage evident on subsequent X-rays. These findings support the use of MRI as a valid method for monitoring structural damage in short-duration RCTs.

Published
2017

11. 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

13. Short-term changes on MRI predict long-term changes on radiography in rheumatoid arthritis: an analysis by an OMERACT Task Force of pooled data from four randomised controlled trials

Author

Peterfy, Charles, primary, Strand, Vibeke, additional, Tian, Lu, additional, Østergaard, Mikkel, additional, Lu, Ying, additional, DiCarlo, Julie, additional, Countryman, Peter, additional, Deodhar, Atul, additional, Landewé, Robert, additional, Ranganath, Veena K, additional, Troum, Orrin, additional, and Conaghan, Philip G, additional

Published
2016
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14. Characterization of patients with chronic refractory gout who do and do not have clinically apparent tophi and their response to pegloticase.

Author

Edwards, N Lawrence, Singh, Jasvinder A, Troum, Orrin, Yeo, Anthony E, and Lipsky, Peter E

Subjects
GOUT diagnosis, GOUT suppressants, AGE distribution, CHRONIC diseases, CREATININE, DRUG resistance, GLOMERULAR filtration rate, GOUT, HEALTH surveys, INTERPERSONAL relations, KIDNEYS, PHYSICAL fitness, QUESTIONNAIRES, URIC acid, URINALYSIS, SYMPTOMS, PAIN measurement, VISUAL analog scale, TREATMENT effectiveness, SEVERITY of illness index, DISEASE duration, DISEASE complications, THERAPEUTICS
Abstract

Objective To determine the characteristics and response to pegloticase of patients with chronic refractory gout with and without clinically apparent tophi. Methods Results from two randomized controlled trials of pegloticase in patients with chronic refractory gout with clinically apparent tophi or without tophi were used to assess baseline and on-treatment between-group differences. Results Patients with tophi were significantly older than those without tophi, had a significantly longer duration of disease, higher numbers of tender and swollen joints, higher Patient Global Assessment scores and Health Assessment Questionnaire-Disability Index scores, and lower Arthritis-Specific Health Index scores. Patients with tophaceous gout also had significantly lower scores for physical functioning, role physical, social functioning, and the physical component summary scores of the Short Form 36 vs patients without tophi. In addition, subjects with clinically apparent tophi had a significantly lower mean estimated glomerular filtration rate. Pegloticase treatment of tophaceous patients caused significant reductions in serum urate, flares, Patient Global Assessment, tender joints, swollen joints, Health Assessment Questionnaire-Disability Index, visual analogue scale pain and Short Form 36 Bodily Pain, whereas patients without tophi had significant improvement in serum urate, flares, Patient Global Assessment, tender joints, and Short Form 36 Bodily Pain, but not swollen joints, Health Assessment Questionnaire-Disability Index functional score or pain visual analogue scale. Treatment with pegloticase had no effect on estimated glomerular filtration rate despite significant lowering of the urinary uric acid: creatinine ratio. Conclusion Patients with chronic refractory gout and clinically apparent tophi have more severe disease as well as reduced renal function. Both groups experienced significant clinical benefit with pegloticase treatment, although no change in renal function was noted. [ABSTRACT FROM AUTHOR]

Published
2019
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15. Proceedings from The 8th Annual International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) Conference

Author

Troum, Orrin M, Pimienta, Olga L, Olech, Ewa, Østergaard, Mikkel, Thiele, Ralf, Seraphine, Judy L, Bruyn, George A W, Peterfy, Charles, Troum, Orrin M, Pimienta, Olga L, Olech, Ewa, Østergaard, Mikkel, Thiele, Ralf, Seraphine, Judy L, Bruyn, George A W, and Peterfy, Charles

Abstract

The International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) was founded in 2005 with the goal of discussing matters related to imaging in rheumatology, particularly, validation, education, and use in both clinical practice and research. The field of musculoskeletal (MSK) imaging is continuously evolving; therefore, education for healthcare providers in this field is of paramount importance. ISEMIR's international faculty and world-renowned experts presented the newest information as it relates to the use of magnetic resonance imaging (MRI) and ultrasound (US) at the 8th annual ISEMIR meeting that took place on April 17-18 in Santa Monica, California. Presentations from the meeting can be viewed at www.isemir.org.

Published
2016

19. Proceedings from the 7th Annual International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) conference

Author

Troum, Orrin M., primary, Pimienta, Olga L., additional, Schmidt, Wolfgang A., additional, Ostergaard, Mikkel, additional, D’Agostino, Maria Antonietta, additional, Gaylis, Norman, additional, Arnold, William, additional, Ben-Artzi, Ami, additional, Ranganath, Veena, additional, Seraphine, Judy L., additional, and Peterfy, Charles, additional

Published
2015
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20. Short-term changes on MRI predict long-term changes on radiography in rheumatoid arthritis: an analysis by an OMERACT Task Force of pooled data from four randomised controlled trials.

Author

Peterfy, Charles, Strand, Vibeke, Lu Tian, Østergaard, Mikkel, Ying Lu, DiCarlo, Julie, Countryman, Peter, Deodhar, Atul, Landewé, Robert, Ranganath, Veena K., Troum, Orrin, Conaghan, Philip G., Tian, Lu, and Lu, Ying

Abstract

Objective: In rheumatoid arthritis (RA), MRI provides earlier detection of structural damage than radiography (X-ray) and more sensitive detection of intra-articular inflammation than clinical examination. This analysis was designed to evaluate the ability of early MRI findings to predict subsequent structural damage by X-ray.Methods: Pooled data from four randomised controlled trials (RCTs) involving 1022 RA hands and wrists in early and established RA were analysed. X-rays were scored using van der Heijde-modified or Genant-modified Sharp methods. MRIs were scored using Outcome Measures in Rheumatology (OMERACT) RA MRI Score (RAMRIS). Data were analysed at the patient level using multivariable logistic regression and receiver operating characteristic curve analyses.Results: Progression of MRI erosion scores at Weeks 12 and 24 predicted progression of X-ray erosions at Weeks 24 and 52, with areas under the curve (AUCs) of 0.64 and 0.74, respectively. 12-week and 24-week changes in MRI osteitis scores were similarly predictive of 24-week and 52-week X-ray erosion progressions; pooled AUCs were 0.78 and 0.77, respectively. MRI changes in synovitis at Weeks 12 and 24 also predicted progression of X-ray joint damage (erosion and joint-space narrowing) at Weeks 24 and 52 (AUCs=0.72 and 0.65, respectively).Conclusions: Early changes in joint damage and inflammation detected with MRI predict changes in joint damage evident on subsequent X-rays. These findings support the use of MRI as a valid method for monitoring structural damage in short-duration RCTs. [ABSTRACT FROM AUTHOR]

Published
2017
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21. Clinical and radiographic outcomes at 2 years and the effect of tocilizumab discontinuation following sustained remission in the second and third year of the ACT-RAY study

Author

Huizinga, T W J, primary, Conaghan, Philip G, additional, Martin-Mola, Emilio, additional, Schett, Georg, additional, Amital, Howard, additional, Xavier, Ricardo M, additional, Troum, Orrin, additional, Aassi, Maher, additional, Bernasconi, Corrado, additional, and Dougados, Maxime, additional

Published
2014
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22. Proceedings from the 5th annual international society for musculoskeletal imaging in rheumatology annual conference

Author

Conaghan, Philip G, Østergaard, Mikkel, D'Agostino, Maria Antonietta, Gaylis, Norman, Arnold, William, Olech, Ewa, Wells, Alvin, Peterfy, Charles, Seraphine, Judy L, Troum, Orrin, Conaghan, Philip G, Østergaard, Mikkel, D'Agostino, Maria Antonietta, Gaylis, Norman, Arnold, William, Olech, Ewa, Wells, Alvin, Peterfy, Charles, Seraphine, Judy L, and Troum, Orrin

Abstract

Since its inception, ISEMIR has held an annual education meeting highlighting the changes in the utilization of imaging tools for the management of rheumatic diseases. ISEMIR's international faculty and world-renowned experts have discussed these topics at a very high scientific level. The evolution of the content demonstrates the rapidly changing environment in the field of rheumatology. Advances in treatment have led to the increased use of magnetic resonance imaging (MRI) and ultrasound (US). This publication is based upon the proceedings from the 2012 ISEMIR educational meeting that took place on April 26th in Chicago, Illinois. Presentations from the live proceedings can be viewed at www.isemir.org.

Published
2013

23. The utility of magnetic resonance imaging for assessing structural damage in randomized controlled trials in rheumatoid arthritis: Report from the imaging group of the American College of Rheumatology RA clinical trials task force

Author

Ranganath, Veena K., primary, Strand, Vibeke, additional, Peterfy, Charles G., additional, Østergaard, Mikkel, additional, Deodhar, Atul, additional, Landewe, Robert, additional, Troum, Orrin, additional, and Conaghan, Philip G., additional

Published
2013
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25. Proceedings of the 2013 Rheumatology Winter Clinical Symposia

Author

Kavanaugh, Arthur, primary, Fleischmann, Roy, additional, Bergman, Martin Jan, additional, Ruderman, Eric, additional, Troum, Orrin, additional, Wells, Alvin F., additional, Martin, George, additional, Calabrese, Leonard H., additional, Gibofsky, Allan, additional, Strand, Vibeke, additional, and Cush, John J., additional

Published
2013
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29. Clinical and radiographic outcomes at 2 years and the effect of tocilizumab discontinuation following sustained remission in the second and third year of the ACT-RAY study.

Author

Huizinga, T W J, Conaghan, Philip G, Martin-Mola, Emilio, Schett, Georg, Amital, Howard, Xavier, Ricardo M, Troum, Orrin, Aassi, Maher, Bernasconi, Corrado, and Dougados, Maxime

Subjects
FOOT radiography, HAND radiography, JOINT radiography, METHOTREXATE, THERAPEUTIC use of monoclonal antibodies, ANTIRHEUMATIC agents, BLOOD sedimentation, DRUG therapy, COMBINATION drug therapy, LONGITUDINAL method, RESEARCH funding, RHEUMATOID arthritis, TREATMENT effectiveness, BLIND experiment, DISEASE progression, TOCILIZUMAB
Abstract

Objective: To assess the efficacy and safety of tocilizumab (TCZ) plus methotrexate/placebo (MTX/PBO) over 2 years and the course of disease activity in patients who discontinued TCZ due to sustained remission.Methods: ACT-RAY was a double-blind 3-year trial. Patients with active rheumatoid arthritis despite MTX were randomised to add TCZ to ongoing MTX (add-on strategy) or switch to TCZ plus PBO (switch strategy). Using a treat-to-target approach, open-label conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), other than MTX, were added from week 24 if Disease Activity Score in 28 joints based on erythrocyte sedimentation rate (DAS28-ESR) >3.2. Between weeks 52 and 104, patients in sustained clinical remission (DAS28-ESR <2.6 at two consecutive visits 12 weeks apart) discontinued TCZ and were assessed every 4 weeks for 1 year. If sustained remission was maintained, added csDMARDs, then MTX/PBO, were discontinued.Results: Of the 556 randomised patients, 76% completed year 2. Of patients entering year 2, 50.4% discontinued TCZ after achieving sustained remission and 5.9% achieved drug-free remission. Most patients who discontinued TCZ (84.0%) had a subsequent flare, but responded well to TCZ reintroduction. Despite many patients temporarily stopping TCZ, radiographic progression was minimal, with differences favouring add-on treatment. Rates of serious adverse events and serious infections per 100 patient-years were 12.2 and 4.4 in add-on and 15.0 and 3.7 in switch patients. In patients with normal baseline values, alanine aminotransferase elevations >3×upper limit of normal were more frequent in add-on (14.3%) versus switch patients (5.4%).Conclusions: Treat-to-target strategies could be successfully implemented with TCZ to achieve sustained remission, after which TCZ was stopped. Biologic-free remission was maintained for about 3 months, but most patients eventually flared. TCZ restart led to rapid improvement.Trial Registration Number: NCT00810199. [ABSTRACT FROM AUTHOR]

Published
2015
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32. Magnetic Resonance Imaging Is More Sensitive Than Radiographs in Detecting Change in Size of Erosions in Rheumatoid Arthritis

Author

CHEN, TIMOTHY, CRUES, JOHN, ALI, MUHAMMAD, and TROUM, ORRIN

Abstract

OBJECTIVE: To evaluate the technological performance of magnetic resonance imaging (MRI) with respect to projection radiography by determining the incidence of changes in the size of individual bone lesions in inflammatory arthritis, using serial high-resolution in-office MRI over short time intervals (8 months average followup), and by comparing the sensitivity of 3-view projection radiography with in-office MRI for detecting changes in size and number of individual erosions. METHODS: MR examinations of the wrists and second and third metacarpophalangeal joints were performed using a portable in-office MR system in a total of 405 patients with inflammatory arthritis, from one rheumatologist's practice, who were undergoing aggressive disease modifying antirheumatic drug therapy. Of the patients, 156 were imaged at least twice, allowing evaluation of 246 followup examinations (mean followup interval of 8 months over a 2-year period). Baseline and followup plain radiographs were obtained in 165 patient intervals. Patients refused radiographic examination on 81 followup visits. RESULTS: MRI demonstrated no detectable changes in 124 of the 246 (50%) followup MRI examinations. An increase in the size or number of erosions was demonstrated in 74 (30%) examinations, a decrease in the size or number of erosions in 36 (15%), and both increases and decreases in erosions were seen in 11 (4%). In the 165 studies with followup radiographic comparisons, only one examination (0.8%) showed an erosion not seen on the prior examination and one (0.8%) showed an increase in a previously noted erosion. CONCLUSION: We showed that high-resolution in-office MRI with an average followup of 8 months detects changes in bony disease in 50% of compliant patients during aggressive treatment for inflammatory arthritis in a single rheumatologist's office practice. Plain radiography is insensitive for detecting changes in bone erosions for this patient population in this time frame.

Published
2006

33. Identification of Wrist and Metacarpophalangeal Joint Erosions Using a Portable Magnetic Resonance Imaging System Compared to Conventional Radiographs

Author

Crues, John, Shellock, Frank, Dardashti, Siamak, James, Timothy, and Troum, Orrin

Abstract

OBJECTIVE: To compare magnetic resonance (MR) images obtained using a portable MR system to radiographs for identifying bone erosions in the wrists and metacarpophalangeal (MCP) joints of patients with inflammatory arthropathy. METHODS: MR imaging and radiographs were performed in wrists (n = 227) and 2nd and 3rd MCP (n = 188) of 132 patients with inflammatory arthritis to identify erosions. MR imaging was performed using a portable MR system. Findings per body location and per patient were calculated and compared. Additionally, intraobserver and interobserver reliabilities were calculated. RESULTS: MR imaging identified bony erosions in 125 (95%) patients and in 315 (78%) body locations. By comparison, radiographs identified erosions in 78 (59%; p < 0.05) patients and in 156 (39%; p < 0.05) body locations. Intraobserver reliability (K = 0.564) and interobserver reliability (K = 0.429) exhibited moderate agreement, with reader agreement in 80% of the joints scored. CONCLUSION: There was superior sensitivity to bone damage using the portable MR system compared to radiographs of the wrists and MCP joints, suggesting that this scanner is extremely promising for assessment of inflammatory arthritis.

Published
2004

34. Mechanisms of Hyperkalemia in Systemic Lupus Erythematosus

Author

Lee, Frederick O., Quismorio, Frank P., Troum, Orrin M., Anderson, Pamela W., Do, Yung S., and Hsueh, Willa A.

Abstract

• We found that nearly 10% of 142 patients with systemic lupus erythematosus (SLE) had persistent, unexplained hyperkalemia. Renal mineralocorticoid resistance has been suggested to account for the hyperkalemia in SLE. We studied the renin-aldosterone response to intravenous furosemide (60 mg) and upright posture and the renin response to converting enzyme inhibition (captopril, 50 mg) and upright posture in five patients with SLE and hyperkalemia (group 1) and five normokalemic patients with SLE (group 2). Renal function was comparable. Plasma chloride level was higher and bicarbonate level slightly lower in group 1 than in group 2. Plasma cortisol level was normal in all patients. None of the patients was receiving nonsteroidal anti-inflammatory drugs or corticosteroids at the time of study. Basal plasma renin concentration and plasma aldosterone level were not significantly different between the two groups, although both tended to be higher in group 2. However, four of the five patients in group 1 had significantly blunted renin response to captopril compared with group 2. The same four patients also had blunted renin and aldosterone responses to furosemide. Thus, the majority of hyperkalemic patients with SLE had an impaired renin and aldosterone response to stimulation. We conclude that hyporeninemic hypoaldosteronism plays a key role in the pathogenesis of hyperkalemia in SLE.(Arch Intern Med 1988;148:397-401)

Published
1988
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35. Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Author

McErlane, Flora, Beresford, Michael W., Baildam, Eileen M., Thomson, Wendy, Hyrich, Kimme, Chieng, Alice, Davidson, Joyce, Foster, Helen E., Gardner-Medwin, Janet, Lunt, Mark, Wedderburn, Lucy, Nikiphorou, Elena, Carpenter, Lewis, Kiely, Patrick, Walsh, David, Dixey, Josh, Young, Adam, Kapoor, Sabrina R., Filer, Andrew, Fitzpatrick, Martin, Fisher, Benjamin A., Taylor, Peter C., Buckley, Christopher, McInnes, Iain, Raza, Karim, Young, Stephen P., Dougados, Maxime, Kissel, Karsten, Amital, Howard, Conaghan, Philip, Martin-Mola, Emilio, Nasonov, Evgeny, Schett, Georg, Troum, Orrin, Veldi, Tiina, Bernasconi, Corrado, Huizinga, Tom, Durez, Patrick, Genovese, Mark C., Richards, Hanno B., Supronik, Jerzy, Dokoupilova, Eva, Aelion, Jacob A., Lee, Sang-Heon, Codding, Christine E., Kellner, Herbert, Ikawa, Takashi, Hugot, Sophie, Ligozio, Gregory, Mpofu, Shephard, Kavanaugh, Arthur, Emery, Paul, Fleischmann, Roy, Van Vollenhoven, Ronald, Pavelka, Karel, Guérette, Benoît, Santra, Sourav, Redden, Laura, Kupper, Hartmut, Smolen, Josef S., Wilkie, Ross, Tajar, Abdelouahid, McBeth, John, Hooper, Lindsey S., Bowen, Catherine J., Gates, Lucy, Culliford, David, Edwards, Christopher J., Arden, Nigel K., Adams, Jo, Ryan, Sarah, Haywood, Hannah, Pain, Helen, Siddle, Heidi J., Redmond, Anthony C., Waxman, Robin, Dagg, Abigail R., Alcacer-Pitarch, Begonya, Wilkins, Richard A., Helliwell, Philip S., Norton, Sam, Williams, Richard, Halls, Serena, Law, Rebecca-Jane, Jones, Jeremy, Markland, David, Maddison, Peter, Thom, Jeanette, Parker, Ben, Urowitz, Murray B., Gladman, Dafna D., Bruce, Ian, Croca, Sara C., Pericleous, Charis, Yong, Harry, Isenberg, David, Giles, Ian, Rahman, Anisur, Ioannou, Yiannis, Warrell, Clare E., Dobarro, David, Handler, Clive, Denton, Christopher P., Schreiber, Benjamin E., Coghlan, John G., Betteridge, Zoe E., Woodhead, Felix, Bunn, Christopher, Abraham, David, Desai, Sujal, du Bois, Roland, Wells, Athol, McHugh, Neil, Abignano, Giuseppina, Aydin, Sibel, Castillo-Gallego, Conception, Woods, Daniel, Meekings, Adam, McGonagle, Dennis, Del Galdo, Francesco, Vila, Josephine, Mitchell, Sheryl, Bowman, Simon, Price, Elizabeth, Pease, Colin T., Andrews, Jacqueline, Bombardieri, Michele, Sutcliffe, Nurhan, Pitzalis, Constantino, Lanyon, Peter, Hunter, John, Gupta, Monica, McLaren, John, Regan, Marian, Cooper, Annie, Vadivelu, Saravanan, Coady, David, Griffiths, Bridget, Lendrem, Dennis, Foggo, Heather, Tarn, Jessica, Ng, Wan-Fai, Goodhead, Charlotte, Shekar, Priya, Kelly, Clive, Francis, Gail, Bailey, Ann-Marie, Thompson, Lynsey, Hamilton, Jennifer, Salisbury, Chris, Foster, Nadine E., Bishop, Annette, Coast, Jo, Franchini, Angelo, Hall, Jeanette, Hollinghurst, Sandra, Hopper, Cherida, Grove, Sean, Kaur, Surinder, Montgomery, Alan, Paskins, Zoe, Sanders, Tom, Croft, Peter R., Hassell, Andy B., Coxon, Domenica E., Frisher, Martin, Jordan, Kelvin P., Jinks, Clare, Peat, George, Monk, Helen L., Muller, Sara, Mallen, Christian, Hider, Samantha L., Roddy, Edward, Hayward, Richard, McErlane, Flora, Beresford, Michael W., Baildam, Eileen M., Thomson, Wendy, Hyrich, Kimme, Chieng, Alice, Davidson, Joyce, Foster, Helen E., Gardner-Medwin, Janet, Lunt, Mark, Wedderburn, Lucy, Nikiphorou, Elena, Carpenter, Lewis, Kiely, Patrick, Walsh, David, Dixey, Josh, Young, Adam, Kapoor, Sabrina R., Filer, Andrew, Fitzpatrick, Martin, Fisher, Benjamin A., Taylor, Peter C., Buckley, Christopher, McInnes, Iain, Raza, Karim, Young, Stephen P., Dougados, Maxime, Kissel, Karsten, Amital, Howard, Conaghan, Philip, Martin-Mola, Emilio, Nasonov, Evgeny, Schett, Georg, Troum, Orrin, Veldi, Tiina, Bernasconi, Corrado, Huizinga, Tom, Durez, Patrick, Genovese, Mark C., Richards, Hanno B., Supronik, Jerzy, Dokoupilova, Eva, Aelion, Jacob A., Lee, Sang-Heon, Codding, Christine E., Kellner, Herbert, Ikawa, Takashi, Hugot, Sophie, Ligozio, Gregory, Mpofu, Shephard, Kavanaugh, Arthur, Emery, Paul, Fleischmann, Roy, Van Vollenhoven, Ronald, Pavelka, Karel, Guérette, Benoît, Santra, Sourav, Redden, Laura, Kupper, Hartmut, Smolen, Josef S., Wilkie, Ross, Tajar, Abdelouahid, McBeth, John, Hooper, Lindsey S., Bowen, Catherine J., Gates, Lucy, Culliford, David, Edwards, Christopher J., Arden, Nigel K., Adams, Jo, Ryan, Sarah, Haywood, Hannah, Pain, Helen, Siddle, Heidi J., Redmond, Anthony C., Waxman, Robin, Dagg, Abigail R., Alcacer-Pitarch, Begonya, Wilkins, Richard A., Helliwell, Philip S., Norton, Sam, Williams, Richard, Halls, Serena, Law, Rebecca-Jane, Jones, Jeremy, Markland, David, Maddison, Peter, Thom, Jeanette, Parker, Ben, Urowitz, Murray B., Gladman, Dafna D., Bruce, Ian, Croca, Sara C., Pericleous, Charis, Yong, Harry, Isenberg, David, Giles, Ian, Rahman, Anisur, Ioannou, Yiannis, Warrell, Clare E., Dobarro, David, Handler, Clive, Denton, Christopher P., Schreiber, Benjamin E., Coghlan, John G., Betteridge, Zoe E., Woodhead, Felix, Bunn, Christopher, Abraham, David, Desai, Sujal, du Bois, Roland, Wells, Athol, McHugh, Neil, Abignano, Giuseppina, Aydin, Sibel, Castillo-Gallego, Conception, Woods, Daniel, Meekings, Adam, McGonagle, Dennis, Del Galdo, Francesco, Vila, Josephine, Mitchell, Sheryl, Bowman, Simon, Price, Elizabeth, Pease, Colin T., Andrews, Jacqueline, Bombardieri, Michele, Sutcliffe, Nurhan, Pitzalis, Constantino, Lanyon, Peter, Hunter, John, Gupta, Monica, McLaren, John, Regan, Marian, Cooper, Annie, Vadivelu, Saravanan, Coady, David, Griffiths, Bridget, Lendrem, Dennis, Foggo, Heather, Tarn, Jessica, Ng, Wan-Fai, Goodhead, Charlotte, Shekar, Priya, Kelly, Clive, Francis, Gail, Bailey, Ann-Marie, Thompson, Lynsey, Hamilton, Jennifer, Salisbury, Chris, Foster, Nadine E., Bishop, Annette, Coast, Jo, Franchini, Angelo, Hall, Jeanette, Hollinghurst, Sandra, Hopper, Cherida, Grove, Sean, Kaur, Surinder, Montgomery, Alan, Paskins, Zoe, Sanders, Tom, Croft, Peter R., Hassell, Andy B., Coxon, Domenica E., Frisher, Martin, Jordan, Kelvin P., Jinks, Clare, Peat, George, Monk, Helen L., Muller, Sara, Mallen, Christian, Hider, Samantha L., Roddy, Edward, and Hayward, Richard

Abstract

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JA

36. 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

37. Imaging in vasculitis.

Author

Troum OM, Pimienta OL, and Wells A

Abstract

Purpose of Review: Systemic vasculitides are characterized by inflammation of blood vessels. Their classification is based on the size of the blood vessels involved - large, medium, or small. Vasculitis early diagnosis and reliable monitoring are crucial to establish a treatment plan and prevent serious complications. Based on these considerations and depending on the location of the affected vessels, the importance of imaging modalities including ultrasonography (US), magnetic resonance Imaging (MRI), magnetic resonance angiography (MRA), computed tomography (CT), computed tomography angiography (CTA), and [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) has progressively increased. In addition to physical exam and laboratory data, these imaging tools offer complementary information about vascular changes occurring in vasculitis.This review summarizes the different imaging modalities being utilized to diagnose and monitor vasculitis., Recent Findings: The most recent update for the use of imaging in vasculitis is referenced in the 2023 European Alliance of Associations for Rheumatology (EULAR) recommendations and the American College of Rheumatology (ACR) guidelines in 2021. Recent advances in PET imaging in large vessel vasculitis include improved technological imaging acquisition and the use of novel radiotracers for cellular and immune targets. FDG-PET has now been demonstrated to have high sensitivity and specificity to detect temporal arteritis., Summary: Imaging plays a significant role in the evaluation of vasculitis and continues to gain importance in the diagnosis and monitoring of disease activity. Differences exist between the ACR guidelines, which advocates for temporal artery biopsy, and the EULAR guidelines, which favors imaging modalities for the initial evaluation and diagnosis of large vessel vasculitis (LVV). Prerequisites for appropriate clinical management utilizing imaging in patients with vasculitis are the availability and access to skilled clinicians to interpret the images and the cost of these techniques not being prohibitive., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2024
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